Chapter 13 problems of childhood

growth & development for children behavior ,which is normal for one age group is considered abnormal for other -according to Maslow hierarchy of needs for children Basic physical need ( air –water-food-elimination -& sleep ) -high level : security ,love ,belonging ,self esteem -moving from dependency to independent function is the goal

Normal childhood development : Definition of ( growth ,development ) -children growth in cephalocaudal direction from head to tail (head movement ) Growth occur from proximal to distal ( CNS then PNS ) -grouth is continuous process -box 13-1 ( developmental period )

Common behavioral problems of childhood : colic :* infant –late afternoon –healthy ,well feeding crying more than 3 hours teach parent : changing feeding procedure adequate time for burping cuddling quite restful environment aromatherapy (lavender ) avoid over handling infant message with oil

feeding disorder :* overeating ( obesity ) under eating ( malnutrition ) presence of ; 1- swallowing problems 2-chocking 3-depression n 4-aneroxia or bulimia nervosa

Problems with sleep ;* Night terrors Falling sleep Night time awakening Bed time rituals : reading book ,limiting TV Tempar tantrum : Anger & frustration 1-4 years old Result from loss of control Low self image Breath holding spells : -up to 5 years Child become upset & frustrated Begins to cry without sound Stop breathing ( blue ,limp ,unresponsiveness )

Seizure like behavior Resolve 30-60 seconds Rule out any medical problem Mental health problem of the childhood ; Mental problems in adulthood had root in childhood period Table 13-3 ( mental health problems in childhood ) Factors affecting mental health disease : 1- birth of siblings 2-moving to new city 3-stress & worry -type of peer group

Abuse & neglect : Victimization :the process of causing harm Abuse : causing harm or maltreating another Neglect : not meeting child basic needs ( food ,clothes ,shelter, love, belonging ) Physical abuse ; -burns ,bruises, fracture ,head & abdominal injuries -sexually abuse : in appropriate sexual activity -emotional or psychological abuse : criticism ,rejection ,isolation ,terrorism

-chronic anxiety & depression has roots in childhood period Neglecting & abuse triggered by; parental characteristics 1- 2-social isolation 3-teenage of motherhood 4-aggressive environment

Anxiety with children : Vague,uneasiy feeling ,occur in response to threat -separation anxiety : Lead to obsessive compulsive behavior Lead to school avoidance Fear from leaving home Social phobia Treatment ; support with school members & reassurance Antidepressant drugs

Somatoform disorder : Signs & symptoms of illness without physical cause Unconsciously complain as headache ,pain ,upset stomach Common in school period * depression ; parent who are depressed the risk for child to be depressed Equal in boy & girls Feel of unhappiness Lack of interest in activities ,which was previously enjoyed

* PTSD : Repeated exposure to violence Comes after traumatic events Fear ,helplessness ,horror ,avoid any things, associated with trauma ,night mares Violence behavior : acquired from TV ,aggressive behavior in the school Bullying : repeated use of aggressive behavior ممارسة سلوك العنف على الآخريين أمام الناس ليلفت إنتباه الآخرين

Victim : smaller ,quieter , more sensitive Result of bullying : Academic level Behavioral level Legal Social problem The effect for both ( assault & victim )

ADHD; Bad boy ,who couldn't sit-down More in boy ratio 7;1 Associated with ; 1- learning disabilities 2-speech disorder 3-brain dysfunction 4- hyperactivity -short attention span ,restlessness ,clumsiness -difficult to complete school work -easily distracted Normal or above average intelligent ,aggressive, depressive behavior

Treatment ; Family orientation & support Reinforcement program Drugs ( Ritalin ) oppositional defiant disorder : disobedient ,hostile behavior ,lose their tempers, argue with adults, refuse to compromise ,blame others treatment : family therapy

* eating disorder : feeding & eating disorders of infancy & early childhood Fail to eat adequately – wt loss ,failure to gain weight -without gastro-intestinal problems -food available but child doesn't eat Age 1-3 years ,with malnutrition ,delay in development Treatment ; -rule out medical causes -teaching parent about appropriate feeding technique Monitor weight gain * pica: persistent eating non- food items more than one month Infant : eat paint ,hair ,string ,plaster ,clothes

Older children :eat sand ,pebbles ,insect, animal dropping ,leaves Adult ;clay ,soil, laundry starch Pica: mental retardation ,autism Treatment : rule out any physical problem as mineral or vitamin deficiency Remove items which eat away Replace unacceptable item by more acceptable food

* rumination : Uncommon feeding disorder Infants regurgitate ( bring up & rechewed food ) 3-12 months Found in mental retardation Clinical picture; Infant arch the back ,hold the head back Make sucking movement with the tongue Sense of satisfaction when food is regurgitate Malnutrition

elimination disorder @enuresis :involuntary urinary incontinence child 5 years ,running in families Types of enuresis ; a- primary nocturnal enuresis wetting in bed at night b- diurnal enuresis : day time wetting c- secondary enuresis develops after child has achieved bladder control * primary nocturnal enuresis : Bed wetting in the night More in boy Main cause unknown

May be related to ; 1- developmental delay in sleep –awake mechanism 2- bladder capacity * diurnal enuresis : Less common ,day time wetting ,ADHD Equal in boy & girls Also has bed wetting at night

* secondary enuresis ; After stressful events ( birth siblings ,or divorce ) Associated with emotional stress ,& anxiety Treatment ; reassurance & emotional support Medication : desmopressin ,impramine Establish bedtime routine * encopresis : repeated voluntary passage of feces in inappropriate places Over 4 years of age

No physical abnormalities More in boy Treatment : rule out physical problems Establish routine bowel care program Reinforce child Give him responsibility to rinse soiled clothing

Autism

* mental retardation ; Intellectual function of the brain below the average IQ ratio test less 70 ( retarded ) examine ( self care ,home living ,communication ) Causes of mental retardation ; 1- fetal alcohol syndrome 2-inborn error of metabolism (IEM ) 3-down syndrome (trisomy 21) 4- birth injury 5- high fever 6- hormonal imbalance 7-poisoning 8-accident & falling down 9- hereditary problem

Management : encourage child to be functioning Safe environment Development of life skills * learning disorder = academic skills disorder Affect child ( thinking ,reading ,writing ,calculation ,spelling ,listening abilities ) Drop out of the school ,cause unknown may be due to ;

a. fetal alcohol syndrome b.lead poisoning c. genetic problem treatment : rule out ( hearing ,visual ,speech problems ) special educational class dyslexia : problems with reading ينس كلمات وهو يقرأ يحذف حرف ويغير معنى كلمة

* communication disorder ; Problems of language appear at 3 yrs old ,speak rapid or slow rate They need love ,patience ,& encouragement on daily basis * pervasive developmental disorder ; Tendency to spread through out Difficult with social interaction Difficult in communications skills Behavior is differ of the same age

Main cause unknown may be ; a. mental retardation b. congenital infections c. abnormal CNS function * autism : disorder of communication ,social interaction ,& behavior * Rett syndrome ;motor ,language ,social problem ,loss of previous skills 5 months -4 yrs ,head growth decrease Hand movement like hand wringing Loss of social interest ,& activities Sever speech impairment

* aspergers syndrome; Sever long impairment in social interaction Repeated behavior ,interest ,& activities * childhood disintegrative behavior : Sever regression * autism ;present in infancy or early childhood ,not disease ,syndrome of associated behavior Defect in nervous system development Serious problem of social interaction & communication More in boys

Low IQ ratio, motor skills good ,but used inappropriate Difficult to make social contact with people but with objects Abnormal speech ,abnormal playing activities ,child doesn't act appropriate for his mental age

Management : complete physical examination ( nervous system ) Group therapy * schizophrenia : Disturbance thought pattern ,distorted reality Problems in memory Impaired interaction Bizarre movement Hypo or hyperactivity Inappropriate emotion Phobia, its long term disorder

General overview objective of therapy ; 1- meet basic needs of the child 2-provide opportunities 3-encourage self care & independence

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