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BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
BEHAVIOURAL and psychological disorders in pediatrics
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BEHAVIOURAL and psychological disorders in pediatrics

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  • 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 feelingConflictHostilityPressurized 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”
  • 13. Encopresis (Soiling)Clinical Manifestations and Diagnosis: History “diet” Offensive odour Poor appetite Abdominal pain painful defecation in retentive encopresis Lethargy Physical examination“Abdominal distention/Palpable stool masses/rectal examination/Neurologic examination” Laboratory Barium enema Rectal biopsy Anorectal manometry Bloodtests
  • 14. Encopresis (Soiling)Management:ToiletingSkillsDietandexerciseLaxativesorenemasEncourage&reward
  • 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.
  • 23. TEMPER TANTRUMIgnorethetantrumManagement:stop whatyoure doingand removeyour childfrom thesituationdiscusswith yourchild thebehavioryoupreferredPretend thatyou donteven seeyour childduring thetimeout, butyou can stillassure his orher safety

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