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3.00: Personal hygiene
Published in Fiona Broadley, Supporting Life Skills for Young Children with Vision Impairment and Other Disabilities, 2020
Children become ready for toilet training at different times. For a child with severe sight impairment it is likely that the absence of incidental learning – being able to see others using a potty or toilet – will further delay their readiness. By contrast, some may be so distressed by soiling themselves that they push for early training. There are plenty of publications on the market to assist with the process, but nothing specifically geared to vision impairment. If you are experiencing difficulties, you may find your health visitor or school nurse can offer advice. Both teams often contain specialists or can refer you to a more appropriate service. As a rough guide, girls are physically ready earlier than boys, but you are looking at a window somewhere between 18 and 36 months. Toileting programmes change with fashion and greater scientific knowledge, but the most important thing is that it works for your child. If your child cannot maintain a good posture or has other physical needs, a referral to occupational therapy or physiotherapy may help.
Importance of collaboration in pelvic reconstruction: How to avoid complications and extra interventions
Published in Alejandra Vilanova-Sánchez, Marc A. Levitt, Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
Molly E. Fuchs, Kate McCracken, Daniel G. DaJusta
Often, children are ready for a Malone before we know the status of urinary outcomes. The decision to create a Malone should not be made without considering the possible future urologic needs. It is important to wait to use the appendix for a Malone channel until one is sure that the child will not require a Mitrofanoff channel for catheterization of the bladder. Tissue sharing is critical in the surgical planning of complex patients. The appendix should be preferentially used for a Mitrofanoff channel because the alternative to a Mitrofanoff, a Monti channel, requires a bowel resection, bowel anastomosis, and has higher complication rates than Mitrofanoff creation. Additionally, a Malone has other viable alternatives such as cecal flap neo-Malone, cecostomy tube, or continued rectal enemas. If it is not yet known if a child will require a Mitrofanoff, rectal enemas should be continued until that decision can be made. If an antegrade option is required or a child is not tolerating rectal enemas, a temporary cecostomy tube is also an option until the plan for urinary reconstruction can be clarified. Typically by 4 or 5 years of age, the urologic plan can be determined after toilet training efforts have been exhausted. It is critical to fully evaluate both the urologic and gastrointestinal needs of a patient prior to committing the child to an intervention. Frequently these procedures can be done in combination and can allow for tissue sharing [1].
Common vulvar and vaginal complaints
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Girls usually develop labial adhesions while still in diapers, with an estimated peak incidence of 3.3% in girls 13–23 months of age.1 The adhesions arise from the perfect storm of a prepubertal hypoestrogenic vulva and an inflammatory inciting event occurring in a girl predisposed to developing adhesions. Even with meticulous hygiene practices, some girls with very sensitive skin may be predisposed to inflammation from the presence of urine or feces in the diaper. The variable hygiene habits of toilet-training toddlers may exacerbate the problem. As the adhesions progressively close the labia minor over the vestibule, urine can become trapped in the vagina during voiding, then with slow release the perineum becomes wet and irritated, further increasing adhesion formation. Triggers of labial adhesions include vaginal infections and inflammatory skin conditions such as lichen sclerosus (see Chapter 10), and trauma to the perineum from straddle injury or sexual abuse. In areas where female genital mutilation is endemic, labial adhesions are unfortunately an intended outcome of this practice.
Contact: William S. Burroughs’s philosophy of love
Published in International Review of Psychiatry, 2023
Object relations theory is often thought to have begun when Melanie Klein began to expand upon Freud’s theory of pregenital stages. Her main innovation was her detection of an Oedipal-like mixture of love and hate directed by children towards their mothers (Klein, 1935, 1946/1986). During the first psychosexual phase, the oral-cannibalistic, the child experiences the breast as either a ‘good breast’ that gives satisfaction, or a ‘bad breast’ that poisons the child by withholding the life-giving liquid from him (Klein, 1935, pp. 140–141). The anal phase, especially in Klein’s early writings, follows the Freudian line, but adds an emphasis on the child’s temptation to view the parents as persecutors who could annihilate him in retaliation for the phantasied cannibalistic attacks made upon the ‘bad breast’ during the oral period (Klein, 1946/1986, pp. 187–188). The other challenge for the toilet-training child is to avoid becoming wracked with subconscious anxiety and guilt over what might be termed his ‘oral-iginal sin’ (my term) of wishing to rid himself of their existence by suppressing his knowledge of them as ‘bad objects’ (Klein & Klein, 1952/1975, pp. 72–73).
A consecutive case series analysis of a behavioral intervention for enuresis in children with developmental disabilities
Published in Developmental Neurorehabilitation, 2018
Joanna Lomas Mevers, Colin Muething, Nathan A. Call, Mindy Scheithauer, Shannon Hewett
For participants who did not participant in additional self-initiation training (n = 29) caregivers reported that 51.72% (n = 15) were engaging in some form of self-initiation at follow up. For these participants, the only communication training conducted was prompting the child to mand prior to each bathroom trip. Given that nearly half the children acquired some form of self-initiation, there is some evidence that teaching children to mand for the bathroom maybe accomplished without direct training and supports the incorporation of communication training during toilet training.
The Prevalence of Bladder and Bowel Dysfunction in Children with Cerebral Palsy and its Association with Motor, Cognitive, and Autonomic Function
Published in Developmental Neurorehabilitation, 2023
Moriah Baram, Luba Zuk, Tohar Stattler, Michal Katz-Leurer
When investigating the age of toilet training, 20 parents reported a specific age for their child being toilet trained (Table 2); around half of the parents mentioned situations in which the child was not toilet trained. Seven out of 29 children with existing BBD (24%) were given treatment. Two were treated with pelvic floor physiotherapy and urotherapy. Daytime enuresis was the most common problem, while nighttime enuresis and daytime encopresis were the second most prevalent. Around half of the children (18/39) presented more than one sign of BBD.