COMMON BEHAVIOURAL

DISORDERS IN CHILDREN

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DYSFUNCTIONAL
BEHAVIOURS

WHAT CAN AFFECT BEHAVIOUR IN
A CHILD?
 Heredity

 Environment
 Learning

Conditioning
 Positive reinforcements

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

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

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

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

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.

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.

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

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.

4.EVENING COLIC
• Intermittent episodes of abdominal
pain and
severe crying in normal infants
• Begins at 1-2 wks age and persists till 34 mo.
• Crying usually in late afternoon or
evening
• Diagnosis :

“ Infant cries for > 3 hrs per day for > 3 day

per week for > 3 weeks”

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

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

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

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 1315 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.

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

6.PICA
Repeated or chronic ingestion of nonnutritive substances.
– Examples: mud, paint, clay, plaster,
charcoal, soil.
• It’s an eating disorder.
• Normal in infants and toddlers.
• Passing phase.

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.

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

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

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.

7.BREATH HOLDING SPASMS
Management:

• Referral to Child Guidance Clinic:
• Referral to Child Psychologist

– If BHS accompanied with head banging or highly
aggressive behavior

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

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

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

SHYNESS
Causes: Genetic & Environment

Management
 Assess
 Talk

 Provide

exposure
 Don’t compare child
 Don’t criticize
 Reward
 Encourage
 Help
 Don’t force

Thank
Q