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Common child developmental and behavioral problem :no_good::skin-tone-4:…
Common child developmental and behavioral problem :no_good::skin-tone-4: (1/2)
Common child developmental problem
Global delayed development
Delayed gross motor
Delayed speech
Specific language impairment
Social communication disorder
Autism spectrum disorder
Syndrome
Down syndrome
Fragile X syndrome
Williams syndrome
Angelman syndrome
Prader-Willi syndrome
Velocardiofacial syndrome
Rett syndrome
Turner syndrome
:one:
Pica
Def
:bulb:
persistent
eating nonnutritive substances
at least 1 month
Inappropriate
to deve level eg. 5 yr normal IQ but หยิบอะไรเข้าไปกินดินเหมือนเด็ก 6 yr ที่หยิบทุกอย่างเข้าปากเฉย
Not part of a cultural practice
usu. remit in childhood (มักหายเอง)
Common in ASD, ID, lesser degree in obsessive compulsive and schizophrenic disorders
Etiology
:baby_chick:
Nutritional def (Iron, Zn & Ca)
Low socioeconomic factors (lead paint exposure)
Child abuse & neglect
Family disorganization (poor supervision)
Mental disorder
Learned behavior
Biochemical disorder
Cultural & familial factors
Ddx
:pineapple:
Anorexia nervosa
Factitious disorder (โรคแกล้งทำ)
Non-suicidal self-injury in personality disorders
Sequelae
:timer_clock:
Lead poisoning
Iron def anemia
Mechanical bowel problem
Intestinal obstruction/perforation
Dental injury
Parasitic infection
Treatment
:leaves:
Combined behavioral, social & medical approaches
Neglect? and family supervision
Mental disorders & developmental delay
Behavioral treatment interventions
Sequelae require specific Rx
Ingestion of hair - require medical or surgical intervention for a gastric bezoar
:two:
Enuresis
Def
:bulb: by
DSM V
Ddx
:pineapple:
Etiology
:baby_chick:
Delayed maturation of Cortical mechanism--that allow voluntary control of micturition reflex
Defective sleep arousal
:arrow_down:ADH production at night ➯ :arrow_up: urine output (nocturnal polyuria)
Genetic factor
Sleep disorder
2 ° Etiology
:baby_chick:
UTI
CKD
HyperCa
HypoK
Constipation
Endocrine dysfunc (DM, DI, hyperthyroidism)
Seizures
Spinal dysraphism
Neurogenic bladder
Pinworm infection
Drugs (SSRI, valproic acid, clozapine)
Combined
nocturnal & diurnal diuresis ➯ more likely
Abnormalities of Urinary tract
Treatment
:leaves:
จะได้ฉี่กลางคืนน้อยๆ vibes
Voids at bed time
Avoid extraneous sugar & caffeine after 4PM
Fluid intake restricted to 2 Oz after 6 or 7PM
If snores and adenoids are enlarged ➯ refer to ENT
Active Rx avoided in < 6 yr
Reassure: self-limited & avoid punitive measures (affecting child's psychologic deve)
Effective in children who are motivated to stay dry
Therapy
Motivation therapy: Star chart for Dry night
Condition therapy: Loud auditory or Vibratory alarm attached to moisture sensor in underwear
(Success 30-60% with relapse rate)
Drugs
:grapes:
Normal child deve on elimination
:grapes:
Toilet training
:grapes:
Types
:lower_left_crayon:
Day/Night
Diurnal diuresis: while awake
Nocturnal diuresis: during sleep
1°/2°
1°:
Never
been consistently dry thru the night
2°: Wetting
after ≥ 6 months of dryness