Children are not little adults: Addressing rehabilitation needs of children
19 November 2021
By Nukhba Zia and Fleur Smith
20 November marks World Children’s Day. This year’s theme, ‘A better future for every child’, provides a great opportunity to recognize the importance that rehabilitation plays in doing just that.
Of the world’s 2.3 billion children under 18 years of age, 3% are estimated to have a need for rehabilitation. Further exploration of these estimates from the World Health Organization (WHO) in collaboration with the Institute of Health Metrics and Evaluation (IHME), shows that the need for rehabilitation tends to increase with age, and boys are estimated to have higher rehabilitation needs compared to girls in the same age group (Table 1).
|Table 1: Number of children in need of rehabilitation by age group and sex|
|Age categories||Number (in millions)|
|Under 5 years||33||18||15|
Conditions requiring rehabilitation tend to vary across different age groups. Figure 1 shows that rehabilitation needed for mental disorders, which includes autism and intellectual disability, is common among children under nine years of age, while older children’s rehabilitation needs are largely due to musculoskeletal disorders, which include fractures, amputation, arthritis and low back pain. Cerebral palsy is the most common neurological disorder in children and the leading cause of physical disability in childhood. The greatest need for rehabilitation for children is in South-East Asia and Africa.
The recently launched UNICEF report on child disability data shows that there are 240 million children globally with disabilities, with most living in low- and middle-income countries. The greatest proportion of these children, across all age groups, experience psychosocial difficulties including behavioral and learning difficulties. This correlates with WHO/IHME rehabilitation need estimates, especially in the younger age groups.
As data improves, we are gaining a clearer picture of the need for timely and effective rehabilitation for children with developmental and acquired conditions. The global push towards integration of rehabilitation into health systems through efforts like Rehabilitation2030 and AT2030 are driving the agenda to achieve universal health coverage and Sustainable Development Goal 3 of good health and well-being for all. The goal of rehabilitation is to improve the functioning of individuals who need rehabilitation including assistive technology (AT).
Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) is a multi-country activity supporting the rehabilitation needs of the population and vulnerable groups. ReLAB-HS takesa life course approach to strengthening rehabilitation services and developing the local workforce and technical capacity to provide rehabilitation to adults, older people, and children.
However, children are not little adults. Their rehabilitation needs evolve with their growth and development, requiring family-centred approaches and interventions that translate to all the usual environments and activities of childhood. For some children, their rehabilitation needs may be short term, but for many children, particularly those with developmental disabilities, their need for rehabilitation may be ongoing throughout their life, with early identification of these needs and timely access to intervention key to optimizing outcomes.
While Pediatric Rehabilitation is a specialized field, the onus of care is not just on the pediatric rehabilitation provider. As in the larger field of rehabilitation, children with rehabilitation needs require a network of services that can help with improved functioning. In strengthening systems for rehabilitation for children, aspects that need to be focused on include:
- Developing capacity for early identification, referral, and treatment by training pediatricians, medical officers, community health workers, maternal and child health nurses and traditional birth attendants. This allows children to achieve their maximum potential through timely and effective intervention. This promotes inclusion and participation from an early age, with benefits for the child, their family and community, and societal as a whole through.
- Engaging and empowering primary caregivers with knowledge and resources that equip them to provide care at home and be able to seek facility level care as needed by the child.
- Providing inclusive, accessible, affordable rehabilitation services to children near their area of living and ensuring continuum of care as children go through different phases of their growth and development
- Providing access to quality and standard assistive technology that is age-appropriate to improve child’s independence and ability to participate in age-appropriate activities, and reduce their dependency on caregivers
Drawing on the experience of ReLAB-HS partners in rehabilitation for children – including Humanity and Inclusion’s early childhood development programs and Miracle Feet’s integration of clubfoot identification and management into primary and district level health care – targeted activities are planned to understand implementation and lessons learned from these experiences. We hope that these lessons from the field will facilitate implementation of timely and effective rehabilitation service delivery models that cater to the needs of children in the ReLAB-HS countries and beyond and contribute to a better future for every child.