1. BEHAVIOURAL ANDPSYCHOLOGICALDISORDERS IN PEDIATRICSRania HeshamFaculty of MedicineAlexandria University
2. BEHAVIORAL AND PSYCHIATRICDISORDERS IN PEDIATRICSThumb suckling.Nail bitingEnuresis .Encopresis.PICABreath HoldingTemper Tantrum
3. THUMB SUCKINGDefinition:Thumb sucking or finger sucking is a habitdisorder due to feeling of insecurity andtension reducing activities.“sleep pattern / new sibling /tension ”Complication:TeethMastication & swallowingThumb• Facial distortion• Speech difficulty•
4. THUMB SUCKINGManagement:FamilysupportPraisingandencouragingThumbbusydentist andspeechtherapist
5. NAIL BITINGDefinition:Nail baiting is bad oral habit especially in school age children beyond 4years old(5 - 7 years). It is sign of tension and self punishment to cope with thehostile feeling towards parents.Cause:Imitating the parent who also a nail biter.Insecure feelingConflictHostilityPressurized study at school or home.Watching frightening violent scenes.
6. NAIL BITINGBusy handwith activitiesor play.Praised for wellbreaking thehabit.Help the child toovercome theproblemManagement:
7. ENURESIS ( BED WETTING )Definition:The repetitive involuntary passage of urine at inappropriate placeespecially at bed,during night time, beyond the age of 4 to 5 years. It is foundin 3 to 10 percent school children ♂ >1. Primary (75%) 2. Secondary (25%)Causes: Psychological factors Delayed maturation of the cortical mechanisms Sleep disorder-enuretic children Reduced antidiuretic hormone production at night Genetic factors Organic factors Constipation Infection Sleep apnea
8. ENURESIS ( BED WETTING ) Small functional bladdercapacity Deep sleepers Nocturnal polyuria Genetic factors – (familyhistory) Delayed maturation of thecortical mechanisms Reduced antidiuretichormone production atnight Diabetes insipidus psychological cause Urinary Tract Infection Constipation Diabetes (Mellitus &Insipidis) Chronic Renal Failure Neurological causes Sleep disorder-enureticchildren OSAPrimary Enuresis Secondary enuresisCauses:
9. ENURESIS ( BED WETTING )Clinical Manifestations and Diagnosis: A careful history Medical History “Diseases” Family history A complete physical examination Urinanalysis “pus - Glu – sp.gravity” Bacteriuria Renal ultrasonogram
10. CLINICAL FEATURES OF ENURESIS(DIAGNOSTIC CRITERIA)
11. ENURESIS ( BED WETTING )Management: Organic causes - specific treatment. Non organic cause:EmotionalsupportVoidingbeforebedtime-Encourage andreward thechild fordrynights.Auditoryorvibratory alarm*Desmopressin acetatate*Oxybutyincholoride*Impiramine
12. Encopresis (Soiling)Definition:Watery contents from proximal colon may leak around the hard fecalmass and pass per-rectum involuntary , unperceived by the childleading to soiling of his underwear . ♂ >1.Retentive encopresis 2.Nonretentive encopresis1.Primary 2. SecondaryCauses: Primary subtype: Developmental delay Secondary subtype: Psychosocial stressors - Conduct disorder Toilet Fears “avoiding” Metabolic “Hypothyroidism /Hypokalemia /Hypercalcemia/Dehydration”
15. PicaDefinition:This eating disorder involves repeated or chronic ingestion of non-nutritivesubstances, which may include plaster, charcoal, clay, wool, ashes, paint,and earthpredisposing factors: Mental retardation autism and other brain-behavior disorders lack of parental nurturing Family disorganization Poor supervision lower socioeconomic classes
16. PicaChildren with pica are at an increased risk for: Lead poisoning Iron-deficiency anemia Soil-borne parasitic infections Morbidity includes choking, poisoning, infectionsand intestinal obstruction. Dental abnormalities Affects Bone and Teeth “absorption of Ca++”Physical examination : Manifestations of toxic ingestion Manifestations of infection or parasitic infestation Gastrointestinal (GI) manifestations Dental manifestations
17. PicaManagement:ZincandironReinforcement of otherbehaviorsselectiveserotoninreuptakeinhibitors(SSRIs)A dentistmay beconsulted
18. Breath holdingDefinition:A breath holding spell is an involuntary pause in breathing,sometimes accompanied by loss of consciousness.It usually occurs in response to an upsettingor surprising situation.(n.6m-6yrs).Types: A cyanotic spell is caused by a change in the child usual breathingpattern, usually in response to feeling angry or frustrated. A pallid spell is caused by a slowing of the childs heart rate, usually inresponse to pain.
19. Breath holdingCauses: change in the child breathing or a slowing of the heart rate by pain or by strong emotions “Fear – Confrontation” Breath holding spells can run in families genetic conditions, such as Riley-Day syndrome or Rett syndrome. Children with iron deficiency anemiathe body doesn’t produce a normal number of red blood cells
20. Breath holdingClinical manifestations : Fainting (for less than a minute) Twitching muscles, a stiff bodyCyanotic spell Pallid spell breathe too fast or toohard The skin red or blue-purple “around the lips” short burst of intensecrying heartbeat may slow down Skin pale and sweaty. a single cry or no cry atall.
21. Breath holdingManagement :help your childfeel securechild on thefloor and keephis or herarms, legs, andhead fromhittinganything hardor sharpNo treatmentnecessary“no epilepsyno braindamage”
22. TEMPER TANTRUMDefinition:A tantrum is the expression of a childs frustration with the physical, mentaloremotional challenges of the moment ranges from crying to screaming ,kicking ,hitting and breath holdingCauses: Seeking attention Physical challenges :Tired , hungry or uncomfortable Mental challenges :childs difficulty learningor performing a specific task, or difficulty using words toexpress thoughts and feelings.