Child Psychiatry

Question 1

3 stages of acute separation response

Answer 1

1) Protest
2) Despair
3) Detachment

Question 2

Psychological effects hospitalisation/ chronic illness

Answer 2

1) Anxiety
- emotional/ behavioural/ educational difficulty 2-3x more common in children with chronic illness than healthy children
2) Despair
- depression
- low self-esteem
- impaired self-image
3) Anger
- behavioural problems common
4) Developmental regression
- school dysfunction common

Question 3

Food refusal O/E

Answer 3

Healthy, well-nourished child securely in centiles of growth chart OR
Thin, small child w faltering growth

Question 4

Hx food refusal

Answer 4

What is parent most concerned about?
 Typical mealtimes:
o Past history of force-feeding
o Irregular meals, so child not predictably hungry
o Unsuitable meals
o Unreasonable large portions
o Distractions: e.g. TV
 How much does child eat between meals? (sweets or crisps not always regarded as food)
 Food variety?

Question 5

Advice food refusal mx

Answer 5

Impossible to force a child to eat, so avoid confrontation at meal times
Develop relaxed atmosphere
Use favourite foods as a reward. Introduce other rewards for compliance at mealtimes, e.g.extra TV time
Reduce eating btwn mealtimes if necessary (although many young kids prefer small, freq snacks)

Question 6

Features anorexia nervosa

Answer 6

Self-induced wt loss -> low BMI (

Question 7

Anorexia Nervosa O/E

Answer 7

Slow-to-relax tendon reflexes
Reduced peripheral circulation
Bradycardia
Amenorrhoea
Fine lanugo hair
Doesn't lose pubic/ axillary hair but incompletely established puberty is delayed 
Ankle oedema (low plasma proteins)
Proximal myopathy

Question 8

AN bloods

Answer 8

Low T3
Sometimes low plasma proteins
Low FSH and LH (non-cyclical low levels)

Question 9

Mx AN

Answer 9

Refeeding, aim for 0.5kg gain/wk in OPs
Psychological therapies (e.g. CBT, family therapy)
Small for age need hospitalisation

Question 10

Disturbances of sleeping

Answer 10

Common in toddlers

Question 11

Nightmares

Answer 11

Nightmares: Bad dreams that can be recalled by child.
normal, only need specialist if occur freq/ stereotyped in content
if kid scared of bed can leave door open/ nightlight on

Question 12

Disturbances of sleeping advice

Answer 12

Create bedtime routine
Tell child to lie quietly in bed until they fall asleep
If unsuccessful, may need graded pattern of lengthening periods btwn tucking child into bed, leaving room before they fall asleep, so child learns to fall asleep alone.
If refractory may need specialist referral.

Question 13

Night terrors

Answer 13

Night terrors: not common. Not part of dream sequence, occurs in 1st couple of hours.
Parents find child sitting up in bed, seemingly awake, obviously disorientated/ confused/ distressed/ unresponsive.
Parasomnia (rapid emergence from 1st period of deep, slow-wave sleep)
Child settles back to sleep, no memory in morning.
May be ass w sleepwalking
Will grow out. Waking before can help. Reassure parents

Question 14

School refusal definition

Answer 14

Inability to attend school due to overwhelming anxiety - DISPROPORTIONATE to stresses from school
Anxiety may present as nausea, headache, otherwise not being well - confined to weekday, term-time mornings, clear up by midday

Question 15

School refusal causes

Answer 15

1) Separation anxiety persisting from toddler years (typical children

Question 16

School refusal mx

Answer 16

Tx any underlying emotional disorder
Gently promote increasing separation from parents (e.g. stay overnight at friend’s house)
Arrange early return to school
Reward child for returning to school
Address any bullying or educational difficulties

Question 17

ADHD definition

Answer 17

persistent pattern of inattention, hyperactivity and impulsivity that is more freq and severe than in other people at a similar level of dvpmnt

Question 18

ADHD epidemiology

Answer 18

Boys > girls (3:1)

Btwn 10-50/ 1000 children

Question 19

ADHD Dx

Answer 19

Must show core sx of inattention, hyperactivity and impulsivity
Must be present before age 7 and persist for 6 months
Present in 2 settings (e.g. home and school)

Question 20

ADHD Clin features

Answer 20

• Kids with ADHD have too much energy
- Can’t sit still, are restless and fidgety
• Difficulty in attending to one thing for long period and in following instructions
• Schoolwork disorganised, never finished, contains many careless errors
• Child tends to be forgetful, boisterous, reckless and accident prone
• All these problems -> low self-esteem and sometimes to disobedience, temper tantrums and other antisocial behaviour
- Dep mood common
- Behaviours vary in severity btwn places- e.g. Worse at school vs home

Question 21

ADHD Mx

Answer 21

Preschool/ school-age, mild-moderate: behavioural interventions, refer to educational psychologist
More severe: medication, usually for children >6
Stimulants e.g. methylphenidate, dexamphetamine BUT can -> anorexia, wt loss, reduced growth, insomnia, headaches

Question 22

Autism definition

Answer 22

Classically difficulties in 3 areas:

1) Social deficits
2) Communication deficits
3) Restricted/ repetitive interests and behaviours

Question 23

Autism epidemiology

Answer 23

Prevalence 3-6/1000

M>F (4:1)

Question 24

Autism clin features

Answer 24

Usually presents between 2-4 yrs
1) Social deficits - most specific to autism
- E.g. Babies that don’t like being held
- reduced eye contact
- lack of gestures
- unusual facial expressions
2) Communication deficits
- Speech completely absent in 30%
- Echolalia
- Odd prosody (unusual stress/ rhythm/ pitch/ intonation)
- Pronoun reversal (referring to themselves as he or she)
- Lack of reciprocity in conversations
3) Restricted/ repetitive interests and behaviours
- Deep interest in things others would find mundane, e.g. Washing machines, number plates
- “Obsessive desire for sameness” - autistic child has stereotyped behaviour and are distressed if there’s a change in their envt
- Odd motor behaviours, e.g. Running in circles, flapping hands repeatedly
- Repetitive behaviours, e.g. Lining up toys
If only some behaviours present, may be described as having autistic features but not full spectrum.

Question 25

Asperger syndrome

Answer 25

Child with social impairments of ASD but at milder end, near-normal speech development

Question 26

Mx autism

Answer 26

Parental support
Applied behavioural analysis: behaviour modification approach, needs 25-30h individual therapy each week so costly and time-consuming