CAMHS Flashcards
Familial risk factors for behavioural disorders
Angry discord between family members
Parental mental illness, especially maternal depression
Bereavement
Divorce and subsequent loss of parent figure
Intrusive overprotection
Lack of parental authority
Physical/sexual abuse
Emotional rejection
Excessive criticism
Inconsistent, unpredictable discipline
Using child to fill parental emotional needs
Inappropriate responsibility or expectation of the child
Features meal refusal
Child refusing to eat any/much of prepared meals
“mealtimes are a battle”
Child healthy and well-nourished with normal growth
Factors contributing to meal refusal
Past history of force feeding Irregular meals: child is not predictably hungry Unsuitable meals Unreasonably large portions Multiple opportunity for distraction
Mx meal refusal
Offer adequate range of wholesome food Avoid confrontation at mealtimes delevop a relaxed atmosphere Use favourite foods as rewards: use other rewards for compliance at mealtime .e.g. TV Reduce eating between meals
Difficulty settling at night causes
Too much late afternoon sleep Displaced sleep/wake cycle Separation anxiety Overstimulated/overworked in evenings Kept awake by environmental factors Erratic parenting Use of bedroom as punishment Dislike of darkness and silence Chronic physical conditions .e.g. sickle cell crisis
Mx sleeping difficulty
Creating bedtime routine which cues child
Telling child to lie quietly until they sleep
No screen time 1h before sleep
Graded pattern of leaving child
Features night terrors
Occur 1.5hrs after settles Child sitting up in bed, eyes open, seemingly awake Disorientated, confused, distressed Unresponsive to questions or reassurance Child settles within minutes No recollection of episode
Mx toddler disobedience
Ensure demand is reasonable for development of child
Positive instructions not negative instructions
Praise for compliance even when spontaneous
“if you do… we can do…”
Avoid empty threats
Follow through with consequences
Ignore non-significant episodes
Medical factors of poor behaviour
Global or language delay
Hearing impairment
Medication with bronchodilators and anticonvulsants
Mx tantrums
Affect and attention before the tantrum Distraction Avoiding antecedents Ignoring: effective, no surrender Time out from positive reinforcement: walk away, separate from other children Hold firming if risk of danger Star chart 1-2-3 principles: stop-if-consequence
Causes nocturnal enuresis
UTI
Faecal retention reducing bladder volume and causing bladder neck dysfunction
Polyuria from osmotic diuresis/ concentrating disorders
Developmental, attentional and learning difficulty
Ix nightime enuresis
Indicated with recent onset bed wetting, daytime enuresis, UTI, diabetes, ill health
Urinalysis
Normal development nocturnal enuresis
Infrequent bed wetting is common in children
>2 nghts/week present in 6% of 5y and 1.5% 10y
More common in boys
Usually genetically determined delay in sphincter competence
Typically resolves spontaneously
Mx Nocturnal Enuresis
Reassurance and explanation
Ceasing punishment
Excessive fluid intake/ abnormal toileting addressed
Waking and lifting does not promote long term dryness
Star chart for sheet change NOT dry nights
No child blame for wet nights
Enuresis alarm
-1/3 relapse but succeed with second trial of alarm
Desmopressin (ADH synthetic analogue): children >7y
-short term use .e.g. sleepovers and holidays
-sublingual tablet and fluid restriction
-continued for 3-6m
Factors contributing to faecal soiling
Faecal retention and constipation: -pain from fissure -fear of punishment for incontinence -toileting anxiety Urgency of defecation Neuropathic bowel Diarrhoea overwhelming bowel control Mental age below 4y Intentionally as a hostile act
Mx Constipation
Treatment of fissures Emptying rectum: stool softener .e.g. macrogol 2w +/- stimulant laxative Maintenance laxative therapy Regular toileting star charts
Features somatic symptoms
Recurrent medically unexplained symptoms
Aggrevated by dtress
Usually recurrent abdo pain (9y) and headache (12y)
Limb pain, aching muscles, fatigue, neurological signs with increasing age
Pain further away from umbilicus more likely to be organic (Apley’s rule)
Pain may be limited to school days or specific events
Features Tics
Quick, sudden, co-ordinated movement Apparently purposeful Recurrs in the same part of the body Can be suppressed to some extent Typically around face and head: blinking, frowning, head fliching, sniffing, throat clearning, grunting Boys more commonly affeced Average onset 8y, peak at 11y Occur when child is inactive Disappears when concentrating
