EARLY INTERVENTION IN HIGH RISK BABIES
Early intervention is a systematic and structured activities designed to remediate developmental delays or incorrect patterns that may be experienced by children through play. The program is individualized to meet the specific needs of each child and to help all infants reach growth milestones in every area of development. Early intervention helps in each of the four main areas of development: gross motor and fine motor, language, social development and self help skills.
Early intervention applies to enrichment programmes for children from birth to six years who are discovered to have or to be at risk of developing a disabling condition or have other special needs that may affect their development
In the crucial development that takes place between birth to six years, when patterns are forming in the brain, any kind of injury or trauma to the brain will affect certain regions/areas in the brain. There will be gaps and the strands of wool that we used to imagine connections in the brain will not form or those formed may not be strong since further learning will not be possible due to the injury caused in that region. Unfortunately once the nerve connections in the brain have been destroyed it cannot grow or regenerate again.Does this mean that new connections are not possible? Or that nothing can be done for the infant. This is where early interventions play an important role in the infant’s growth and development.
New connections can certainly be formed in the brain during this time. Through structured stimulation it is important that we ensure that new connections are formed. True, the affected areas of the brain may not be able to have the connections or they may not be as strong as those in the rest of the brain. Our work is to give intense exposure to help the child learn the activities and form connections which bypass the area of the brain that has been destroyed. Thereby the child is developing alternate ways of doing the same task. Think of a new road, fly over or diversion that has been made to avoid a large market having some of the best shops. By taking the diversion we will not be able to shop at those particular shops, reaching other market places will take more time but we will still be able to get some of the desired items.Therefore connections will definitely be made and a child will be able to move ahead in his/her development but it may not be one hundred percent perfect as a connection when there is no injury to the brain.
RISK FACTORS FOR BRAIN INJURY
Complications during delivery are the main cause of brain injury.
- Infants with low birth weight
- Infants who are born before term (premature)
- Incompatibly of blood group of parents Rh factor.
The injury can take place while the unborn child is still in the mother’s womb. This could be due to many reasons such as the mother has a fall, an accident, emotional stress, if the mother is exposed to certain infections, harmful medicines or radiations especially during the initial stages of pregnancy, or due to smoking, alcohol or drug abuse by the mother.
EARLY INTERVENTION IS FOR NOT ONLY FOR CHILDREN WITH SPECIAL NEEDSIT BENEFITS CHILDREN WHO SHOW DEVELOPMENTAL DELAY IN ANY AREA OR INFANTS WHO ARE AT RISK BECAUSE OF THE FACTORS MENTIONED EARLIER.
Early Intervention will only benefit if there is early identification of infants who
- are at risk of developmental delay
- are already showing developmental delay.
- have impairment of certain motor or sensory functions
- Regular follow up of infants who are at risk due to factors mentioned above will help in early identification of impairments.
- Knowledge of developmental milestones will help identify the delays at the earliest.
- Knowledge of impairments that challenge the infant’s growth and development.
There was a famous doctor in England called Dr. Winnicot who had said years ago (as early as 1964) that there is no such thing as a baby alone, it the baby and someone else. Usually this someone else is the mother/family. The importance and interdependency of the baby on family and the families involvement in bringing up the child comes out very well from this remark. Parents know their child the best. All individuals working in field of early intervention should keep this foremost in their mind.
No early intervention program will be successful if parents are not part of the program; their needs are equally important and have to be taken into consideration while planning the program.
Early Intervention is not about providing random stimulation. Stimulation has to be structured, intense, goal oriented, continuous and specific to the needs of the child and the family.
The number of children who need early intervention has gone up. The reasons are many, changing lifestyles of people, more awareness, increase in the level of chemicals in our daily life. Infants who are premature or born with low birth weight have better chances of survival due to advanced medical facilities yet they may need early intervention to avoid delay.
Early stimulation enhances synapse generation in growing brain
Reduce stimuli that have negative impact on brain
Enhance positive stimuli
Aims of Early Stimulations:
- Stimulate the child through the normal developmental channels.
- Prevention of developmental delay
- Prevention of abnormalities
- To prevent atrophy of muscles
- To prevent contractures of joint
- To decrease the tone of muscle in hypertonia and vice versa
- To prevent tightening of tendons
What is done in early stimulation?
- Stimulate the child in all sectors of development- motor, cognitive, Neurosensory , language
- Developmentally appropriate stimulation – through the normal developmental channel ( stimulate to achieve the next mile stone rather than age appropriate mile-stone )
- Physical stimulation by passive exercises to prevent development of hypertonia
- Motivate the parent to stimulate the baby with appropriate stimuli
Who needs early stimulations?
- High risk babies:
- Pre mature babies
- Low birth babies
- Birth asphyxia
- Children who are suffering from any kind of developmental delay.
Avoid over stimulations shown negative effects on development when many inputs of different natures are simultaneously started.
When should early intervention start?
Early intervention should begin any time shortly after birth and continue until the child reaches the age three
Early intervention starts as soon as possible in NICU to increase parental awareness of infant’s abilities.
Faculty of physiotherapy