Childhood developmental behavior Flashcards
1
Q
Definition of short stature?
Differential?
A
- past age 2 yrs: ht below 2.3%
- goal: diff b/t benign and pathological etiologies
differential:
- familial short stature
- constitutional growth delay
- turner syndrome
- inflamm bowel disease or some systemic disease: malnutrition
- growth hormone deficiency
2
Q
Dx approach for short stature pt?
A
- thorough H & P! Always!!
- look at growth curve velocity on growth chart
- use formula using parents ht to determine child’s adult ht
- bone age determination
3
Q
Calc of child’s ht by parents’ heights?
A
- add parents hts together in inches
- divide by 2
- for boys add 2.5 inches
- girls: subtract 2.5 inches
- rough approximate
4
Q
Benign short stature etiologies?
A
familial short stature:
- bone age same as child’s age
- hx of one or both parents being short
- genetic: will be short adult
constitutional growth delay:
- bone age is less than child’s age - plot ht at bone age and is usually more in normal range
- usually have delayed puberty and longer period of growth, end result is normal adult ht
5
Q
Most impt first step in newborn’s life?
A
- bonding with his/her caregivers
- infant hasn’t learned he/she is separate from caretakers
- physical contact with mother or father represents protection to the baby (birth - 4 mos)
- babies deprived of care are more irritable, more easily startled and fussier throughout infancy than babies who have known mothering
- CAN’T spoil an infant!!
6
Q
Bonding/attachment problems?
A
- mother ill b/c of complications or chronic probs
- single parent-increased stress
- no outside support for parents
- post-partum blues, depression or psychosis
- marital stress
- abuse
- not having wanted baby from the beginning
- too much support around: family and friends
7
Q
Temper tantrums occurence?
A
- typical behavior in 2-4 yos
- consists of whining, screaming, crying and throwing one’s self on the floor
- usually to do with frustration: learning how to communicate
- easily overwhelmed - used to schedules
- may be overtired
- they want their own way
8
Q
4 goals of misbehavior?
A
- attention
- power
- revenge
- display of inadequacy
9
Q
Temper tantrums advice for parents?
A
- try to avoid putting the child in situations where they are tired and exposed to a lot of stimulating activity
- give them easy choices b/t 2 things
- ignore tantrum unless they are harm to themselves
- distract them
- warn them of consequences
- don’t hit or spank them
- after it is over give them hug and tell them you love them
- always consider mental health of parent, behavioral problems much more common in children of depressed mothers
- encourage teaching prosocial behavior and empathy
- educate parents about reinforcing the positives
10
Q
When to seek help with tantrum throwing children?
A
- parent is uncomfortable with their response or their feelings (parent needs to remain calm)
- parent keeps giving in when the tantrum is over something the child wants
- tantrums arouse a lot of bad feelings
- they are increasing in frequency, intensity, or duration
- child frequently hurts himself or others
- child is destructive
- child displsays mood disorders: negativity, low self-esteem or extreme dependence
11
Q
Potential underlying problems - TT?
A
- hearing or vision probs
- chronic illness
- language delay
- learning disability
12
Q
What is considered abnormal aggressiveness? What does future look like for these kids?
A
- chronic aggressiveness in 5 yos and up
- odds are very high that they will experience repeated failure in school
- life will be frustrating and disappointing
- they may inflict a great deal of emotional and physical pain upon others
- studies show that potentially long term aggressive behavior can very accurately be ID in kids as young as 3-4
- antisocial behavior can continue into adulthood if no intervention by 3rd grade
- early intervention in homes, school, and communities i key to preventing kids from becoming violent teens/adults
13
Q
Prevention of children becoming overly aggressive?
A
- limit exposure to tv and videos
- intervene as early in child’s life as possible
- intervention begun at early age shows that success in preventing long term violent behavior is high
- if child 9-10 is still chronically aggressive odds of successful intervention low
- consult with medical and mental health professionals
14
Q
Possible causes of aggressive behavior?
A
- poor parenting
- trauma in form of abuse or neglect
- brain damage: closed head injury, lack of O2 during birth or prenatal exposure to drugs/toxins
- genetic abnormalities
- other health probs
- marital problems resulting in family instability
- observation of aggression at school or at home
15
Q
Strong warning signs of overly aggressive child?
A
- cruelty to animals
- fire starting
- sexualized behavior
- aggressive behavior outside norm: threats, breaking things, throwing things or hurting others
- self-injury: head banging, cutting, substance abuse
- extreme non-compliance
- lack of behavior change despite consistent consequences
- evidence of psychosis (hearing or seeing things - hallucinations)
- lack of remorse or empathy for other people’s feelings
16
Q
Possible reasons for biting?
A
- relieve pain from teething
- experience sensation of biting
- satisfy need for oral-motor stimulation
- imitate other kids or adults
- get attention
- act in self-defense
- communicate needs and desires: hunger or fatigue
- communicate feelings: frustration, anger, confusion or fear
17
Q
Management of biting?
A
- tell child biting hurts, no biting. Give child that was bit comfort and attention
- talk to child who did the biting - calmly
- ask why it happened
- tell them it is not allowed
- tell child that they hurt other child, no biting
18
Q
What should you not do with biters?
A
- avoid labeling child as a biter (negative)
- never bite child back
- avoid getting angry, yelling or shaming child
- avoid giving too much attention to child after biting
- don’t force child who bit and child who was hurt to play together
- don’t punish children who bite:
punishment doesn’t help child learn discipline and self-control, makes child angry, upset, defiant and embarrassed, undermines relationship b/t child and caregiver
19
Q
What are some sleep disturbances?
A
- bedtime refusal or resistance
- delayed sleep onset
- prolonged night awakenings
- night terrors
20
Q
Prevalence of sleep disturbances?
A
- 25-50% of kids older than 6 mo have night wakings
- 10-15% of toddlers have bedime resistance
- 15-30% preschool age kids have difficulties falling asleep and night awakenings
- 25-40% 4-10 year olds:
15% have bedtime resistance, 11% have sleep related anxiety - 11% of adolescents have hx of insomnia
- night terrors are rare
21
Q
Factors involved in sleep disturbances?
A
- nighttime sleep duration largely influenced by genetics
- intrinsic factors:
child’s temperament
medical issues
circadian preference
neurodevelopmental disabilities
anxiety disorders
22
Q
Eval of sleep disturbances?
A
- BEARS B= bedtime issues E= excessive daytime sleepiness A= night awakenings R= regularity and duration of sleep S= snoring (sleep apnea)
-Hx: medical, developmental, family, behavioral assessment, sleep logs
23
Q
Interventions - sleep disturbances?
A
- bedtime routine:
pattern, same time, no TV or electronics prior - systemic ignoring: extinction, let them fuss for a couple of minutes, have them fall asleep in crib
- positive reinforcement
- parent education
24
Q
What are night terrors? Presentation?
A
- occur during first half of night (nightmares occur second half)
during sleep terror episode a child may:
- sit up in bed
- scream or shout
- kick and thrash
- sweat, breathe heavily, have a racing pulse
- hard to awaken, but if awakened will be confused
- inconsolable
- stare wide-eyed
- get out of bed and run around the house
- generally in morning child will not remember the sleep terror although nightmare may be partially remembered
25
Q
What factors contribute to sleep terrors?
A
- sleep deprivation or extreme tiredness
- stress
- fever
- sleeping in unfamilar surroundings
- light or noise
- overfull bladder
- things that can be assoc:
OSA, RLS, migraines, head injuries, meds, genetics
26
Q
Reasons to eval kids that have night terrors?
A
- happening excessively
- leading to daytime somnolence
- hurting self or others
- lead to child being afraid to got to sleep
- last beyond teen years
- appear to follow same pattern
Eval:
sleep log, study, rare use of benzodiazepans
27
Q
Who is in charge of toilet training?
A
- enitirely under control of child
- must be ready and neurologically mature
- must est regular bowel frequency
- avoid pressuring and punishment for accidents
- reiterate positive reninforcement
- expect periods of regression with stressors
28
Q
Factors that contribute to toilet training resistance?
A
- 20% of developmentally normal kids have this issue
factors: - attempting training too early
- excessive parent-child conflict
- irrational fear or anxieties about toliet
- difficult temperament, such negative perisistence or poor adaptability
- hard, painful stools from chronic constipation
- these children may be trying to exert their independence or control in power struggle with their parents
29
Q
Dental care in babies?
A
- more kids with dental decay than asthma
- recommended toddler should have 1st dental visit when first teeth erupt:
eval for abnorm of teeth and oral mucosa, assess for dental plaque, assess for white spots and cavities
30
Q
What kids are at risk for development of dental disease?
A
- parent/caregiver low socioeconomic status
- prolonged breast or bottle feeding (older than 12 months)
- frequent consumption of sugary beverage or snacks
- prolong use of sippy cups
- use of bottles at bed time, esp with sweetened beverages
- exposure to passive smoke
- children with special health care needs
- insufficient fluoride exposure
- visible plaque on upper front teeth
- enamel pits and defects
- nonnutritive sucking
31
Q
Dental caries prevention?
A
- early brushing with smear of fluorinated toothpaste
- fluoride!
- flossing
- regular dental check ups
32
Q
Why is visual screening so impt? What are we assessing for?
A
- visual loss in early life can lead to perm. visual loss
- can be a sign of systemic illness
visual assessment: cataracts strabismus amblyopia retinoblastoma glaucoma asymmetric pupil greater than or equal to 1 mm diff in size - ptosis: unilateral
33
Q
Infant visual development?
A
- visual fixation is seen shortly after birth: 20/400
- by 3 mos. infants can follow an object
- by 6 mos. have developed steropsis and binocular vision
- by 3-5 years vision reaches 20/20
34
Q
Hearing screening in babies?
A
- sig hearing loss is most common disorder at birth
- occuring in 1-2 infants/1000
- mandated screening of all infants prior to d/c from hospital
- early ID improves outcomes
- screening for older kids when there is a concern
35
Q
Categories of intellectual disability?
A
- IQ: statistically derived number reflecting ratio of age appropriate cognitive fxn and child’s level of cognitive fxn
- mild: 50-69
- mod: 35-49
- severe: 20-34
- profound: under 20
36
Q
Intellectual disability if deficits in what?
A
- deficits (more than 2) in development of: language motor skills attention abstract reasoning visual spatial skills academic or vocational achievement
37
Q
What are some causes of intellectual disability?
A
- x’somal abnorm (4-28%)
- fragile x syndrome
- monogenetic conditions
- structural CNS abnorm
- complications of prematurity
- enviro or teratogenic causes
- cultural-familial mental retardation
- metabolic or endocrine causes
- unknown: majority - 30-50%
38
Q
eval and tx of pt with intellectual disability?
A
- should be eval by team of professionals
- tx: tailored to individual
usually combo of tx:
- speech and language therapy
- special education support
- OT or PT
- behavioral therapy or counseling
39
Q
Diff types of parenting? What seems to be most successful?
A
- authoritative: best outcomes
- authoritarian
- permissive/indulgent
- neglectful
- family dynamics may fluctuate and individual parents may have differing parenting styles
40
Q
School performance can reveal what?
A
- learning problems
- changes in performance usually worsening performance is signal of stressor in younger children:
new sibling
divorce
move to new location
abuse
41
Q
Peer relations importance?
A
- children begin to play together and share around 3-4
- impt that young kids are allowed to socialize to learn skills of interacting with other kids
- as child gets older peers have greater influence it is impt that child has strong sense of self-esteem so he/she won’t be easily swayed by peer pressure
42
Q
How can home life affect child’s behavior and self-esteem?
A
- socioeconomic status
- cultural beliefs
- number of siblings
- parenting
- presence of abuse
- whether extended family involved
