I
DEVELOPMENTAL HIP DYSPLASIA
or adolescents,
people w ith
diabetes
mellitus
or
eating disorders
,
or those who
have any other medical condition.
detrusor instability
Inappropriate contraction of the detru-
sor muscle in the wall of the
bladder
that causes an uncontrollable release of
urine even when the bladder is not suf-
ficiently full to trigger urination. It may
have various causes, including bladder
inflammation, obstruction of the blad-
der outlet (for example, by a stone or,
in men, by an enlarged
prostate gland
),
or damage to the nerves supplying the
bladder. (See also
incontinence, urinary
.)
Deutschlander’s disease
A tumour of one of the
metatarsal bones
in the foot.
development
The process of growth and change by
w hich an individual matures physically,
mentally, emotionally, and socially. It
takes place in major phases: during the
first two months of pregnancy
(see
embryo
),
and, to a lesser extent, during
the rest of pregnancy (see
fetus
);
dur-
ing the first five years of life (see
child
development
);
and then again during
puberty
and
adolescence
.
developmental delay
A term used if a baby or young child
has not acquired new skills w ithin the
expected time range. Normally, new
abilities and new patterns of behaviour
appear
at
given
ages,
and
existing
behaviour patterns change and some-
times disappear (see
child development
).
Delays
vary in
severity,
and
may
affect the development of one or more
of the following skills: hand-eye coor-
dination, walking, listening, language,
speech, or social interaction.
GENERALIZED DELAY
A child who is late in most aspects of
development usually has a generalized
problem. This may be due to a severe
visual or hearing impairment, limited
intellectual abilities (see
learning difficul-
ties
),
or damage to the brain before,
during, or after birth. For further infor-
mation on possible causes of generalized
delay, see the table above.
SPECIFIC FORMS OF DELAY
Delay in movement and walking often
has no serious cause. In some cases,
however, there are specific causes; these
can include
muscular dystrophy
and
spina
bifida
.
Delay in developing manipulative
CAUSES OF
DEVELOPMENTAL DELAY
Physical or emotional deprivation (child
abuse). Lack of affection, stimulation,
or teaching.
Severe visual impairment. Vision is vital
for normal development in all areas.
Children learn to recognize objects
before learning their names, they learn
about sounds by seeing which objects
make which sounds, and they become
motivated to crawl and walk by the
desire to explore their surroundings
(see
vision, disorders of; blindness
).
Severe hearing impairment (see
deafness
).
Learning difficulties.
Damage to the brain before, during, or
after birth, or in infancy. The results of
damage depend on which parts ofthe
brain are damaged and on severity (see
brain damage; cerebral palsy).
Severe, prolonged disease of any organ or
body system (such as bone, heart, kidney,
muscle, and nutritional disorders).
skills (the ability to pick up and use
objects with the hands) is often due to
lack of adequate stimulation.
Delayed
speech
development
may
have various causes. The most im por-
tant is
deafness
,
w hich may cause the
child to be unresponsive to sound.
Autism
is a rare cause; in this condition,
hearing is normal but the child may
be unresponsive to the human voice.
Another possible cause is generalized
difficulty w ith muscle control, w hich
may affect speech production; this may
occur in children who have cerebral
palsy. Damage to, or structural defects
of,
the
speech
muscles,
the
larynx
(voicebox),
or the mouth may also
cause speech difficulties, as may any
disorder that affects the speech area of
the brain (see
aphasia
;
dysarthria
;
dys-
phonia
;
speech disorders
).
Children vary enormously in the age
at w hich they gain control of bladder
and
bowel function.
Usually,
bowel
control is acquired first. Delay in blad-
der control is much more common
than
delay
in
bowel
control.
Such
delays have many possible causes (see
enuresis
;
encopresis
;
soiling
).
ASSESSMENT
Delays may first be noticed by parents;
if this is the case, a health visitor or
doctor should be consulted promptly.
Delays may also be detected during
routine developmental checks w ith a
health visitor, family doctor, or paedia-
trician. These checks are performed at
various ages, but usually at birth, six
weeks, six to eight months, 18 to 24
months, three years, and five years.
A child who shows signs of develop-
mental delay should undergo a full
assessment. This w ill usually include a
physical examination, along with
hear-
ing tests
,
vision tests
,
and a thorough
developmental
assessment. The
child
may need to undergo further investiga-
tions, such as blood tests, to check for
any genetic abnormality, or referral to a
specialist such as a neurologist, speech
therapist, or physiotherapist.
TREATMENT
The treatment depends on the severity
and probable cause of the delay. It may
include a course of
speech therapy
or
family therapy
,
or provision of physical
aids such as
glasses
or a
hearing aid
.
Par-
ents are often of prime importance in
providing help for their child. In some
cases, however, the child may also ben-
efit from being admitted to a school or
special unit that provides education for
children with specific difficulties.
developmental hip dysplasia
A disorder present at birth in w hich the
head of the
femur
(thigh-bone) fails to
fit properly into the cup-like socket in
the
pelvis
to form a normal joint. One
or both of the hips may be affected.
CAUSE AND INCIDENCE
The cause of developmental hip dyspla-
sia is not known. The condition is more
common in girls, especially in babies
born by
breech delivery
or following
pregnancies in w hich there was an
abnormally small amount of amniotic
fluid surrounding the fetus.
TREATMENT
If the dislocation is detected in early
infancy,
splints
are applied to the thigh
to manoeuvre the ball of the joint into
the socket and keep it in position. These
splints
are
worn
for
about
three
months and usually correct the prob-
lem. Progress may be monitored by
ultrasound scanning
and
X-rays
.
Correc-
tive surgery may also be required.
OUTLOOK
If treatment is delayed, there may be
lifelong problems with walking. W ith-
out
treatment,
the
dislocation often
leads to shortening of the leg, limping,
and early
osteoarthritis
in the joint.
D
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