BEHAVIORAL DISORDERS IN CHILDREN

BEHAVIORAL DISORDERS IN CHILDREN

Children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviours that are outside the norm for their age.Some of these abnormalities are have genetic lineage and therefore difficult to manage and some are acquired and thus manageable.
Let us discuss common problema which most of have encountered in our day to day to lives.

Temper Tantrums
source
Temper tantrums include behaviors that occur when the child responds to physical or emotional challenges by drawing attention to himself and can include yelling, biting, crying, kicking, pushing, throwing objects, hitting and head banging.


Tantrums typically begin at 18-36 months of age.

Inability to assert autonomy or perform a complex task on his/her own causes frustration to the child which cannot be effectively communicated due to limited verbal skills. The frustration therefore is acted out as undesired behaviors.


Such behavior peaks during second and third year of life and gradually subsides by the age of 3-6 yr as the child learns to control his negativism.

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ADVICE FOR PARENTS

*Parents should be asked to list situations where disruptive behavior are likely to occur and plan strategies to avoid these. For example, they should ensure that the child is rested and fed, and should carry a snack for the child when going for an outing.

*During a tantrum, the parents' behavior should be calm, firm and consistent and they should not permit the child to take advantage from such behavior.

*The child should be protected from injuring himself or others.


*At an early stage, distracting his attention from the immediate cause and changing the environment can abort the tantrum.

*A 'time out', i.e. asking the child to stay alone in a safe and quiet place for a few minutes, is useful.

*Give plenty of positive attention. Reward your little one with praise and attention for positive behavior.

*Try to give toddlers some control over little things. Offer minor choices such as "Do you want orange juice or apple juice?"
Don't ask do u want orange juice-which inevitably may be answered -NO.

BREATH HOLDING SPELLS

Breath holding spells are reflexive events typically initiated by a provocative event that causes anger, frustration or pain causing the child to cry. Children don't have breath-holding spells on purpose..

They may look like a seizure, but there are no seizure discharges seen on the electroencephalogram (EEG) recording of the brain, therefore the child does not need to be treated with seizure medication.

The crying stops at full expiration and the child becomes apneic and cyanotic or pale. In some children heart rate may slow down (pallod spell)

In some cases the child may lose consciousness, become hypotonic and fall. If the spell lasts for more than a few seconds, brief tonic-clonic seizure may occur.

Breathholding spells always revert on their own within several seconds, with the child resuming normal activity or falling asleep for some time.

Breath holding spells are rare before 6 months of age, peak at 2 yr and abate by 5 yr of age.

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Diagnosis is based on the setting and the typical sequence of crying, cyanosis or pallor with or without brief loss of consciousness.

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**ADVICE FOR PARENTS**

After a thorough examination of the child, the parents
should be reassured. They are explained that the apneic spells are always self-limited and do not lead to brain injury or death.
<>br The family IS advised to be consistent in their behavior with the child, remaining calm during the event, avoid picking the child up (since this decreases blood flow to the brain) and to turn him to the side so that secretions can drain.

As the child recovers, they should avoid exhibiting undue concern nor give in to his demands if the spell was provoked by anger or frustration.


Children with iron deficiency should receive iron supplementation.

PICA

Pica is the persistent ingestion of non-nutritive substances such as plaster, charcoal, paint and earth for at least 1 month in a manner that is inappropriate for the developmental level, is not part of a culturally sanctioned practice and is sufficiently severe to warrant independent clinical attention


Subtypes are characterized by the substance eaten:
Source
Acuphagia (sharp objects)
Amylophagia (starch)
Cautopyreiophagia (burnt matches)
Coniophagia (dust)
Coprophagia (feces)
Emetophagia (vomit)
Geomelophagia (raw potatoes)
Geophagia (dirt, soil, clay)
Hyalophagia (glass)[9]
Lithophagia (stones)[10]
Mucophagia (mucus)
Pagophagia (ice)
Plumbophagia (lead)
Trichophagia (hair, wool, and other fibers)
Urophagia (urine)
Hematophagia (Vampirism) (blood)
Xylophagia (wood, or derivates of wood such as paper).


It is a common problem in children less than 5 yr of age.However, it has been seen in pregnant females, schizophrenics and other mwntal illnesses.

Factors speculated to predispose to pica include mental retardation, psychosocial stress (maternal deprivation, parental neglect and abuse) and other behavioral disorders. Poor socioeconomic status, malnutrition and iron deficiency are commonly associated with pica but their etiologic significance has not been established.


Children with pica are at an increased risk for lead poisoning and subsequent brain damage, iron deficiency anemia and parasitic infestations.

Management comprises behavior modification, alleviating the psychosocial stress.

[Source] (Textbook of pediateicsby OP GHAI)
Textbook of pediateics by NELSON.
Indian Association of pediatrics (IAP) Textbook.

All images used are CC0-Public domain licenced.
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