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COMMON BEHAVIOURAL PROBLEMS . COMMON BEHAVIOURAL PROBLEMS . BEHAVIOUR is the action or reaction of something under specified circumstances. . WHAT IS A BEHAVIOURAL PROBLEM ?.
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COMMON BEHAVIOURAL PROBLEMS BEHAVIOUR is the action or reaction of something under specified circumstances.
WHAT IS A BEHAVIOURAL PROBLEM? Any behavior that disturbs the individuals ability to function adequately, will constitute a behavior problem.
TYPES OF BEHAVIOURAL PROBLEMS IN RELATION TO AGE GROUP • INFANCY • Feeding problem • Colic • Stranger anxiety • Breath holding spells • Temper tantrum
Cont….. • MID-CHILDHOOD • Stuttering • Pica • Sleep problem • Enuresis • Encopresis
Cont…. • PRESCHOOL CHILD • Hyperactive or restless child • Head banging/Body rocking • Thumb sucking • Nail biting • Masturbation • Lack of clarity in speech
ADOLESCENCE • Jealousy /sibling rivalry • Juvenile delinquency
FEEDING PROBLEMS • UNDERFEEDING • Caused by improper feeding techniques such as decreased frequency or duration of feeding, • Inadequate quantity or quality of feeding • Early introduction of top feeding • Nipple confusion. • Brest problems. • Improper burping • Abnormal mother infant bonding • Chronic systemic illness in infant
Cont…….. 3 • OVERFEEDING • Caused by parents 'ignorance about nutritional requirement of the children. • Upwelling of the mother to Brest feed and reliance on bottle feed.
NURSINGMANEGEMENT • Parents should be counseled regarding daily dietary allowance • Teach the parents about feeding technique and type of food to be used. • Adequate and expulsive Brest feeding can over come the problem of over feeding.
Cont………. • HEAD BANGING • This involve rhythmic hitting of the head against a solid surface often the crib mattress. • This occur in 5-6% of children during infancy and toddler years. • This is common at bedtime before going to sleep or after a child wakes during night or in the morning.
Head banging typically occurs with the child lying face down – banging the head down into a pillow or mattress. In the upright position, the head is banged against the wall or headboard repeatedly. Head banging usually disappear within 18 months, and might do so in as little as weeks or months. Banging can result in callus formation . abrasions and contusion can occur at the site
NURSING MANAGEMENT • Reassurance of the parents that head banging alone is not a sign of developmental disability • Significant injury is unlikely . • Padding of the heard surface can decrease the chance of injury. • Parents should ignore the behavior as attention in the form concern or punishment can reinforce it.
COLIC • Colic is characterized by intermittent episodes of abdominal pain or severe crying in young infants who are otherwise well. • It is usually begins at 1-2 weeks • of age and can persist till 3-4 • months of age. • The crying usually occurs in the • late afternoon or evening.
DIAGNOSIS The diagnosis is conformed when the infant cries for more than 3hours per day for more than 3day per week for more than 3 weeks.
CLINICAL FEATURES • The attack usually begins suddenly with a loud cry. • Crying occurs continuously and may last for many hours. • Face become red and the legs are drawn up on the abdomen. • The abdomen become tense . • The attack terminates when infants is completely exhausted.
CONTD……. colic start happening with in few weeks after birth, reach a peak by 4-6 weeks and subside by 3-4 months of age.
MANAGEMENT COUNSELING is the most effective method for helping parents cope successively with their infant’s crying. Nurse should ensure the parents that your child id not sick so as to unburden them. The parents should be told that all young infants are irritable and fussy and cry to some degree on an average of 2-3 hrs per day.
CONT…….. 3 By about 6-7 months, the infant can differentiate between the primary care giver and others. thus at this develop fear of unfamiliar people or strangers. The infant, when approached by some unfamiliar person, turns away, even cry or runs towards the primary caregiver. This is known as the Strangers reaction.
NURSING MANAGEMENT Infant is managed with relaxation technique such as slowly exposing them to the stranger, initially from the distance. Reassurance of parents is required as this behavior is gradually declines. If the behavior persists than the child should be referred to psychiatrist to evaluate for associated anxiety disorder.
Cont…….. 5 • Reassure your child. • If toddler seems scared, upset, or wary when other adults approach her (pressing her face to your leg may clue you in), do your best to reassure her that everything is okay . • Stay within arm’s reach. • When toddler stranger anxiety sets in, it’s key to make it clear to your child that she’s “safe” by holding her or staying close to her. And be sure to give her lots of love and affection as she gets acclimated (or re-acclimated) to the new (or familiar) face.
Cont…….. • Coach your friends and family. • Let everyone know that your toddler needs a little time to warm up to people. • Explain that it’s best not to rush in and pick her up or demand hugs and kisses the minute they see her Instead, tell them to play it cool for a bit, and then maybe, after your toddler seems comfortable, offer her a favorite toy to entice her to connect with them.
BREATH HOLDING SPELL A breath holding spell is an involuntary pause in breathing, sometimes accompanied by loss of consciousness. It usually occurs in response to an upsetting or surprising situation.
CAUSES • A small number of children have severe spells. • Usually the spells stop by the time a child reaches ages 6 – 8years. • Breath holding is seen in some normal children from as early as age 2 months, but it can start as late as 2 years old.
CONT…….. 4 • Although they often occur with tantrums, breath holding spells are not thought to be a willful act of defiance. • Children with iron deficiency anemia may also have increased episodes of breath holding.
CONT………. 5 • Breath holding spells appear to be a response to fear, pain, a traumatic event. • The sudden reaction can cause the nervous system to temporarily slow the heart rate or breathing, causing breath holding and color changes.
CONT……… 6 • Symptoms • Bluish discoloration of the skin caused by lack of oxygen (cyanosis) or loss of skin color (pallor) • Crying and then stopping breathing (apnea) • Momentary unconsciousness or fainting • Short seizure-like movement (one to two jerks)
TREATMENT • No treatment is usually necessary. • Avoiding situations that provoke temper tantrums can help reduce the number of spells your child . • Placing a cold cloth on your child's forehead during the spell may shorten the episode. • Breath holding spells that do not cause the child to become unconscious are best ignored, in the same way temper tantrums are ignored.
CONT……... • If your child has an iron deficiency, should start iron replacement treatment. • When a spell occurs, be sure that your child is in a safe place where he or she won't be hurt during a fall or a brief seizure. • After the spell, try to be calm and avoid giving too much attention to the child, because this can reinforce the behaviors that lead to the breath holding spells.
Possible Complications The biggest risk is injury, especially head injury, due to a fall during a spell.
NURSING MANAGEMENT • Reassurance of the parents that spell will not harm the child. • Protect child during a spell, lay the child on the floor and keep his or her arms, legs, and head from hitting anything hard or sharp • Try to distract him or her before the behavior reaches the point that typically provokes a spell.
SEEK MEDICAL HELP When Your child may stop breathing for up to 1 minute (60 seconds) during a spell. If your child doesn't wake up quickly and start breathing again than seek MEDICAL HELP.
THUMB SUCKING Thumb-sucking is normal in babies and young children. A natural sucking instinct leads some babies to suck their thumbs during their first few months of life, or even before birth. Babies may also suck on their fingers, hands.
Why do babies suck their thumbs? Babies have a natural urge to suck, which usually decreases after the age of 6 months. But many babies continue to suck their thumbs to soothe themselves. Thumb-sucking can become a habit in babies and young children who use it to comfort themselves when they feel hungry, afraid, restless, sleepy, or bored.
CONT…….. 3 • Thumb-sucking is normal in babies and young children. • A natural sucking instinct leads some babies to suck their thumbs during their first few months of life, or even before birth. • Babies may also suck on their fingers, hands, or items such as gloves
4 Alveolar Prognathism - Caused by thumb sucking and tongue thrust
COMPLICATIONS • Teething problems • Respiratory problems • Gastro-intestinal problems • Palate changes • Teeth pushed forward • Buck teeth • Dental bite problems
NAIL BITING This is a habit of biting or eating nails most of the time. it is usually diagnosed after 3 yrs of age. it is more common in girls than in boys. This is found in all socio-economic classes. The peak age for the development of this disorder is 5-7 yrs or 13-15 yrs Nail biting may be a learned behavior.
CAUSES3 • DEVELOPMENTAL CAUSES • This disorder is common in the biting stage and teething stage as a gratifying oral habits. • EMOTIONAL FACTORS • These include tension, anxiety, parental neglect, strictness, stress of exams and excessive fear.
COMPLICATIONS • Teething problems • Respiratory infections • Gastro intestinal tract infection. • Cosmeticproblems infection in the bone (osteomyelitis) of his finger tip.
NURSING MANAGEMENT • No therapeutic measures are needed. most children grow out of this habit by the age of 5 or 6 years. • Try to remove the precipitants. • Use various behaviour modification technique such promise of a reword to correct the faulty behavoiur. • Keep the child normally busy during the day time. • suggest an alternative activity such as playing with play dough or wiggling his fingers around. • Use of play therapy is beneficial in the management of the disorder
Cont……… • Identify the cause of nail biting and try to remove that cause. • Identify the precipitant and try to remove them • The environment should be free of tension and fear for the proper development of the child. • Give proper explanations to the child. • Distract the mind of the child by play therapy.
