Meeting the Needs of Children and Families

Professor: Ms. Lisa McCaieSubmitted By: Hira Khara

Course: ECEP 233 – Sec 062 Due Date: April 2, 2013

Case Study and Personal Views

Zenna Zenna is a part of our daycare centre for long time, she has now moved in

to the pre-school room. Lately, I have observed atypical development in many areas of her development. I was a little concerned about her growth when her mother came one day and told me that, doctor diagnosed Zenna with Epilepsy. (Case Study)

To begin with, I was most importantly concerned with the condition of Zenna, she is just a preschooler and unfortunately going through one of the hardest phases of a person’s life. She needs and requires care, protection, assurance of safety and availability and most important she requires the right to live without fear and panic with all independence just like her peers with typical development. Secondly, I can imagine the stress and anxiety her family is going through. Her mother is told by the doctors to have a complete bed rest for a difficult premature delivery. Her needs include a range of support and assistance from my side as an individual and as an Early Childhood Educator towards her daughter Zenna and her health.

Needs of the Child and Family

https://picasaweb.google.com/m/search?q=child+with+family+cartoon&psc=G&mode=ONE&start=12

Physical Needs of the Child

Family Doctor Pediatrician Adaptive Devices Nurse at home (if needed) Nutritionist Developmentally appropriate environment. Peer Support

Socio-emotional Needs of the Child

Early Childhood Educator, consultant/specialist to assist the child in the childcare setting

Specialists and Psychiatrists to provide assessment of the child.

The child might need the help of a psychiatrists. Specialist to monitor the child for any behavioral

issues. IEP specialists.

Needs of the Family

Community resources (Agencies, organizations, workshops)

Caregivers (Early Childhood Educator) Psychologists, Psychiatrists, Family Doctor Counseling services Public Health Nurse Support of a Social Service Worker

Understanding Epilepsy

The epilepsy is usually related with theunconditional amount of seizures. But beforeunderstanding epilepsy we have to acknowledge the difference between epilepsyand seizures.

Epilepsy and Seizures

http://www.youtube.com/watch?v=peDApnr2oBk

Epilepsy

Also known as seizure disorder and status epilepticus. Defined as recurrent chronic seizures A person with epilepsy might have many seizures in a

row. THIS IS A MEDICAL EMERGENCY. Seizures could be same type or different types. Definition: Epilepsy is usually described as neurological

condition that is characterized by recurring unprovoked seizures.

Video

http://www.youtube.com/watch?v=nRW5K2kCM68

How do we define Seizures?

Disruptive discharge of brain’s electrical activity which results in excessive brain activity.

Occurs momentarily. Over activity of the neurons in the brain can cause

variable symptoms. Definition: A seizure is a temporary disturbance in the activity of

the brain.

Types of Seizures

Generalized Partial

Categorizing Seizures

Partial Seizures

Also known as Focal seizures. Includes small areas of the brain. The symptoms differ depending on the area

of the brain involved. Two types:

Simple partial seizuresComplex partial seizures

Simple Partial Seizures

Simple partial seizures begin with a single seizure focus in one particular area of the brain.

They generally do not progress to generalized seizures and there is no loss of consciousness involved.

Usually involves rhythmic or repetitive movements of the body such as twitching of the extremities.

Can also have psychic symptoms especially feeling of deja vu (feeling that something that is happening now has happened before as well).

Simple Partial Seizures Cont.

These seizures usually have a very short duration usually less than a minute.

The patient can resume regular activity right away.

Complex Partial Seizures

Impaired consciousness Includes Automatisms: Repetitive purposeless

movements such as lip smacking. Can last up to 3 minutes. Post period of seizures includes fatigue,

headache, memory loss. Can progress to generalized seizures.

Generalized Seizures

Also known as Grand Mal seizures Caused by diffuse abnormal activity in the

brain. It includes most of the brain area, most

commonly: the Motor areas responsible for movement.

Absence seizures and Tonic-Clonic seizures are most common types

Myotonic Seizues

Shortest duration Muscle contractions with resulting jerky

movements of extremities. Usually occurs during morning and in clusters.

Tonic-clonic Seizures

Tonic phase: contraction of muscles especially in the extremities.

Clonic phase: jerking of extremitiesLoss of bowel and bladder controlLoss of consciousness, screaming, fallsPost-ictal period: after the seizure the

patient may be confused, speech impairment, headaches and/or soreness.

Aclonic Seizures

Loss of muscle tone Resulting in drop attacks Risk of injury associated with falls Be aware of head injuries.

Absence Seizure Cont.

Sudden stopping of activity with blank staring.

Lasts only a few seconds. Can reoccur several times. Loss of awareness but not consciousness.

Absence Seizures

A typical example of absence seizure:Susie is a bright young girl who is always

excited to paint. One day her teacher noticed that Susie suddenly stopped painting and stared in to space for a few seconds and then resumed her activity. This process was noticed several times a day by her teacher and she believes that the child is daydreaming.

Video

Absence Seizure (Common amongst All types)

http://www.youtube.com/watch?v=9HiKwTm755o

How Common is Epilepsy?

15,500 new cases of epilepsy per year in Canada

Prevalence is 5 in 1000 children Rate of epilepsy is higher in males Risk increases with age Epilepsy is more common than Cerebral Palsy,

Parkinson’s Disease and Multiple Sclerosis combined

Risk Factor

Family history of seizures Exposure to recreational and seizure

precipitating drugs. History of febrile seizures (seizures in infants

that occur after a high fever).

What Causes Epilepsy?

The most common cause of epilepsy is unknown.

Followed by traumatic injuries to the brain, neoplasms, lead poisoning and brain injury at birth.

What Triggers Epilepsy?

Missed medication – Most common cause Flashing lights Stress/anxiety/loss of sleep Drugs Illness

Diagnosis of Seizure disorder

Diagnosis of seizures includes several steps:Rule out metabolic causes such as hormonal

changes, electrolyte disturbances, drug side effects by doing blood tests.

Recreational drug screening by urine testing.EEG studies to observe brain activity.Assessment by neurologists and neuroradiologists

Treatment of Epilepsy

Epilepsy is treated at as a Medical Emergency and a strict protocol is followed.

Long term treatment with Anti-epileptic medications.Choice of drug depends on the type of seizures.Partial seizures are commonly treated with

Ethsuximide.Generalized seizures are treated with valproic

acid.

Difference b/w Adult and Childhood Seizures

Since the brains are developing, there are more chances of long term deficits.

There are psychological sequel of having a long term neurological disorder.

Can precipitate memory loss and problem with school work.

Low self esteem and fear of being in public resulting in isolation.

Dos and Don’ts when someone is having

seizures? Stay calmProtect the child from any more harm and

remove hazards.Turn the child on their side.Elevate the head while providing support.Call for help and document what

happened.

Don’t !!

Put food or drink in the child’s mouth. Restrain them. Try to awake them. Try to prevent tongue biting by putting your

own hand in the mouth.

Myth Busters

Epilepsy can not be passed on to others, it is not contagious.

It is not a psychiatric illness, epilepsy has a physical cause which is over activity of neurons in the brain.

Children usually do not remember having the seizure.

Risk of death is minimal if proper steps are taken. Food and diet are not causes of epilepsy.

Modifications in the Child Care Setting

Physical Adaptation

Children with epilepsy are surely to treat and acknowledged as normal as any other child under the car of the child care service providers. They have a right to be treated as their fellow typically developing peers. However, looking at the pros and corns of the condition and the severity of the disorder, there are number of physical changes that can be done in order to provide autonomy to Zenna within the child care setting.

Physical Space: It is important to make the child care physical space interactive yet a seizure-

friendly zone because of the large amount of time children spend on an average day. I would provide a safe physical environment to Zenna, such as the removal of sharp edged materials in the room, glass tops and hard floors. Also, the room can be carpeted especially different centers of the room where she spend a lot of her time playing. Moreover, padded surfaces and corners are needed so that can minimize injuries in case of seizures or falls. It is also important that she be seated in an area that provides extra space in the event of a seizure.

Material, toys and equipments: Children with epileptic episodes do not require having any special sort of

materials, toys or equipments during their play time but they are surely in need of safe age appropriate toys. I would make sure to provide the materials in the environment that are not only age appropriate but also safe in terms of playing with. I would not provide sharp edged, easy to break utensils and especially hard big constructing blocks in the environment.

Labeling System: There are some specific learning problems children with epilepsy experience

due to the condition and the frequency of the seizures. This not only affects their level of self-esteem but also creates difficulties in understanding the daycare environment as it takes longer for new information to process. Language and academic problems mostly occurs to the child with epilepsy. To help Zenna overcome this difficulty I would provide one by one repetitive session of all the materials present in different centers of the environment. Also, I would put pictures in the environment along with dark/bold letters that helps her in reading the signs without stressing her mind.

Adaptive devices: Children with epilepsy are at greater risk of having injuries due to

sudden falls and hitting themselves to the floor. It is important to provide them safe and secure environment to take risks which allow them experience autonomy. Some of the adaptive devices that I would like to bring to the environment are related to Zenna’s own safety such as, protective head equipment such as bicycle helmets, elbow pads, and kneepads. Also, I would encourage her to wear loose but soft clothes in order to avoid any harm.

Flexibility in routines: Routines and schedules are important for all the children. It is also

essential to create a healthy lifestyle for children with Epilepsy. I would make sure to try to establish a regular routine for eating, sleeping, and medications for Zenna. I would also encourage her to be active and participate in activities to the best of her ability. Moreover, I would clear my expectations to her and would help her in transition time. I would also try to ensure that she gets enough rest especially after an event of seizure.

Staff Support and Training: Working with the staff members and the care providing team

is essential for the success of the child in all fields of life. I would make sure to work with a team of caregivers and staff members present in the childcare setting to seek help and support in observing Zenna throughout the day and also to minimize my own stress level in order to plan further for her. I would also like to take informational workshops on epilepsy so I could provide my whole heart support to Zenna and her family.

Teaching Strategies

A committed caregiver or a teacher works a lot for the success of all the children in her care, but the most committed teacher through her teaching method and strategies can create wonders to the life of most of the children.

Memories are made, stored and found by our brain throughout our lives. Links made among our brain cells help us to remember things like our thoughts, skills, and experiences. According to the Epilepsy society, “memory can be one of the key issues that affect people with epilepsy. This can be for many reasons, including the type of seizures they have, the effects of medication, the effect of concentration or mood, lack of sleep or age, or the effect of epilepsy surgery.” (Epilepsy Society)

Prompting and Fading As mentioned, one of the most common side effects of epileptic fits or

seizures is decrease in the attention and concentration level of the children. The processing rate of new information of the brain gets slow and the child with epilepsy suffers in learning new skills. Also at times, (depending on the severity of the seizure) it is difficult for the child to recall or remember the skill that had learned before. This eventually happens to be a big problem for children with epilepsy. It is important to understand that the aftermath of a tiring epileptic fit and sometimes the dosage of medications make difficult for these children to pay attention.

Prompting and Fading is one of the most supportive teaching strategies. It is helpful in learning new skills and for recalling and reminding the already learnt skill. In terms of helping Zenna in her physical space, I would like to use a variety of cues to allow her to become focused on learning new skills. Some of the important instructional cues would include visual, gestural and sometimes physical prompts. Moreover, teachers need to modify instructions a little bit such as, if a skill is already learned then focusing on only those prompt that would help child recognizing the skill.

Prompting and Fading Cont.

There are 5 easy steps of prompting and fading to learn new skills and focusing on already learned. Defining the skill to the child Identifying suitable prompt

(gestural, verbal, physical etc) Use of prompt, reinforcing the

child and fading or reducing the force of the prompt

Monitoring the results IF needed, return to stronger

prompts (for recalling).

Visual Support

Visual support is very helpful in understanding the instructions. It should be clear, simple in language and consistent so that the child with epilepsy knows what is expected from him. Repetition and direct instruction through visual and verbal support is needed so that a child can easily perform the task. Visual support allows more time to process information and help memory in learning new words and skills. Play skills can also enhance with visual. It can teach how toys are used in variety of ways. (Connectability, week 8 notes). Apart from play, it is a wonderful opportunity to talk to Zenna and to tell her about Epilepsy with the help of visual communication such as pictures, videos etc.

Task Analysis Since focus and attention of a child with epilepsy is

hindered even when he/she is not having seizures. Caregivers can help bringing focus and attention of the child in the environment by various means of teaching strategies. One such strategy is Task Analysis. To teach a new skill to the child it is important to break down the task into smaller steps that can help child acknowledge his/her own potential. Task Analysis is important for the child so he/she can cope with his/her peers and gain self confident. I would like to spend some time with Zenna in the room specially to learn about how good she is at any new task I wanted her to grasp. I would write down the steps of the task according to her ability and level of understanding. Also I would keep record of the observation after teaching her new skill. It would help me identifies the areas where she needs assistance and where to fade assistance (prompts).

Giving Instructions

Instructional language is essential. It has to be simple, consistent and clear so the child will know what is expected of him. Use of consistent ways of interacting and patterned use of language helped the child a lot in getting directions and also set up for success. Realistic expectations are set for the child and provide a predictable, continuous experience for the child with seizures. Each child learns on his own pace and children with epileptic fits require a little more time to process in information in their mind. It is important for the teacher to allow enough time for the child to process and wait patiently for the result.

Focused on Learned Skill

Children with Epilepsy may experience low self-esteem due to the embarrassing fits or seizures in front of peers and everyone. It is very important to look for the possible ways in helping to promote success. The most important strategy that can be applied is focusing on the skill that the child already knows and has developed skill in that. Children would enjoy interacting if you would make the learning task a little challenging for the child. In the environment I would like to observe Zenna and see what skills and tasks she can perform without any assistance and support. After that to make her learn new teaching skills I would like to add a little challenging situation in the steps (process) of the same task that she knows and also would like to generalize the task so she would understand it applies everywhere in the environment. It is the responsibility of the teachers to introduce new tasks to the children and to help children achieve success in learning new tasks.

Individual Education Plan (IEP)

Administering medication or the seizures themselves results in interrupting the learning activities of classroom. Therefore it is said by the Epilepsy Foundation that in some cases of severe interruption or distraction it may be necessary to develop an Individual Education Plan (IEP) for the child with epilepsy. IEP are made at the presence and help of the specialist, the care giving team and parents.

Inclusion of typically developing children

It is commonly said that children learn most from their peers. They build their confidence when they are around their friends and they can see the world together with their own ideas, ways and perspectives. Children when explained can be the best source of help for their peers.

To include the typically developing children in understanding

the perspective that there is a child with special needs in the room I would like to tell following important things.

Discussion with Children about Epilepsy

During the circle time or small gatherings I would like to explain children in an appropriate way about epilepsy. Using books, pictures, play, or videos.

Explaining about the cause of the seizure, what it is and what may happen during a seizure.

The child is like everybody else in the room except for the brief periods of time when the child is having epileptic fit.

Epilepsy is not at all contagious and you can’t catch it just like a cold or pink eye.

Talk about what should be done on daily basis, such as helping child with epilepsy in their medication and what should everyone has to do when a seizure occur.

Buddy System

It's natural for a child who has epilepsy to feel different from other children. Children with epilepsy may develop emotional problems, such as depression and poor self esteem. These problems may come from,

Self = anger, embarrassment and frustration or Environment = Children with epilepsy may be teased

by other children. Using a daily or weekly buddy system can provide help to

the children understand the child with the special needs in the room. This would impart a level of comfort in other children. Moreover, they would understand that the child is as normal as they are. Some form of peer help such as playing together outside or spending a whole day with the child with epilepsy (during lunch time and free play) may not only help all the children in understanding emotional and social needs of the child but also help in building the self-esteem of the child with epilepsy through peer support.

Needs of the Family

Most of the people are afraid of the unknown. After the child is diagnosed parents experience the feelings of fear and worry. These feelings of misery are normal and common, and often occur in understanding and accepting epilepsy as a part of their child's life. Some parents and family members are not ready for the new challenges and demands and it will take time to accept the reality.

Collaboration with Parents

Caregivers have an excellent opportunity to collaborate with the parents and to enrich them with enough information about the topic of Epilepsy.

An ECE can offer the parents, To take part in the special IEPs for their child and to seek assistance

on how and what could be the beneficial thing for the child. To seek family counseling to help everyone understand how to deal

with the special need of the child. Asking for Form 14 permission to help child with resource

consultant/specialties. If they want to attend workshops related to the services and

information provided on the topic of Epilepsy. Answer to their questions by gathering a lot of information on the

topic of Epilepsy.

Role of an Early Childhood Educator

An Early childhood Educator along with the help of the staff members can arrange monthly mini workshops at the child care centre for the parents. The purpose of these workshops is to include the parents in the daily, weekly and monthly progress of the child with epilepsy and to provide information about several safety measures and techniques at home. For example, use of monitors in child’s room, padded furniture, safe bathing, safety with water, kitchen and fire, and outside play.

Moreover, ECE can ensure that siblings would understand about the problem and suffering of the child with epilepsy. If they consider them different, they should try to spend more time with them.

Young Children quickly pick up on parent’s anxiety. An ECE can help parents understand that they must set aside some time each week for their own self. Take time for a relaxing, go for a walk, and interact socially with friends and with people. It will help minimizing their stress.

Local Agencies and Resources for Parents

Epilepsy Toronto

Epilepsy Toronto supports adults and children living with epilepsy for over 50 years. Because of the non-profit registered charity, Epilepsy Toronto is accountable to the public at large, and run by a volunteer Board of Directors.

It offers number of free programs and services, exciting events throughout the year, and provides lots of information on epilepsy as well. Epilepsy Toronto helps everyone whether they have epilepsy or just interested being a community member. Epilepsy Toronto provides counseling, education, and employment support to the people living with epilepsy.

Part of their Mandate is to provide support and encouragement to the people with epilepsy and help them to connect with all others who are going through same situations and experiencing same challenges in life. This can help them build self-confidence.

One of their services is for Children and Youth. It is researched by the agency that “more than half of all newly-diagnosed patients with epilepsy are children under the age of 10.” (Epilepsy Toronto) They provide one to one counseling and support to the parents of a child with epilepsy on social, educational and medical concerns and also help them empower and mange with their child's epileptic condition.

Contact Information Epilepsy Toronto

468 Queen St. EastSuite 210Toronto, ONM5A 1T7

Phone: (416) 964-9095Fax: (416) 964-2492E-mail: info epilepsytoronto.orgWebsite: www.epilepsytoronto.org

Epilepsy Ontario

Epilepsy Ontario established in 1956 is one of the biggest non-profit health charity organizations working for the people living with epilepsy. Epilepsy Ontario today has 16 epilepsy agency affiliates and partners.

The structure and management now over the years have evolved into a most reputable organization much greater than it was expected when established.

Mission statement: “Epilepsy Ontario exists to promote independence and optimal quality of life for those living with seizure disorders by promoting information, awareness, support services, advocacy, education and research.” (Epilepsy Ontario)

Numbers of services are provided by the agency throughout the province that includes: Counseling service for newly diagnosed patients or parents of a child. Seminars and workshops are provided to the parents. Resources are available in the form of electronic and print media covering all

aspects of epilepsy. Medical help and referrals are also discussed on requests.

Contact Information Epilepsy Ontario Suite 803- 3100 Steeles Avenue East

Markham, ON Canada L3R 8T3 905-474-9696

1-800-463-1119 (toll free in Ontario)info@epilepsyontario.org

http://epilepsyontario.org/

Epilepsy Canada

Mission Statement: “Epilepsy Canada organization is to enhance the quality of life for persons affected by epilepsy through promotion and support of research and facilitation of education and awareness initiatives that build understanding and acceptance of epilepsy.” (Epilepsy Canada)

Epilepsy Canada established in 1966 is a non-profit organization which is run by the national board providing services to the people and families living with epilepsy. It is entirely dependent on the public donations and support to continue their research and educational programs.

Their mission is to promote awareness of epilepsy and to research more about it.

To advocate for the betterment of the people living with epilepsyTo create awareness about the severity of epilepsy amongst the high officials

of government.To clear the minds of the individuals about the myths related to epilepsy. To address the needs of people living with epilepsy such as, treatment, health

care services and diagnosis.

Contact Information

2255B Queen St E, Suite 336 Toronto, ON, M4E 1G3 Tel: 1-877-734-0873 Fax: 905-513-9461 Charity Registration Number: 13117 6042 RR0001 email: epilepsy@epilepsy.com website: http://www.epilepsy.ca/en-CA/Home.html

Sick Kids

The Hospital for Sick kids is a health-care community devoted to help and improve the health of the children.

Mission Statement: “Sick Kids is to provide the best in family-centered, compassionate care, to lead in scientific and clinical advancement, and to prepare the next generation of leaders in child health.” (SickKids)

Sick Kids help in the diagnosis and treatment of epilepsy in the children. It also provides a detail list of other resources for the parents so they can get help from their local agencies.

Contact Information

The Hospital for Sick Children555 University AvenueToronto, OntarioCanadaM5G 1X8

Important contacts: General inquiries: 416-813-1500

Patient information/locating: 416-813-6621Ontario Poison Centre: 416-813-5900Telehealth Ontario info line: 1-866-797-0000

Website: http://www.sickkids.ca/

Community Care Access Centre (CCAC)

Total14 communities across Ontario, provides care at home and community.

Mission statement: “To deliver a seamless experience through the health system for people in our diverse communities, providing equitable access, individualized care coordination and quality health care.”

CCAC is funded by local health networks through the ministry of health. The following services are provided by CCAC at home and in community

such as schools and other health care homes. Nurses,TherapistsLanguage and speech therapyPersonal social worker support.

Contact Information

(416) 506-9888 or feedback@toronto.ccac-ont.ca toronto.communitycareresources.ca

http://www.ccac-ont.ca/

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Youtube Videos: http://www.youtube.com/watch?v=nRW5K2kCM68 http://www.youtube.com/watch?v=9HiKwTm755o http://www.youtube.com/watch?v=peDApnr2oBk