1. Chapter 13
problems of childhood

2. 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

3. 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 )

4. 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

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

7. 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 )

8. Seizure like behavior
Resolve 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

10. 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

11. -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

12. 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

14. 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

15. * 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

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

17. 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

18. 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

19. * 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

21. 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

22. * 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

23. 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

24. 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

26. * 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

27. 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

28. Autism

29. * 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 high fever
6- hormonal imbalance
7-poisoning accident & falling down
9- hereditary problem

30. 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 ;

31. 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

33. * 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

34. 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

35. * 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

36. 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

37. 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

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

39. شكرا لحسن الإستماع