1. 4. 4. 2. Provide protective helmet to prevent head traum
         3. Implement seizure precautions.
      5. Goal: provide early detection of and correction for vision and hearing defects.
         1. Arrange for screening tests.
         2. Assist family with obtaining corrective devices: eyeglasses, hearing aids.
      6. Goal: promote locomotion.
         1. Encourage “infant stimulation” program to assist infant in reaching developmental milestones.
         2. Refer to physical therapy for exercise program.
         3. Incorporate play into exercise routin
         4. Use devices that promote locomotion: parallel bars, crutches, and braces.
         5. Surgical approach may be needed to relieve contractures.
      7. Goal: encourage independence in ADL.
         1. Adapt clothing, feeding utensils, et to facilitate self-help.
         2. Encourage child to perform ADL as much as possible; offer positive reinforcement.
         3. Assist parents to have realistic expectations for their child; avoid excessively high expectations that might increase frustration.
      8. Goal: promote self-esteem.
         1. Praise child for each accomplishment or for sincere effort.
         2. Help child dress and groom self daily in an attractive “normal” manner for developmental level and ag
         3. Encourage child to form friendships with children with similar problems.
         4. Enroll child in “special ed” classes to meet his or her needs.
         5. Encourage parents to expose child to wide variety of experiences.
   5. Evaluation/outcome criteria:
      1. Patent airway and adequate oxygenation maintaine
      2. Adequate nutrition maintained, and child begins to grow and gain weight.
      3. Child has an acceptable means of verbal communication.
      4. Safety is maintaine
      5. Vision and hearing within normal limits using corrective devices pm.
      6. Child is as mobile as possible, given disabilities.
      7. Child is performing ADL, within capabilities.
      8. Child has positive self-image/self-esteem.
2. Spina bifida (myelodysplasia)
   1. Introduction: Three different types of spina bifida:
      1. Spina bifida occulta —a “hidden” bony defect without herniation of the meninges or cord; not visible externally, no symptoms are present, no treatment is neede
      2. Spina bifida cystica—visible defect of the spine with external saclike protrusion.
         1. Meningocele —Table 5-2
         2. Myelomeningocele —see Table 5-2 Most serious type of spina bifida cystica and also most common.
   The remainder of this section deals with myelomeningocele exclusively.
   2. Assessment:
      1. Congenital defect.
      2. Readily detected by visual inspection in delivery room: round, bulging sac filled with fluid, usually in lumbosacral are
      3. Sensation and movement: complete lack below the level of the lesion.
      4. Urinary: retention, with overflow incontinenc
      5. Fecal: constipation, fecal impaction, oozing of liquid stool around impaction.