Problems of Childhood Chapter 13 Copyright © 2013 by Elsevier Inc. All rights reserved.

Problems of Childhood (p. 139) Health care providers who work with children must have an understanding of normal growth and development as well as an awareness of each child’s individual pace. Children must master skills that move them from complete dependence to independent functioning in only a few short years.

Normal Childhood Development (p. 140) Growth Increase in physical size Development Enhanced ability in skills or functions Proceeds from simple to complex--the younger the child the less complex and as get older will develop more complex development Children grow in Cephalocaudal (head to tail) direction Proximal-distal (near-far) pattern Differentiation- moving from simple to complex-going from gross motor skills to fine motor skills Growth is a continuing process. Table 13-2 Emotional Development Tasks of Childhood

Common Behavioral Problems in Children (p. 141) Colic consists of a set of behaviors that are seen most commonly in middle-class infants. A colicky infant is defined as a healthy, well-fed child who cries for longer than 3 hours every day for more than 3 weeks. Feeding disorders range from overeating to undereating. # of children overweight 4x higher than 40 yrs ago; Early intervention/education help Problems with sleep are common to many children. Night terrors, problems falling asleep, and nighttime awakenings Setting up bedtime rituals will help Can you identify any other interventions for colic? What types of cues should parents be looking for in their infant’s crying? What can they tell the parent? Why is it no longer typical for parents to let their children cry themselves to sleep? What are some other methods of establishing good “sleep hygiene” in a child?

Common Behavioral Problems in Children cont’d. (p. 141) Temper tantrums are a common expression of anger and frustration. Occur in children between 1 and 4 years of age. Occur in 50% to 80% of children in this age group. Help control tantrums by causing distractions; refocus the child; praise him when child behaves well; keep child safe; keep reinforcing good behaviors Breath-holding spells occur from 6 months and can last until 5 years of age. After ensuring child is safe then leave in safe place and ignore behavior What are some ways to control tantrums once they have started? Besides praise for regaining control, what else can be done after a tantrum has subsided to reduce the chance of tantrums occurring in the future?

Mental Health Problems of Children (p. 142) The major mental health problems of childhood are grouped into seven categories. **Table 13-3** Each child is an individual. The diagnosis is less important than the person. When a child demonstrates absence of growth, an inability or refusal to change, or failure to achieve the developmental tasks of his or her age- group, mental health assistance should be sought.

Environmental Problems (p. 142) Growing up is a difficult process for children who are poor, homeless, abused, or neglected. Poverty and mental health problems go hand in hand. In today’s times approximately 20% of the children in the US live in poverty Homelessness Know your own feelings about subject Have positive attitude; delay asking questions about occupation, address, next of kin, etc Promise them that the information gathered is confidential Abuse and neglect Abuse is causing harm to or maltreating another. Neglect is not meeting a child’s basic needs for food, clothing, shelter, love, and belonging. Victimization of children is seen in many forms Often the root of adult problems What is the impact on children of homelessness, abuse, and neglect? What percentage of the homeless in the United States are children? What types of unique difficulties do homeless children pose for the health care community?

Problems with Parent-Child Interactions (p. 144) One of the most common parent-child problems is conflict. Parent-child conflicts Parents who set limits and enforce them consistently provide stability for children to test their limits in healthy ways. No child or parent escapes childhood without conflict.

Problems with Parent-Child Interactions cont’d. (p. 144) Primary caregiver dysfunction When a parent is unable to meet the needs of a child, a disturbance in the parent-child interaction exists. Support and educate parents, and help them develop more effective and appropriate child care skills. Aggressive intervention can improve the long-term outlook for the children of these parents.

Emotional Problems (p. 144) Emotional problems occur in children when they cannot cope successfully with their situations. Anxiety Infants and toddlers experience separation anxiety. Usually fears decrease with age; if 4 yr old still having separation anxiety for more than a few weeks may need to have child see School avoidance (anxiety-based school refusal) is a behavioral pattern in which the child refuses to attend school. Most children’s bouts of anxiety are relieved when they receive reassurance and emotional support. If anxiety does not interfere with relations with family or friends or activities at school, the child is coping effectively. Identify two therapeutic interventions for the child with anxiety.

Emotional Problems cont’d. (p. 144) Depression Describes a symptom, an emotional state, and a clinical syndrome Clinical findings of depression Persistent state of unhappiness that interferes with pleasure or productivity Therapeutic interventions Reduce the problems that are causing depression. Provide the child with emotional support to cope effectively. Children with depression may exhibit different symptoms than those of adults with depression. They may not directly verbalize feelings of hopelessness or sadness. They may not always act sad, which misleads adults to think that the mood changes are temporary.

Emotional Problems cont’d. (p. 144) Somatoform disorder Signs or symptoms of illness without a traceable physical cause Common in school-age children When stress is relieved, the child returns to a healthy level of functioning. Children with somatoform disorders need understanding and reassurance.

Emotional Problems cont’d. (p. 144) Posttraumatic stress disorder Can develop following an extremely traumatic event that involves injury or threat to the child Traumatic events are relived repeatedly, and the child goes to great lengths to avoid anything associated with the trauma. Treatment focuses on early recognition and emotionally supportive care.

Behavioral Problems (p. 145) Children and violence Acts of aggression are common in schools where children may be bullied or intimidated. Children may witness violence in the home and adopt it as a method for solving problems or resolving conflict. If a child’s conduct becomes inappropriate over time, a disruptive behavioral disorder may be diagnosed. The two disruptive behavioral disorders most commonly encountered are Attention-deficit/hyperactivity disorder Conduct disorder List behaviors that are seen in children with attention-deficit/hyperactivity disorder.

Behavioral Problems cont’d. (p. 145-146) Attention-deficit/hyperactivity disorder (ADHD) Now the most commonly diagnosed mental health problem in childhood Occurs more frequently in boys; before age 7 ADHD is a syndrome—a cluster of behaviors related to inattention and impulsive actions. Fidgets, difficulty sitting still, easily distracted, blurts out, difficulty following instructions, difficulty sustaining attention in tasks or activities, difficulty playing quietly, talks excessively or out of turn, does not seem to listen, loses things needed, engages in dangerous activities Treatment Requires a multidisciplinary approach Positive reinforcement Parent and child education Medication Must be monitored closely by the nurse

Behavioral Problems cont’d. (p. 146-147) Disruptive behavioral conduct disorder Children with conduct disorders are defiant of authority. They engage in aggressive actions toward other people, refuse to follow society’s rules and norms, and violate the rights of others. Typically a boy with social and academic problems, truancy, defiant to authority, engages in tantrums, running away, and fighting Treatment Providing a stable environment and consistently enforced limits Early diagnosis and treatment are very important if these children are to become productive members of society; otherwise prognosis will be poor. Why is early diagnosis of a disruptive behavioral (conduct) disorder important?

Behavioral Problems (p. 147) Disruptive behavioral conduct disorder Oppositional defiant disorder Recurring pattern of disobedient, hostile behavior toward authority figures Children frequently lose their tempers, argue with adults, deliberately annoy other people, and refuse to compromise. Treatment includes family therapy that stresses limit setting and consistency. What are the main characteristics of oppositional defiant disorder? Why might the long-term outlook be poor if problems are present before adolescence?

Problems with Eating and Elimination (p. 147) Children who have problems with eating are defined as routinely failing to eat adequately. Causes: Can result from repeated unsuccessful attempts to feed an irritable infant Parental mental health problems Abuse Neglect Treatment focuses on ruling out a cause.

Problems with Eating and Elimination cont’d. (p. 148) Pica is persistent eating of nonfood items for longer than 1 month. Often seen in children with the following: Mental retardation Developmental disorders Vitamin deficiencies Mineral deficiencies Rumination disorder Infant regurgitates and rechews food. Malnutrition may occur because food is brought back to the mouth soon after it is eaten. Often disappears as the child grows older

Problems with Eating and Elimination cont’d. (p. 149) Enuresis Involuntary urinary incontinence of a child 5 years of age or older Primary nocturnal enuresis Wetting the bed at night Diurnal enuresis Daytime wetting Secondary enuresis Develops after the child has achieved bladder control Encopresis Repeated, usually voluntary, passage of feces in inappropriate places in a child 4 years of age or older with no physical abnormalities

Developmental Problems (p. 148) Mental retardation Children are considered mentally retarded only if they have problems in general intellect and adaptive functioning. Children who repeatedly score lower than 70 on IQ tests are defined as mentally retarded. The more important measure is the child’s adaptive functioning. We must define how well the child copes with the demands of life; such as self care, home living, communication and social skills, academic skills, self direction, and work, leisure, safety, and health activities. ***Table 13-6*** List therapeutic actions that can be used for children with mental retardation. Members of treatment team are likely to be: speech pathologist, physical therapist, occupational therapist, dietician, and nurse.

Developmental Problems cont’d. (p.149) Learning disorders Diagnosed when a child with normal intelligence falls below other children of the same age and grade on standard reading, mathematics, or written tests A child has a learning disorder only if the specific problem interferes with academic achievement or activities of daily living. Children with learning disabilities often have low self-esteem and lack the social skills of other children. Examples: Dyslexia ADHD What are the types of learning disorders? What are some possible causes of learning disorders?

Developmental Problems cont’d. (p.150) Communication disorders Communication disorders may result from neurologic or other medical conditions, but the cause is often unknown. Phonological disorder Failure to use speech sounds expected for his or her age group Expressive language disorder Speaking at a rapid or slow rate, with strange rhythms and word use Stuttering Pattern of speech in which sounds are repeated frequently

Pervasive Developmental Disorders (p. 149-150) Asperger’s syndrome Long-lasting impairment in social interactions, such as eye contact, inappropriate facial expressions, showing little emotions, with repeated patterns of behaviors, interests, and activities Childhood disintegrative disorder Severe regression in many areas after 2 years of normal development Children have difficulty with social interaction skills, communication skills, and learning. Autism Disorder of communication, social interactions, and behavior Rett syndrome Development of motor, language, and social problems and loss of previous skills List and describe the behaviors seen in children with pervasive developmental disorders. Autism is the most commonly diagnosed pervasive developmental disorder. Why might parents of a child with childhood disintegrative disorder resist or deny such a diagnosis?

Schizophrenia (p. 151) Condition associated with disturbing thought patterns and a distorted reality Signs, symptoms, and behaviors of children with schizophrenia vary widely. The core disturbance lies in lack of contact with reality and the child’s retreat into his or her own world. Early recognition and treatment are important because schizophrenia is often a long-term disorder. How does schizophrenia in children differ from the disorder in adults? Research shows that schizophrenic children may have attention and memory problems that interfere with their ability to carry information into the short-term or working memory.

Therapeutic Actions (p. 151) The primary goals of therapeutic interventions for children with mental health problems include early identification and treatment. Specific goals are developed for each child. General interventions are focused on the following: Meeting basic needs Providing opportunities Encouraging self-care activities List general interventions for children with mental health problems. Meeting basic physical needs can range from gentle reminders to providing total personal care. Many children with mental health problems have a special need to be nurtured, and the caregiver may be the only person available to provide for those needs. Care providers should find creative ways to encourage young clients to grow and expand on their ability to function.

Therapeutic Actions (p. 151-152) Assessment Tools Denver II-gross and fine motor skills; language; social skills Preschool Readiness Screening Scale-maturation; school readiness Early Language Milestone Scale-speech and language development Infant Temperament Questionnaire, Toddler Development Scale, Behavioral Questionnaire, Middle Childhood Questionnaire- all measure temperament at different ages List general interventions for children with mental health problems. Meeting basic physical needs can range from gentle reminders to providing total personal care. Many children with mental health problems have a special need to be nurtured, and the caregiver may be the only person available to provide for those needs. Care providers should find creative ways to encourage young clients to grow and expand on their ability to function.