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Treatment & Management

Medical Care

1. Early identification of children

with developmental delays.

2. The mainstay of treatment ofMR/ID is developing a

comprehensive management

plan for the condition.

3. Physical activity and obesity are

major contributors to disease in

MR/ID.

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Treatment & Management

4. Pain:

Manifestations of pain in peoplewith severe to profound MR/ID

include crying, screaming,grimacing, protective postures(eg, arching, fetal position),rocking, and aggression.

Common causes of acute paininclude dental caries/abscesses,GERD, constipation, UTI,spasticity (when MR/ID isassociated with cerebral palsy),pressure sores, and fractures.

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Treatment & Management

In addition, neuropathic pain due

to dysautonomia or motor spasms

may create chronic disturbances.

5. Written, verbal and pictoral forms

of communication as well as

gestures and demonstrations are

helpful for those with MR/ID to

ensure mutual understanding and

improve treatment adherence.

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Treatment & Management

6. Sedation/anesthesia: Patients

with MR/ID requiring anesthesia

may have different reactions than

the general population, such asparadoxical reactions to

benzodiazepines, and care should

be taken to use the lowest dose

and titrate slowly.

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Treatment & Management

7. Sexuality/abuse: A significantly

higher proportion of children and

adults with MR/ID have

experienced some form of abuse,with some estimates of up to

70%, which contributes to mental

health issues. This should be

addressed at each medical visitand especially in the setting of

changes in behaviors, such as

increased aggression.

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Treatment & Management

Consultations

Developmental pediatrician orpsychologist

Geneticist and counselor

Psychiatrist

Dentist

Podiatrist

Special education/educational therapist

Occupational, speech and/or physicaltherapist

Behaviorist

Pharmacist

Durable medical equipment providers

Social services agencies/social workers

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Treatment & Management

Diet

Nutritional supplements are of no

proven benefit.

Activity Because obesity is more prevalent in

those with MR/ID, regular physical

activity should be included in the

management plan. Adaptive exerciseprograms for those with

concomitant physical disabilities

should be recommended as needed.

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Treatment & Management

Nursing Management

1. Assess all children for signs ofdevelopmental delays.

2. Administer prescribed medicationsfor associated problems such asanticonvulsants for seizuredisorders, and methylphenidate

(Ritalin) for attention deficithyperactivity disorder.

3. Support the family at the time ofinitial diagnosis by actively listeningto their feelings and concerns andassessing their composite strengths.

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Treatment & Management

4. Facilitate the childs self-care abilities byencouraging the parents to enroll the child

in an early stimulation program,establishing a self-feeding program,initiating independent toileting, andestablishing an independent groomingprogram (all developmentally appropriate).

5. Promote optimal development byencouraging self-care goals and emphasizethe universal needs of children, such asplay, social interaction and parental limitsetting.

6. Promote anticipatory guidance and problem

solving by encouraging discussionsregarding physical maturation and sexualbehaviors.

7. Assist the family in planning for the childsfuture needs (e.g. Alternative to home care,

especially as the parents near old age); referthem to community agencies.

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Treatment & Management

8. Provide child and family teaching

Identify normal developmentalmilestones and appropriatestimulating activities including play

and socialization. Discuss the need for patience with

the childs slow attainment ofdevelopmental milestones.

Inform parents about stimulation,

safety and motivation. Supply information regarding normal

speech development and how toaccentual nonverbal cues, such asfacial expression and body language,to help cue speech development.

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Treatment & Management

Explain the need for discipline that issimple, consistent and appropriate tothe child.

Review an adolescents need for simple,practical sexual information thatincludes anatomy, physicaldevelopment and conception.

Demonstrate ways to foster learningother than verbal explanation becausethe child is better able to deal with

concrete objects than abstractconcepts.

Point out the importance of positiveself-esteem, built by accomplishingsmall successes in motivating the child

to accomplish other tasks.

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Treatment & Management

9. Encourage the prevention ofmental retardation

Encourage early and regular

prenatal care. Provide support for high risk

infants.

Administer immunizations,

especially rubella immunization. Encourage genetic counseling

when needed.

Teach injury prevention both

intentional and unintentional.