Understanding and Managing Common Behavioural Problems

1. Common Behavioural Problems and Management Mrs.Sharin Neetal D'souza

2. Common Behavioural Problems and Management Prepared by: Mrs.SharinNeetalD’souza Lecturer Dept.Child health nursing Yenepoya nursing college Reviewed by: Prof.Umarani J Dr.PriyaReshmaAranha Mrs.Sharin Neetal D'souza

3. Learning objectives At the end of the class students will be able to • list the causes for behavioural problems • enumerate the classification • explain the behavioural problems according to age group and its management Mrs.Sharin Neetal D'souza

4. Causes of Behavioural Problems Mrs.Sharin Neetal D'souza

5. Classification Mrs.Sharin Neetal D'souza

6. Habit Problems • Thumb sucking • Nail biting • Tics • Enuresis • Encoperesis • Breath holding spell • Stealing • Bruxism ( teeth grinding ) Mrs.Sharin Neetal D'souza

7. Feeding problems • Food refusal • Over eating • Pica • Anorexia Nervosa • Bulemia Nervosa Mrs.Sharin Neetal D'souza

8. Sleep Problems • Somnambulism ( sleep walking ) • Somniloquy ( sleep talking) • Night mares/ night terrors • Insomnia Scholostic Problems • School Phobia • Repeated Failure • School Absentism • Hyperactive attention deficit disorders • Reading and mathematical disability Mrs.Sharin Neetal D'souza

9. Adjustment Problems • Misobedience • Misconduct • Tempertantum Emotional Problems • Negativism • Jealousy • Fear , anxiety, anger • Shyness Mrs.Sharin Neetal D'souza

10. Mrs.Sharin Neetal D'souza

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12. Behavioural Problems in Infancy Mrs.Sharin Neetal D'souza

13. Resistance to feeding Mrs.Sharin Neetal D'souza

14. Management • Regular oral stimulation. • Encourage the mother to involve pleasure activities. • Treat the underlying cause like mouth ulcers, sore throat, nasal congestion etc Mrs.Sharin Neetal D'souza

15. Abdominal colic • Starts within the first week after birth. • Commonly seen in overactive infants. Causes • Idiopathic • Hunger • Immaturity of intestine • Cows milk allergy • Swallowing of excess air • Abdominal distension Mrs.Sharin Neetal D'souza

16. Signs and symptoms • Pulling up of arms and legs • Crying continuously • Excess of swallowing of gas Mrs.Sharin Neetal D'souza

17. Management • Explain the condition • Reassure the parents • Place the baby in a upright position and burp • Promote mother and infant bonding • Administer the antispasmodics • Provide small amount of feeds Mrs.Sharin Neetal D'souza

18. Stranger anxiety Mrs.Sharin Neetal D'souza

19. Breath holding spell • Occur in children between 6month – 5 years Causes Frustration or anger Mrs.Sharin Neetal D'souza

20. Signs And Symptoms • Violent crying • Sudden cessation of breathing on expiration • Cyanosis and rigidity • Loss of consciousness and tonic clonic movements • Pallor • Heart rate –slow Lasts for 1-2 minutes Mrs.Sharin Neetal D'souza

21. Management • Provide reassurance • Identify and correct the precipitating factors • Avoid overprotection of child • Avoid punishment • Repeated attack of spell need to be evaluated for convulsive disorders • Psychotherapy Mrs.Sharin Neetal D'souza

22. Temper tantrum Mrs.Sharin Neetal D'souza

23. It is a sudden out burst or violent display of anger and frustration. • Results in bitting, kicking, throwing objects, hitting, crying, rolling on floor, screaming loudly, banging limbs etc. • Occurs in maladjusted children usually single child and pampered child. Mrs.Sharin Neetal D'souza

24. Causes • Emotional insecurity • Imitation of adults • Frustration • Unmet needs • Attention seeking Mrs.Sharin Neetal D'souza

25. Management • Educate the parents • Parents should talk to the child to find out the cause of frustration . • Provide adequate rest and sleep. • Avoid the overprotection to the child • Protected from causing injury to the self as well as others • After temper tantrum child's face and hand should be washed and play materials can be provided. Mrs.Sharin Neetal D'souza

26. Behavioural Problems in childhood Mrs.Sharin Neetal D'souza

27. Thumb sucking • It is a habit disorder due to feeling of insecurity and tension reducing activity. Mrs.Sharin Neetal D'souza

28. Causes 1) Parental causes • Overprotection by parents • Neglect by parents • Strictness of parents • Disharmony between parents 2) Due to Teachers • Excessive strictness • Excessive punitive attitude of teachers Mrs.Sharin Neetal D'souza

29. Due to Sibling and Friends • Excessive competition • Separation from friend or sibling Other causes Loneliness and boredom Tiredness Frustration and anxiety Separation from parents Mrs.Sharin Neetal D'souza

30. Problems caused by Thumb sucking Mrs.Sharin Neetal D'souza

31. Management Do’s • Divert the child’s attention. Engage him/her in play activities. • Hands and fingers of the child should be kept busy in some interesting activity like drawing. • Offer praise and rewards to the child for not sucking thumb. • Distract the child when he feels bored. Mrs.Sharin Neetal D'souza

32. Put gloves on child’s hands/ wrap the thumb with a cloth /bandages. • A non-toxic bitter testing substance can be applied on Childs thumb . • Take help of elder children for explanation to younger sibling • Encourage the child to socialize Mrs.Sharin Neetal D'souza

33. Don'ts • Donot scold / punish / forcefully remove the thumb from the mouth • Donot beat the child Mrs.Sharin Neetal D'souza

34. Nail biting /Onyclophagia • It is a common oral compulsive habit in children and adults. It is a just way of coping with stress/comporting self. Mrs.Sharin Neetal D'souza

35. Causes • Out of curiosity/ Boredom • To relieve stress and anxiety • Habit • Nervousness • Lack of confidence • Insecurity • Feeling shy • Fear • Tiredness Mrs.Sharin Neetal D'souza

36. Management • Application of clear, bitter tasting nail polish to the nails. • Address the child’s anxieties, make the child speak about his/her worries. • Do not punish the child . • Keep the child’s hands and nail clean. • Keep the child’s fingernail trimmed to decrease the temptation. • Do not pressurize the children to stop biting nail. Mrs.Sharin Neetal D'souza

37. Reassure the child with Love and Affection. • Help the child to aware of this bad habits. • Suggest the substitute activity like car rides or holding a smooth stone in free hand while reading or writing. • Behavioural therapy . Mrs.Sharin Neetal D'souza

38. Enuresis/ bed wetting It is the repetitive involuntary passage of urine at inappropriate places especially at bed, during night time beyond the age of 4-5 years. It is found in 3-10% in school children. Mrs.Sharin Neetal D'souza

39. Causes • Small bladder capacity. • Improper toilet training • Deep sleep with inability to relieve the signals from distended bladder to empty it. Emotional factors • Punishment • Sibling rivalry • Emotional deprivation- insecurity and parental death. • Emotional conflict and tension • Desire to gain attention Mrs.Sharin Neetal D'souza

40. Environmental factors • Dark passage to toilet • Cold/ fear of toilets • Long distance of toilet from bedroom • Lack of sanitation facilities Organic cause • Spina bifida • Juvenile DM • Seizures Mrs.Sharin Neetal D'souza

41. Types Mrs.Sharin Neetal D'souza

42. Primary enuresis :- children have never been successfully trained to control urination. There may be delay in urination of sphincter control. Secondary enuresis :- children have been trained but revert to bed wetting in response to some stress. Mrs.Sharin Neetal D'souza

43. Nocturnal enuresis – Bed wetting during night • Diurnal enuresis --> bed wetting day time • Mixed Enuresis  combination of both nocturnal and diurnal type. Mrs.Sharin Neetal D'souza

44. Management • Assess the home conditions of the child, his/her socioeconomic status and family conditions. • Explore child parent relationship . Child’s relationship with playmates , teachers and siblings should be evaluated. • Try to build the child’s self confidence. • Parents should be explained about the factors related to bed wetting. Mrs.Sharin Neetal D'souza

45. Child should be made habitually made to pass urine before going to bed. • Parents should be asked to not to scold or punish. • Child made fully awaken by parent and made aware of passing urine at night . • Child is trained to hold urine for longer time . • Severe cases – tricycle antidepressant • Supportive psychotherapy Mrs.Sharin Neetal D'souza

46. Encopresis It is the passage of faeces into inappropriate places after the age of 5 years, when the bowel control is normally achieved. Mrs.Sharin Neetal D'souza

47. Types Primary – chronic soiling from infancy onwards. Secondary – regressive soiling occurs after attaining bowel control. Mrs.Sharin Neetal D'souza

48. Associated Problems • Chronic constipation • Faecal impaction • Parental over concern • Toilet fear • Attention deficit disorders • Poor school attendance • Learning difficulties Mrs.Sharin Neetal D'souza

49. Management • Take history of bowel training • Encourage the use of toilet • Regular bowel habit training • Adequate intake of roughage and fluid in the diet. • Parental support and reassurance • Counselling for child and parent Mrs.Sharin Neetal D'souza

50. Speech Problems can be found as disturbances of voice, articulation and fluency Mrs.Sharin Neetal D'souza