Part 05. Children with special health needs
PART 5. Children with Special Health Needs
Chapter 39 Failure to Thrive (FTT)
;
*growing ÀÌ 3rd or 5th percentile ÀÌÇÏ È¤Àº
´Ü±â°£¿¡ decreased growth°¡ 75th percentileÀ̻󿡼 25th
percentileÀÌÇÏ·Î µÈ child
#
Categories
- organic FTT : underlying
medical condition
- Nonorganic or psychosocial
FTT
Epidemiology & Etiology
#
low birth weight childrenÀÇ 5-10% -+
#
children living in puverty
| FTT¿Í °ü·ÃµÈ
factorµé
#
°¡Á·ºÒÈ, maternal depression -+
#
psychosocial FTT
; *¡ãcommon due to
child-parent interaction
#
major ofganic causes of FTT
Table 39-1
Clinical Namifestations
#
Sx
¨ç Ç¥ÁØ height, weight¿¡ µµ´Þ ¸øÇÔ
¨è alopecia
¨é loss of subcutaneous
fat
¨ê muscle massÀÇ °¨¼Ò
¨ë dermatitis
¨ì recurrent infection
¨í marasmas
¨î kwashiorkor
#
*¡ãSymptom
; in developed contury
-
poor growth detected in the ambulatory setting
;
in developing contury
-
*recurrent inf. , marasmus,
kwashiorkor
#
FTTÀÇ degree°áÁ¤
; ÃøÁ¤¹æ¹ý
-
growth parameter(weight, height & weight/height ratio)¸¦
growth chart¿¡ ±âÃʸ¦ µÎ¾î ageÀÇ
median value ÀÇ percentage·Î °è»ê
-
growth chart´Â Ưº°ÇÑ medical problemÀÌ ÀÖ´Â ¼Ò¾Æ¿¡¼´Â
À¯¿ëÇÏÁö ¾Ê´Ù.
/
e.g. prematurity
; prematurity¿¡¼´Â
prematurityÀÇ Á¤µµ¿¡ ´ëÇØ correction ÇØ¾ß ÇÔ
; weight
¨Í
mild FTT :
75 - 90 % of standard
¨Î
moderated FTT : 60 - 74 % "
¨Ï
severe FTT : 60 % ÀÌÇÏ "
;
height
¨Í
mild : 90 - 95%
¨Î
moderate : 85 - 89%
¨Ï
severe : 85% ÀÌÇÏ
;
weight/height ratio
¨Í mild : 81-90%
¨Î
moderate : 70-80%
¨Ï
severe : 70% ÀÌÇÏ
#
FTTÀÇ course
;
weight ¡æ height ¼ø¼·Î °¨¼Ò
-
*chronic malnutritionÀ»
°¡Áø children : normal
weight for height
/
¿Ö³ÄÇϸé weight & height ¸ðµÎ °¨¼Ò
#
Laboratory data
; not helpful
; *initial screen
-
CBC, lead level, UA, electrolyte
; other tests
-
TFT, Test for GER & malabsorption, organic and amino acids, sweat test
-
Hx. & ph/Ex. ½Ã indication ÀÌ µÇ¸é ½ÃÇà
Diagnosis
#
psychosocial FTTÀÇ Dx. ¿¡ Áß¿äÇÑ °Í
: feeding observation
#
Cause of insufficient growth
¨ç ºÎ¸ð°¡ ÀûÀýÇÑ calorie¸¦ °ø±ÞÇØÁÖÁö
¸øÇÔ
¨è ¾ÆÀ̰¡ ÃæºÐÇÑ calorie ¸¦ ¼·ÃëÇÏÁö ¸øÇÔ
¨é ¾ÆÀ̰¡ ÃæºÐÇÑ calorie¸¦ º¸À¯ÇÏÁö ¸øÇÔ
Table 39-2
Table 39-3
Treatment
#
°¡Á¤¿¡¼ÀÇ ÀûÀýÇÑ ¼öÀ¯È¯°æÀÌ Áß¿ä
#
underlying medical conditionÀÇ Ä¡·á
#
¡ÚPsychosocial FTT¸¦ °¡Áø Older Infant ¿Í Young
ChildrenÀÇ Ä¡·á
;
meal time : ´ë·« 20-30min.
;
solid food before liquid
;
minimized environmental distraction
;
eat with other people & not be force fed
;
high-calorie food
; limited water, juice,
low-calorie beverages
#
ÀûÀýÇÑ calorie feeding¿¡ ¹ÝÀÀÇØ¼
weight gainÀÌ µÇ¸é psychosocial FTTÀÇ Áø´ÜÀÌ ¼°Ô µÈ´Ù.
#
¢¾Indication for Hospitalization
¨ç severe malnutrition
¨è further diagnostic
& laboratory evaluationÀ» ÇÊ¿ä·Î ÇÒ ¶§
¨é catch-up growthÀÇ °á¿©
¨ê evaluation of the
parent - child feeding interaction
#
*psychosocial FTT ¿¡¼
ÀÔ¿ø ±â°£Àº 10ÀÏ-2ÁÖ
#
ÀÔ¿øÀÇ ¸ñÀû
¨ç
catch-up growth À¯Áö
¨è ÀûÀýÇÑ À½½Ä°ú ¼öÀ¯ÇüÅ¿¡ °üÇØ ºÎ¸ðµéÀ» ±³À°½ÃÅ´
Prognosis
1. 1¼¼¿¡ FTT´Â ÀÌÀ¯¿Í »ó°ü¾øÀÌ ÁÁÁö¾Ê´Ù.
2. psychosocial FTTÀÇ
1/3Àº »çȸÀû Á¤¼Àû ¹®Á¦¿Í ÇÔ²² ¹ßÀ°ÀÌ Áö¿¬µÊ
3. organic FTTȯ¾ÆÀÇ ¿¹ÈÄ´Â ´Ù¾çÇÏ´Ù.
Chapter 40. Developmental Disabilities and Chronic illness : An Overview
#
Functional limitation
Def: Áúº´ÀÇ Áõ»óÀÇ °á°ú·Î¼ ÃÊ·¡µÇ´Â ¹®Á¦
¿¹)
poorly functioning knee, hearing impairment
#
Disability
Def: Áúº´À̳ª Àå¾Ö¸¦ °¡Áö°í ÀÖ´Â °Í¿¡ ´ëÇÑ social implication À̳ª °á°ú
¿¹)
¿îµ¿¿¡ °æÀïÀûÀ¸·Î Âü¿©ÇÒ ¼ö ¾ø´Â°Í.
±¸µÎ·Î ´ëÈ¿¡ ¾î·Á¿òÀÌ ÀÖÀ½À¸·Î½á »ý±â´Â »çȸÀû °Ý¸®
40.1 Chronic Illness In
Childhood
Epidemiology, Severity & Outcome
1.
¼Ò¾Æ¿¡¼ÀÇ chronic illnessÀÇ
epidemiology´Â ¼ºÀο¡¼ÀÇ long-term illness¿Í ´Ù¸£´Ù.
2.
¾Æµ¿±â¿¡ ÈçÇÑ chromic physical condition ÀÇ
2 groups
¨ç allergic disorders : ÁÖ·Î
asthma, eczema, hay fever
¨èneurologic disorders : ÁÖ·Î
seizure disorder, cerebral palsy°°Àº neuromuscular
condition
¨é Representative
childhood condition ¿¡ ´ëÇÑ prevalence rate
Issues Common To Diverse Chronic Conditions
common issues for children - chronic
illness and their families
Developmental Aspects Of Long-Term Illness
#
long-term childhood illness¿¡ ÀÖ¾î¼ ¼ºÀå¹ßÀ°°ú ¿¬·çµÈ 2°¡Áö
issue
1. Áúº´ ±âÀü¿¡ ´ëÇÑ ¼Ò¾ÆÀÇ ÀÌÇØ·ÂÀÇ ¹ßÀü
2. ¼Ò¾Æ ¹ßÀ°ÀÇ ´Ù¸¥ ´Ü°è¿¡ ´ëÇÑ Áúº´ÀÇ ¿µÇâ
#
Çе¿Àü±âÀÇ ¾î¸°À̳ª ÃʱâÇе¿±â ¾î¸°ÀÌ´Â Áúº´¿¡ °üÇØ ±¸Ã¼ÀûÀÌ°í »ó´ëÀûÀ¸·Î
Ç¥¸éÀûÀÎ ÀÌÇØ¸¦ °¡Áö´Â °æÇâÀÌ ÀÖ´Ù.
Áï Çе¿Àü±â ¶Ç´Â Çе¿ Ãʱ⠾Ƶ¿Àº Áúº´ÀÌ ±ÔÄ¢¿¡ µû¸£Áö ¾ÊÀº ¹ÝÀÀÀ¸·Î »ý°¢
±¹¹ÎÇб³ 4-56ÇгâÀº Áúº´À» ÀÏÀ¸Å³ ¼ö ÀÖ´Â ¿ÜºÎÀÇ
event·Î ºÎÅÍ ÀÚ½ÅÀ» ºÐ°£Çϱâ
½ÃÀÛÇÏ¸ç ¼¼±Õ¿¡ ´ëÇÑ °³³ä ¶ÇÇÑ ÀÌÇØ°¡ °¡´É.
#
*By 8th Grade
; understandphysiologic
mechanisms for illness
; appreciate many
interrelated causes of illness & symptom of illness
; understand interaction of
body parts, for example heart & lungs
# ¶ÇÇÑ Áúº´ÀÇ ¿µÇâÀ¸·Î´Â À¯¾Æ±â¿¡´Â ¼ºÀå°ú ¹ß´Þ¿¡ ¿µÇâÀ» ¹ÌÄ¡¸ç Çе¿Àü±â ÈĹݿ¡´Â ÀÚÀ²¼º,
¿îµ¿¼º, ÀÚ±â Á¶Àý¹ß´Þ ½Ã±âÀ̹ǷΠÀÌ·± ±â´É¿¡ ¿µÇâÀ» ¹ÌÄ¡¸ç ÀæÀº °á¼®À¸·Î Ãʱ⠻çȸȿ¡ ÁöÀåÀ» ÁØ´Ù.
¼Ò¾Æ Áß±â ¹× »çÃá±â¿¡´Â °æÀï´É·Â, µ¶¸³¼º,
Ã¥ÀÓ°¨, ¹Ì·¡ ¿¡ ´ëÇÑ °èȹÀ» ¼¼¿ì´Â ½Ã±â·Î ÀÌ·± ±â´É¿¡ ¿µÇâÀ» ¹ÌÄ£´Ù.
µû¶ó¼ ¿¬·É Áõ°¡¿¡ µû¶ó Áúº´¿¡ ´ëÇÑ ¼³¸íÀ» ±× ½Ã±â¿¡ ¸Â°Ô ´Ù½Ã ÇØ ÁÖ¾î¾ß Çϸç Áúº´¿¡ ÀÇÇÑ ¹ß´Þ¿¡ ´ëÇÑ ¿µÇâµµ ÀûÀýÇÑ °èȹÀ» ¼¼¿ì°í ÁöħÀ» Á¦°øÇØ Á¤»ó ¹ß´Þ
À» °¡´ÉÇÏ°Ô µµ¿Í¾ß ÇÑ´Ù.
Integration children with chronic conchtions into
communities
Pediatric care in the communities
40.2 Mental Retardation
#
Mental retardationÀÇ Æ¯Â¡
: intelligence¿Í
adaptive behavior¿¡ ÀÖ¾î¼ ½É°¢ÇÑ Àå¾Ö·Î ºÎÅÍ ÃÊ·¡µÇ´Â ÀÛ¾÷
(performance)¿¡ ÀÖ¾î¼ÀÇ Á¦ÇÑ
#
4°¡Áö °¡¼³. (»õ·Î¿î Á¤ÀÇÀÇ ÀûÀýÇÑ Àû¿ë¿¡ ÇʼöÀû)
1. ¹®ÈÀû, ¾ð¾îÀû ´Ù¾ç¼ºÀ» °í·ÁÇÏ¿© Æò°¡
2. adaptive skillÀÇ Á¦ÇÑÀÌ Æ¯À¯ÇÑ ³ªÀÌÀÇ ¾ÆÀ̵é°ú ÁöÁöÇØÁÖ±â
À§ÇÑ °³º°ÈµÈ ¿ä±¸¸¦ Áö ÀûÇÏ´Â
community environment ³»¿¡¼ ÀϾÙ.
3. adaptive limitation˼
strength¿Í ÇÔ²² Á¸ÀçÇÑ´Ù.
4. ÀûÀýÇϰí Áö¼ÓÀûÀÎ ÁöÁö·Î, mental retardationÀ» °¡Áø »ç¶÷ÀÇ
life functioningÀÌ ´ë°³
Çâ»óµÉ °ÍÀÌ´Ù.
Etiology And Pathogenesis
1. Neurobiologic root of MR.
¨ç brainÀÇ ±¸Á¶Àû ÀÌ»ó
¨è ´ë»çÀÌ»ó
¨é °¨¿°(esp. CNS)
¨ê malnutrition
¨ë hypoxic-ischemic
injury
2. MRÀÇ pathogenesis¿¡ ÀÖ¾î¼ÀÇ
potential contributiny factors
Epidemiology
#
Àα¸ÀÇ ¾à 3%°¡ Æò±ÕÀÌÇÏÀÇ 2SDÀÌÇÏÀÇ
IQ¸¦ °¡Áü
#
Mental retardationÀÇ 80-90%´Â
mild range
5%¸¸ÀÌ
severe to profound·Î Àå¾ÖµÊ
#
MRÀÇ Á¤µµ¿Í socioeconomic state¿ÍÀÇ °ü°è
¨ç mild MR :
Socioeconomic status¿¡ ¿ªºñ·Ê
¨è moderate to severe MR
: ¸ðµç income group¿¡¼ µ¿ÀÏÇÏ°Ô ³ªÅ¸³²
#
MRÀÇ Dx : ¨Í
adaptive behavior
¨Î IQ
Clinical Manifestations
1. Down syn.
2. primary microcephaly
3. Cardinal Sx. of MR
: delayed achievement of
developmental milestone
4. severe MR
: Ãâ»ýÈÄ Ã¹ 1³â¿¡
psychomotor skill¿¡¼ ÇöÀúÇÑ Áö¿¬À» º¸ÀÓ
5. moderate retardation
¨ç normal motor
development
¨è toddler year¿¡
delayed speech & language abilities
6. mild retardation
¨ç Çб³ µé¾î°£ ÈıîÁö Àß ¸ð¸¦ ¼ö ÀÖÀ½.
¨è º¸À°¿øÀ̳ª child care programÀÇ Âü¿©·Î ¾Ë ¼ö ÀÖ´Ù.
7. Natural Hx. of MR
¨ç availability of
appropriate educational & therapeutic experience
¨è neuromaturation
¨é associated
disabilities
¨ê plateau periods : °üÂû°¡´ÉÇÑ
( measurable) ÁøÀü(progress)ÀÌ ÃÖ¼ÒȵǴÂ
½Ã±â
¨ë MRÀ» °¡Áø ´ëºÎºÐÀº ¼Ò¾ÆµéÀº ÀÏ»ýÀ» ÅëÇØ »õ·Î¿î ±â¼úÀ» ȹµæÇÏ°í ¹è¿ì±â¸¦ °è¼Ó
¨ì ÀÌÀü¿¡ ȹµæÇß´ø skillÀ» ÀÒ¾î¹ö¸®´Â
¼Ò¾ÆµéÀº Áß¿äÇÑ subgroup ÀÌ´Ù.
¿Ö³ÄÇÏ¸é ¨Í progressive neurologic
disorder °¡ ÀÖ´ÂÁö Á¶»çµÇ¾îÁ®¾ß ÇÔ.
¨Î developmental deteriorationÀº
rarely reversible
¨í potential contributing
factors in the Pathogenesis of Mental Retardation
¨î Common protective
factor
¨Í
good physical health
¨Î normal rate of growth
¨Ï
healthy parent-child attachment
¨Ð
cohesive family unit within a supportive social network
8. Ph/Ex.
¨çAtypical physical
features that may be associated with increased incidence of MR.
¨è chromosomal
abnormality ¶Ç´Â teratogenic effect¿¡ µû¸¥
phenotypic Ư¡
¡ÚDiagnosis
; Æò±Õ ÀÌÇÏÀÇ Àü¹ÝÀûÀÎ ÁöÀû´É·Â
: IQ standard score 70-75 ȤÀº ±× ÀÌÇÏ
;
10 adaptive skillÁß¿¡¼ 2°³ ȤÀº ±× ÀÌ»óÀÇ °áÇÔÀÌ ÀÖÀ» ¶§
¨ç
communication
¨è
self-care
¨é
home living
¨ê
social skill
¨ë
community use
¨ì
self-direction
¨í
health & safety
¨î
functional academics
¨ï
leisure
¨ð
work
;
*DDST¿Í nonstandardized developmental scalesÀº
Áø´Ü¿¡ µµ¿òÀÌ
µÇÁö ¾ÊÀ½
- screening testÀ̱⠶§¹®ÀÓ
#
¡ÚReliable Diagnostic Measure
¨ç Bayley scales of
Infant development
¨è stanford-Binet
Intelligence scale
¨é wechsler scale
#
Lab
¨çIndications
for Laboratory Assessment of the young child with Mental retardation
¨è
known cause ÀÇ MRÀ» °¡Áø ¸ðµç ¼Ò¾Æ¿¡°Ô´Â fragile X syndromeÀ»
R/oÇϱâÀ§ÇØ routine karyotypeÀ» ÇØ¾ß ÇÑ´Ù.
Treatment
1. specialized educational &
therapeutic service
2. routine health maintenance
Prevention
1. Prenatal Dx.
¨ç ultrasound
¨è amniocentesis
¨é chorionic villous
biopsy
2. prenatal intervention option
¨ç experimental fetal
surgery (uterus³» intracranial shuntÀÇ ÀåÂø)
¨è elective termination
of pregnancy
3. specific postnatal treatment
¨ç metabolic ds. ex) phenyl ketonuria
¨è ±¸Á¶Àû ÀÌ»ó ex)
hydrocephalus
Chapter 41 Care Of The Child With A Fatal Illness
#
fatal ds. ¸¦ °¡Áø ¼Ò¾Æ¿Í ±×µéÀÇ °¡Á·À» careÇÏ´Â ¸ñÇ¥´Â ±× °æÇèÀÌ °¡Á·ÀÇ ´ÜÇÕ È¤Àº
Á¤¼Àû, °¨Á¤Àû
wellbeingÀ» ÁõÁø½Ã۱â À§ÇÑ ¹æ¹ýÀ¸·Î ±×µéÀÇ °íµ¿°ú ½½ÇÄÀ» Àß ±Øº¹
Çϵµ·Ï µµ¿ÍÁÖ´Â °ÍÀÌ´Ù.
The initial phase
#
fatal outcomeÀ» °¡Áú ¼ö ÀÖ´Ù´Â °ÍÀ» ¼Ò¾Æ°¡ ¾Ë°Ô µÉ ¶§ Áø´Ü°ú °¡´ÉÇÑ outcomeÀÌ Á÷ Á¢ÀûÀ̰í Ä£ÀýÇÏ¸ç °ÇÏ°Ô ºÎ¸ð¿¡°Ô Àü´ÞµÇ¾î¾ß
ÇÑ´Ù.
<management>
#
Ä¡¸íÀû ÁúȯÀ» °®´Â ¼Ò¾Æ¿¡°Ô ¸»ÇØ ÁÙ °ÍÀº ¾Æµ¿ÀÇ ¹ßÀ°»óÅÂ, Áúº´ÀÇ ¼ºÁú,
ȯ°æ¿¡ µû ¶ó ´Ù¸£´Ù.
#
¾î¸° ¼Ò¾ÆµéÀº ±×µéÀÇ ºÎ¸ðµéÀÇ ¹ÝÀÀ°ú ÇൿÀ¸·ÎºÎÅÍ ¹º°¡ À߸øµÇ°í ÀÖ´Ù´Â °¡´ÉÇÑ fatal illnessÀÇ »ç½Ç±îÁö ¾Ë°Ô µÈ´Ù. ¾ÆÁÖ ¾î¸° ¼Ò¾Æ´Â Á×À½¿¡ ´ëÇØ ´ÜÁö ºÐÀýÀûÀ¸·Î °³³äÀ» °¡Áö°í ÀÖÀ» »ÓÀÌ´Ù.
#
2¼¼ ÀÌÀü¿¡´Â Á×À½ÀÇ °³³äÀÌ ¾ø´Ù. (piaget)
#
±× ÀÌÈÄ¿¡´Â °¡¿ªÀûÀ̰ųª ÀáÀ» ÀÚ´Â °Íó·³ ÀϽÃÀûÀ̶ó´Â »óÅ·Π°³³äÀÌ ¹ß´Þ
#
adolescent´Â Á×À½À» ºñ°¡¿ªÀû ÀΰÍÀ¸·Î º¸³ª ¸Õ °ÍÀ¸·Î »ý°¢Çϰí physiologicÇϸç
°¡´ÉÇϸé ÀÌ·ÐÀûÀ¸·Î ¼³¸íÇÒ ¼ö ÀÖ°Ô µÈ´Ù.
#
Bluebond-LangnerÀÇ several stages
: ȯÀÚ°¡ Ä¡¸íÀûÀÎ Áúº´ÀÌ ÁøÀüÇÒ ¶§ °¡Áú ¼ö ÀÖ´Â °³³ä
¨ç Áúº´ÀÌ ÀÌÀüÀÇ °Ç°»óÅ¿¡¼ºÎÅÍÀÇ ´Ü¼øÇÑ ÇÑ º¯È·Î Ãë±Þ
¨è Áúº´ÀÌ ½ÉÇÏÁö¸¸ ÀϽÃÀûÀÌ´Ù.
¨é Àç¹ßÇϰí Áö¼ÓÀûÀÎ Àå¾Ö¸¦ °¡Áö°ÔµÇ¸ç Áúº´ÀÌ Áö¼ÓÇÏ´Â °ÍÀ¸·Î º¸À̳ª ¾ðÁ¨°¡´Â
ÇØ°áµÉ ¼ö ÀÖ´Ù.
¨ê ¿©·¯¹øÀÇ Àç¹ßÈÄ¿¡´Â Áúº´ÀÌ °è¼Ó µÉ °ÍÀÌ°í ¾ÆÀÌ´Â ´õ ÁÁ¾ÆÁöÁö ¾ÊÀ» °ÍÀÌ´Ù´Â
È®½Å
¨ë Ä£±¸³ª ÀÌ¿ô ȯÀÚÀÇ Á×À½ µÚ¿¡ "³ª´Â Á״´Ù"´Â °á·Ð¿¡ µµ´Þ
#
ȯÀÚ³ª ºÎ¸ðµéÀ» À§ÇØ »ê´Ù´Â Èñ¸ÁÀ» À¯ÁöÇÏ´Â °ÍÀÌ ÀûÀýÇÏ´Ù.
#
´ëºÎºÐÀÇ ¾î¸°ÀÌ´Â ÁöÁöÇØÁÖ°í Çϱ³¼±»ý´ÔÀÇ °ü½É°ú Ä¡·áÀÚÀÇ °ü½ÉÀ» º¸¿©ÁÖ¸é
¾ÇÈµÇ¾î °¡´Â ÁúȯÀÇ ÇÊ¿¬¼ºÀ» È帮´Âµ¥ µµ¿òÀÌ µÈ´Ù.
#
preadolescents, adolescentÀÇ °æ¿ì´Â Ä¡·á°èȹ¿¡ ´ëÇØ ¾î¸°ÀÌ¿Í ÀdzíÇÏ°í ±×µéÀÇ
Áú¹®¿¡ ´äÇÏ°í ºÎ¸ðÀÇ ÇÔ²² Âü¿©ÇÏ°í ¼ÖÁ÷ÇÔ, ½Å·Ú,
ÇùÁ¶ µîÀÌ µµ¿òÀÌ µÈ´Ù.
#
Ä¡¸íÀû ÁúȯÀÇ Áø´ÜÀ» ¾ðÁ¦ ¾î¶»°Ô ¾î¸°ÀÌ¿¡°Ô À̾߱â ÇØ¾ß ÇÒ Áö °áÁ¤ÇÏ´Â °ÍÀº
ºÎ¸ðÀÇ ÃæºÐÇÑ ÀÌÇØ, µ¿ÀÇ,
ÇùÁ¶°¡ ÀÖ¾î¾ß ÇÑ´Ù.
<Management
of Pain>
#
¾ÆÁÖ ¾î¸° ¾Æµ¿Àº ÅëÁõÀ» ¸» ÀÌ¿Ü ´Ù¸¥ ÇüÅÂ, immobility,
depressionµîÀ¸·Î ³ªÅ¸³½´Ù.
µû¶ó¼ prnÀ¸·Î ÁøÅëÁ¦¸¦ »ç¿ëÇÏ´Â °Íº¸´Ù´Â ±ÔÄ¢Àû °£°ÝÀ¸·Î »ç¿ëÇÏ´Â °ÍÀÌ ÁÁ´Ù.
#
older children, adolescent´Â ÀÚ½ÅÀÇ medicationÀ» Ã¥ÀÓÁö°í Á¶ÀýÇÒ ¼ö ÀÖ´Ù.
<Other
resources>
#
ÀÇ»çµéÀº ´Ù¸¥ Àü¹®ÀÎ Áï, family minster, Á¤½ÅÀû Ãæ°íÀÚµîÀÇ
µµ¿òÀ» ûÇÒ ¼ö ÀÖ´Ù.
#
¶ÇÇÑ °°Àº Áúº´À» °®´Â ¾Æµ¿ ¹× °¡Á·ÀÇ ¸ðÀÓ ¶ÇÇÑ ¾î¸°ÀÌ care¿¡ µµ¿òÀÌ µÈ´Ù.
<Terminal
care>
#
Á×À½ÀÌ ÀÓ¹ÚÇϸé ȯÀÚ¸¦ Æí¾ÈÇÏ°Ô ÇØ ÁÖ¾î¾ß ÇÏ¸ç °¡´ÉÇÑ ºÎ¸ð´Â °¡±îÀÌ ÀÖ¾î¾ßÇϸç ÀÇ»ç´Â ¾çÂÊ¿¡ µµ¿òÀÌ µÇ¾î¾ß ÇÑ´Ù.
ÀÇ»çÀÇ Áö¼ÓÀû Èï¹Ì, °ü½ÉÀº ÀÌ ½Ã±â¿¡
deterioration, Æ÷±â, ºÐ³ë¸¦ ¸·´Âµ¥ Áß¿äÇÏ´Ù.
#
Á×À½ÀÌ ´ÚÄ¡¸é ȯÀÚ, ħ´ë,
¹æÀ» ¸»¾¦È÷ Á¤¸®ÇÏ°í ºÎ¸ð°¡ ¾ø´Ù¸é Áï½Ã ¿À°ÔÇϰí
»óȲÀ» ¼³¸íÇÔ
#
»ç¸ÁÈÄ ºñ½ÁÇÑ °æÇèÀÇ ºÎ¸ðµéÀÇ ¸ðÀÓÀº ºÎ¸ð¿¡°Ô µµ¿òÀÌ µÈ´Ù.
<Postmorterm
examination>
#
°¡Á·À» °¡Àå Àß ¾Æ´Â Ã¥ÀÓÀÖ´Â Àǻ簡 postmortem
examnination¿¡ ´ëÇÑ request¸¦
ÇØ¾ßÇÑ´Ù.
<Family
Support>
#
¾ÆÀ̰¡ »ç¸ÁÇÑ ÈÄ ±×·± groupÀÇ ºÎ¸ðµéÀÌ ÀڽŵéÀÇ °æÇèÀ» ³ª´ ¼ö ÀÖ´Â ±âȸ¸¦
ÁÖ´Â °ÍÀÌ Áß¿äÇÏ´Ù.
<Death
of the Newborn infant>
#
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Chapter 42. Children at Special Risk
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¿¹¹æ Ãø¸é ¿¡¼ÀÇ care
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ÀÇÇÐÀû Ãø¸é¿¡¼ÀÇ care
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program
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in Poverty>
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ÀÌ·± ¾î¸°À̵éÀÇ care´Â ȯ°æÀ» Çâ»ó½ÃÄѼ
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Children in poverty >
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ÀÏÀÚ¸®°¡ ¾ø´Â ¾Æ¹öÁöµéÀº ÈçÈ÷ psychosomatic SxÀÌ ¹ß»ýÇϱ⠽¬¿ì¸ç,
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°¡³ÇÑ ÁýÀÇ ¾ÆÀ̵éÀº °ÅÀÇ ¸ðµç ¿øÀÎÀ¸·Î ÀÎÇÑ Áúº´ÀÇ »ç¸ÁÀ²ÀÌ Æò±ÕÀÌ»óÀÌ´Ù.
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Children of immigrants >
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hepatitis, parasiticds, ¿µ¾ç°áÇÌÀÌ ¿ì¼¼Çϸç psychologic stressµµ ³ô´Ù.
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Homeless Children >
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homeless childrenÀº Áúº´ÀÇ ºóµµ°¡ Áõ°¡ÇÑ´Ù.
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family dysfunction
abuse
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school failure
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¾à¹°³²¿ë (crack cocaine)
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Inherent strength in vunerable children & intervention >
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°íÀ§Ç豺 ¾Æµ¿À» À§ÇÑ programÀº À¯»çÇÑ ¼ºÁúÀÇ ±ºÀÌ´Ù.
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teamÀÌ ÇÊ¿äÇÏ´Ù.
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