CHILD & ADOLESCENT PSYCHIATRY:

Feeding and Eating Disorders, Elimination

Disorders and Tic Disorder

Dr.Ola Ibigbami
MBChB(Ife), MSc.Clini.Psychol.(Ife), MSc CAMH(Ibadan), FWACP(Psychiatry)
Dept. of Mental Health, Obafemi Awolowo University
Ile Ife, Osun State
oibigbami.oauife.edu.ng
safeandsane.org.ng
 Feeding & Eating Disorders of Infancy or
Early Childhood
Pica
• Persistent eating of non-nutritive substances for a period
of at least one month inappropriate to developmental
level
• Eating is not part of a culturally sanctioned practice

Rumination Disorder
• Repeated regurgitation and re-chewing of food
• May be as a result of disrupted parent-child attachments
• Regurgitate, re-chew, drool and re swallow their food
• Dehydration, electrolyte imbalance, slow weight gain,
malnutrition & tooth decay can be seen

• Treatment: Behavioural techniques

 Elimination Disorders
Functional Encopresis
• Repeated passage of faeces into a place not
appropriate for that purpose, whether
involuntary or intentional
Diagnosis
• One such event a month for at least 3 months
• Chronological & mental age of at least 4 years
• Not due to physical disorder
• With constipation & overflow incontinence
• Without constipation & overflow incontinence
 Elimination Disorders
Clinical description
• Daytime is much more common than nocturnal encopresis
• Could be primary or secondary
• 75% to 90% are constipation with overflow incontinence
• Conduct problems to express anger
• Less common than enuresis
• 4:1 male predominance
• Higher rates in individuals with mental retardation
• Inadequate or punitive toilet training
• Stress related factors
Treatment
• Evaluate to rule out possible structural abnormalities
• Psychiatric assessment
• Decompaction and behavioural treatment
• Treat other causes
Elimination Disorders
Functional Enuresis
Diagnosis
• Repeated voiding of urine during the day or
night into bed or clothes, whether involuntary or
intentional
• Behaviour is present at least twice a week for at
least 3 consecutive months
• Chronological age is at least 5 years (or
equivalent development level)
• Not due to direct physiological effect of a
substance (diuretic) or a general medical
condition (diabetes, spina bifida, seizure)
 Functional Enuresis
Clinical description
• Bedwetting is more common than daytime urinary
incontinence
• Nocturnal enuresis typically occurs 30 minutes to
3 hours after onset of sleep
• Could be primary or secondary
• Male dominance
• Run in families--particularly males
• Most undergo spontaneous remission
Functional Enuresis
Evaluation & treatment
• Psychiatric evaluation
• Recent psychosocial stressors
• Occasionally an EEG is indicated
• Behavioural methods:
• Restriction of pre-bedtime fluid intake
• Mid-sleep awakenings for voiding
• Rewards for successful nights
• Alarm Clock
• Bell & pad success rate of 90% & relapse rate of 40%
(Not available here)
• Antidepressants-- Imipramine if resistant to
behavioural methods
TIC DISORDERS
Tourette’s Disorder (Gilles de la Tourette)
• Characterised classically by convulsive muscular jerking
& explosive utterances
• Coprolalia (obscene utterances) & copropraxia (obscene
gestures) could also occur
• Associated psychiatric problems are common

Treatment
• Mild tics usually respond to explanation & reassurance
• Severe tics--behavioural modification & medication
(haloperidol)
 Separation Anxiety Disorder
• Unrealistic worry about possible harm befalling people to
whom the child is attached
• Fear will leave & not return
• Unrealistic worry that some untoward event will separate
them from those to which the child is attached
• Persistent reluctance or refusal to go to school because of
fear about separation
• Persistent reluctance or refusal to go to sleep separately
from someone to whom child is attached
• Persistent inappropriate fear of being alone
• Repeated nightmares about separation
• Repeated occurrence of physical symptoms following
separation
• Excessive recurrent distress in anticipation of, during, or
immediately following separation
Treatment
• Systematic desensitisation & antidepressants