This document provides an overview of behavioral disorders in children. It begins with an introduction stating that normal children are well-adjusted when their emotional, physical and psychological needs are met. It then defines behavioral problems as significant deviations from socially accepted norms. The main causes and various types of behavioral disorders are discussed, including habit disorders, speech disorders, eating disorders, sleep disorders, personality disorders, and anxiety disorders. Specific behavioral disorders like enuresis, encopresis, nail biting, thumb sucking, pica, anorexia nervosa, bulimia nervosa, somnambulism, sleep talking, nightmares, stuttering, and school phobia are then defined and their causes, signs/symptoms
2. INTRODUCTION
Normal children are happy, healthy and well
adjusted. This adjustment is developed by
providing basic emotional needs along with
physical and psychological needs for their mental
well -being. The emotional needs are considered
as emotional food for healthy environment. Major
behavioural problems are significant deviation
from socially accepted normal behaviour.
3. DEFINITION
Behavioural problems include disorders that
represents significant deviation from the normal
behaviour. The root of the problem usually is
traceable to the home or school environment
7. 1. ENURESIS
The word derived from the Greek word
“enourein” means “to void urine”. It can
either during the day or at night.
Enuresis is a disorders of involuntary
micturition in children who are beyond the
age when normal bladder control should
have been required.
It is common during 4 years to 1 years
age.
9. CAUSES
Faulty or defects in toilet training
Overactive bladder
Feeling of shame and guilt
Emotional atmosphere
Organic causes like UTI
10. SIGN AND SYMPTOMS:
Wetting during the day
Frequency urgency, or burning
urination.
Straining, dribbling, or other
unusual symptoms with urination
Cloudy or pinkish urine
11. MANAGEMENT
The home condition, socioeconomic status and
habits of the family should be found out.
Child parent relations should be explored.
Analysis of the time of bed wetting frequency
and relation to sleep should be done.
Restriction of flid intake in the evening and
helping the child in developing the habit of
passing urine before going to the bed.
12. 2. ENCOPRESIS
Encopresis refers to passage
of feaces into inappropriate
place at any age when bowel
control should have been
established.
13. CAUSES:
Anatomic abnormality
Emotional disturbances
Improper toilet training
Stress in school activity
Overprotection
Fear related to toilet
Poor parent child bonding.
14. SIGN AND SYMPTOMS:
Withhold defecation
Distended abdomen
Diarrhoea related to irritation of
GI tract
Tensed feeling
Aggressiveness
15. DIAGNOSTIC
EVALUATION:
History of bowel elimination
Physical examination
Detail about pattern of current
toilet practice
MANAGEMENT
-Establish regular bowel
habits
-Reassurance and help from
psychologist for counselling
of child and parents.
16. 3. NAIL BITING
Nail biting is bad oral
habit especially in
school-age children
beyond 4 years of age(5
to 7 years)
17. Persistent nail biting may be incidicative of emotional problem.
Psychosomatic
Sign and symptoms
Rotation
Alteration of incisal edge or incisor
Inflammation of nail bud
Management
The child’s hand to be kept busy with creative activities or play.
Punishment to be avoided.
The child should be praised for well kept hand by breaking the
habit to maintain self -confidence.
ETIOLOGY
19. CAUSES
Emotional
insecurity.
Feeling of isolation
Boredom
Stress
MANAGEMENT
Positive reinforcement
Identify the real issue and provide
comfort.
Do not scold the child
Offer gentle reminders
21. 1.PICA
PICA is characterized by an appetite for
substance largely non- nutritive and the
habit must persist for more than one
month, at an age when eating such objects
is considered developmentally
inappropriate.
22. CAUSES
Associated with mental retardation.
Iron deficiency and vitamin deficiency
Mineral deficiency
Maternal deprivation
Family issues
Parental neglect
Poverty
23. SIGN AND SYMPTOMS
Children are often anaemic
Minera and vitamin deficiencies
Intestinal and parasitic infestation are generally
associated
25. 2. ANOREXIA NERVOSA
It is a characterized by voluntary refusal
to eat, significant weight loss, a
pronounced disturbance of body image.
26. CAUSES
Neurotransmitter
disturbances
Deficit ego development
Familial conflicts.
CLINICAL FEATURES
Extreme wight loss
Intense or irrational fear of
weight gain
Distorted body image
Hypothermia
Cardiac dysrhythmia
Cold intolerance
27. MANAGEMENT
Nutritional counselling by a dietician regarding
healthy eating habits and balanced diet
Individual therapy
Family therapy
Enhancement of self esteem
28. 3. BULIMIA NERVOSA
It is a disorder of binge eating, where the
individual consume the large amount of
food with lack of control followed by the
various compensatory behaviours.
29. CAUSES:
Family history of
depression
Substance abuse
Eating disorders
Sports career in
which body weight
should low.
SIGN AND SYMPTOMS
Intense fear of getting fat
Binge eating stops when
abdominal discomforts
occurs
Self -induced vomiting.
Fasting or excessive exercise.
32. 1.Somnambulism
This is a common sleep disorder. It is also
called sleep walking. In this condition,
children are aware of the environment
during the episode but are indifferent to it.
33. MANAGEMENT:
Locking the doors and windows of the
room in which the child is sleeping.
Removing all the dangerous objects
and corrections of superstitions.
Provide small doses of diazepam in
advanced cases.
34. 2. Sleep talking(smililoquy)
It is sleep-disorder, in which child talks
during sleep.
These children talk irregularly and give the
gaps same like conversations.
Parents when observe they feels that child is
talking with somebody.
35. CAUSES:
Children who are having
incomplete talk during the day
time by the influence of
parents.
Stress and anxiety
Childrens who are having the
conflicts with siblings and
school mates.
Children who have more
feeling of the home sickness.
MANAGEMNET:
Always sleep with these children
and assure them they are with
them.
Satisfy the child’s need
Resolve the child’s conflicts
Don’t show any movie or story
video before sleep
Give comfortable environment for
sleep
36. 3. NIGHT MARES AND NIGHT
TERRORS
In this disorders, child awakens due to
frightening bad dream and child conscious
about surroundings, night mares associated
with dreams.
37. MANAGEMENT
Child should have light diet in dinner and pleasant
scene and stories at bed time.
Comforted the child and reassured him physically
and verbally
Sitting at the bed side until the child feel secure and
is ready to go back to sleep
39. 1.SLUTTERING AND STAMMERING
Stammering is also known as sluttering.
It is a speech disorder in which the flow is
disrupted by involuntary repetitions and
prolongation of sounds, words and
syllables. Also there is involuntary silent
pause or blocks.
40. CAUSES:
Developmental
factors
Neurogenic
factors
Psychological
factors
SIGN AND SYMPTOMS:
Interruption in the flow of speech
Prolongation and repetition of words
Child may have hesitation
Problems in starting a word or phrase
Speech may come out in spurts
Trembling lips and jaws when trying to
talk.
Interjection of ‘uhm’ used more frequently
before attempting to utter
41. MANAGEMENT:
Behaviour modification and relaxation therapy to resolve
conflict and emotional stress.
Child should be reassured and helped in breath control
exercise and speech therapy.
Parents need counselling to rationalize their expectations
of child’s achievement according to the potentiality.
These children have normal or high IQ level, so they need
encouragement and guidance.
44. School phobia
It is a refusal to go to school or to stay in school
without any attempts to conceal.
It is a emotional disorders o the children who are afraid
to leave the parents especially mothers.
School phobia is also called school refusal
46. SIGN AND SYMPTOMS
High level of anxiety
Headache
Nausea
Abdominal pain and palpitations
47. MANAGEMENT:
Habit formation for regular school
attendance
Play session and other recreational
activities
Improvement of school environment
Family counselling
49. Nurse play a vital role for
prevention, early identification and
management of behavioural disorders
in children.
Assessment of specific problems of
the child by appropriate history and
detection of the responsible factors.
Informing the parents and making
them aware about the causes of
behavioural
50. Problems of particular child.
Assisting the parents, teachers
and family members for
necessary modification of
environment at home school
community.
Encouraging the child for
behaviour modification as
needed.
51. Promoting healthy emotional
development of child by
adequate physical, psychological
and social support.
Creating awareness about
psychological disturbances which
may lead to behavioural
problems during developmental
stages.