Children with deficiency in motor,verbal,physical,mental, compromised adaptability, and behavior development are evidently more susceptible to injury compared to the able counterparts.Limitation and impairments potentiates risk, aggravates secondary conditions and accelerates disease processes.
Global estimates accounts for 12 million non fatal injuries which occur at home of which children with disabilities are four times more prone.Over 80 percent of children with disability live in developing countries.India alone contribute to 26.8 million disable people according to 2011 National Census.Among those 2.2 percent effected, 0.41 are visually impaired,0.42 hearing,0.45 movement,0.12 mental retardation and 0.17 affected by multiple disabilities were recorded.
Characteristically most of these injuries depends on various factors like age,time,cause,type,body part,location and activity.For example,fall was the number one cause related to stage of learning to walk,poisoning due to to mouth exploratory behavior was a significant cause of injury among children age 1-3 years. Burns from hot food or liquids was commonly observed within 12-18 months.Home was the most common critical factor accounting to 50 percent of pediatric injuries among children with disabilities. Hazard of open fire,unintentional cuts and curbs,unattended pointy object like pencil or tooth brush,unlocked fireworks,animal bites,slippery floor were the major contributing factor. Worth mentioning are the self inflicted injuries among children with mental retardation,cerebral palsy, including repetitive and compulsive behavior among Autism spectrum disorder.These may include rhythmic head rubbing to severe head banging in combination with biting,scratching or hair pulling.Most of the dental trauma includes Ellis class 1 fracture(enamel only)with 46-48 percent prevalence and may also cause total avulsion (loss of tooth) in children with mental disability.
Despite the rising interest in children with disability, growing economic and family burden,medical cost remains a single most important barrier to seek health services.Paucity of the research in relation to health seeking behavior and frequency needs indexing. Higher experiences of poor oral health and alarming numbers of unattended trauma to the teeth implicates financial burden associated with medical care and assistive devices,and require constant need for personal support. At present most of these special needs assistance center and schools in rural and urban division are run by voluntary groups or non government organization only.
Based on the rising cost and impending risk, prevention should be a primary concern. Enabling parents to recognize that trauma as an inevitable possibility,appropriate home measure should be planned and outlined when children with disabilities are provided medical services.Impact of dental trauma on speech and nutrition,sharp edges following tooth fractures, sensitivity due to dentin exposure, increase susceptibility to caries and loss of tooth should be emphasized in order to decrease incidence of injury.
Dedicated network of pediatrician, pediatric dentist,nurses,staff and volunteers with adequate training is a suggested long term approach since every child of disability requires specific care for them.It is essential to recognize different types of disabilities and their limitation,respecting their autonomy and family consent during specific management.Early identification,repeated conditioning,positive expression through specialized intervention with judicious followup should aim to avoid complex procedure under general anesthesia.
GAMEFACE 