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Part 05. Children with special health needs

³ªµµ¸ô¶ó

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¿¡ À־ 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⠻çȸȭ¿¡ 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 Çϸ砠    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¿¡ À־ ½É°¢ÇÑ Àå¾Ö·Î ºÎÅÍ ÃÊ·¡µÇ´Â ÀÛ¾÷ 

   (performance)¿¡ À־ÀÇ 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 limitationÀº 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¿¡ À־ÀÇ 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 ÃÖ¼ÒÈ­µÇ´Â 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 À̻󠠠   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» °ÍÀ̴ٴ         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 ÀÖ¾î¾ßÇϸ砠   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>

# ¾ö¸¶°¡ ¾Æ±âÀÇ care½Ã¿¡ Âü¿©Çϵµ·Ï ÇÒ ¼ö Àִµ¥ ÀÌ´Â ±×³àÀÇ ¾Æ±â°¡ ¾î¶§´ÂÁö È®

  ½ÇÇÏ°Ô ¾Ë ¼ö Àֱ⠶§¹®ÀÌ´Ù.

# ¾Æ±â°¡ »ç¸Á½Ã¿¡ º´¿ø¿¡¼­ ¾ö¸¶¿Í ¾Æ±â°¡ ¶³¾îÁ® ÀÖÀ» ¶§ ¾Æ±âÀÇ ½Ãü°¡ ¾ö¸¶³ª  

  ¾çÄ£¿¡°Ô ÁÖ¾îÁ®¼­ ¾ö¸¶ÀÇ Ä§´ë¿·À̳ª ´Ù¸¥ °÷¿¡ ÀÖÀ» ¼ö ÀÖ´Ù.  ÀÌ´Â ½ÇÁ¦·Î ¾Æ±â

  °¡ ÀÖ¾ú°í, ¾î¶°Çß´ÂÁö¿¡ °üÇØ ¾Ë ±âȸ¸¦ ÁÖ±â À§Çؼ­´Ù.

# µ¿Á¤°ú ÀÌÇØÀÇ ¸»ÀÌ µµ¿òÀÌ µÈ´Ù.

Chapter 42. Children at Special Risk

# ¿¹¹æ Ãø¸é ¿¡¼­ÀÇ care

 ¨ç °¡³­À» °æ°¨½ÃŰ´Â °Í

 ¨è poor housing°æ°¨

 ¨é lack of jobs °æ°¨

# ÀÇÇÐÀû Ãø¸é¿¡¼­ÀÇ care

 ¨ç specially organized program

 ¨è multidiscipline team

 ¨é special financing

<Children in Poverty>

# ÀÇ»çµéÀº ¿µ±¸ÀûÀÎ °¡³­ ¼Ó¿¡ »ç´Â ºÎ¸ðµéÀÇ Àڽĵ鿡°Ô À־ ¹ßÀ°°ú Çൿ¿¡

  °æ°è½ÉÀ» °¡Áú Çʿ䰡 ÀÖ´Ù.

# ÀÌ·± ¾î¸°À̵éÀÇ care´Â ȯ°æÀ» Çâ»ó½ÃÄѼ­ ±×µéÀÇ full potentialÀ» ¼ºÃëÇϵµ·Ï Çϴ°͠   ÀÌ´Ù.

< Children in poverty >

# ÀÏÀÚ¸®°¡ ¾ø´Â ¾Æ¹öÁöµéÀº ÈçÈ÷  psychosomatic SxÀÌ ¹ß»ýÇϱ⠽¬¿ì¸ç, ±×µéÀÇ ¾ÆÀ̵鵵 À¯»çÇÑ Áõ»óÀÌ »ý±æ ¼ö ÀÖ´Ù.

# °¡³­ÇÑ ÁýÀÇ ¾ÆÀ̵éÀº °ÅÀÇ ¸ðµç ¿øÀÎÀ¸·Î ÀÎÇÑ Áúº´ÀÇ »ç¸ÁÀ²ÀÌ Æò±ÕÀÌ»óÀÌ´Ù.

(¿¹¿Ü: ¹éÀÎ, °¡³­ÇÏÁö ¾ÊÀº ¾î¸°ÀÌ¿¡¼­ ÈçÇÑ ÀÚ»ì°ú ±³Åë»ç°í´Â Á¦¿Ü)

# ÀÇ»çµéÀº °¡³­À» Ä¡·áÇÒ ¼ö´Â ¾øÁö¸¸ ºÎ¸ðµéÀÇ Àç»ê, ÀçÁ¤»óÅ¿¡ À־ ºÒ¸®ÇÑ º¯È­¿Í °¡Á·µéÀÇ ¼ö½ÀÇÏ·Á´Â ³ë·Â¿¡´ëÇØ ¹°¾îº¼ Àǹ«°¡ ÀÖ´Ù.

< Children of immigrants >

µ¿³²¾Æ½Ã¾Æ¿Í ³²¾Æ¸Þ¸®Ä«¿¡¼­ ¿Â ¾ÆÀ̵éÀº ÀϹÝÀûÀ¸·Î ¼­À¯·´ Ãâ½Å ¾ÆÀ̵鿡 ´ëÇØ ¼¼¿ö³õÀº Æò±ÕÀÌÇÏÀ̰í, ³ôÀº ºñÀ²ÀÇ hepatitis, parasiticds, ¿µ¾ç°áÇÌÀÌ ¿ì¼¼Çϸç psychologic stressµµ ³ô´Ù. 

< Homeless Children >

# homeless childrenÀº Áúº´ÀÇ ºóµµ°¡ Áõ°¡ÇÑ´Ù.

Ex) Àå¿°, ºóÇ÷, neurologic disorder, °æ·Ã, ÇൿÀÌ»ó, mental illness, dental problem,

   trauma¿Í ¾à¹°³²¿ëÀÇ ºóµµ Áõ°¡

# 50%¿¡¼­ ¹ßÀ°Áö¿¬, ½ÉÇÑ ¿ì¿ïÁõ, ÇнÀÀå¾Ö¿Í °°Àº psychologic problemÀ» °¡Áø´Ù.

< Runaway & thrownaway children  °¡Ãâ¾Æµ¿°ú ¹ö·ÁÁø ¾Æµ¿ >

# 10´ë°¡  ´ëºÎºÐÀ» ±¸¼º

# ¿µ±¸ °¡ÃâÀÇ ¿øÀÎ

  family dysfunction

  abuse

  °¡³­

  Ãæµ¿ Á¶Àý ºÒ·®

  psychopathology

  school failure

< °í¾Æ¿ø ¾Æµ¿ >

°í¾Æ¿ø ȤÀº º¸È£½Ã¼³¿¡ ÀÖ´Â ¾Æµ¿ Áõ°¡¿¡ ±â¿©ÇÏ´Â °Í

  ¾à¹°³²¿ë (crack cocaine)

  ¾Æµ¿ Çдë & °ÅºÎ

  °¡³­

< Inherent strength in vunerable children & intervention >

# °íÀ§Ç豺 ¾Æµ¿À» À§ÇÑ programÀº À¯»çÇÑ ¼ºÁúÀÇ ±ºÀÌ´Ù.

# teamÀÌ ÇÊ¿äÇÏ´Ù.

# service¸¦ Àå±â°£¿¡ °ÉÃÄ °è¼ÓµÇ´Â °ÍÀÌ Áß¿äÇÏ´Ù.