Module 1: An Overview of Children with Special Health Care Needs and Oral Health
Special Care- Overview of CSHCN

1.1 Definitions and Terminology

Definitions

The Maternal and Child Health Bureau has defined CSHCN as those “who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services of a type or amount beyond that required by children generally.” 1


Mini Quiz

Using the above definition, how many U.S. children and adolescents ages 17 and younger have a special health care need?

Mini Quiz, A 2%, B 9%, C 13%, D 20%

20% of U.S. children and adolescents ages 17 and younger have a special health care need. 2


The American Academy of Pediatric Dentistry has defined special health care needs as “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for individuals with special needs requires specialized knowledge acquired by additional training, as well as increased awareness and attention, adaptation, and accommodative measures beyond what are considered routine." 3

Terminology

An important concept for providing care to CSHCN is the use of “people first” language. 4 People whose bodies or minds work differently should be viewed first as people and second as people with special health care needs (e.g., a child with cerebral palsy). In the past, such individuals were inappropriately labeled by their diagnosis, such as the epileptic child or the cerebral palsy child. Medical diagnoses are important for providing health care and ensuring that appropriate services are available, but not for social interaction.

“People whose bodies or minds work differently should be viewed first as people and second as people with special health care needs.”

Therefore, in the dental office, the focus should be on people’s abilities and their individuality, not their limitations. “Handicapped” and “disabled” are outdated terms that invoke negative stereotypes. For example, rather than referring to “handicapped parking” or a “handicapped restroom” say “accessible parking” or “an accessible restroom.” Instead of describing “a child who can’t walk” or “a child who is confined to a wheelchair” say “a child who uses a wheelchair.”

“The good physician treats the disease; the great physician treats the patient who has the disease.”

William Osler, M.D.
A founding father of Johns Hopkins Hospital