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Children who inherit sickle cell disease, primarily African Americans and Hispanics, are at risk for serious medical conditions and require special care both at home and in school. Sickle cell disease is recognized as an "Other Health Impairment" and identified students may be eligible for special education services under the Individuals with Disabilities Education Act (IDEA). This report reviews the description and management of sickle cell disease, including physical areas affected, medical problems associated with the disease, and proper treatment. A case study details a school's failure to accommodate a child with the disease. The educational rights of a student with the disease are examined within the framework of IDEA: goals of early intervention; types of service considerations; identification, location, and evaluation; inclusion; eligibility determination; individualized education program development; and placement safeguards. Implications are listed for educators and administrators in accommodating students with sickle cell disease. These include teacher education about the disease and its impairments; communication with parents; learning environment modifications; due process; student academic and social evaluation; and "search and find" coordination with social agencies, health care providers, and educators. (SAS)

This paper describes the "Sickle Cell Counselor" (SCC), a goal based scenario on permanent display at the Museum of Science and Industry in Chicago. SCC is an exploratory hypermedia simulation program which provides users with a basic understanding of Sickle Cell Anemia. The user of the program plays the role of a genetic counselor, and, while playing this role, can do laboratory tests, calculate risks, ask experts for information, and advise clients about the results. The paper begins with a brief description of the SCC which emphasizes the design features most relevant to the patterns of interaction that emerged. These include the design of the task presented to the user, the organization of the database, and guidance given to the user by the system. Three evaluations of SCC which were conducted with museum users in order to better understand how they interacted with the program, are also presented. These studies examined patterns of usage, the cognitive gain of the program, and the effects the counseling task had on learning. Discussions of how particular features of the program affected the interactions of the users and their implications for the design of computer-based learning environments conclude the paper. (Contains 17 references.) (JLB)

New findings about child nutrition and cognitive development indicate that undernourished children are typically fatigued and uninterested in their social environments. Such children are less likely to establish relationships or to explore and learn from their surroundings. Undernourished children are also more susceptible to illness and, thus, more likely to be absent from school. These factors result in a loss of opportunities for undernourished children and in a loss of contributions to society. An overview of research reveals that children in the United States suffer a mild to moderate degree of malnourishment associated with poverty. A combination of environmental insults and undernutrition has been shown to result in growth retardation and developmental delays. Unless irreparable physiological damage has occurred, improvements in environment and nutrition can rectify the developmental effects to which a young child is exposed. Nutrition programs such as the Special Supplemental Food Program for Women, Infants, and Children (WIC), the School Breakfast Program, the School Lunch Program, the Summer Food Service Program and the Food Stamp Program play key roles in safeguarding the health and cognitive develop of children who are at risk for undernutrition. Addition benefits provided by these programs include savings in medical costs and savings in special education programs. (VL)

A hypermedia simulation, Sickle Cell Counselor, has been developed to anchor instruction for museum visitors using the task of advising couples about the decision to have children when there is a substantial genetic risk of sickle cell disease. A visitor can perform simulated laboratory tests and ask questions via interactive video. The anchored instruction model is closely related to cognitive apprenticeship theory. Patterns of interaction between the user, simulating the role of a genetic counselor, and the program are illustrated through an annotated example. The genetic counseling role makes the Sickle Cell Counselor a compelling program, but the human interest facet is really just a motivational device. The program supports the acquisition of the target knowledge well. The user is supported with knowledge from an experts screen, from learner-initiated coaching, and from implicit task guidance. An evaluation with adults at a community church (21 pretests and 10 posttests) suggests substantial gains in knowledge about sickle cell disease, as well as confidence in the material learned. Ten figures present evaluation findings. (Contains 10 references.) (SLD)

This article discusses key components relevant to providing appropriate services for students with health care needs, reviews common health conditions in school-aged children and youth and recommended medical management, and describes school health care needs and related accommodations that may be made for students with each condition. (Contains references.) (CR)

This research investigated factors affecting children's health, based on empirical analyses of data from Washington, D.C. and national data. By most measures, poor children experience disproportionate morbidity and mortality. Yet certain ear and vision problems exhibit a U-shaped relation to family income in both national statistics and the Washington sample. Analyses of this relation suggested crowded housing and limited access to care as possible causes of higher prevalences among poor children in the study sample; mechanisms for the affluent were unclear. Additional analyses identified various economic factors underlying apparent racial differences in children's anemia. Focusing on ambulatory care, the research found different patterns of health outcomes and service utilization across practice settings. Thus, although lower utilization seemed detrimental to poor children's health overall, utilization levels across settings evidently had less to do with these health outcomes than did other provider or system features. Finally, both national and study data revealed persisting inequalities in measures of utilization and barriers to access. In the study sample, the most significant barriers appeared to be low income practices, high provider charges, and absence of Medicaid. Findings suggest that current policy trends may exacerbate present deficiencies in illness prevention and early diagnosis among the disadvantaged. (Author)

The problems of those children who are chronically malnourished, the cultural environment of malnutrition, and the extent to which children are temporarily or permanently handicapped in learning because of malnutrition are discussed in this booklet. It also describes hunger and its effects on child development. The topics addressed are: definition of malnutrition, the prevalence of malnutrition, the brain, severe malnutrition and learning, chronic malnutrition and learning, deficiency and learning, hunger and learning, the cycle of malnutrition, and rehabilitation. It is concluded that prolonged severe malnutrition during gestation or early infancy when the brain is rapidly growing can lead to permanent behavioral handicaps. Such severe malnutrition is quite infrequent in the United States. The effects of moderate or chronic malnutrition are not as clearly understood. Adverse behavioral consequences of chronic undernutrition seem to lie in the areas of attentiveness, curiosity, activity, and social responsiveness rather than in learning itself. The consequences of iron deficiency are likely to be in these same areas. The incidence of hunger among children is nearly impossible to measure. Although it does not permanently affect the brain, hunger probably adversely affects learning. Corrective policies must include insuring preventive health care beginning with the pregnant mother and extending through childhood. (Author/AM)

This study investigated the cognitive and behavioral functions associated with iron deficiency anemia in infants and toddlers and the short-term effects of therapy on such behaviors. Subjects were 24 iron deficient and anemic infants, 9 to 26 months old. The subjects were randomly assigned to a treatment or control group. The Bayley Scales of Infant Development were administered before the institution of treatment with intramuscular iron or placebo, and the test was readministered in 5 to 8 days. Children treated with iron showed a significant increase, compared to the controls, in their scores on the Mental Development Index. The treated group also became more alert and responsive and demonstrated improvement in tests of gross and fine motor coordination. These findings support the hypothesis that iron deficiency in infants produces developmental alterations and that these changes are rapidly reversible with iron therapy. (Author/SB)

Although many workshops on sickle cell anemia have been held, it is still difficult to implement a comprehensive training program for sickle cell anemia clients in many communities. Research data on the topic are somewhat nebulous and insufficient political and social pressure have been exerted to change attitudes and take action towards the disease. Research has found no cure for the disease and treatment is palliative. Because sickle cell anemia is said to disrupt mental processes through environmental stresses, as associated with racism, the client may blame his physical attributes for the problems and societal pressures he faces. The 1978 questionnaire survey conducted (by this author) in South Bend, Indiana, indicates the need for counseling on the subject. In group counseling, the facilitator should be flexible enough to adapt to the needs of the client. The more verbal interaction that takes place, the more effective the counseling process will be. Current medical knowledge pertaining to sickle cell anemia shows that changes are occuring. The disease and the accompanying physiological crisis and complications can now be talked about. (Author/WI)

The science of genetics is perceived to offer hope that a large number of the 3,000 inherited diseases which afflict human beings may be prevented or controlled. This document addresses some of the advances that have been made in this field. It includes an introduction and sections on: "The Beginning of Human Genetics"; "Unlocking the Secrets of DNA"; "The Development of Recombinant DNA Techniques"; "A New Understanding of Sickle-Cell Disease and Other Blood Disorders"; "How to Use DNA Fragments to Detect a Disease"; "How DNA Probes Find Their Match"; "Stalking the Most Elusive Genes"; "The Rapid Growth of Gene Mapping"; "Zeroing In on Cancer Genes"; "A Bank of Living Human Cells"; "GenBank: A National Database of Nucleic Acid Sequences"; and "The Promise of Genetic Therapy." A glossary of terms is also included. (TW)

This document records hearings before the U.S. Senate Committee on Agriculture, Nutrition, and Forestry and its sub-committee on Nutrition. The hearings, dated March 15 and April 9, 1984, were conducted in order to evaluate and reauthorize the special supplemental food program for Women, Infants and Children (WIC), due to expire in 1984. Testimony came from staff from the General Accounting Office, state and local family health and nutiriton officals, U. S. Senators, local WIC program directors, professors of nutrition and maternal and child health, the president of the National Association of WIC Directors, and the director of the Center on Budget and Policy Priorities. The evaluation focused on, among other matters, the effectiveness of WIC in increasing birth weight, lowering infant mortality, decreasing the percentage of infants with anemia, improving the nutritional state of women with poor weight gain during pregnancy, and the health program's capacity to function preventively. The document closes with a cost-benefit analysis of the WIC program, prepared by the Congressional Research Service of the Library of Congress. (RDN)

Reviews the existing literature on psychosocial interventions for children and adolescents with sickle cell disease and suggests some developmentally appropriate modifications for approaches designed for adults. Particular attention is paid to nonpharmacological pain management strategies that include coping skill training, educational programs, self-help and support groups, and family counseling. (SLD)

Compared measures of peer relationships and emotional well-being of children with sickle cell disease (SCD) to those of same-classroom peers. Found that, compared to nondiseased subjects, SCD females were perceived as less sociable and less well accepted; SCD males were perceived as less aggressive. No other differences were identified for emotional well-being or psychological adjustment. (HTH)

The purpose of this study was to determine if there was any significant difference in overall leg strength gains in individuals with sickle-cell-trait as compared to non-sickle-cell-trait individuals, as measured by the leg dynamometer. Twenty black male first-year college students were used in this study. The subjects were divided into a control group which was randomly assigned and an experiemental group assigned on the basis of sickle-cell test results. The subjects were pretested for overall leg strength. Both groups then followed the same exercise program three days a week for an eight-week period. All exercise periods consisted of five minutes. On completion of the exercise program, a posttest was administered to both groups. Both a t-test and a Mann-Whitney U-test were used to test the hypothesis. Results indicated that high intensity exercise had no more effect on overall strength gained in the legs of non-sickle-cell-trait than on sickle-cell-trait individuals. (Author/PB)

The purpose of this study is to present an experimental investigation of the manifestations of aphthous ulcers, glossitis, and cheilosis in the oral cavities of 25 subjects, the use of ferrous gluconate supplements for the control of the lesions in 13 subjects, and the hemoglobin levels at initial and final clinic visits of all subjects for time periods varying from one month to four years. On the basis of the findings and within the limitations posed, it is concluded that: (1) the presence of the oral lesions does not appear to be significantly related to hemoglobin levels, which fall well within the generally accepted normal limits; (2) although hemoglobin levels may fall within the generally accepted normal limits, ferrous gluconate supplements have a profound effect upon reversal of established oral lesions and the prevention of recurrences; (3) hemoglobin levels that are at the lower limits or below the recognized minimum normal range seem to accompany or promote the occurrence of oral lesions; (4) females appear to have a tendency toward occurence of iron deficiency more often than males, and therefore show more frequent manifestations of oral lesions apparently related to the hemoglobin level in the blood; (5)when ferrous gluconate supplements are prescribed for the management of oral lesions, subjects show an increase in hemoglobin determinations, and the majority show marked improvement in the oral conditions following treatment; (6) when ferrous glutonate supplements are not prescribed for the management of lesions, subjects show no improvement; and (7) although the regular intake of iron supplements is not recommended, some subjects require daily supplements. It is recommended that the relationship between nutrition and dental health be amplified in school health programs, expecially in underprivileged urban areas. (DMT)

Maintains that research from developing countries may help in understanding effects of poverty on child development in the United States, citing three cases: (1) the link between anemia and decreased levels of mental and motor development; (2) the positive effects of supplemental nutrition programs on child development; and (3) effects of poor nutrition and concurrent illness on school performance. (MDM)

Examined adjustment problems for children and adolescents with sickle cell anemia (SCA). Parents provided information on social, emotional, academic, and family adjustment of 327 children with SCA. Over 25% of children had emotional adjustment problems in form of internalizing symptoms (anxiety and depression); at least 20% had problems related to social functioning and academic performance. (Author/NB)

Describes investigation utilizing sickle cell disease subjects from a stress and coping project. Found little stability in classification of individuals' adjustment, low congruence in behavior problem patterns and diagnoses, and less stability in adjustment by child report than mother report. Suggests children's coping strategies are intervention target for enhancing adjustment. (Author/CRR)

Compared blood screening data for 200 urban and rural pregnant women in Nigeria. Found that rural subjects had a greater incidence of moderate anemia than did urban subjects, and corpuscular hemoglobin concentrations fell with increased gestational age. No relationship was found between hemoglobin counts and nutrition habits. (HTH)

Reports on development of adult sickle cell support group and provides description of psychosocial factors most prevalent in patients' lives (anxiety about death, disruption of social support network, disability, dependence on pain medication, conflicts with health care providers). Notes that support group enhanced participants' knowledge about disease, improved physician-patient relationship, and helped resolve psychosocial adjustment problems. (Author/NB)

Found that 64% of 50 children aged 7-12 years with sickle cell disease had parent-reported behavior problem. Internalizing types of behavior problems and diagnoses were most frequent. Maternal anxiety accounted for 16-33% of variance in mother-reported internalizing and externalizing behavior problems, respectively, and child pain-coping strategies accounted for 21% of variance in child-reported adjustment problems. (Author/NB)

Examined a sample of 177 infants (age 9 through 12 months) with iron deficiency anemia (IDA) from low-income French, African, and North African Muslim families in Paris. Found a higher than normal incidence of otitis media and respiratory diseases such as bronchitis among the infants. Also examined the relationship between infant IDA and child behavioral indices. (MDM)