Early identification and prevention of mental retardation helps in terms of treatment for some conditions, better planning and management of cases, and counseling. Diagnostic procedures are available during pregnancy for early detection: blood tests, amniocentesis, ultrasound, fetoscopy, and urine tests; tests available for the newborn are blood tests for hypothyroidism, PKU; urine tests for metabolic disorders; apgar scores for screening of neurological deficits; neurobehavioral assessments, developmental schedules; neurodevelopmental screening; sensory examination; speech and language assessments; EEG; and imaging techniques. Early identification of mental retardation is beneficial in aiding the child's development and personality and in helping parents adjust mentally and learning to cope with caring for the child. Sometimes, it can help to limit the number and extent of the handicap. Prevention can be primary, secondary, or tertiary. The emphasis is on planned pregnancies, regular prenatal care, regular health checkups for mother and child, immunization, nutrition, prevention of environmental hazards and accidents, early identification and screening, genetic studies and counseling, family planning, and creation of awareness among the general population. Inadequate prenatal care is associated with prematurity and low birth weight, which are linked to mental retardation. Prenatal care for the pregnant woman involves participating in regular prenatal checkups, maintaining good nutrition, having preliminary screening, attending promptly to illnesses and infections, and getting immunized at the appropriate time. Avoidance of the following is recommended: unnecessary and nonprescribed drugs, physical accidents, exposure to radiation and teratogens, alcohol and tobacco consumption, exposure to infections such as measles, rubella, or syphilis, toxins and poisons such as lead, and attempts at abortion. Genetic counseling can provide information on the disorders, the mode of inheritance, risks of recurrence, and options available as alternatives. Complicated pregnancies and labors require hospital delivery. Trained personnel at home or at a health center is appropriate for normal deliveries. High-risk infants need intensive care. The best age for mothers to bear children is between 20 and 30 years. The community can disseminate information as a prevention effort.
There are 4.3 million deaths annually (33% of all child deaths) due to acute upper and lower respiratory infections including measles and pertussis. Morbidity is much higher: in India 30-35% of pediatric hospital admissions are for acute respiratory infections (ARI). Some of the risk factors for ARI are bottle feeding, overcrowding, outdoor and indoor pollution, low birth weight, and malnutrition, according to World Health Organization studies. A typical example of an Indian child with frequent hospitalizations for lower respiratory infections is a case where the father smokes and the mother works outside the home, which is a squatter hut near a highway and a power plant. In Rio de Janeiro, risk factors are maternal stress or depression, poor supervision, and poor housing. Prevalence of ARI was 80% in a 15-day recall period. In Gambia, children of polygamous unions and those exposed to indoor cooking fires are at high risk. In Hong Kong, poor environmental air quality has been identified with ARI. In the US factors associated with ARI are smoking, passive smoking, and air pollution. A child exposed to smoking will have 20% more days being bedridden than otherwise.
Several types of environmental degradation and their philosophical implications are discussed in this essay. Environmental degradation causes chemicalization and degradation of the health of the body and harm to the soul and mind because of the resulting unmet needs of the many and the greedy consumption of the few. Degradation of the water supply is caused by overuse of water for cash crops, contamination of water by night soil, and improper disposal and piping of sewage. The resulting water-borne diseases, such as cholera, are then mistreated by giving children anti-diarrheal drugs that keep the germs in the body. Bottling of mineral water further reduces the supply for the poor. People should instead put bottles of water in the sun or use wood apple or drumstick seeds to purify water. Chemicalization of the environment has resulted in major disasters such as Mina inmates disease, the Bhopal disaster, the Bichri acid drinking water tragedy, crippling of youths in Karnataka by pesticide-poisoned crabs, and poisoning by use of pesticide containers for food. Usually those responsible go free, and socially conscious officers are fired. People have to protect themselves by taking such action as: recycling envelopes, eating non-processed foods, composting instead of burning leaves, and trying to get codes passed for baby food, drugs, vehicle emissions, and factory effluents.
Clinically evident lead poisoning is rare in Indian children but is more common than in adults. In children, lead poisoning may appear as fever, seizures, anemia, or abdominal pain, while in adults it is more likely to manifest as chronic minor peripheral neuropathy or gum pigmentation. Children with acute lead poisoning can be treated with chelators such as EDTA and BAL, but many are left with permanent brain damage. The most common sources of acute lead poisoning in Indian children are inhalation of fumes from burned car batteries, ingestion of flaking paint, consuming food cooked in cheap aluminum or brass utensils, and eating contaminated soil. The sources of chronic lead poisoning are water from lead pipes and fumes from industrial or automotive exhaust. Another common source in India is application of "kajjal" to children's eyes. Sources of lead in Western countries, such as drinking water, canned food, residential paint, automotive fuel, and ambient air quality, are regulated by law. None of these are regulated in India.
An overview is provided of the gravity of the problems of trauma from conflicts and effects on the health and survival of children and the relevance for India. Article 39 of the convention of the Rights of the Child adopted by the UN General Assembly is an agreement "to promote physical and psychological recovery and social reintegration of a child victim of any form of neglect, exploitation, abuse, inhuman treatment, or armed conflicts." The World Summit expanded the provision to include protecting women and children from the effects of war and to work toward preventing future conflicts. Safe corridors must be secured in order to protect children and families from surrounding war or violence. Concern for children was first indicated in the formation of UNICEF in the aftermath of World War II. Since that time, civilians, mostly women and children, have been the dominant population suffering from the effects of war. By 1991, 80% of the 20 million killed and the 80 million wounded were women and children involved in 150 conflicts. In the recent past, the Gulf War had a disastrous impact on children. Infant mortality increased from 39/1000 to 111/1000 and low birth weight rose from 5% to 12%. Child mortality of these under 5 years increased from 48/1000 to 143/1000. Another impact of armed conflicts on children is psychological trauma and detachment from emotional ties and enjoyment, and sleeplessness. Other symptoms are described. Recent action to counteract children's trauma has been taken in Kuwait, Mozambique, and Sri Lanka. Community-based programs help to identify needy children through parent and teacher education and to offer counseling. Several manuals are available on how to help children affected by war. One strategy is the establishment of a trauma center. In the Philippines, programs have been developed to involve children in therapy through drama, painting, and dance. India has experienced severe rioting, which has left many women and children orphaned. Programs need to be developed to deal with the effects on women and children.
