The woman pulls out a photo of her family when she was younger. Noel starts laughing and she says 'What are you laughing at?' - to which he replies, 'I'm not laughing at you, I'm laughing at the little one in the middle!'
She says 'That's my little brother. He's handicapped.'
Then Noel starts spouting shit like 'What a wonderful face! Lovely expression he has!' Due to the fact he's just mocked a handicapped child on national television.
That's not an accurate description, but the general jist of it.