Good prenatal and obstetrical care can greatly decrease the
risk of prematurity. No one has yet clearly defined exactly how much of an
effect good nutrition may have in preventing birth defects. There is little
doubt that extreme malnutrition in the mother can have serious consequences for
her child. There are more subtle forms of malnutrition-involving deficiency of
a vitamin or a mineral-which may predispose to the birth of a handicapped
child. Most obstetricians today stress the importance of good diet for the
mother and instruct their patients in sound eating habits.
Diseases present in a pregnant woman can significantly
influence the health of her child. They can, and should, be detected and treated
even before a woman becomes pregnant. Failing that, their early detection and
treatment during pregnancy can be helpful in avoiding handicaps for the child.
By getting a chance to know a patient long before delivery, throughout her
pregnancy, an obstetrician can anticipate and be prepared for any problems that
may arise at the time of birth.
Good obstetrical and anesthetic care during
labor and delivery are important in preventing brain damage. Improper use of
forceps and techniques to hasten labor and delivery can cause brain damage in
the infant. General anesthesia, narcotics, sedatives, and obstetrical
complications have some potential for depressing the breathing center of the
newborn, with the risk that insufficient oxygen may reach the brain, resulting
in damage there.
Many obstetricians prefer to have an anesthesiologist present
at delivery to administer the anesthetic for the mother and to evaluate and
treat any respiratory difficulties that may arise in the infant. Similarly,
pediatric care during the first months of life helps in primary prevention,
particularly in the area of prompt detection and treatment of an infection such
as meningitis, which is a common cause of brain damage in the early period
after birth.
Unfortunately, in about 40 percent of cases it is not
possible to detect or prevent causes of brain damage. For example, some errors
of metabolism- either hereditary or arising spontaneously-are difficult to
detect immediately at birth and treat adequately. Radiation is probably a somewhat
exaggerated hazard.
Nevertheless, every physician will attempt to keep
radiation exposure to a minimum during pregnancy, because of harmful effects
demonstrated in animal studies and because the effects in humans of x-rays,
except in very large doses, are still not clearly established.
Occasionally,x-ray study may be required to detect disease; at such times, there should be
no hesitancy about its use. Secondary preventive measures are most effective
when applied early.
Early detection and proper evaluation of CP may require
study by a neurologist and other specialists who are most often readily
available at a children's hospital.
The aim of secondary prevention is to keep emotional
difficulties from arising as a result of handicap and to train the CP patient
and his or her family to utilize to the fullest their abilities to overcome
physical and personality problems. A child with CP needs individual evaluation
and a program of therapy most appropriate for him.
The program-to prevent
loss of the child's potential for maturation and independence-may include
medicines, various forms of counseling, physical therapy, and special training.
There are medicines to help control the seizures which may afflict some of
those with CP Other medications help minimize uncontrolled movements; still
others aid learning ability and may help bring about a more positive attitude
toward life and work.
Antibiotics are available as needed to help combat
infections to which defective body systems are prone. Vocational counselors,
social workers, and psychologists are just a few of the professional people
whose special training enables them to assess the mental and physical assets
of a child with CP and advise the best way to maximize these assets. It is
often difficult to gain insight into the real capabilities of children with CPbecause of difficulties of communication resulting from speech and hearing
impairment, depression, and withdrawal. Help in overcoming such difficulties is
increasingly available now at centers dealing with the problems of CPo Physicaltherapists can help to correct deformities and to educate muscles to perform
such important functions as walking, eating, and dressing.
Speech therapists, occupational therapists, and sympathetic
teachers are other members of the team. In many areas now, special schools and
special classes are available to train children with CPo Employment is an
important part of every adult's life. Training for jobs- if necessary, for jobs
under special, favorable conditions such as those to be found in sheltered
workshops-is helping many with CP. Today, it is being recognized increasingly
that the handicapped are often punctual, dependable, even outstanding workers.
Employment often gives new meaning to the life of a CP victim because it
establishes goals and makes the patient feel more independent and self-
sufficient, important factors in the maturation of anyone's personality. Those
CP victims who are mentally retarded often function well in employment where
there are simple repetitive tasks to perform. They may derive tremendous
satisfaction from jobs that nobody else is willing to per- form. It is
surprising what the handicapped can achieve with training and encouragement.
Ambition to achieve is an important attitude to be inculcated in a child withCP.
