Behavioural problems of toddlers 3.pptx.

Behavioral problems of infants

1. SEMINAR PRESENTATION By, S DHIVYA POOJA BSC(N) 3 rd YEAR

2. GUESS THE TOPIC

3. BEHAVIOURAL PROBLEMS OF TODDLERS By, S DHIVYA POOJA BSS.NURSING 3 rd YEAR

4. OBJECTIVES Introduction Definition Prevalence Behavioural problems classification Types of behavioural problems Causes Symptoms Treatment Behavioural assessment of child Nursing responsibility

5. INTRODUCTION Parents often complaint to the paediatrics that their child is very stubborn, does not listen to their commands, is very demanding and aggressive . It is important to identify these problems in the initial stages as they can be managed optimally to help the child grow normally and have balanced mental health.

6. DEFINITION Behaviour : It is anything that is observable and measurable. Behaviour is learned over time through the environment. Behavioural disorder : It is defined as manifestation of behaviour that is noticeably different from that expected in the school or community.

7. PREVALENCE It is common in children. Serious disorder have been reported between 10% and 15%. The problems are seen in both genders, but certain problems like attention deficit hyperactivity disorder (ADHD) are more common seen in boys

8. CLASSIFICATION OF BEHAVIOURAL PROBLEMS Age Frequency Severity Effect on development

9. TYPES OF BEHAVIOURAL DISORDERS Body rocking Head banging Breath holding spells Thumb sucking Nail biting Evening colic Strange anxiety Temper tantrum Pica Enuresis Encopresis Bruxism

10. HEAD BANGING This involves rhythmic hitting of the head against a solid surface often the crib matters. REASON Pain Attention seeking Frustration

11. TREATMENT •Environmental should be created in a way that child cannot get injured. •Activities should be provided to the child, which can be comprehend by him and can engage him . •Provide emotional security. •Padding of bed rails to prevent injury.

12. BODY ROCK It is characterised by rhythmic forward and backward swaying of the trunk most frequently in sitting position REASON Self soothing to relax and fall sleep Child nervous system is not fully developed a result they can’t control motor function

13. SYMPTOMS Rock their entire body in rhythmic manner. Rock a part of the body, like their hand, arm, leg and head. Shake their body. TREATMENT Reassure the parents that it will resolve with time. If the child has neuropsychoatric behaviour then consult psychiatric

14. BRUXISM It is the forcible grinding, clicking or clenching of teeth mostly occurring during sleep. It can due to emotional stress or disturbing . CAUSES Pain from teeth Improperly aligned teeth Stress anger or fear Parasites tapeworm or pinworm Nasal Obstruction

15. SYMPTOMS Grinding noise at night . Complaints of facial pain or pain in the lower jaw. The dentist can examin singns of wear and tear on the teeth to confirm . TREATMENT Correactoin of malocclusion. Conselling of the child for strees . Instruct the child to clinch the teeth tightly for 5 seconds, repeat several times for 2 weeks to relive tension. Aviod watching or reading horror movie at bed times.

16. BREATH HOLDING SPELLS A breath holding spell is an involuntary pause in breathing, sometimes accompanied by loss of consciousness it is usually occurs in response to an upsetting or surprising situation. Causes Fear Pain Or traumatic event The sudden reaction to fear can cause the nervous system to temporarily slow the heart rate or breathing.

17. TYPES Blue spells Pale spells Sometimes the both In rare seizure

18. SYMPTOMS After the child passes out, they’ll lie simply on the floor. They may also ; Arch their body Become stiff jerk their body a few times Wet them self TREATMENT During the episode, lie them on their side and watch them do not put anything in their mouth or splash with water. No Special medical treatment is required. Avoiding situations that provoke Tempe tantrum can help reduce the number of spells.

19. THUMB SUCKING Thumb sucking is a natural habit of infants and young children they do it to soothe themselves. CAUSES Thumb sucking makes child feel secure Soothing Or to fall asleep Calm down

20. SYMPTOMS Malocclusion Mastication difficulty Speech difficulty Lisping TREATMENT Ignores Use protective reinforcement Identify triggers

21. NAIL BITING Nail biting is another habit disorder in toddler and pre school children. CAUSES Gratifying oral habits Anxiety Parental neglect Stress of exam

22. SYMPTOMS AND EFFECT Teething problems Respiratory tract infections Gastrointestinal infection Digital deformity TREATMENT Remove precipitants- Provide a stress free and caring environment Behaviour modification technique- praise the child for well kept hands, keep the child busy in other creative activities, avoid punishment. Play therapy Parentral reassurance

23. STRANGE ANXIETY The child can differentiate between the primary care givers and others. At this stage the child develop fear of unfamiliar people or stranger. CAUSES Fear of unknown SYMPTOMS Crying Clinging Withdrawing – Becoming quite, or hiding Avoiding eye contact Running away

24. TREATMENT Teaching relaxation techniques such as gradually exposing them to stranger initially from a distance and asking them to great and slowly advance

25. TEMPER TANTRUM It is a certain outburst or violent display of frustration and angle has physical aggressive or resistance. Biting, throwing objects, crying, rolling on Floor or banging Limbs are common activities during temper tantrum. CAUSES Fatigue Or hungry Parents fails to discipline a child Iorn deficiency

26. SYMPTOMS Biting throwing objects Lack of sleep TREATMENT In general parents advice to ; Set a good example to child Pay attention to child Spend quality time with child Have open communication During temper tantrum Parental should ignore the child during the episode and once child is calm , tell that such behaviour is not acceptable to child. Never bit or threaten child.

27. STUTTERING The defect In speech like stumbling and spasmodic repetition of some syllables with pauses. Difficulty occurs in pronouncing consonants due to the spams of lingual and palatal muscle. It begins in 2-5years age and more common in males. CAUSES Stress and anxiety Genetics Neurogenic stuttering Degenerative neurological disorder.

28. SYMPTOMS Hard time starting a word, phrase or sentence. Repeating a sound, syllable or word. Adding extra words such as “umm”. TREATMENT Parents should be reassured. They should not express undue concern & should accept his speech without pressuring him to repeat. Children with secondary stuttering should consult speech therapist.

29. PICA It is a habit disorder characterized by repeated or chronic ingestion of non- nutritive substance. Examples; Mud, paints, clay, plaster, charcoal, soil, soap, eggshells etc. PREDISPOSING FACTORS Parental neglect Inadequate supervision Mental retardation Lack of affection Psychological neglect, orphans Family disorganization Lower socioeconomic class

30. TREATMENT Screening should be done for iron deficiency anemia , worm infestation, lead poisoning and family dysfunction. Treat cause accordingly Usually remits in childhood but can continue into adolescence

31. ENSURESIS It is defined as the repeated voiding of urine in the bed or cloths at least twice per week. ETIOLOGY Diabetes UTI Deficiency in night time anti diuretic hormone Genetic Mental disabled children

32. SYMPTOMS Wetting during the day time Frequency ,urgency Constipation Cloudy urine. DIAGNOSIS Complete history and physical examination Urinalysis Urine culture Ultrasonography

33. MANAGEMENT No punishment should be given to the child parents should be to sure that bedwetting is due to maturational delay and is not intentional Motivational therapy Behavioural modification Bladder training Pharmacological therapy DDAVP is synthetic ADH and is used to decrease night time urination Imipramine

34. ENCOPRESIS Is define as repeated passage of feces at inappropriate places ( eg.clothing or floor). CAUSES Constipation Lack of toilet training Training at too early an age or an emotional disturbance Low fiber diets Not drinking enough water Avoidance of school bathrooms

35. DIAGNOSIS History and physical examination Developmental screening Abdominal x ray Rectal examination for fecal impaction. MANAGEMENT Bowel cleansing use laxative Nutritional changes Bowel training Behaviour management use picture and stories or puppets Family support : family members should provide love and support to the child

36. BEHAVIOURAL ASSESSMENT OF CHILD Child behaviour is systematically observed and recorded, according to antecedents (situation) , feeling, thought, behaviour and consequences . Parent can be involved in this recording. Older children can do this on their own.

37. NURSING RESPONSIBILITY Assessment of specific problems of the child by appropriate history and detection of the responsible factors. Informing the parents and making them aware about the cause of behavioural problems of the particular child. Assisting the parents, teachers and family members for necessary modifications of environment at home and school and community. Encourage the child for behaviour modification as needed. Promoting healthy emotional development of the child. Providing counselling services for children and their parents to solve the problems.

38. SUMMARY

39. CONCLUSION Children show a wide variety of behaviours which create problems to the parents, family members and society. Behavioural problems always require special attention.

40. JOURNAL Behavioral problems among school going children are of significant concern to teachers and parents. These are known to have both immediate and long-term unfavorable consequences Five hundred children aged 6-18 years were randomly selected from a government school in Kanpur. Uttar Pradesh, and assessed for cognitive, emotional, or behavioral problems using standardized tools. This study is conducted by Anindya Kumar Gupta, Monica Mongia , and Ajoy Kumar Garg

41. BIBLIOGRAPHY Wifirst son David, Hockenberry J. Marilyn:wong’s essential of pediatric nursing, first South Asia edition;page no. 416- 419 Datta parul , Pediatric nursing;second edition jaypee brothers medical publishers;page no. 188- 194 Panchali pal ; textbook of pediatric nursing; paras medical publishers, page no. 498- 505

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