Do You Know the Four Hidden Challenges for Those with Developmental Disabilities?
by Lisa DiFalco
There are challenges that are subtle but that can have profound health consequences on those with developmental disabilities. The issue of potential aspiration, dehydration and more may be of particular concern with patients who have difficulty communicating verbally. There are four main challenges that healthcare professionals should be aware of that increase the likelihood of morbidity in those with developmental disabilities. This is seen in research noting an increase in mortality rates in children and adolescents with developmental disabilities that calls for more attention to conditions often secondary to the disability itself.
Caregivers and healthcare professionals may believe they are doing all they can for someone in their care and yet miss the signs of “the fatal four” challenges impacting this population. These challenges can be prevented and managed when guidelines provided from the Division of Developmental Disabilities Services are followed. Learn to see the signs and offer intervention and treatment for the major challenges of aspiration, dehydration, constipation and seizure disorder.
During or following swallowing, the entrance of food, medication, saliva, fluid or other material into the trachea and beyond is the first of four challenges that may cause a fatality in those with developmental disabilities. All of these foods and materials can cause blockages and interfere with respiration. Immediate action is necessary to address this specific issue and avoid serious consequences. Health professionals, nurses and caregivers need to be aware of the individuals who may be susceptible to an aspiration problem. Signs that an individual is at high risk for aspiration include:
- The need for medication that may reduce voluntary muscle coordination or lead to drowsiness;
- The need for modified food texture;
- A patient history of gagging, coughing or choking while eating; and
- The need for others to feed the individual.
Aspiration is a serious problem for some people with developmental disabilities. Beyond action when aspiration occurs, there are ways to avoid or minimize such risk. Caregivers and healthcare providers may:
- Have the individual stay upright after a meal for 45 minutes, or as directed;
- Use positioning to assist with swallowing when eating;
- Reduce the size of bites and slow the eating pace; and
- Change the temperature, texture or consistency of the diet.
These are all guidelines to keep in mind to reduce the chances of aspiration in a susceptible individual. Awareness of each patient’s needs will help make the feeding process easier and possibly prevent unnecessary choking, gagging or aspiration.
Four out of five patients could be suffering from dehydration since this challenge impacts more than 240 million people in America. Insufficient fluid levels can lead to dehydration. In these cases, the person loses more fluid than he or she takes in. Certain drugs and conditions may influence the levels of fluid that are eliminated from an individual’s body. Proper fluid levels are needed for the necessary metabolic activities in the body. Fluids influence waste removal, the creation of cellular energy, chemical balances and temperature control. Some important factors can lead to an increased risk of dehydration, including:
- The frequent refusal of fluids and foods;
- Choking and coughing during meals accompanied by dysphagia;
- The need for assistance with the intake of fluids; and
- An inability to access fluids independently.
Healthcare professionals and primary caregivers should be aware of how to prevent dehydration. Guidelines suggest:
- Encouraging individuals to drink from eight to 10 glasses of fluid daily;
- For those reluctant to drink fluids, offering foods high in fluid content; and
- Providing more fluids for those who perspire heavily, have a fever, work hard or are very active.
These are all useful suggestions to help individuals with developmental disabilities stay hydrated and prevent complications that may arise from dehydration.
Constipation happens when affected individuals have problems passing stool. Bowel movement frequency varies by individual. The factors that place individuals at increased risk are:
- Poor swallowing skills;
- Inadequate fiber and liquids in a diet;
- Muscle weakness; and
- Neuromuscular degenerative disorders.
It is possible to avoid or minimize constipation using the following interventions:
- Susceptible individuals should consume a low-fat, high-fiber diet;
- Review side effects of prescribed medications;
- Offer encouragement and opportunities for additional physical activity; and
- Have a positioning schedule with individuals in an upright position for a period of time for any non-mobile individuals.
These interventions should make bowel movements easier and normalize stools for those who experience significant constipation.
Seizure Disorder (Epilepsy)
Underlying brain dysfunctions in individuals with developmental disabilities may lead to recurring seizures or epilepsy. A number of factors can increase the possibility of seizures in an individual including:
- Traumatic brain injuries;
- Brain aneurysms, hemorrhages, clots and tumors;
- Congenital brain malformations; and
- Prenatal and postnatal injury to the brain.
There are ways to help affected people manage the frequency and severity of their seizures. Steps include:
- Maintenance of a healthy weight;
- Regular exercise;
- A healthy diet;
- Stress management; and
- The consumption of prescribed seizure medication.
Many challenges can impact the health and well-being of a person with developmental disabilities. Aspiration, dehydration, constipation and seizure disorder comprise “the fatal four.” These conditions can go unrecognized and require special attention for those serving the needs of this population. These conditions are often unpredictable, may have a sudden onset, have subtle symptoms, and be difficult to detect when communication challenges exist between a caregiver and the affected individual. These factors require more attention from parents, caregivers, behavioral therapists, teachers and other health professionals who engage and care for those with developmental disabilities to prevent a serious health complication or fatality. New training is available to interested parties who want to enhance their understanding of IDD challenges and treatments.