Please enable JavaScript.
Coggle requires JavaScript to display documents.
Common child developmental and behavioral problem :no_good::skin-tone-3:…
Common child developmental and behavioral problem :no_good::skin-tone-3: (2/2)
:three:
Encopresis
Def
:bulb:
Repeated
passage of feces into inappropriate places
<voluntary or unintentional>
Behavior is
not exclusively due to PSO effect of a substance
(eg. laxative)
or a general medical condition
except thru
mechanism involving constipation
At least one event a month for
≥ 3 months
Chronological age of
≥ 4 yrs
(or equivalent developmental lvl)
Etiology
:baby_chick:
Organic
(5-10%)
Anatomic
Imperforated anus
Anal stenosis
Hirschsprung ds
Neurologic
Spinal cord lesion
Hypothyroidism
Medication
Laxatives
TCAs
Diuretics
Functional
(90%)
Chronic withholding
Triggered by Painful stool
Pushed toilet training
Afraid of potty
Unacceptable public toilets
Restrictions at school
Treatment
:leaves:
Medication
:pill:
:small_blue_diamond:
Rapid
disimpaction
:small_blue_diamond:
Slow oral
impaction
:small_blue_diamond:Maintenance
Long term (yr)
Short term (mo)
Weaning
when
?
:When 1-2 soft bowel movements daily (usu. after 6 mon)
:poop:
Prevent further constipation with high-fiber diet, mineral oil or laxatives
Softening the stool
Fecal disimpaction
Toilet training: sit on toilet after meal for 5-10 min
Positive reinforcement
Not respond to soiling with punitive measures
If behavioral or psychiatric problems are evident -> Group or Individual psychotherapy mayb necessary
:!: If parents become over-involved & controlling, this won’t work
:earth_americas:
Prevalence
4% in 5-6 yrs old
1.5% in 11-12 yrs old
Types
:lower_left_crayon:
Retentive/Non-retentive
Retentive: With constipation 65-95%
Non-retentive: 5-20%
1°/2°
1°:
persists
fr infancy onward
2°: Appear after successful toilet training
:four:
Thumb sucking
Def
:bulb:
Self soothing, most
give up by 2 yrs
2 yrs: Autonomy
➯ คว้าของมาเป็นของตัวเอง ➯ มือเต็มถือของรักของหวง ➯เลิกดูดนิ้ว
Not
give up by 2 yrs
If continued
beyond 5 yrs
➯ Paronychia, Anterior open bite
If
resumed at 7 - 8 yrs
➯ Sign of stress
Treatment
:leaves:
Reassure parents that it's
transient
Improve parental attention/nuturing
Teach parent to ignore and give more attention to positive aspects of child's behavior
Provide child praise/reward for substitute behaviors
Bitter salves, thumb splints, gloves ➯ :arrow_down: thumb sucking
:five:
Nail biting
Def
:bulb:
Bad oral habit
esp. in school age beyond 4 yr
If
persists to 5-7 yrs old
➯ Sign of tension & Self punishment to cope with the hostile feeling towards parent
Etiology
:baby_chick:
Imitating parents who also is nail biter
Insecure feeling
Conflict
Hostility
Pressurized study at school or home
Watching frightening violent scenes
Complication
:timer_clock:
Paronychia
Digital abnormalities
Treatment
:leaves:
Distract
Use of bitter-tasting substances
:six:
Aggression & Bullying
Def
:bulb:
serious
symptoms
:warning:
assoc. with
significant morbidity & mortality
might not grow out of this behavior
found in :male_sign: > :female_sign:
(in boy consistent fr preschool to adolescents)
difficult temperament relate with later aggressiveness
often perceive social cues & react with inappropriate hostility toward peers & parents
Ddx
:pineapple:
*(for Ddx causes & motives)
:diamond_shape_with_a_dot_inside:Correlated with
Chaotic
Impoverished family home
Result for unemployment
Family discord
Exposure to community & domestic violence
Criminality & psychiatric disorders
Teenage mom
Limited resources & support
Warning
:warning:
:diamond_shape_with_a_dot_inside: High risk for
Suspension fr school
School failure
:diamond_shape_with_a_dot_inside: Comorbids
Learning disorders
ADHD
Oppositional defiant disorder (ODD)
Intermittent explosive disorder (IED)
Conduct disorder
Disruptive mood dysregulation disorder
Treatment
:leaves:
Persistent aggressive behavior ➯ Early intervention
Callous (อารมณ์ด้านชาไม่มีความรู้สึกไรเลย), not empathetic, often aggressive ➯ Mental health evaluation