Children With Special Needs, How Can We Afford Optimal Care?

Caring for children is an art and I have been enjoying my practice in this field for more than thirty years. During this long time I have heart breaking experiences when I face a child with special needs. 
The expression “a child with special needs” is much better one and it is preferred to be used instead of the expression “handicapped child” which is annoying word to the parents. 
Children with special needs primary include all children with different types of disabilities. 
Disability is consequence of a partial or complete impairment that may be physical, sensory, mental, cognitive and developmental or combination of these that results in restrictions on an individual's ability to practice and participate in what is considered "normal" in their everyday activity.


Introduction
Caring for children is an art and I have been enjoying my practice in this field for more than thirty years. During this long time I have heart breaking experiences when I face a child with special needs. The expression "a child with special needs" is much better one and it is preferred to be used instead of the expression "handicapped child" which is annoying word to the parents.
Children with special needs primary include all children with different types of disabilities.
Disability is consequence of a partial or complete impairment that may be physical, sensory, mental, cognitive and developmental or combination of these that results in restrictions on an individual's ability to practice and participate in what is considered "normal" in their everyday activity [1].
From this definition physical handicapping of whatever origin is one facet for disability, which includes motor impairment, including upper or lower limb loss or impairment as well as visual and hearing impairment [2].
On the other side, autism is a neurodevelopmental disorder characterized by impaired communication either verbal or non-verbal as well as social interaction, that is associated with restricted and repetitive behavior [3].
Autism is considered a disease with genetic background and some environmental modifiers contribute to its variable clinical presentations [4].
Autism is one of major reasons for childhood disabilities which need a lot of effort to help and support the families and to provide the proper management for autistic child [5].
The question now; do we have to give a special care for the child with disability only?
Childhood is a vulnerable age group and there are many problems which necessitate special attention and special care in this age. Children who have psychological, social and behavioral problems are in a real need for help and support like a child with disability. Examples for these conditions are child abuse and behavioral addiction in children.
Child abuse is an important pediatric health problem. There are many types of child abuse including psychological, sexual as well as physical abuse. Child negligence is a part of child abuse [6].
The importance of child abuse is that there are potential harms to the child which is usually an intentional action from side of the person who is caring the child who may be one of his parents.
Such children are badly in need for special care and psychological supports [7].
Another important problem in early childhood period is behavioral addiction which is defined as a compulsive engagement in rewarding non-drug related behavior [8].
Addiction of video games and watching television more than 2 hours per day are examples of behavioral addiction which has a negative effect on school performance and required an advice and support to prevent and correct the associated dysfunction [9].
And so, the term "child with a special needs" can be consider as an umbrella to include all children who are in need for medical, psychological and or social support apart from those well know traditional medical treatable conditions affecting the heart, kidney and other body organs.

And then, why early childhood is a vulnerable period?
Child development is not simply steady growth but actually it is a dynamic process. During infancy the child is totally dependent on caregivers. During child development, he pass to independent life slowly from early to late childhood and then to adulthood periods.
Another important point is that skills are acquired as a number of linked domains [10]. Development in each skill goes through a number of steps. Simple skills are usually acquired before more complex skills.
The final aim of this developmental process is to have a child who is physically active, mentally alert and socially adapted.
We have to emphasize that the final development of a child is the result of interaction between his dormant genetic potential and his environment [11]. Some of these factors promote and enhance this developmental process while others have a negative effects on overall final development.
Disability early in life can be a consequence of exposure to some risk factors like poverty; discrimination; poor caregiver interaction; violence, abuse and neglect [12]. Here, we have to ask another question, do we have to do something for those children?
We have many intervention programs like early childhood intervention programs which are designed to support young children who are at risk of developmental delay as well as children who have been diagnosed as having developmental delays or disabilities. Such programs comprise a range of services and supports to promote and enhance children's personal development, strengthen family competencies, and help the social inclusion of families and children. Examples include specialized services like: medical service, psychological support service, social services, rehabilitation service, familyfocused support, and special education. These services must be well planned and easily provided to any child with special need for such services and can be delivered through all available ways including health-care clinics, hospitals, early intervention centers, rehabilitation centers, community centers and schools [13].

But, is it enough? What else? How can we afford complete and competent services for all children who are in need for special care?
A good suggestion is to establish a childhood institute with special mission to build integrated, competent and complete services to provide an optimum help and care to children with special needs within the institute. This mission is of great value and help especially in developing countries.
This integrated care will include pediatrician, psychiatrist, physiotherapist, language therapist and surgical care if indicated.
Social care is another very important aspect of care and it must be one of essential integrated services in such institute.
Here, we have to emphasize that, among causes of childhood disability, genetic factors and diseases related to inborn error of metabolism are important factors for early childhood disability. These conditions raise the importance of early diagnosis and early interventions to decrease the incidence of disability in the community.
So, one important aspect of caring those children is providing good quality laboratory for diagnosis of genetic diseases, and diseases of inborn error of metabolism.
It is also, essential to provide an advanced neuroimaging laboratory which is of great value in diagnosis and follow up the patients.
Another major aim of such childhood institute is to provide a professional as well as academic training for persons who will participate in caring children with special needs especially pediatrician and psychiatrists.
Finally, we have to gather sincere and concerted efforts on both the local & international levels, as well as providing the appropriate time and funds to build up such institutes with integrated services to provide the optimal care and help to those children; our kids, our hearts and our future.
By these gathering, we can be on the sound track that enables us to offer optimum care for the child with special needs.
Am I dreaming? I think no.