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Pediatrics > Developmental Disorders & Behavior DO > Flashcards

Developmental Disorders & Behavior DO Flashcards

1
Q

By what age do day and night patterns developed?

A

4 months

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2
Q

By what age do adult patterns of sleep establish

A

age 3

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3
Q

amount of sleep needed for infants

A

16-20 hours per day
then transition to 9-12 blocks with a nap in between

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4
Q

main sleep complaint for children < 12?

A
  • Difficulty initiating or maintaining sleep that is viewed as a problem by child or caregiver
  • Characterized by severity, chronicity, frequency, and associated impairment in daytime function in the child or family
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5
Q

s/s of sleep disorders

A
  • Excessive daytime sleepiness
  • Hyperactivity-impaired attention
  • Poor school performance
  • Behavior problems-bad mood, irritability
  • Obesity-link to inadequate sleep
  • Failure to thrive
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6
Q

components of good sleep hygiene

A
  • Good sleep environment (dark, quiet, cool temp)
  • Sleep should be in same place—naps and bedtime
  • Infants fed in parents’ arms, placed in crib to sleep
  • Put to bed when moderately tired to reduce resistance
  • Help develop self-soothing techniques
  • Stick to good routine
  • No TV or computer in room
  • Try to keep household atmosphere calm
  • Keep journal of things that cause sleeping problems
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7
Q

what is the Trained Night Feeding

A
  1. First couple months of life, children feed middle of night
  2. 12 wks, can and should sleep through night
  3. However, some > 6 mo who wake up are fed to encourage immediate return to sleep
  4. Sleep cycle now changed due to learned hunger, so consume full meal at night
  5. In children who have learned to sleep all through night, middle of night awakenings 5-6 mos appearing genuinely hungry, probably ready for solids, or need to increase volume of formula/breast milk/day and evening
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8
Q

mgmt for trained night feedings

A
  1. Parental education
  2. Teach ways to recognize hunger vs. fussy cues
  3. Don’t automatically feed fussy baby
  4. At 4 mos - don’t go into room at first sound of rustling or fussiness, allow to return to sleep w/o parental intervention
  5. Waking at night w/o requiring a feeding between 4-8 mos
  6. Management needed when persistent family disruption and stress occur
  7. Re-establish bedtime routines
  8. Bedding with parent scent
  9. Put into bed awake
  10. Daytime naps < 2 hr
  11. Allow 1-2 min of crying, then check q 2-5 min
  12. Touch, but do not pick up or cuddle
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9
Q

what is Developmental night awakening

A
  • 8-10 months, may wake up again through night
  • Coincidental processes, including inc mobility, fear reactions to strangers, nightmares, object permanence (ability to remember things out of sight)
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10
Q

mgmt for developmental night awakenings

A
  • Educate parents at 6 mo WCC
  • Re-establish bedtime routine
  • Maybe introduce night light
  • Give a couple minutes to let child self-soothe
  • Go into room, reassure child that he/she is ok (don’t cuddle or feed), and lay down beside bed/crib where child can see, and go to sleep
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11
Q
  • habits of falling asleep in certain circumstances (in a parent’s bed, being fed in parents’ arms)
  • Results in prolonged parental assistance for child to go to sleep due to nocturnal arousal
  • Is a conditioned response
A

Sleep-Onset Associations

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11
Q

mgmt for Sleep-Onset Associations

A
  • Put child in bed/crib while awake at bedtime
  • Can put mother’s scent in bed
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12
Q
  • “another story”
  • may reflect parental difficulty in setting limits
  • associated with multiple curtain calls for stories, hugs, water, and potty
  • Toddlers/Preschool kids may get up after being laid down
  • Unintentionally reinforced by parents, even if displeasure voiced
A

limit-setting disorder

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13
Q

Bedtime routines should be how long?

A

≤30 min

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14
Q

mgmt for limit setting disorder

A
  • daily schedule, careful limit setting
  • Limited to a defined set of activities/length of time
  • “only one more”
  • Promise preschooler to check on them if they are scared
  • Put to bed when tired, don’t nap close to bedtime
  • Don’t give in
  • Positive reinforcement
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15
Q

causes of bedtime fears?
mgmt?

A
  1. Stress from separation from parents
  2. Aggressive peers
  3. Frightening video games or movies
  4. Monsters
  5. check for monsters, don’t watch scary stuff; nightlights; give reassurance to child
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16
Q
  1. Unusual behaviors or experiences that occur during sleep or the transition between sleep and wake
    - is not fully awake and may or may not remember the event the next morning
  2. Generally resolves spontaneously
  3. Strong familial component exists
  4. Include night terrors and nightmares
A

Parasomnias

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17
Q

s/s night terrors

A
  • Partial awakenings from sleep
  • Characterized by physiologic arousal including pallor, sweating, pupillary dilation, piloerection, and tachycardia
  • sit up, scream, and appear terrified
  • run, and fight you, and doesn’t remember in morning
  • unresponsive to parental comforting
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18
Q

causes of night terrors

A
  • increased with illness, stress, or deprivation
  • May be precipitated by full bladder, fatigue, loud noises
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19
Q

mgmt for night terrors

A
  • Parental reassurance of benign nature
  • Resolve 95% of time by age 8
  • Empty bladder before bedtime, keep room dark and quiet
  • wake child up 15 min before expected episode for week
  • 30-60 min afternoon nap
  • EEG if intractable cases
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20
Q

Child can dream clearly around when?

A

14 months

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21
Q

night terrors MC occurs when during the night?

A

first third of the night

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22
Q
  • Extremely common and occur during last 1/3 of night
  • MC between 3 and 6 years
  • recalled as frightening images and the child can describe dream and talk about it
  • Can be comforted and responds to parental reassurance
A

nightmares

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23
Q

mgmt for nightmares

A
  • self-limited
  • Chronic nightmares can be treated with relaxation exercises
  • stories in which they master a situation
  • very severe: trazodone or Benadryl with the idea of deep sleep to sleep through
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24
Q

An infant who mistrusts more than trusts (unreliable or unpredictable caregiving in first year) tends to be ?

A

more clinging and demanding as a result of insecurity of caregiver’s availability

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25
Q
  • Excessive distress when separated from home/major attachment
  • Fear of harm or losing attachment
  • Fear of an event causing separation
  • Refusal to go to school, day care or elsewhere
  • Fear/reluctance of being alone or without major attachment
  • Refusal to go to sleep without being near major attachment
  • Repeated nightmares of theme of separation
A

Separation Anxiety

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26
Q

mgmt for Separation Anxiety

A
  • Reassurance
  • Surround with familiar people if you have to leave
  • If leaving with a new babysitter, invite them over once or twice before to get familiarity
  • Be patient, consistent, establish a goodbye ritual: pleasant, loving, firm goodbye, with assurance you will be back
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27
Q
  • Fear of strangers
  • Cling to mom/dad or familiar caregiver when unfamiliar person comes around
  • learned the difference between people they know, and people they don’t know
  • starts 6-8 months, can last up to and > 24 months
  • Related to separation anxiety
  • Natural phase during development
  • Can happen to a person who they previously did not have anxiety for
A

Stranger Anxiety

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28
Q

mgmt for Stranger Anxiety

A
  • Reassure child
  • Stay within arms reach
  • Reassure adult
  • Coach your friends and family
  • Exposure therapy
  • Stick around for a bit if are going to leave child with babysitter
  • Have patience
  • If at WCC, can have child sit on mom’s lap to reassure them
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29
Q
  • One who kicks, bites, hits, bullies, destroys, and or demands
  • times of frustration, threats, anger, and rage
  • Genetics can play a role
  • MC Boys
  • Learning disabilities can play a role in older children and adolescents
A

aggression

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30
Q

RF for aggression

A

Harsh discipline, insecure early attachment, abuse, neglect, low income, home environment, family conflict/dysfunction

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31
Q

As kids with aggression age, they can exhibit worse antisocial behaviors such as:

A
  1. Can lead to conduct disorder
  2. Oppositional defiant disorder
  3. Substance abuse
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32
Q

mgmt for aggression

A
  1. Praise for socially acceptable behaviors
  2. Establish rules
  3. Get professional help if needed, and get help at school
  4. Look at child-rearing practices (inconsistent/harsh discipline, domestic violence, abuse, neglect)
    - Acute family stressors
    - Characteristics of child
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33
Q
  1. MC between ages of 12 months-4 years
  2. Can occur ≥1x per week
  3. At 1 year, child has some physical independence, which puts them at a physical danger, then parental intervention - imposes limits, which frustrates the child
  4. The child seeks autonomy and mastery over the environment
  5. Due to limited motor and language skills, impulsiveness, or parental restrictions, they flip out
  6. a reflection of immaturity
A

Temper Tantrums

34
Q

mgmt for temper tantrums at 6 month WCC

A

stress parental time away
gives the child a sense of security that the adult will come back, and gives parents stress free period of rigors of care

35
Q

mgmt for temper tantrums at 9-12 month WCC

A

Environmental/home safety discussed - reduces accidents and decreases potential adult-toddler power struggle

36
Q

mgmt for temper tantrums at 15-18 month WCC

A

Offer alternatives: nap time renews energy for parent and toddler, praise cooperation, give choices and decision making (green or blue shirt)

37
Q

general mgmt for temper tantrums

A
  1. Minimize need to say no (home environment earlier)
  2. Time out - 1 minute per year of age
  3. Use distractions
  4. Pick your battles
  5. Never let hurt themselves or others
  6. Don’t use negative terms
  7. Positive reinforcement
  8. Ignore the minor displays of anger
  9. Don’t hold grudge or punish severely
  10. Don’t give in to tantrum
  11. If severe, frequent, and disruptive outside of nml tantrums: psychologist/psychiatrist referral
38
Q

Such spells usually precipitated by anger, frustration, fear, or minor injury
In rare instances, mild seizure like movements of extremities can occur

dx?

A

Breath-Holding Spells

39
Q

2 types of Breath-Holding Spells?

A
  1. cyanotic
  2. pallid
40
Q
  • precipitated more by anger and frustration
  • emits a short, loud cry, takes a deep breath, and holds it
  • occurs after approx. 30 seconds
  • Either episode ends or become rigid or limp and lose consciousness

which type of breath-hodling spell?

A

cyanotic

41
Q
  • being preceded by minor injury or fear
  • Initial cry is brief or silent, then spell proceeds as cyanotic
  • An association exists between breath-holding spells and iron-deficient anemia

which type of breath-holding spell?

A

pallid

42
Q

mgmt for breath-holding spells?

A
  • No effective medical therapy
  • anticonvulsants not recommended
  • parents - educate that it is not harmful, just a form of tantrum; continue age appropriate discipline/limits
  • Refer to psychologist/psychiatrist if parent requests or if can’t control
43
Q
  • Becomes aware of need to go
  • Begins to associate fullness with elimination that follows
  • May begin communicating verbally
  • Emerging desire to mimic other children’s behavior
  • Takes pleasure in “doing it him/herself”

what age for toilet training?

A

12-18 mo

44
Q
  • Early ability to briefly control sphincter muscles
  • Better able to sit still
  • Improves ability to picture a goal (using the potty) and remember it long enough to complete the act
  • inc ability to understand verbal explanations
  • inc urge toward self-mastery
  • inc desire to please parents and win praise

what age for toilet training?

A

18-24 mo

45
Q
  • manages simple clothing
  • Improved memory = maintain potty routine
  • Improved imagination = learning through play (dolls, role playing)
  • Takes great pleasure in inc competence
  • Gender awareness encourages imitation of same-sex parents’ bathroom behavior

what age for toilet training?

A

24-36 mo

46
Q
  • Gradual maturing of digestive system = dec in accidents and bedwetting
  • Improved ability to break focus to go to toilet and to resist distraction while getting there
  • Peer pressure encourages toilet use
  • Enjoys completing sticker charts and working to earn rewards

what age for toilet training?

A

3+ y.o

47
Q

methods to improve toilet training?

A
  • As a parent, you can sense when they are ready. Stop playing, hiding, taking diapers off
  • Demonstrating
  • Read them book about potty use, talk with them over and over
  • Put them on potty every hour or so, regardless
  • Reward method
  • Immersion training: take 2 weeks off work and do nothing but potty train
  • Big Boy/Girl underwear/diapers.
  • Run around naked
48
Q

Tactics that help the methods of toilet training:

A
  • Pick right words for body parts, urine, and bowel mvmt
  • Pick a potty chair: one on floor or on adult toilet
  • Help child recognize signs: dancing, stop playing
  • Be consistent and routine
  • Encourage “Big Boy/Girl pants”
49
Q

at what age does thumb sucking stop?

A

age 4/preschool years

50
Q

mgmt for thumb sucking?

A
  • Praise/reward
  • If boredom - keep hands busy (wrist band)
  • Avoid anger, threats
  • Bitter tasting commercial preparations applied to thumbs
  • Combo of aversive taste tx + reward system
  • Nail biting is considered extension
51
Q

T/F: whining and complaining are signs of maturity

A

T: Announcing wants is more grown up than crying about them

52
Q

mgmt with whining

A
  • Don’t create negative situation (ex: shopping when hungry or nap time)
  • Don’t scold or pity
  • Don’t give in
  • meet basic needs for food, sleep, down time, run-around time
  • listen to what they want or why whining
  • be patient
  • change subject or distract
  • let them get frustrations out
53
Q

Exploratory and masturbatory activity can begin around ?, peaking around ? of age

A
  • 2 months
  • 4 years - Starts again around adolescence
54
Q

T/F: Infants/children are capable of a physiological orgasmic response identical to that experienced by an adult

A

F: with exception of ejaculation

55
Q

mgmt for exploration

A
  • pt ed and emphasize that it’s normal - Helps child derive pleasure from own body, Parents should be aware it occurs universally in children
  • Avoid punishing or shaming child
  • If parents observe activity, suggest inappropriateness of manipulating their genitalia in public or in front of others
  • Compulsive, overt practices among children may lead to ridicule socially, or may signify a deeper emotional problem
56
Q
  • self-stimulating behavior
  • Rhythmic movements of head against solid object - Often associated with rocking the head and entire body
  • MC at bedtime or at times of fatigue or stress - Can continue when child is asleep
  • MC during preschool years
A

Head Banging and Rocking

57
Q

possible cause of Head Banging and Rocking?

A
  • soothing, pleasurable experience encountered in utero, from neonatal period and outward
  • Pleasure from mvmt is repeated throughout life (rocking in mother’s arms as child/baby)
  • MC in mentally disturbed, hearing or sight impaired, or kids with severe mental retardation - Represents a compensatory reaction for a lack of stimuli or inability to integrate stimuli
58
Q

mgmt for head banging and rocking

A
  • assuring that no brain injury being done
  • resolves by age 3 yr
  • Mental health profession if lasts into childhood
59
Q

what is Encopresis?

A
  • repeated passage of stool into inappropriate places by a child who is chronologically or developmentally >4
  • voluntary or involuntary
  • MC result from constipation
  • MC 5-6 y/o
60
Q

definition of constipation

A
  • < 3 BM / wk
  • > 1 episode of encopresis per wk
  • Impaction of stool in rectum
  • Passage of stool so large it obstructs toilet
  • Retentive posturing and fecal withholding
  • Pain with defecation
61
Q

2 types of encopresis

A

retentive and nonretentive

62
Q
  • leakage of fecal material involuntarily from impaction
  • constipation x 1 wk unrelieved
  • rectum is so distended with stool that the sacrospinal defecation reflex is no longer energized
  • small amounts of the impaction are extruded intermittently through the external sphincter as a result of gravity, exercise, and relaxation

type of Encopresis?

A

retentive

63
Q
  • Leakage occurs many times a day, or even continuously
  • also hold back stool
  • Resist bowel training deliberately
  • Postpone BM bc playing video games or TV
  • Don’t want to use public restroom
  • Some have fissures around rectum that cause pain

type of encopresis?

A

retentive

64
Q

s/s of retentive encopresis

A
  1. abdominal mass - Midline, suprapubic, irregular, moveable; Rectus abdominis muscles must be relaxed
  2. Rectal exam
    - protruding fecal material in deliberate stool holders
    - dilated rectum in all impacted children and packed with wall-to-wall stool
  3. Labs not needed; can do XR: dilated rectum
65
Q

mgmt for acute retentive encopresis

A
  1. Need for BM everyday, don’t hold
  2. Sodium phosphate enema x 2-3 d
    - If refuse: Miralax x 4 d (one cap full X 3)
    - combo tx is very useful
66
Q

mgmt for chronic retentive encopresis

A
  • Resolve impaction
  • Stool softener (miralax / lactulose) qd x at least months, goal of 1-2 BM per day; ½ - 1 cap qd; 6 months because this is how long it takes for normal to return
67
Q

Passage of normal bowel movements into their underwear rather than use the toilet
Waiting to long to go
Toilet phobias
Scared of public toilets
Don’t want to toilet train

A

nonretentive encopresis

68
Q

mgmt for nonretentive encopresis

A
  • History details passage of stool into underpants
  • PE within normal limits
  • Medication not needed
  • Stop all reminders, pressure, lectures, and threatening to punish
  • Incentives for passing bowels mvmts into toilet, rewards and praise as well
  • Clean underpants immediately
69
Q

what pathological conditions to r/o for encopresis

A

hypothyroidism, neuro disorders such as cerebral palsy, hirschsprung disease, and anatomical abnormalities

70
Q

when to refer for encopresis?

A

pediatric management fails, refusal to sit on toilet if older than 5, refuses to take medication, nonretentive if 8 or older

71
Q

mgmt for eating issues?

A
  • Be patient
  • Keep introducing and trying
  • Kids’ tastes change over time
  • Positive reinforcement
  • Give healthy foods, including finger foods so they can feed themselves
  • “one bite rule” when get around age 2-3
  • With time, the appetite and eating behaviors reach an equilibrium
72
Q
  • impaired reciprocal social interactions, aberrant language development, and restricted behavioral repertoire
  • idiosyncratic intense interest in a narrow range of activities, resist change, and are not appropriately responsive to the social environment
A

Pervasive Developmental Disorders (PDD)

73
Q

ASD is characterized by sx from what 3 categories?

A
  1. qualitative impairment in social interaction,
  2. impairment in communication, and restricted repetitive and
  3. stereotyped patterns of behavior or interests - MC boys
74
Q

behavioral s/s of ASD?

A
  • Qualitative Impairments in social interaction - no eye contact or smiling, lack of sharing or ability to play, sudden mood changes
  • Disturbances of communication and language - Language deviance/delay is characteristic
  • Stereotyped behavior
  • May have aberrant sensory processing
  • Refusal to eat foods with certain tastes or textures
  • Preoccupation with sniffing/licking non-food objects
  • Resistance to being touched
  • Apparent indifference to pain
  • hyperkinesis, short attention span, insomina, enuresis
  • macrocephaly
  • motor deficits, special skills
75
Q

screening for ASD?

A

MCHAT

76
Q

DSM V criteria for ASD?

A

deficits in all three of following:

  1. Social-emotional reciprocity (back/forth conversation)
  2. Nonverbal communicative behaviors used for social interaction
  3. Developing, maintaining, and understanding relationships
77
Q

levels of Social communication/interaction severity in ASD?

A
  • Level 1: requiring support-noticeable impairment without support
  • Level 2: requiring substantial support—marked deficits in communication, impairments apparent even with support
  • Level 3: requiring very substantial support—severe impairments in functioning, very limited initiation of social interactions
78
Q

levels of Repetitive/restricted behavior for ASD dx?

A
  • Level 1: requiring support—behaviors significantly interfere with function
  • Level 2: requiring substantial support—behaviors sufficiently frequent to be obvious to casual observer, interfere with function in variety of settings, distress changing focus/actions
  • Level 3: requiring very substantial support—behaviors markedly interfere with function in all spheres, extreme difficulty coping with change, great distress changing focus/actions
79
Q

mgmt for ASD

A
  • Lifelong disorder with guarded prognosis
  • improve abilities to integrate into schools, develop meaningful peer relationships, and increase the likelihood of maintaining independent living as adults
  • inc socially acceptable behavior, dec odd behavioral sx, and improve verbal/nonverbal communication
  • Educational and behavioral interventions are currently considered the TOC
80
Q
  • A neurodevelopmental disorder that is characterized by a constellation of sx including: deficits in social interactions, social communication, and restricted and repetitive behavior (including stereotyped interests and activities)
  • No significant delays occur in language, cognitive development, or age-appropriate self-help skills
  • Considered to be an Autism Spectrum Disorder
  • MC in boys than girls
A

Asperger Syndrome

81
Q

hallmark sx of Asperger Syndrome?

A

atypical social development

82
Q

DSM 5 dx for asperger?

A

ASD of level 1 severity w/o intellectual impairment

83
Q

mgmt for asperger

A
  • goals are to promote social behaviors and peer relationships
  • Interventions are initiated with the goal of shaping interactions so that they better match those of peers carried out by mental health professionals, developmental pediatricians, and special education personnel
  • With targets being emotional regulation
  • Executive dysfunctions
  • Language and communication skills
  • Social skills
  • Adaptive function
  • Motor skills

Pediatrics (23 decks)

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