This document discusses common behavioral problems in children and their management. It covers problems such as feeding issues, sleep problems, habit disorders, speech problems, emotional problems, and antisocial behaviors. Potential causes are faulty parenting, family environment, medical conditions, and media influence. Management involves treating any underlying causes, behavior modification, counseling, and speech/occupational therapy as needed. The document provides examples and treatment approaches for specific issues like temper tantrums, breath holding spells, nail biting, and pica.
Play in Children or Play Therapy (Importance of Play, Functions of Play, Age-Related Play, Categories of Play, Types of Play, Selection, Safety and Guidelines)..
Play in Children or Play Therapy (Importance of Play, Functions of Play, Age-Related Play, Categories of Play, Types of Play, Selection, Safety and Guidelines)..
An overview of Child Welfare Services (ICDS, Mid Day Meal Program, Balwadi Program, Anganwadi Program, Day Care Center's and New Parent Support Program)..
COMMON BEHAVIORAL PROBLEMS AND THEIR MANAGEMENT in PEDIATRICSRitu Gahlawat
Childhood is the period of dependency. Gradually, children learn to adjust in the environment.
But when, there is any complexity around them they cannot adjust with that circumstance. Then they become unable to behave in the socially acceptable way and behavioral problems develop with them.
Normal children are healthy, happy and well-adjusted.
Every child should have tender loving care and sense of security about protection from parent and family members.
They should have opportunity for development of independence, trust, confidence and self-respect.
Parents should be aware about achievements of their children and express acceptance of positive attitude within the social norms.
Behavioral problems always require special attention.
Sometimes children show a wide variety of behaviors which create problems to the parents, family members and society. Most of the problems are minor and do not have any permanent disturbances but produce anxiety to the parents.
During infancy feeding problems often develop at the time of weaning.
Infant may refuse new foods due to dislike of taste or due to separation anxiety from mother.
It may be due to forced feeding by the mother or may be due to indigestion of new food and abdominal colic.
The infant may have painful ulcer in the mouth or sore throat causing difficulty in swallowing.
There may be nasal congestion or any other pathological cause which need to be excluded.
Mothers usually become frustrated and anxious with this situation, so they need reassurance and guidance in rescheduling the feeding time and change of food items.
Problems like mouth ulcer, sore throat, nasal congestion or any other conditions to be treated accordingly.
Mother should be encouraged to provide tender loving care to her infant and to avoid separation.
Abdominal colic is an important cause of crying in the children.
Some infants may cry continuously for variable periods.
This problem usually starts within the first week after birth, reaches a peak by the age of 4 to 6 weeks and improves after 3 to 4 months.
The infants may cry loudly with clenched fists and flexed legs.
The cause of this colic is not clearly understood. It occurs commonly in overactive infants who are overstimulated by parents.
It can be due to hunger, or improper feeding technique or physiological immaturity of the intestine or cow's milk allergy or aerophagy.
Excessive carbohydrate in food may lead to intestinal fermentation and accumulation of gas which may cause abdominal distension and pain.
Abdominal colic of the baby increases anxiety and tension of the mother.
Baby should be placed in upright position and burping can be done to remove swallowed air.
Psychological bonding with infant must be improved.
Antispasmodic drugs may be administered to relief the colic.
Frequent small amount feeding and modification of feeding technique are very important.
CHILDHOOD BEHAVIORAL DISORDERS AND ITS MANAGEMENT: AGE AND NATURE: INFANCY , ...Manisha Thakur
CHILDHOOD BEHAVIORAL DISORDERS AND ITS MANAGEMENT: AGE AND NATURE: INFANCY , TODDLERS , ADOLESCENCE: SPEECH DISORDERS: SOMNAMBULISM, SOMNILOQUY. EATING DISORDERS: ANOREXIA NERVOSA AND BULIMIA. MOVEMENT DISORDERS: TICS. SPEECH DISORDERS: STUTTERING, CLUTTERING, STAMMERING. DISORDERS OF TOILET TRAINING: ENURESIS, ECOPRESIS. DISORDERS OF HABIT: TEMPER TANTRUM, BREATH HOLDING SPELLS, THUMB SUCKING, NAIL BITING. ADHD, SCHOOL PHOBIA, STRANGER ANXIETY.
An overview of Child Welfare Services (ICDS, Mid Day Meal Program, Balwadi Program, Anganwadi Program, Day Care Center's and New Parent Support Program)..
COMMON BEHAVIORAL PROBLEMS AND THEIR MANAGEMENT in PEDIATRICSRitu Gahlawat
Childhood is the period of dependency. Gradually, children learn to adjust in the environment.
But when, there is any complexity around them they cannot adjust with that circumstance. Then they become unable to behave in the socially acceptable way and behavioral problems develop with them.
Normal children are healthy, happy and well-adjusted.
Every child should have tender loving care and sense of security about protection from parent and family members.
They should have opportunity for development of independence, trust, confidence and self-respect.
Parents should be aware about achievements of their children and express acceptance of positive attitude within the social norms.
Behavioral problems always require special attention.
Sometimes children show a wide variety of behaviors which create problems to the parents, family members and society. Most of the problems are minor and do not have any permanent disturbances but produce anxiety to the parents.
During infancy feeding problems often develop at the time of weaning.
Infant may refuse new foods due to dislike of taste or due to separation anxiety from mother.
It may be due to forced feeding by the mother or may be due to indigestion of new food and abdominal colic.
The infant may have painful ulcer in the mouth or sore throat causing difficulty in swallowing.
There may be nasal congestion or any other pathological cause which need to be excluded.
Mothers usually become frustrated and anxious with this situation, so they need reassurance and guidance in rescheduling the feeding time and change of food items.
Problems like mouth ulcer, sore throat, nasal congestion or any other conditions to be treated accordingly.
Mother should be encouraged to provide tender loving care to her infant and to avoid separation.
Abdominal colic is an important cause of crying in the children.
Some infants may cry continuously for variable periods.
This problem usually starts within the first week after birth, reaches a peak by the age of 4 to 6 weeks and improves after 3 to 4 months.
The infants may cry loudly with clenched fists and flexed legs.
The cause of this colic is not clearly understood. It occurs commonly in overactive infants who are overstimulated by parents.
It can be due to hunger, or improper feeding technique or physiological immaturity of the intestine or cow's milk allergy or aerophagy.
Excessive carbohydrate in food may lead to intestinal fermentation and accumulation of gas which may cause abdominal distension and pain.
Abdominal colic of the baby increases anxiety and tension of the mother.
Baby should be placed in upright position and burping can be done to remove swallowed air.
Psychological bonding with infant must be improved.
Antispasmodic drugs may be administered to relief the colic.
Frequent small amount feeding and modification of feeding technique are very important.
CHILDHOOD BEHAVIORAL DISORDERS AND ITS MANAGEMENT: AGE AND NATURE: INFANCY , ...Manisha Thakur
CHILDHOOD BEHAVIORAL DISORDERS AND ITS MANAGEMENT: AGE AND NATURE: INFANCY , TODDLERS , ADOLESCENCE: SPEECH DISORDERS: SOMNAMBULISM, SOMNILOQUY. EATING DISORDERS: ANOREXIA NERVOSA AND BULIMIA. MOVEMENT DISORDERS: TICS. SPEECH DISORDERS: STUTTERING, CLUTTERING, STAMMERING. DISORDERS OF TOILET TRAINING: ENURESIS, ECOPRESIS. DISORDERS OF HABIT: TEMPER TANTRUM, BREATH HOLDING SPELLS, THUMB SUCKING, NAIL BITING. ADHD, SCHOOL PHOBIA, STRANGER ANXIETY.
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2. “Whenchildren cannot adjust to a complex environment
around them, theybecome unableto behave in thesocially
acceptable way resultingin exhibitionof peculiar behaviors
and this is called as BehavioralProblems”
18. MANAGEMENT
Assurance and Guidance in rescheduling thefeeding.
Treat mouthulcers, sore throat, nasalcongestion or any
other conditions to be treated accordingly.
Mother should be encouraged to provide tender loving care
to the infantand to avoid seperation.
21. RISKFACTORS/ CAUSES
a) Overactive infants whoare stimulatedby parents.
b) Hunger.
c) Improper feedingtechnique.
d) Physiological immaturityof the intestine.
e) Accumulationof gas
22. MANAGEMENT
a) Baby should be placed in upright position and burping can be done to
remove swallowed air.
b) Psychological bonding with infant to be improved.
c) Antispasmodic drugs (Dicyclomine Infants >6 months:
5 mg PO q6-8hr; not to exceed 20 mg/day PO )
may be administered to relief the colic.
d) Frequent small feeds and modification of feeding technique are
important.
e) Abdominal colic of the baby increases anxiety and tension of the
mother, she requires explanation andhelp of solving problems.
27. DEFINITION
“From theage of18 monthsto3years, thechildbeginstodevelop
autonomyand starts separatingfromprimary caregivers.
When they can’texpress theirautonomythey becomefrustrated
and angry.
Some ofthemshow theirfrustrationwithphysical aggressionor
resistancesuch as biting,crying, kicking,throwing objects,hitting
and head banging.This kindofphysical aggressivebehavior is
known asTemper Tantrum.”
30. MANAGEMENT
Temper tantrums often cease with age.
Remove over protection and faulty parental attitude
During anattack,the child should be protected from injuring himself
and the others.
Deviating his attention from the immediate cause and changingthe
environment can reduce the tantrum
31. Parents should be calm, loving, firm and consistent and suchbehavior
should not allow the child to takeadvantage of gainingthings.
Some temper tantrums result from the child’s frustration at failing to
master a task.These canbe managed by distracting the child and
permitting success in more manageable activity.
Ignoring is an effective way to avoid reinforcing tantrums although
young children should be held till they regain control.
“Time out procedure”- In using time out procedure, parents should
not attempt to inflict a fixed number of minutes of isolation. The goal
should be to help the child develop self regulation.
33. DEFINITION
“Breath holdingspells are reflexive events in whichtypically
there is a provoking event thatcauses anger, frustrationand
child starts to cry. The crying stops at fullexpiration whenthe
child becomes apnoeic and cyanotic or pale.”
34. INCIDENCE
Seen in4-5 % of pediatric population
Commonin the children of age group 1-5 years of age.
Beginsbefore 18 monthsof age.
Commonin girls and thosefrom lower social class and
nuclear families.
35. SIGN AND SYMPTOMS
It is observed in response to the frustration or anger during disciplinary
conflict. The child is found with
• Violent crying
• Hyperventilation
• Sudden cessation of breathing on expiration
• Cyanosis & rigidity
• Look pallor & life less
• Bradycardia
• Spasm of laryngeal muscles
The attack last for one or two minutes, then glottis relaxed and
breathing resumed with no residual effects.
36. MANAGEMENT
Parentsneeds assurance aboutthe harmless effectsof the
attackand should be tolerant, calm and kind.
Identificationand correction of precipitating factors
(emotional, environment) are essentialapproach.
Overprotective natureof parents may increase unreasonable
demand of the child.
37. Punishmentis not appropriate and may causes another
episodes. Repeated attackof the spells need to be evaluate
withcareful history, physical examinationsand necessary
investigationsto evaluate convulsive disorder or any other
problems.
38. TREATMENT
Attentionmust be directed to coexisting iron deficiency
anaemia,if any and prompt treatmentoffered for its
correction.
Very frequentlyoccurring BHSs may respond to atropine
sulphate,0.01 mg thrice a day.
Response to Piracetam(appears to reduce
erythrocyte adhesion to vascular
endothelium, hinder vasospasm, and
facilitate microcirculation”),an expensive agent,
too is gratifying.
39. PROGNOSIS
As thechildgrows, frequency of spells decreases. Finally
almost all such children are symptom free by the age of 5 or
6.
Incidence of temper tantrumand other behavioural disorder
children is high.There is no evidence thatepilepsy occurs in
greater portion in themthanin the normal population.
42. THUMBSUCKING NAILBITING
Thumb sucking is defined as the habit
of putting thumb into the mouth most
of the time. It usually involves placing
the thumb into the mouth and
rhythmically repeating sucking contact
for a prolonged duration
NAILBITING is a phenomenon
demonstrated by children beyond 4
years of age.It may continue to up to
adolescence and evenin later life.
43. CAUSES
Kindof insecurity.
Conflictor hostility.
Draws a sense of pleasure from such self-stimulations.
A gratifying action especially under unpleasantand
unsatisfyingfeedingsituation.
46. SPEECH PROBLEMS
Speech problems are common in
childhood. These can be found as
disturbance of voice(pitch disorder),
articulation (baby talk) and fluency.
47. CAUSES
Hearing defect
Cleftlip Cleftpalate
Facial and bulbar Paralysis etc.
EmotionalDeprivation
48. STUTTERING / STAMMERING
Stuttering or stammering is a defect in
speech characterized by interruptions in the
flow of speech, hesitations, spasmodic
repetitions and prolongation of sounds
specially of initial consonants.
It is a fluency disorder begins between 3-5
years
50. RISKFACTORS
More inboys with fear.
Timid personality
Positive familyhistory of language& speech difficulty.
51. SIGN AND SYMPTOMS
Interruption in the flow of speech.
Hesitations.
Spasmodic repetitions.
Prolongation of sounds specially of initial
consonants.
52. MANAGEMENT
Behavior modification.
Relaxation therapy.
Parents need counseling.
Breath control exercises and speech
therapy
Fluency Shaping Therapy
Stuttering Modification Therapy
53. CLUTTERING
Cluttering is a speech and communication
disorder characterized by unclear and
hurried speech in which words tumble
over each other.
There are awkward movements of hands,
feet, and body.
These children have erratic and poorly
organized personality and behavior
pattern
55. DELAYED SPEECH
Delayed speech beyond 3 to 3.5years can
be considered as organic causes like
Mental Retardation, Infantile autism,
hearing defects or several emotional
problems.
58. MANAGEMENT
Structural abnormalities should be treated.
Speech therapy should be done adequately.
In absences of structural abnormalities, the
responsible emotional disorder or factors
should be ruled out.
Guidance and counselling.
Parents should be informed about the
modification of family environment and
correction of deprivation
60. PICA
Pica is a habit disorder of eating non edible
substances such as clay, paint, chalks,
pencil, plaster from wall etc.
61. Causes
Parentalneglect, poor attentionof thecaregiver, inadequate
love and affection,mentalhealthconditions like mental
retardation and OCD etc.
Nutritionaldeficiencies.
Children of poor socio economic statusfamily,malnourished
and mentallysubnormal children.
63. DIAGNOSIS
Blood investigations
According to the Psychiatric classification, a
person is said to have pica, only if:
a) Persistent eating of non nutritive substances for
a period of at least one month.
b) Does not meet the criteria for either having
autism, schizophrenia, or Kleine-Levin
syndrome.
c) The eating behavior is not culturally sanctioned.
d) If the eating behavior occurs exclusively during
the course of another mental disorder.
64. TREATMENT
Treatment of the deficiencies.
Parental counseling.
Education and guidance
Behavior modification
Psychotherapy
66. Sleep disorder are common in children with
anxiety, tension & over activity. These
problems are present with or without
physical symptoms of behavioural
disorders.
67. SOMNAMBULISM
Walking and carrying out complex activities
during the state of sleep is termed as
Somnambulism.
Child moves aimlessly during the sleep.
68. INCIDENCE
It is more common in boys.
It is seen in 5-8 % of children in the age of
5-12 years.
70. MANAGEMENT
Plan for scheduled awakenings
Room should be free from dangerous
articles.
Provide comfortable environment.
Parents need to be educated and
counseled regarding the disease.
76. SCHOOLPHOBIA
Definition
“School phobia is persistent and abnormal
fear of going to school.”
It is emotional disorder of the children who
are afraid to leave the parents, especially
mother and prefer to remain at home and
refuse to go to school profusely.
77. SIGNS AND SYMPTOMS
Recurrent physical
complaints like
abdominal pain
Headaches which
subside if allowed to
remain at home.
78. MANAGEMENT
Habit formation.
Improvement of school environment.
Assessment of health status of the child to
detect any health problems for necessary
interventions.
Family counseling.
Behavior techniques.
80. ENURESIS
DEFINITION
Enuresis is a disorder of involuntary
micturition in children who are beyond the
age when normal bladder control should
have been acquired.
Enuresis refers to the wetting of one’s
clothes or one’s bed past the age of 3
years.
81. INCIDENCE
It is common during 4 years to 12 years
age group.
Studies suggest that 2.5 % in the age
group of 0-10 years have enuresis and at
age 5, it is 7 % for males and 3 % for
females.
85. INVESTIGATIONS
Full medical history
Genital and neurological examination
Urinalysis for albumin, sugar, microscopy,
and culture
If the child has UTI, he should be further
evaluated by USG, cysto urethrogram and
uro dynamic studies
95. TREATMENT
Pharmacotherapy –
Haloperidol is the drug of choice.
In severe cases, pimozide or clonidine
can be used.
Antipsychotics (blocks dopamine
receptors)
Benzodiazepines to reduce anxiety
Serotonin reuptake inhibitors.
96. NON-PHARMACOLOGICAL
• Behavior therapy may be used.
• Parents and the family should be
educated and counseled about course of
disorder and spontaneous re-solvement of
disorder.
• Relaxation exercises have proven
efficacy.
• Awareness training.
97.
98. TYPES
CLASS I: INATTENTION + HYPERACTIVITY +
IMPULSIVENESS.
CLASS II: HYPERACTIVITY + IMPULSIVENESS
CLASS III: INATTENTION
102. NURSING INTERVENTION
Develop a trusting relationship with the child.
Ensure safe environment.
Offer recognition for successful attempts and positive reinforcement.
Provide information and materials related to the child’s disorder and
effective parenting techniques.
Explainand demonstrate positive parenting techniques
Coordinate overall treatment plan with schools, collateral personnel and
the family.
105. ANOREXIA NERVOSA
Definition
Anorexia Nervosa is a eating disorder
found as a refusal of food to maintain
normal body weight by reducing food
intake, especially fats and carbohydrates.
The core psycho pathological feature is the
dread of fatness, weight phobia and a drive
for thinness.
110. DEFINITION
Bulimia nervosa is characterized by
episodes of binge eating followed by
feelings of guilt, humiliation, depression and
self condemnation
111. ETIOLOGY
More common in first degree, biological relatives
of people with bulimia.
Specific areas of chromosome 10p linked to
families with a history of bulimia
Possible role of serotonin levels in brain.
Society’s emphasis on appearance and thinness.
Family disturbances or conflict.
Sexual abuse.
Learned maladaptive behavior.
Struggle for control or self identity.
115. According to Dr. Sethna, Juvenile
delinquency involves wrong doing by a
child or a young person who is under an
age specified by the law of the place
concerned.
A juvenile delinquent is a person who is
below 16 years of age (18 years in case
of a girl) who indulges in antisocial
activity.
117. MANAGEMENT
Reform of Juvenile Delinquents
Probation
Reformatory Institutions
Psychological Techniques
a. Play Therapy
b. Finger Painting
c. Psychodrama
