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39
An unfortunate death to which I must draw attention is one which occurred in a baby of five
months whose mother was revaccinated. The baby developed eczema vaccinatum and died from
massive gastro-intestinal haemorrhage.
There were two "cot deaths". One was an illegitimate infant of three months who, in spite of
excellent care by a registered daily minder, died from acute bronchopneumonia. The other infant,
also aged three months, was found suffocated in its perambulator. This infant was extremely well
cared for, and there was no question of any negligence on the part of the mother.
Turning to the older age range, nine children between the ages of one and five years died, and 10
between the ages of five and fifteen years. Four deaths were due to leukaemia or malignant neoplasms,
three to severe congenital abnormalities and five children died as a result of road or other
accidents.
It is perhaps worth noting that two children in the older age group died from asthma. It used to be
thought that asthma was a troublesome condition rather than a cause of death in childhood. But in
spite of sophisticated therapy these tragedies do occur.
MATERNAL MORTALITY
No maternal deaths were reported in Westminster in 1970; there were two such deaths during
the previous year.
HANDICAPPED CHILDREN
Of recent years considerable attention has been focussed on the needs of the handicapped child
and his family.
A child may be handicapped by reason of some congenital abnormality or deformity, as a result
of disease or injury in early life or of adverse emotional and environmental conditions. There is a
tendency for handicaps to be multiple. The same pathological process that causes a physical handicap
may also lead to an intellectual one. A child with impaired physical or mental development may also
suffer from emotional deprivation, over protection and lack of opportunity in his home environment
to achieve his potential.
The emotional needs of handicapped children—the longing for love which a physically unattractive
child so badly needs, the self-awareness which he must learn at a very early age, or the frustration at
lack of ability which is expressed in temper tantrums—these are problems for the family. The whole
family must be involved, but when the daily regime of a young child is considered, it is the mother
who bears the greatest burden. The mother will need help in understanding that when the other
siblings have outstripped the handicapped child in agility, performance and control of bodily
functions, this one will continue to need the care usually bestowed on a baby. She will also need to
learn, and this is a difficult lesson, that a handicapped child must also be subject to the ordinary
rules of social behaviour. He must be allowed and encouraged to do things for himself such as feeding
and dressing. He must learn to accept "no" without resorting to temper tantrums or even fits in an
attempt to get his own way.
The local authority, the hospital and general practitioner service and voluntary organisations all
have a part to play in meeting the needs of handicapped children and their families. The early diagnosis
of and treatment for the condition is a medical responsibility. Support of the family in the home by
provision of material help and advice on day to day management is a role undertaken by health
visitors or social workers, while early training and education may be undertaken by nursery nurses
or nursery teachers. For any satisfactory service a team approach is essential. No matter who provides
the help it must be co-ordinated. There must be full assessment of the family's immediate needs and
of the child's potential. The parents must be given a realistic prognosis and helped to accept it by
counselling on a long term basis.
As a first step in the co-ordination of the services for handicapped children, the Health Department
maintains a register to encourage the early identification of handicaps, to ensure follow up by regular
review, to arrange for appropriate management and treatment, and where necessary to ascertain for
special education. Children may be placed on the register because of congenital abnormalities
notified at birth, or because of failure to make normal progress in any sphere of development whether
this is due to physical or mental handicap or adverse emotional or environmental conditions.