1. Health Related Issues

2. 1.Sleep problems 2.Elimination problems 3.Chronic Illnesses 1.Sleep problems 2.Elimination problems 3.Chronic Illnesses

3. Sleep Disorders The Regulatory Functions of Sleep –main activity of brain in first years –essential for brain development –deprivation impairs functioning of the prefrontal cortex, leading to decreased concentration diminished ability to control basic drives, impulses, and emotions The Regulatory Functions of Sleep –main activity of brain in first years –essential for brain development –deprivation impairs functioning of the prefrontal cortex, leading to decreased concentration diminished ability to control basic drives, impulses, and emotions

4. Sleep Disorders (cont.) Maturational Changes –change over the course of maturation –adolescents often chronically sleep-deprived Maturational Changes –change over the course of maturation –adolescents often chronically sleep-deprived

5. Dyssomnias Disorders of initiating or maintaining sleep Quite common in childhood See chart in book (next slide) Disorders of initiating or maintaining sleep Quite common in childhood See chart in book (next slide)

6. Table 12.1 Dyssomnias

7. Parasomnias Disorders in which behavioral or physiological events intrude upon ongoing sleep Common afflictions of early to mid- childhood; children typically grow out of them Partial wakings during various sleep cycles Disorders in which behavioral or physiological events intrude upon ongoing sleep Common afflictions of early to mid- childhood; children typically grow out of them Partial wakings during various sleep cycles

8. Parasomnnias 1.Sleep terrors Following stage IV sleep; early in night Early childhood: crying, sobbing, thrashing, not able to comfort fatigue Later childhood/adolesc.: screaming, panic, fear, possible wild running Psychological factors usually relevant 2.Nightmares- scary dreams; REM sleep; early morning Often reflect normal emotional struggles 3.Sleepwalking – see sleep terror 1.Sleep terrors Following stage IV sleep; early in night Early childhood: crying, sobbing, thrashing, not able to comfort fatigue Later childhood/adolesc.: screaming, panic, fear, possible wild running Psychological factors usually relevant 2.Nightmares- scary dreams; REM sleep; early morning Often reflect normal emotional struggles 3.Sleepwalking – see sleep terror

9. Table 12.2 Parasomnias

10. Reid et al. - Quiz A friend has a 2 year old that won’t go to sleep at night by himself. Your friend has to lie in bed with him until he finally falls asleep, then she sneaks out of the room, hoping that he will not wake up. If he does wake up, she has to go through the whole process again. She is quite tired and frustrated. What would you suggest she do? Be as specific as possible. Why do you suggest what you suggest?

11. Sleep Disorders (cont.) Treatment –Sleep hygiene –behavioral interventions –Night Terrors/Sleepwalking –Nightmares: Provide comfort Reduce stress Treatment –Sleep hygiene –behavioral interventions –Night Terrors/Sleepwalking –Nightmares: Provide comfort Reduce stress

12. Elimination Disorders Enuresis –involuntary discharge of urine twice a week for three months or accompanied by significant distress or impairment, 5 years old –Ratio or girls/boys night/day –Primary/secondary Enuresis –involuntary discharge of urine twice a week for three months or accompanied by significant distress or impairment, 5 years old –Ratio or girls/boys night/day –Primary/secondary

13. Elimination Disorders (cont.) Enuresis –Causes deficiency of antidiuretic hormone genetic predisposition immature signaling mechanism –treatments behavioral training methods Bell and pad alarm medication Enuresis –Causes deficiency of antidiuretic hormone genetic predisposition immature signaling mechanism –treatments behavioral training methods Bell and pad alarm medication

14. Elimination Disorders (cont.) Encopresis –passage of feces into inappropriate places once per month for 3 months at least 4 years old –2 subtypes: with or without constipation and overflow incontinence –primary or secondary –psychological problems likely result from, rather than cause it Encopresis –passage of feces into inappropriate places once per month for 3 months at least 4 years old –2 subtypes: with or without constipation and overflow incontinence –primary or secondary –psychological problems likely result from, rather than cause it

15. Elimination Disorders (cont.) Encopresis (cont.) –causes untreated constipation abnormal defecation dynamics Encopresis (cont.) –causes untreated constipation abnormal defecation dynamics

16. Chronic Childhood Illness persists for more than 3 months or requires hospitalization for more than 1 month DSM-IV categories have limited applicability to children Adjustment Disorder persists for more than 3 months or requires hospitalization for more than 1 month DSM-IV categories have limited applicability to children Adjustment Disorder

17. Chronic illnesses Affect 10% to 20% of child population Asthma most common Low incidence of psychological problems but some increased risk of psychological adjustment difficulties Affect 10% to 20% of child population Asthma most common Low incidence of psychological problems but some increased risk of psychological adjustment difficulties

18. Factors affecting adjustment Parental stress and adjustment Family resources Social support Illness conditions: severity, prognosis, ability to function Parental stress and adjustment Family resources Social support Illness conditions: severity, prognosis, ability to function

19. Interventions Problem focused coping for family Reduce stress Coping skills for pain/procedure management Problem focused coping for family Reduce stress Coping skills for pain/procedure management

20. Table 12.3 Estimated Population Prevalence of Selected Chronic Diseases and Conditions in Children, Ages 0-20 in the United States