Nursing profession good knowledge

1. BEHAVIOURAL PROBLEMS AND
NUTRITIONAL PROGRAMMES IN
INDIA
GUIDED BY,
MRS GRACE MANE
HOD CHILD HEALTH NURSING
INE MUMBAI
PRESENTATION BY,
CHARUTA KUNJEER
1ST YEAR MSC STUDENT
INE MUMBAI

2. #General objectives:
At the end of the class students will be able to gain in-
depth knowledge regarding behavioral problems in
children and national nutritional programme.
#Specific objectives:
1. To define behavioral disorder.
2. To explain types of behavioral disorders.
3. To enlist causes of each behavioral disorders.
4. To discuss management of each behavioral
disorder.
5. To elaborate National Nutritional Programme in
India.

3. INTRODUCTION
Normal children are healthy, happy and well
adjusted. This adjustment is developed by
providing basic emotional needs along with
physical and physiological needs for their mental
well-being. The emotional needs are considered as
emotional food for healthy behavior. The children
are dependent on their parents, so parents are
responsible for fulfillment of the emotional needs.

4. But when, there is any complexity around them
they cannot adjust with that circumstances. Then
they become unable to behave in the socially
acceptable way and behavioral problems develop
with them. Sometimes children show a wide
variety of behaviors which create problems to the
parents, family members and society.

5. Most of the problems are minor and do not have
any permanent disturbances but produce anxiety
to the parents. Major behavioral problems are the
significant deviations from socially accepted
normal behavior. These problems are mainly due
to failure in adjustment to external environment
and presence of internal conflict. Behavioral
problems always require special attention.

6. CAUSES OF BEHAVIOURAL
DISORDERS

7. 1.Faulty Parental Attitude:
• Overprotection,
• dominance,
• unrealistic expectation,
• over criticism,
• unhealthy comparison,
• under-discipline or over
discipline,
• parental rejection,
• disturbed parent-child inter
action,
• broken family (death, divorce),
etc. are responsible factors for
development of behavioral
problems.

8. 2.Inadequate Family Environment
• Poor economical status,
• cultural pattern,
• family habits,
• Child rearing practices,
• superstition,
• parent's mood and job
satisfaction,
• parental illiteracy,
• inappropriate relationship
among family members, etc.
influence on child's behavior and
may cause behavioral disorders.

9. • Mentally and Physically Sick or Handicapped
Conditions Children with sickness and disability
may have behavioral problems, Chronic illness
and prolonged hospitalization can lead to this
problem.

10. 3.Influence of Social
Relationship
• Maladjustment at home and
school,
• disturbed relationship with
neighbors,
• school teachers,
• schoolmates and playmates,
• favoritism, punishment, etc.
may predispose behavioral
problems.

11. 4.Influence of Mass Media
• Television, radio periodicals and high-tech
communication systems affect the school
children and adolescence leading to conflict and
tension which may cause behavioral disorder.

12. 5.Influence of Social Change
• Social unrest, violence, unemployment, change in
value orientation, group interaction and hostility,
frustration, economic insecurity, etc. affect older
children along with their parents and family
members resulting abnormal behavior.

13. BEHAVIORAL PROBLEMS
IN CHILDREN

14. • Feeding problems -Food fad, food refusal,
overeating, impaired appetite, pica, anorexia
nervosa, bulemia-nervosa.
• Habit disorders -Thumb sucking (finger
sucking), nail-biting, enuresis, encopresis, tics,
breath holding spell, bruxism (teeth-grinding),
rolling and head banging.
• Sleep problems -Sleep walking
(somnambulism), sleep talking (somnoloquy),
night terrors, nightmares, insomnia,
hypersomnia, narcolepsy, cataplexy.

15. • Educational difficulties -School phobia,
truancy, repeated failure, school absentism,
hyperactive attention deficit disorders.
• Adjustment problems -Disobedience,
misconduct, tem per tantrum. & Emotional
problems-Negativism, jealousy, shyness, fear ,
anger, anxiety, timidity.
• Antisocial problems -Delinquency,
destructive attitudes, kleptomania (compulsive
stealing), substance abuse, drug addicts.

16. • Sexual problems -Masturbation, precocious
sexuality, homosexuality, hyper-sexuality ,
incest, sexual assault, etc.

17. BEHAVIORAL PROBLEMS OF
INFANCY

18. Manifestations of behavioral problems
during infancy :
• Resistance to feeding or impaired appetite,
• Abdominal colic,
• Stranger anxiety,
• Resistance to parental interference to explore
environment and vomiting as attention seeking
behavior in disturbed parent-child relationship.

19. Resistance to Feeding or impaired
Appetite
• 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.

20. • 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.

21. • Mothers usually become frustrated and anxious
with this situation, so they need reassurance and
guidance rescheduling the feeding time and
change of food items.
• Problems like mouth ulcer, sore throat, nasal
congestion of any other conditions to be treated
accordingly.
• Mother should be encouraged to provide tender
loving care to her infant and to avoid separation

22. Abdominal Colic
• 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.

23. • 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

25. • Managing it with : She required explanation and
help for solving the problem.
• Baby should be placed in upright position and
burping can be done to remove swallowed air.
• Psychological bonding with infant to be improved.
• Presence of any organic cause to be excluded and
necessary management to be arranged.
• Antispasmodic drugs may be administered to relief
the colic.
• Frequent small amount feeding and modification of
feeding technique are very important

26. Stranger Anxiety (Separation Anxiety)
• Mother is significant
person during infancy for
satisfaction of needs,
feeling of comfort,
pleasure and security.
• The infant does not belief
any other persons except
mother, because they
have trust relationship
with mothers only.

27. • In absence of mother, if any
new person approaches, the
child will start crying due to
feeling of insecurity, fear and
anxiety.
• This crying may upset the
parent, but it is an indication
that parent have done a
great job in the emotional
development of the infant by
deep mother-child or parent-
child bondage.

28. • Separation anxiety is a vital steps of emotional
development and may continue up to 13 to 15
months of age.
• This anxiety usually reduced when the strangers
gradually approach from distance in a familiar
place specially in presence of the mother or
father.
• In absence of parents, loving concern of the
stranger is very important.

29. BEHAVIORAL PROBLEMS OF
CHILDHOOD

30. Temper Tantrums
Temper tantrum is a
sudden outburst or
violent display of
anger, frustration and
bad temper as physical
aggression or resistance
such as rigid body,
biting, kicking, throwing
objects, hitting, crying,
rolling on floor,
screaming loudly,
banging limbs, etc.

31. • Temper tantrum occurs in maladjusted children.
The activity is directed towards the environment
not to any person or anything.
• It is normal in toddler, may continues to
preschool period and become more severe
indicating the low frustration tolerance.
• It is found usually in boys, single child and
pampered child.

32. • Temper tantrum occurs
when the child cannot
integrate the internal
impulses and the demand of
reality.
• The child become frustrated
and reacts in the only ways
he/she knows i.e. by violent
bodily activity and crying,
using great deal of muscular
activity and striking out
against environment. When
no substitute solution is
available temper tantrum
result.

33. If temper tantrum continues,
• The child needs professional help from child
guidance clinic.
• Parent should be made aware about the beginning of
temper tantrum and when the child loses control.
• Parent should provide alternate activity at that
time.
• Nobody should make fun and tease the child about
the unacceptable behavior.
• Parent should explain the child, that the angry
feeling is normal but controlling anger is an
important aspect of growing up.
• The child should be protected from self-injury or
from doing injury to others.

34. • Physical restraint usually increase frustration
and block the outlet of anger.
• Frustration can be reduced by calm and loving
approach.
• Overindulgence should be avoided.
• After the temper tantrum is over the child's face
and hands should be washed and play materials
to be provided for diversion.
• The child's tension can be released by vigorous
exercise and physical activities.
• Parents must be firm and consistent in behavior.

35. Breath-holding Spell
• Breath holding spell may occur in children
between 6 months to 5 years of age.
• It is observed in response to frustration or anger
during disciplinary conflict.
• The child is found with violent crying,
hyperventilation and sudden cessation of
breathing on expiration, cyanosis and rigidity.
• Loss of consciousness, twitching and tonic-
clonic movements may also be found.
• The child may become limp and look pallor and
lifeless.

36. • Heart rates become slow.
• There may be spasm of laryngeal
muscles.
• This attack last for one or two
minutes, then glottis relaxed and
breathing resumed with no
residual effects.
• Parents and family members
become very anxious with the
attack.
• Attempt to prevent the spells is
usually not successful.
• Parents need assurance about the
harmless effects of the attack and
should be tolerant, calm and kind.

37. • Identification and correction of precipitating factors
(emotional, environmental) are essential approach.
• Over protective nature of parents may increase
unreasonable demand of the child.
• The child can use secondary gain as advantages.
• Punishment is not appropriate and may cause
another episodes.
• Repeated attacks of the spells need to be evaluated
with careful history, physical examination and
necessary investigations to exclude convulsive
disorders or any other problems.
• https://youtu.be/ISvbfwFxVeE

38. Thumb Sucking
• Thumb sucking or finger sucking is a habit
disorder due to feeling of insecurity and tension
reducing activities.
• It may develop due to inadequate oral
satisfaction during early infancy as a result of
poor breastfeeding.
• In older children, this habit may develop when
they are tired, bored, frustrated or at bed and
want to sleep, but feel lonely.

39. • If thumb sucking continues beyond 4
complications may arise as malocclusion and
maliganent of teeth, difficulty in mastication and
swallowing.
• It may cause deformity of thumb, facial
distortion and speech difficulties with
consonants (D and T) and GI tract infections.

40. • If the child develops thumb sucking at the age of 7 or
8 years, it indicates a sign of stress.
• Parents and family members need support and to be
adviced not to become irritable, anxious and tense.
Praising and encouraging child for breaking the
habit are very useful.
• Distraction during bored time or engaging the
thumb or finger for other activity to be practiced to
keep the hand busy.
• The child should not be scolded for the habit.
• Consultation with dentist and speech therapist may
be required to correct the complications.
• Hygienic measures to be followed and infections to
be treated promptly.

41. Nail Biting
• Nail biting is bad
oral habit especially
in school age
children beyond 4
years of age (5-7
years).
• It is a sign of
tension and self-
punishment to cope
with the hostile
feeling towards
parents.

42. • It may occur as imitating the parent who is also
a nail biter.
• It is caused by feeling of insecurity, conflict and
hostility.
• It may be due to pressurized study at school or
home or due to watching frightening violent
scenes.
• It may continue up to adolescence.
• The child may bite all 10 finger nails or any
specific one.
• The bite may include the cuticle or skin margins
of nail bed or surrounding tissue.

43. • Management: The cause for nail biting to be
identified by the parents with the help of clinical
psychologist and steps to be taken to remove the
habit.
• The child should be praised for well kept hand
by breaking the habit to maintain self-
confidence.
• The child's hand to be kept busy with creative
activities or play.
• Punishment to be avoided.
• Parents need reassurance and assistance to
accept the situation and to help the child to
overcome the problem.

44. Enuresis or Bed Wetting
• Enuresis is the repetitive involuntary passage of
urine at inappropriate place especially at bed,
during night time, beyond the age of 4 to 5 years.
• It is found in 3 to 10 percent school children.
• The most frequent causes are small bladder
capacity, improper toilet training and deep sleep
with inability to receive the signals from
distended bladder to empty it.

45. • The emotional factors responsible for enuresis
are hostile or dependent parent-child
relationship, dominant parent, punishment,
sibling rivalry, emotional deprivation due to
insecurity and parental death.
• The other factors include the child with
emotional conflict and tension, desires to gain
care and attention of parents as in infancy.
• Environmental factors like dark passage to toilet
or cold or fear of toilets at distances from
bedroom may cause bed wetting at night.

46. • The associated organic causes may present
eg: spina-bifida, juvenile diabetes mellitus,
seizure disorders can be excluded.
• Enuresis may be (types)
primary
secondary

47. • Primary or persistent enuresis
is characterized by delayed maturation of
neurological control of urinary bladder, when the
child never achieved normal bladder control
usually due to organic cause.
• secondary or regressive enuresis
the normal bladder control is developed for
several months after which the child again starts
bed wetting at night usually due to regressive
behavior like illness and hospitalization or due to
any emotional deprivations.

48. Management of enuresis
• depends upon the specific cause.
• Assessment of exact cause is very essential by
thorough history, clinical examination and
necessary investigations.
• The organic causes are managed with specific
treatment.
• Nonorganic causes to be managed primarily
with emotional support to the child and parents
along with environmental modification.
• The child needs reassurance, restriction of fluid
after dinner, voiding before bed time and arising
the child to void, once or twice, three to four
hours later.

49. • Interruption of sleep before the expected time of
bed wetting is essential.
• The child should be fully waken up by the parent
and made aware of passing of urine at night.
• The child can assume responsibility for changing
the bed cloths.
• Parents should not be worried about the
problem.
• Parents should encourage and reward the child
for dry nights.
• Punishment and criticism may lead to
embarrassment and frustration of the child.

50. • Bladder stretching during daytime to be done to
increase holding time of urine, using positive
reinforcement and delaying voiding for some
time.
• Drug therapy with tricyclic antidepressant
(Imipramine) are useful.
• Condition therapy by using electric alarm bell
mattress is a effective and safest method, when
the child wakes up as soon as the bed is wet.
• Supportive psychotherapy is important for Child
and parent. Changes of home environment to
remove he environmental causes are essential.

51. Encopresis
• Encopresis is the passage of feces into
inappropriate places after the age of 5 years,
when the bowel control is normally achieved. It
is a more serious form of emotional disturbances
due to unconscious anger, stress and anxiety. It
can be primary or secondary encopresis like bed
wetting. Associated problems are chronic
constipation, parental overconcern, over
aggressive toilet training, toilet fear,

53. attention deficit disorders, poor school attendance
and learning difficulties may be found with
encopresis.
• Assessment of this condition includes
history of bowel training, use of toilets and
associated problems. The child needs help in
establishment of regular bowel habit, bowel
training, dietary intake of roughage and intake
of adequate fluid. Parental support, reassurance
and help from psychologist for counseling of
child and parents may be essential in persistent
problems.

54. Pica
• Pica is a habit disorder of eating nonedible
substances such as clay, paints, chalk, pencil,
plaster from wall, earth, scalp hair, etc. It is
normal up to the age of two years. If it persists
after two years of age, it may be due to parental
neglect, poor attention of caregiver, inadequate
love and affection, etc.
• It is common in poor socioeconomic family and
in malnourished and mentally subnormal
children.

55. • Children with pica may have associated
problems of intestinal parasitosis, lead
poisoning, vitamins and minerals deficiency.
• These children may have problems like
trichotillomania (pulling out of scalp hair and
swallow) and trichobezoar (a big palpable lump
in the to collection of swallowed hair).

57. • Management of this problem is done with
psychotherapy of the child and parents.
Associated problems should be treated with
specific management.

58. Tics or Habit Spasm
• Tics are sudden abnormal involuntary movements.
It is repetitive, purposeless, rapid stereotype
movements of striated muscles, mainly of the face
and neck.
• Tics occur most often in school children for
discharge of tension in maladjusted emotionally
disturbed child.
• It is outlet of suppressed anger and worry for the
control of aggression.
• Tics can be motor or vocal tics.
• Motor tics can be found as eye blinking, grimacing,
shrugging shoulder, tongue protrusion, facial
gesture, etc.

60. • Vocal tics are found as throat clearing, coughing,
barking, sniffing, etc.
• A special type of chronic tics is found as 'Gilles
de la Tourette's Syndrome, characterized by
multiple motor tics and vocal tics.
• It seems to be a genetic disorder with onset at
around 11 years of age.
• It requires for special management with
behavior therapy, counseling and drug therapy
with haloperidol group of drug.
• Parental reassurance and counseling of the child
and parents usually useful to manage the simple
motor or vocal tics.

61. Speech Problems
• Speech disorders are common in childhood. These
can be found as disturbances of voice (pitch
disorder), articulation (baby talk) and fluency.
• Speech problems can be associated with organic
causes like hearing defect, cleft lip and cleft palate,
cerebral palsy, dental malocclusions, facial and
bulbar paralysis, etc.
• The emotional deprivations are also very significant
cause of speech disturbances.
• The common speech problems related to emotional
disorders are stuttering or stammering, cluttering,
delayed speech, dyslalia, etc.

62. Stuttering or Stammering
• Stuttering or stammering is a fluency disorders
begins between the age of 3 to 5 years probably due
to inability to adjust with environment and
emotional stress. It is characterized by interruptions
in the flow of speech, hesitations, spasmodic
repetitions and prolongation of sounds specially of
initial consonants. It is commonly found in boys
with fear, anxiety and timid personality. These
children are usually rigid and have positive family
history of language and speech difficulty.

63. • Management of stuttering includes behavior
modification and relaxation therapy to resolve the
conflict and emotional stress, thus to improve self-
confidence in the child.
• Parents need counseling to rationalize their expectations
of child's achievement according to the potentiality.
• The child should be reassured and helped in breath
control exercise and speech therapy.
• Criticism for speech problem and pressure for normal
speech make the child more handicapped.
• These children are not mentally retarded, they may have
normal or high IQ level.
• So they need encouragement and guidance.
• Stammer suppressors, psychotherapy and drug therapy
may be needed for some children.

64. Cluttering
• Cluttering is 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.
• They need psychotherapy.

65. DelayedSpeech
• Delayed speech beyond 3 to 3.5 years can be
considered as organic causes like mental
retardation, infantile autism, hearing defects or
severe emotional problems. The exact cause
must be excluded for necessary interventions.

66. Dyslalia
• Dyslalia is the most common disorder of
difficulty in articulation.
• It can be caused by abnormalities of teeth, jaw or
palate or due to emotional deprivation.
• Treatment of the structural abnormalities and
speech therapy should be done adequately.

67. • In absence of structural problems, the
responsible emotional disorders or factors
should be ruled out.
• The child need counseling.
• The parents should be informed about the
modification of family environment and
correction of deprivation.

68. Sleep Disorders
• Sleep disorders are common in children with
anxiety, tension and overactivity.
• These problems are present with or without physical
symptoms of behavioral disorders.
• Disturbances of sleep usually occur in deep sleep,
i.e. stage 3 or 4 of NREM (nonrapid eye movement)
sleep.
• The common sleep problems are difficulty to fall
asleep, night mares, night terrors, sleep walking
(somnambulism), sleep talking (somniloquism),
bruxism (teeth grinding), etc.
• In night mares, the child awakens from a frightening
bad dream and is conscious of surroundings.

69. • In night terrors, the child awakens during sleep, sits
up with screaming and terrified to recognize the
surrounding and after sometimes sleeps again.
• In all these problems, the child should have light
diet in dinner and pleasant stories or scene at bed
time. No exciting games and pictures and
frightening stories (ghost, murder, accidents) should
not be allowed at night. Parents should allow relax
comfortable bed and emotionally healthy
environment to the child. In case of sleep walking,
door and windows to be kept closed and dangerous
objects to be removed. In advanced and prolonged
problems consultation with doctors and
psychologists is essential for specific drug therapy
and psychotherapy.

70. School Phobia or School Refusal
• School phobia is persistent and abnormal fear of going to
school.
• It is common in all social group.
• It is an 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 absolutely.
• It is a symptom of crisis situation of developmental stages
and 'cry for help, which needs special attention.
• The contributing factors of school phobia are anxiety about
maternal separation, overindulgent, over protective and
dominant mother, disinterested father, intellectual disability
of the students and uncongenial school environment like
teasing by other students, poor teacher-student
relationship, unhygienic environment, fear of examination,
etc.

71. • The child may complain of recurrent physical
complains like abdominal pain, headaches,
which subside, if the child is allowed to remain
at home.
• The problem can be managed by habit formation
for regular school attendance, play session and
other recreational activities at school,
improvement of school environment and
assessment of health status of the child to detect
any health problems for necessary interventions.
• The most important aspect to manage this
problem is family counseling to resolve the
anxiety related to maternal separation.

72. Attention Deficit Disorders
• Attention deficit disorders (ADD) are learning
disabilities can be related to CNS dysfunction or due to
presence psychoeducational determinants. It is usually
associated with hyperactivity and known as hyperactive
attention deficit disorders. These children are lagging
behind in intellectual and learning abilities with
alteration of behavior patterns.
• The cause of this problem is not understood clearly, bu
predisposing factors can be prematurity or low birth
weight, demanding brain damage due to infections or
injury and interaction between genetic and psychosocial
factors. Impulsive children with poor attention span,
hyperactivity and more attitude are more likely to show
poor learning abilities.

73. • The manifestations may be combinations of reading and
arithmetic disability, impaired memory, poor language
and speech development, inappropriate understanding
of spoken words, etc. The child is usually overactive,
aggressive, excitable, impulsive and inattentive. They
may be easily frustrated, irritated and show temper
tantrums. Social relationship and adjustment are poorly
developed.
• Management is done by team approach including
pediatrician, psychologist, psychiatrist, pediatric nurse
specialist, school health nurse, teachers, social workers
and parents. The approaches of management include
behavior modification, counseling and guidance of
parents and appropriate training and education of the
child. Drug therapy can help to improve the CNS
dysfunction or other associated problems.

74. BEHAVIORAL PROBLEMS
OF ADOLESCENCE

75. Masturbation
• Masturbation or genital stimulation by handling the
genitals gives pleasure to the children. The infants and
toddlers do this out of pure curiosity. The older children
masturbate due to anxiety or sexual feelings. Boys during
teen years mostly engage with this practice. Girls may do
it to a lesser degree, though the number of these practice
is increasing in recent years. Boys may masturbate in
front of friends but girls are more private. Children may
play with each other's genitals or a child may play alone
with own.Adolescents experience sexual excitement and
erection of penis or clitoris followed by relief during
masturbation. It contributes in developing sense of
mastery over sexual impulses and help the adolescents to
capacitate and prepare for heterosexual relations.

76. • Parents should be informed, that masturbation is normal
response during prepubescent and pubescent stage and has a
role in physical and emotional development. It provides a
variety of sexual experiences. It helps in tension release and
development of sexual fantasies and future sexual behavior.
• If parents told about harmful effects of masturbation, when
the child experiences pleasure out of it, then there will be
conflict in the child, which can be associated with guilt feeling
and shame. This conflict may be expressed as physical
symptoms like severe weakness, fatigue, aches and pains and
later as neuroses with feeling of unworthiness and
maladjustment.
• In case of excessive masturbation, the child needs special
attention, facilities for recreation and diversion, sex education
and counseling. Parents should be explained to provide love,
affection and attention to the older children with specific
concern about their feelings. Punishment and threat can
exaggerate the practice. Excessive masturbation can cause
sexual maladjustment in future.

77. Juvenile Delinquency
• Juvenile delinquency means indulgence in an
offence by child in the form of premeditated,
purposeful, unlawful activities done habitually
and repeatedly. Usually these a children belongs
to broken family or emotionally disturbed family
with overcrowded unhealthy environment and
having financial or legal problems.

79. • The factors contributing to the problem are mainly :
• (a) rapid urbanization and industrialization,
• (b) social change and changing lifestyle,
• (c) influence of mass media,
• (d) change in moral standards and value systems
• (e) lack of educational opportunities and
recreational facilities,
• (f) poor economy,
• (g) unsatisfactory conditions at schools and colleges,
• (h) unhealthy student-teacher relationship and
• (i) Tack of discipline.

80. • The juvenile delinquent behavior includes lying, theft,
burglary, truancy from school, run away from home,
habitual disobedience, fights, ungovernable behavior,
mixing with antisocial gang, cruelty to animals,
destructive attitude, murder, sexual assault, etc. In a
broad sense, delinquency is not merely juvenile crime, it
includes all deviations from normal youthful behavior
and antisocial activities.
• These rebellious antisocial behavior is the protest and
response to the constant frustration, maladjustment, low
self-esteem, lack of love and affection and emotional
conflict. It is more common in boys. It is found in the
children with aggressive, dishonest, addictive, unethical,
rigid and disciplinarian parents. Children and adolescent
may involve in delinquent activities in a gang, as the part
of gang activities, just to prove their adventure and brave
nature.

81. • Prevention of juvenile delinquency is
possible by elimination of contributing factors.
• The problem of delinquent behaviors is now
increasing in India and other countries.
• Preventive measures to be emphasized by
healthy family and school environment.
• Healthy parent-child relationship, tender loving
care in the family, ful-fillment of basic needs,
educational opportunities, facilities for sports,
exercise and recreation, healthy teacher taught
relationship, etc are important aspects of
prevention.

82. • Delinquent child needs sympathetic attitude with
necessary guidance and counseling for modification
of behavior.
• The child should be referred to child guidance clinic
for necessary help.
• A team approach is necessary in management of
this condition including social workers,
psychologists, psychiatrists, pediatricians,
community health nurse, school teachers, family
members and parents.
• Modification of social environment and
rehabilitation of the delinquent child should be
promoted.

83. Substance Abuse
• Substance abuse or drug abuse is an threatening social
problem of school going and adolescence age group.
• It is periodic or chronic intoxication by repeated intake
of habit forming agents.
• It is persistent or sporadic use of drugs or any substance
inconsistent with or unrelated to acceptable medical and
social patterns within a given culture.
• The abused agents are mainly tobacco, alcohol, sleeping
pill, tranquillizers, mood elevators, stimulants, opiates,
LSD, cocaine, heroin and cannabis (bhang, ganja,
charas).

84. • The children with this behavioral disorders are
having frustration, emotional conflicts and
disturbed family and school relationship.
• They are victims of gang activities, wrong
adventure, poor parental guidance and lack of
recreation and education.
• They may involve in various antisocial activities
like stealing, shoplifting and even begging.
• The substance abuse is commonly found in
boarding public school.

86. • Preventive Measures:
• 1. Preventive measures of substance abuse include
the following:
• 2. Provision of adequate facilities for recreation and
entertainment, especially in the hostels. Proper
channelization of energies of the adolescents into
Constructive activities.
• 3. Inculcation of the dangers of drug abuse among
students, rehab their teachers and family members.
• 4. Provision of mental health program and
periodical in con psychiatric guidance facilities in
schools. Strict implementation of drug control
measures

87. • The ill effects of substance abuse to be informed
to the public through individual or group health
education or by mass media communication to
create public awareness.
• Parents, Nurse teachers and family members are
also responsible to provide emotional support to
the older children to prevent frustration, theme
conflict, confusion and mental tension.
• They should identify the addicts and arrange for
de-addiction, wherever necessary.
• The addicted children need psychotherapy, de-
addiction services and rehabilitation.

88. Anorexia Nervosa
• Anorexia nervosa is a eating disorder occurs most
often in adolescent girls.
• The problem is found as refusal of food to maintain
normal body weight by reducing food intake,
especially fats and carbohydrates.
• The affected adolescent girls practices vigorous
exercise for weight reduction or induce vomiting by
stimulating gag reflex to remain slim.
• It is a marked disturbance of body image.
• The adolescent thinks that they are fat even though
they are under weight.
• Anorexia means loss of appetite, but in this
condition the affected individual experience true
hunger though they have absolute control over their
appetite into.

90. • There is no specific organic cause of anorexia
nervosa. The affected adolescent may have
associated conditions like disease of liver, kidney,
heart or diabetes.
• Parents of the affected adolescent may be anorectic
and having conflict in relationship with the child or
overprotective which lead to development of
immaturity, isolation and excessive dependence.
• The affected individual is characterized by under
nutrition, marked weight loss, bizarre food intake
patterns, dryness of skin, hypothermia, hypotension,
bradycardia, amenorrhea, constipation, etc.
.

91. • Management of the condition include
psychotherapy, antidepressant drugs, behavior
modification and nutritional child relationship is
essential. Hospitalization may be needed 1 in
complicated cases.

92. NURSING RESPONSIBILITIES
• Assessment of specific problem of the child by
appropriate history and detection of the responsible
factors. Informing the parents and making them
aware about the causes of behavioral problems of
the particular child.
• Assisting the parents, teachers and family members
for necessary modification of environment at home,
school and community. Encouraging the child for
behavior modification, as needed.

93. • Promoting healthy emotional development of
the child by adequate physical, psychological
and social support. Creating awareness about
psychosocial disturbances which may lead to
behavioral problems during develop mental
stages.
• Providing counseling services for children and
their parents to solve the problems, whenever
necessary for tender loving care of the children.

94. • Participating in the management of the problem
child, as a member of health team along with
pediatrician, psychologist and social worker.
Organizing child guidance clinic.
• Referring the children with behavioral problems
for necessary management and support to better
health care facilities, child guidance clinic, social
welfare services and support agencies.

95. Nutritional programmes for children

96. Nutritional programmes followed in India are as:
• Vitamin A Prophylaxis Programme
• Prophylaxis Against Nutritional Anemia
• Iodine Deficiency Disorder Control Programme
• Special Nutritional Programme
• Balewadi Nutrition Programme
• ICDS Programme
• Mid Day Meal Programme

97. Vitamin a prophylaxis
Vitamin A Prophylaxis Programme:
This programme includes administration of a single
massive dose of Vitamin A containing 2 lakh IU
orally to all children under 5 years of age, every 6
months.
This programme was launched by Ministry of Health
and Family welfare in 1970.

99. Prophylaxis against nutritional anemia
National programme for prevention of nutritional
anemia was launched by Government of India during
fourth five year plan.
The programme consists of distribution of iron and
folic acid tablets to pregnant women and young
children (1-12 year of age).

101. Control of Iodine Deficiency
disorders
• lodine deficiency is world's single most
significant cause of preventable brain damage
and mental retardation. In India prevalence of
Goiter is 21.1%.
• The objective of the programme was
identification of Goiter endemic areas so as to
supply iodized salt instead of common salt to
them.

103. • In 1984, the Policy of universal sait iodization was
launched and in 1992 this programme was renamed
as National lodine Deficiency Disorders Control
Programme.
• The programme aimed to decrease overall iodine
deficiency disorder (IDD) prevalence to less than 5%
in school children between 6-12 years of age.

104. • Activities taken under the programme are as
follows:
- Surveys to assess magnitude of IDD.
- Supply of iodized salt in place of common salt.
- Laboratory monitoring of iodized salt.
- Health education and publicity.

105. Special nutrition programme
• This programme was started in 1970 for
nutritional benefit of children below 6 years of
age, pregnant and nursing mothers.
• The supplementary food supplies about 300 Kcal
and 10-12 grams of protein per child per day.
• The beneficiary mothers receive daily 500 kcal
and 25 grams of protein.
• This supplement is provided to them for about
300 days in year.
• The main aim of this programme is to improve
the nutritional status of target groups

107. Balewadi nutrition programme
• This programme was started in 1970 for the benefit
of children in the age group of 3-6 years in rural
Programme is Implemented through Balwadis which
also provides preprimary education to these children.
• The food supplement provides 300 kcal and 10 grams
of protein per child per day.

109. ICDS
• ICDS programme was started in 1975. This
programme includes supplementary nutrition, vitamin
prophylaxis and iron and folic acid tablets
distribution.
• The beneficiaries of this programme are preschool
children, adolescent girls, pregnant and lactating
mothers.

111. Mid day meal programme
• The mid-day meal programme is also known as
school lunch programme.
• It was launched in 1961 throughout the country. The
main objective of the programme is to attract more
children for admission to schools and retain them so
that literacy improvement of children can be brought
about.

113. • Guidelines for mid-day meal preparation
• Meal should be a supplement and not a substitute
to home diet.
• The meal should supply at least 1/3rd of the total
energy requirement and 1/2 of the protein needs.
• The cost of meal should be low should be easy to
prepare.
• Meal Locally available foods should be used to
reduce the cost of meal.
• Menu should be frequently changed.

114. Example (model menu)
Food stuff Gm/day/child
Cereals
Pulses
Oils and fats
Leafy vegetables
Non-leafy vegetables
75
30
8
30
30

115. Questions
• Write Short Note On:
 Pica – A Behavioural Problem
 Thumb Sucking
• Eassy Type Question:
 Define Behaviour Disorders. Enlist Various
Behavioural Disorders. Discuss One Disorder In
Detail.
 Discuss Prevention And Management Of Juvenile
Disorder.
 Enlist The Various Habit Disorders And Describe
Tics Disorder In Details.

116. BILBLIOGRAPHY
 Paraul Datta, Pediatric Nursing, Second Edition, Jaypee
Publication, Page No.177-184
Dorothy Marlow, Textbook Of Pediatric Nursing, South
Asian Edition ,Page No.
 Rimple Sharma’s, Essentials Of Pediatric Nursing,
Second, Page No.629-644
 Ghai Essentials Pediatrics, Ninth Edition, Cbs Publishers
And Distributors, Page No.
 Dr.M.Swaminathan, Food And Nutrition, The Banglore
Printing And Publications, Ltd ,Page No.175-180.
 Wongs, Essentials Of Pediatric Nursing, Eight
Edition,elsevier, Page No.554-559