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Pediatrics Exam 3 > Common behavioral issues > Flashcards

Common behavioral issues Flashcards

1
Q

§ Most teens have ____ -hr sleep phase delay due to changes in hormonal regulation of the circadian system

A

~1-3

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2
Q

T/F Sleeping is not inborn; a behavior
that develops over time

A

T

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3
Q

Two physiologic states of sleep

A
  1. Non-rapid eye movement (NREM) sleep
  2. Rapid eye movement (REM) sleep
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4
Q

Rapid eye movement (REM) sleep

A

■ Brain activity ↑
■ Physiological activity ↑
■ Similar to wakefulness

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5
Q

Non-rapid eye movement
(NREM) sleep

A

■ Sleep stages 1 – 4
■ Most physiologic functions
are markedly REDUCED
compared with wakefulness
■ Pulse ↓
■ Respirations ↓
■ Blood pressure ↓
■ NO penile erection
■ Relatively peaceful state

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6
Q

Nightmares/terrors in NREM sleep:

A

■ Stages 3 & 4
■ Disoriented & disorganized thinking & brief
arousals during these stages associated with
amnesia*
■ Enuresis
■ Somnambulism (sleepwalking)
■ Stage 4 night terrors

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7
Q

Newborns sleep ____ hrs/day

A

10-19
§ 2–5-hour blocks

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8
Q

Nightmares/terros in REM sleep

A

■ Pulse ↑
■ Respiration ↑
■ Blood Pressure ↑
■ > NREM sleep & often higher than during waking
■ Men → partial or full penile erection
■ Near-total paralysis of skeletal muscles
■ Most distinctive feature is dreaming
■ abstract & surreal

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9
Q

Nightmares features (Peak ~3-5 yo)

A

OCCUR DURING REM SLEEP
§ Self limited, no tx needed
■ Usually associated with:
■ Stress
■ Trauma
■ Anxiety
■ Sleep deprivation causes
rebound REM sleep

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10
Q

Guidance to give child who is having nightmares

A

§ Reassure child, discuss the
bad dream (next day)
§ Leave bedroom door open
§ Nightlight
§ Avoid stimuli
§ ie scary shows
§ Others?
§ “Monster Spray” J

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11
Q

Night Terrors (~3-6yo)

A

OCCUR DURING NREM SLEEP
§ Glazed look in eyes, incoherent, &
unresponsive to comforting
§ Child will exhibit rapid breathing,
tachycardia, & sweating
§ Occur ~2 hours after sleep onset
§ Last up to 30 min
§ Parents should let it run its course
§ Child amnestic to the event

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12
Q

Guidance parents can give child with night terros

A

§ If wake ups are predictable
§ Wake child 15 min prior
to the anticipated
arousal
§ Allow child to go back
to sleep 5 min later
§ D/C intervention once
the terrors stop

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13
Q

How to avoid a situation where a child refuses to go to sleep unless rocked/fed

A

■ this is a Learned behavior
■ 1st weeks of life the
result of the parents behavior
§ Put the child to bed
while drowsy, but still
awake
§ Create a quiet, secure
bedtime environment
§ Be Consistent

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14
Q

Proper parental response to child awakening during the night

A

Do not reinforce the behavior
§ Comfort quietly
§ Minimal stimulus
§ Establish normal bedtime routines (Be consistent)

“Cry it out”
§ Progressively responding
later to cries, until child
tires or learns self soothing

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15
Q

Early solids (before 5 months) = ___ night waking, ____ sleeping

A

↓; ↑

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16
Q

Toilet Training prerequisites

A
  • CHILDREN MUST BE READY
    (avg. age 22 – 30 mo)
  • Physiologic sphincter control
  • (~18-24 months old)
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17
Q

Nighttime bladder control is NOT expected until ___ yo

A

5-7

18
Q

T/F Early initiation of toilet training (<27 mo) correlates with a shorter training

A

F - it is longer the earlier you start

19
Q

3 factors associated with toilet training completion at a later age

A
  1. Initiation of training at an older age
  2. Presence of stool toileting refusal
  3. Presence of frequent constipation
20
Q

Developmental readiness signs for toilet training

A

ü Ambulates to the toilet
ü Stable, sitting on the toilet
ü Remains dry for 2-3 hr
ü Able to pull clothes ↑ & ↓
ü Follows 2-step commands
ü Able to communicate the
need to use the toilet

21
Q

Behavioral readiness signs for toilet training

A

ü Imitates behaviors
ü Able to put things away
ü Interested in toilet training
ü Desires to please
ü Independent & controlling
ü Able to resist & say “No,”
BUT ↓ oppositional
behaviors & power struggles

22
Q

Guidance for beginning toilet training

A
  1. Place the “potty” in the child’s bathroom
  2. Encourage child to sit on the potty for 2-3 min/day
    * Initially clothed & after ~1 week without
  3. Child goes with parent to empty soiled diapers into the little potty…
    … & then to the big potty
23
Q

Encopresis & Enuresis

A

These are diagnoses
* Does not achieve urine & bowel continence by 5–6 years of age
* No underlying pathology for the incontinence
* Child does not respond to a full bladder or rectum
* Child is constipated &/or is withholding stools

24
Q

T/F Constipation & enuresis often co-occur

A

T

25
Q

Enuresis guidelines

A
  • Education & avoid judging/shaming the child
  • Behavioral strategies (Be consistent)
  • Limit liquids before sleep & wake the child at night to void
  • Bedwetting alarms
  • Child should rise & void very time the alarm goes off
  • Cures 2/3 of children
  • Failure?
  • Turning off the alarm & go back to sleep
26
Q

Medical Management of enuresis

A
  • Desmopressin acetate (DDAVP)
  • Imipramine (Tofranil®)
  • Imipramine should be used only as a last resort
27
Q

Primary vs. Secondary encorpresis

A

Primary: Stool continence has never been achieved
Secondary: Stool incontinence occurs after a
period of successful toilet training

28
Q

Encopresis guidance

A

Assuming no GI abnormalities…
* Start with treatment of constipation
* Behavioral strategies
* Child sits on the toilet after meals (gastrocolic reflex)
* Read a book
* Establish a bowel regimen;
* Avoid punishing or inducing guilt or shame
* Helping the child to cleanup > criticism & reproach

29
Q

Encopresis medical management

A
  • Oral medication or enema for a
    “bowel cleanse”
  • Consider abdominal Xray
  • Oral medications
  • Fiber, laxatives, or
    mineral oil
  • Never to use mineral oil in any
    child who is at risk of aspiration,
    can cause chemical pneumonitis
30
Q

Stranger/Separation Anxiety

A

Usually appears at about 6-9
months & can last until 24
months of age

31
Q

Discipline vs. Punishment

A

Discipline = (Latin) discipulus → instruction, knowledge
Punishment = (French) punir → inflict penalty, take vengeance

32
Q

Guidance for Aggression/ Frustration
(~3 years)

A

“Time Out” (~1 min/year of age)
■ Calm, few words, NOT a monologue
■ NOT punishment
■ Time to cool down
■ Non-stimulating location
■ No eye contact or interaction

33
Q

Guidance for Temper Tantrums (12 mo to 4 yrs)

A

§ Do not to become angry
§ Help child communicate
§ Present options within the
child’s capabilities
§ Positively reinforce when child
is gaining control
§ If a child’s demand led to the
tantrum, do not grant demand

34
Q

Breath-Holding Spells (6mo – 6yo)

A

■ Reflexive, NOT voluntary,
usually occurs in response to
anger or injury
■ Child holds breath*
■ Becomes pale or cyanotic
■ Usually resolves
spontaneously
■ May lose consciousness
■ Severe cases; tetanic spasms,
body jerks, urinary incontinence

35
Q

Guidance for Breath-Holding Spells
(6mo – 6yo)

A

§ Terrifying for the parents
§ Not harmful & will not cause brain damage
§ Do NOT to become permissive
§ Treat with iron supplementation?

36
Q

Guidance for whining

A

■ Establish regular routines
■ Easier to meet expectations
■ Explain to the child Whining ≠ Attention
■ Respond positively when
tone of voice improves

37
Q

Guidance for Need for Attention

A

§ Younger children
§ Brief attention immediately (use echoing)
§ Younger & older children
§ Special time (Time reserved solely for than child)

38
Q

Guidance for Head-Banging

A

■ Harmless unless severe
■ Usually seen in children with
intellectual disabilities
■ Most children stop by age 3
■ Can occur with sensory
deprivation (neglect)
■ Increase rhythmic activities,
reduce stress

39
Q

Guidance for Thumb-sucking

A

■ Intervene by 36 months
■ Child must be motivated before s/he will consider stopping
■ Thumb guard at night for habitual sucking
■ Topical products may aid
■ Praise child when not sucking
thumb

40
Q

Guidance for refusing food

A

■ Gorging or refusing food
■ Put out a tray with a variety of nutritious foods for the child to have access to for the entire day & then bring the child to regular meal-times
■ If not hungry, they can be excused from the table
■ Disruptive behavior at table?
■ Remove food & excuse from the table & then allow to eat later
■ Do not become involved in a power struggle

Pediatrics Exam 3 (7 decks)

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