child health nursing : behavioural disorders - habit disorders (stereotypic movement disorder ) common habit disorder : thumb sucking, nail biting, tics, enuresis, encopresis, stealing , telling lie . their definition , etiology, types , adverse effects management ( role of parents , assessment ,role of nurse , pharmacological and non pharmacological management . responsibilities of nurses.

1. ARMY COLLEGE OF NURSING
SUBJECT - CHILD HEALTH NURSING - I
TOPIC - HABIT DISORDERS
SUBMITTED BY -
NIKETA THAKUR (29)
BSC NURSING II YEAR

2. BEHAVIOURAL
DISORDERS
HABIT DISORDERS

3. OUTLINE
INTRODUCTION
MANAGEMENT
PROBLEMS
CAUSES
DISORDERS
DEFINITION
SUMMARIZATION
RECAPTULIZATION

4. INTRODUCTION
• HABIT DISORDERS is the
term used to describe
several related disorders
linked by the presence of
repetitive and relatively
stable behaviors that seem
to occur beyond the
awareness of the person
performing the behavior.
• It may be associated with
anger, anxiety or sleepiness.

5. DEFINITION
Habit disorder, also known as
stereotypic movement disorder, is
a childhood onset
neurodevelopment disorder that
causes various types on
nonproductive motor behavior
that causes interference with
normal activities and has the
potential for self-harm.

6. COMMON HABIT DISORDERS
 THUMB SUCKING
 NAIL BITING
 TICS
 ENURESIS
 ENCOPRESIS
 STEALING
 TELLING LIE

7. THUMB SUCKING
 It is the non nutritive thumb sucking
behavior.
 Repeated forceful sucking of thumb
associated with stong buccal and lip
contraction
 If thumb sucking continues up to 5 years
or above indicates emotional problems.

8. ETIOLOGY
• WORKING MOTHER
• AGE OF THE CHILD
• PARENTS OCCUPATION
• ORDER OF BIRTH OF CHILD
• NO. OF SIBLINGS
• FEEDING PRACTICES
• SOCIAL ADJUSTMENT AND STRESS

9. ADVERSE EFFECTS
• ANTERIOR OPEN BITE
• MALIGNED TEETH
• MALFORMATION OF UPPER
PALATE
• SPEECH DISORDERS
• LISPING AND THRUSTING
• MOUTH BREATH

10. MANAGEMENT
• ROLE OF PARENT ( PHYSIOLOGIC )
• REMINDER THERAPY
• CHEMICAL THERAPY
• MECHANICAL THERAPY
Extra approach : Splints, Adhesives.
Intra approach: Fixed palatal crib
Hay rakes
Quad helix
Oral screen

11. Thumb guard
Hay rake Blue grass
Oral screen
Palatal crib

12. NAIL BITING
 Also known as onychophagia.
 It is a common compulsive
habit in children and adult.
 It can be seen in the children
around 5 years of age.

13. ETIOLOGY
• Out of curiosity
• Stress
• Successor of Thumb sucking
• Feeling of insecurity
ADVERSE EFFECTS
• Rotation
• Alteration of incisal edge of
incisor
• Inflammation of nail bed

14. MANAGEMENT
• ASSESSMENT OF PSYCHOLOGICAL ENVIRONMENT
: stress, emotional problems
• NO PUNISHMENT
• BITTER SUBSTANCE USE : such as nail polish
• USE OF LOTION AND WARM OIL : to prevent injury.
• ASEPSIS : parents should take care of child hand
cleanliness.

15. TICS
 Tic is an abnormal involuntary
movement which occurs suddenly,
repetitively, rapidly and is purposeless
in nature.
 ONSET: 2- 15 years.
 75%cases of Tourette's disorder: age 11
years

17. TYPES
SIMPLE COMPLEX
MOTOR PHONIC MOTOR PHONIC

18. ETIOLOGY
• BIOLOGICAL FACTORS
Genetics (autosomal dominant)
Dopamine dysregualtion
Autoimmunity
• SOCAIL AND PSYCHOLOGICAL FACTORS
Some life event
Low birth weight child
Exposure to high level of caffeine in utro

19. MANAGEMENT
GENERAL MEASURES
• Psychoeducation
• Collaboration with school
PHARMACOLOGICAL MANAGEMENT
• ALPHA adrenergic receptor agonist : clonidine, guanfacine
• Typical antipsychotics : haloperidol, pimozide
• Atypical antipsychtics : resperidone, clozapine
PSYCHOLOGICAL TREATMENT
• Cognitive behavioral therapy
• Relaxation therapy
• Habit reversal training

20. ENURESIS
• Also known as bed wetting.
• It is a disorder of involuntary micturition
in children who are beyond the afe when
normal bladder control should have been
acquired.
• Commonly during 4 -12 years

21. TYPES
SECONDARY
PRIMARY
Refers to the condition where no
successful training to control urination
is given to child.
Successfully trained but revert bed
wetting in response to stress.

22. ETIOLOGY
• INAPPROPRIATE TOILET TRAINING
• NEUROLOGICAL DEVELOPMENTAL DELAY
• GENETICS
• EMOTIONAL FACTORS
• ORGANIC CAUSES
CLINICAL FEATURES
• INCONTINENCE
• DYSURIA
• CONTINOUS DAMPNESS
• STRAINING ON URINATION

23. MANAGEMENT
PHARMACOLOGIC :
• Tricyclic antidepressants- Amitriptyline., imipramine PO ×2 mo
• Desmopressin (ADH) - reduce urine production during sleep.
NON PHARMACOLOGIC- Behavioural modification
Parental counselling
Bladder exercise
Alarm device

25. ENCOPRESIS
 Also known as
paradoxical diarrhea.
 It is an involuntary
fecal soiling in children
who are past the age
of toilet training.

26. ETIOLOGY
• INEFFICIENT INTESTINAL MOTILITY
• AGGRESSIVE AND PROLONGED
MEDICAL TREATMENT
• STRESS
• DIETARY MANIPULATION

27. MANAGEMENT
• BEHAVIOURAL TECHNIQUES
• TRAINING
• INITIAL COUNSELLING
• DIETARY MANAGEMENT

28. STEALING
When a child take something that belong to somebody else
without permission is called stealing.
ETIOLOGY
• POOR IMPULSE CONTROL
• TO BE COOL AND IMPRESS OTHERS
• STRESS

29. MANAGEMENT
• USE DISAPPROVAL
• TALK WITH CHILD
• TALK ABOUT ETHICS AND VALUE
• RESTITUTION
• BEHAVIOUR WATCHING

30. TELLING LIE
 To make an untrue statement with intent to deceive.
 Occur in 4-6 years of age.
ETIOLOGY
• TO COVER SOMETHING
• EXPERIMENT
• ATTENTION
• TO GET SOMETHING THEY WANT
• AVOID TO HURT SOMEONE'S FEELINGS

31. MANAGEMENT
• Make conversation about lying or
telling.
• Help your child to avoid situation where
they need to lie.
• Praise your child or owning upto doing
wrong.
• Be a role model for telling truth.

32. BRUXISM
 It is characterized by non -
functional repeated grinding
of teeth with high pitched
sound, usually during sleep.
 Begins in first 5 years of age.

33. ETIOLOGY
• ABNORMAL SLLEP ACTIVITY
• FAMILIAL BEHAVIOUR PATTERN
• PINWORM INFESTATION
• NEUROLOGICAL DISEASE
MANAGEMENT
• BEHAVIOURAL MODIFICATION
• PARENTAL COUNSELLING
• PSYCHOTHERAPY
• PHARMACOTHERAPY (DIAZEPAM?)
• DENTAL REFERRAL NECESSARY

34. NURSING RESPONSIBILITIES
THE FOLLOWING ARE THE NURSING RESPONSIBILITIES
WHILE CARING CHILDREN WITH HABIT DISORDERS :
• Comprehensive assessment
• Eduacte child and family about the course of
disoder.
• Completion of necessary diagnostic tests.
• Psychotherapy and behavioural therapies.
• Parental counselling.
• Use of mechanical devices.
• Setting timetable.
• Provide medication to the child.
• Encourage for dietary modification.

35. Thank YOU
THANK YOU EVERYONE