Management of behavioural disoder of children
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This document discusses common behavioral disorders in children including dysfunctional behaviors, habit disorders, temper tantrums, colic, stranger anxiety, pica, breath holding spasms, stuttering, and shyness. It outlines the characteristics, potential causes, and management strategies for each disorder. Key points include that many behaviors are normal developmental phases, parental responses can reinforce behaviors, environmental factors like neglect may influence disorders, and reassuring parents while encouraging positive behaviors is important for treatment.
Management of behavioural disoder of children
- 1. COMMON BEHAVIOURAL DISORDERS IN CHILDREN
- 3. WHAT CAN AFFECT BEHAVIOUR IN A CHILD? Heredity Environment Learning Conditioning Positive reinforcements
- 4. HABIT DISORDERS 1. Repetitive Behaviors 2. Finger (thumb) sucking 3. Pica 4. Nail biting 5. Teeth grinding (Bruxism) 6. Breath holding spasms 7. Temper tantrums 8. Tics
- 5. 1. Repetitive Behaviors • Benign & self-limiting • Begin between 6 – 10 yrs – Eg. Body rocking, Head banging Head banging – In 5-20% of children during infancy & toddler years – Can result in callus formation, abrasions, contusions • Tt. – Assurance – Teach parents to ignore – as concern and punishment can reinforce it. – Padding
- 6. 2.FINGER (THUMB) SUCKING & NAIL BITING • Sensory solace for child (“internal stroking”) to cope with stressful situation in infants and toddlers. • Reinforced by attention from parents. • Predisposing factors: Developmental delay Neglect
- 7. 2.FINGER (THUMB) SUCKING & NAIL BITING • Most give up by 2 yrs • If continued beyond 4 yrs – number of squelae • If resumed at 7 – 8 yrs : sign of Stress • Adverse Effects – Malocclusion – open bite – Mastication difficulty – Speech difficulty (D and T) – Lisping – Paronychia and digital abnormalities
- 8. 2.FINGER (THUMB) SUCKING & NAIL BITING MANAGEMENT • Reassure parents that it’s transient. • Improve parental attention / nurturing. • Teach parent to ignore; and give more attention to positive aspects of child’s behavior. • Provide child praise / reward for substitute behaviors. • Bitter salves, thumb splints, gloves may be used to reduce thumb sucking.
- 9. 3.TEMPER TANTRUMS • In 18 months to 3 yr. olds due to development of sense of autonomy. • Child displays defiance, negativism / oppositionalism by having temper tantrums. • Normal part of child development. • Gets reinforced when parents respond to it by punitive anger. • Child wrongly learns that temper tantrums are a reasonable response to frustration.
- 10. 3.TEMPER TANTRUMS Precipitating factors • Hunger • Fatigue • Lack of sleep • Innate personality of child • Ineffective parental skills • Over pampering • Dysfunctional family / Family violence • School aversion
- 11. 3.TEMPER TANTRUMS – MANAGEMENT • In general, parents advised to: Set a good example to child Pay attention to child Spend quality time Have open communication with child Have consistency in behavior • During temper tantrum: Parents to ignore child and once child is calm, tell child that such behavior is not acceptable Verbal reprimand should not be abusive Never beat or threaten child Impose “Time Out” - if temper tantrum is disruptive, out of control and occurring in public place.
- 12. 4.EVENING COLIC • Intermittent episodes of abdominal pain and severe crying in normal infants • Begins at 1-2 wks age and persists till 3-4 mo. • Crying usually in late afternoon or evening • Diagnosis : “ Infant cries for > 3 hrs per day for > 3 day per week for > 3 weeks”
- 13. 4.EVENING COLIC Cause • Not known • More likely if the child is over active and parents are over anxious • Could be a manifestation of • hunger, • aerophagia, • cow’s milk intolerance, • immaturity of intestine, • overfeeding, • intake of food with high CHO content
- 14. 4.EVENING COLIC Attack • Begins suddenly with a loud cry • Crying continuous – lasts for several hours – mostly in the late afternoon or evenings • Face becomes red and legs drawn up on the abdomen • Abdomen becomes tense • Attack terminates after exhaustion or after passage of flatus or feces
- 15. 4.EVENING COLIC Management During Episode – Hold the child erect or prone – Avoid drugs – No much role to antispasmodics, carminatives, simethicone, suppositories or enemas Counseling - Coping with the parents – Reassure the parents that infant is not sick – They need to soothe more with repetitive sound and stimulate less with decrease in picking up and feeding with every cry
- 16. 5.STRANGER REACTION / ANXIETY By 6-7 months age infant can differentiate from primary care givers and others At this age they develop fear of others. This may last for a few months to peak around 13- 15 months If infant on approach of stranger behaves with more intense discomfort – such as continuous crying, vomiting, refusal to socialize : Stranger anxiety. It might be an indication for later development of behavioural problem as separation anxiety.
- 17. 5.STRANGER REACTION / ANXIETY Management: • Teach relaxation technique such as slowly exposing them to stranger, – initially from a distance – Asking them to greet and slowly advance • Reassure the parents that the behaviour gradually declines – But if persists, refer to child psychiatrist
- 18. 6.PICA Repeated or chronic ingestion of non- nutritive substances. – Examples: mud, paint, clay, plaster, charcoal, soil. • It’s an eating disorder. • Normal in infants and toddlers. • Passing phase.
- 19. 6.PICA Coprophagia: Consumption of feces Urophagia: Consumption of urine Trichophagia: Consumption of hair Xylophagia: Consumption of wood Amylophagia: Consumption of starch Hyalophagia: Consumption of glass Pagophagia: Consumption of ice Geophagia: Eating of mud, soil, clay, chalk, etc.
- 20. 6.PICA Pica after 2nd yr. of life needs investigation • Predisposing factors : Parental neglect Poor supervision Mental retardation Lack of affection Psychological neglect, orphans) Family disorganization Lower socioeconomic class Autism
- 21. 6.PICA • Screening indicated for: Iron deficiency anemia Worm infestations Lead poisoning Family dysfunction • Treat cause accordingly. • Usually remits in childhood but can continue into adolescence
- 22. 7.BREATH HOLDING SPASMS • Behavioral problem in infants and toddlers. • Child cries and then holds breath until limp. • Cyanosis may occur. • Sometimes, loss of consciousness, or even seizure can occur. • It is child’s attempt to control environment: parents /caregivers. • Benign condition: no risk of epilepsy developing in later life.
- 23. 7.BREATH HOLDING SPASMS Management: • Referral to Child Guidance Clinic: • Referral to Child Psychologist – If BHS accompanied with head banging or highly aggressive behavior
- 24. 8.STUTTERING / STAMMERING • Defect speech • Stumbling and spasmodic repetition of some syllables with pauses • Difficulty in pronouncing consonants • Caused by spasm of lingual and palatal muscles
- 25. 8.STUTTERING / STAMMERING • Usually begins between 2 – 5 yrs. • Reminding and ridiculing aggravate • Child loses self confidence and become more hesitant • They can often sing or recite poems without stuttering
- 26. 8.STUTTERING / STAMMERING Management: • Parents should be reassured • They should not show undue concern and accept his speech without pressurizing him to repeat • Children should be given emotional support • Older children with secondary stuttering should be referred to speech therapist
- 27. SHYNESS Causes: Genetic & Environment Management Assess Talk Provide exposure Don’t compare child Don’t criticize Reward Encourage Help Don’t force