Care needs of older infants/young children

The non-disabled infant

As the healthy infant gets older, the emphasis shifts from attention to supervision. Feeds become less frequent; winding is no longer necessary and the child begins to feed themselves. However, from the age of about six months the development of investigative skills together with increasing mobility puts the healthy child at risk of danger; the level of supervision required to avoid danger is considerable.

The infant with disabilities

At this stage (often between 9 and 15 months), the gap between the care needs of a healthy child and a child with disabilities may have widened to the extent that the needs of the child with disability are significantly in excess. These may include continued attention to bodily functions no longer required by the healthy child and more attention than that needed by the healthy child for the development of new skills such as crawling, standing and walking. The age at which the need for attention of the child with disability becomes greater than that of the healthy child cannot be defined precisely and judgement will depend on the evidence available in the individual case.

Disabilities posing substantial needs

There will be some children with disability with needs persisting or first manifesting at a level in excess of the norm at this age, for example -:

• Children with brittle bones (osteogenesis imperfecta), haemophilia and other severe bleeding disorders in who bumps and falls are associated with the risk of fractures or haemorrhage.
• Mobile children with hearing and/or visual problems who cannot respond to a warning shout or see a potential danger, which a healthy child would avoid.
• Children with cerebral palsy whose mobility is impeded and whose risk of postural deformity is reduced by frequent changes in position by parents.
• Children with a severe learning disability who eat undesirable substances (pica) or exhibit self-mutilation behaviour. A child with severe learning disabilities may also require substantially more stimulation to maximise potential.
• Children in whom developmental delay may first become evident because of a need to continue a level of attention appropriate for a much younger baby.

Night needs in infants and young children

Healthy children under the age of two years normally require a considerable amount of attention, both in frequency and duration, during the night hours for feeding, changing or "settling" - the latter especially during teething. Specific, regular attention at night in excess of normal levels may be required by some children with disabilities whose medical condition calls for parental intervention in the form of turning, nebulizer or oxygen therapy, suction, intubation and care during fits etc.

If precautions are taken at night (such as the child being safely placed in a cot with sides and bumpers if required and used) there may be few conditions requiring watching-over in the absence of attention needs, which are substantially in excess of those needed by a child of comparable age.

However, the need for watching over in excess of normal levels will depend on the evidence available in an individual case. Notably, children with severe learning difficulties may have an abnormal tendency to develop a persistent habit of night wakening. In such cases, attention from parents may be required more than once a night and may last one hour or more.