Emotional and Behavioural Flashcards
List some reasons for a crying baby
1) Wet / dirty nappy
2) Too hot or cold
3) Hungry
4) Wind
5) Colic
6) Environmental stress
7) Reflux
8) Teething
What is infantile colic?
Periodic crying associated with over-feeding / hunger
Often occurs in evenings
Cries may last several hours and be inconsolable, with flushed face, distended tense abdo, and drawn-up legs
What is the rule of 3s for infantile colic?
Cries >3hrs/day
Occurs >3 days/week
Presents for >3weeks
What is the management of infantile colic?
Screen for abuse - “how is your child to get along with?”
Keep upright with frequent burping
Should resolve by 3 months of age
What may be the cause of sudden and severe crying in a baby? (3)
1) OM
2) Intussusception
3) Strangulated inguinal hernia
How may a temper tantrum present? What is the peak age?
Screaming
Hitting
Biting
Breath-holing attacks
Peak age = 18-36 months - terrible twos
What advice may be given to parents complaining of children with temper tantrums?
Avoid precipitants eg hunger and tiredness
Divert tantrum by distraction
Stay calm to teach control
Reward good behaviour
Try to ignore bad behaviour until calm
Use time outs (1 min for each year of life)
What advice may be given to parents complaining of children with feeding problems?
Keep meal times relaxed
Not pressurised into eating
Small helpings that can be finished and seconds given if wanted
Eat as a family if possible
By what age can most children sleep through the night?
3 months
What advice may be given to parents to help sleep hygiene?
Routine at bedtime eg book
Do not rock baby
Crib hygiene - on back, not too many pillows, sleep alone
What is SIDS?
Sudden infant death syndrome = cot death
What increases risk of SIDS?
Baby sleep on their stomachs
Soft mattresses eg memory foam
Additional bedding eg pillows
Compare nightmares to night terrors: Common Age M:F REM? Awaken? Remember?
Nightmares: Common Any age M=F Occur in REM Child awakens Child remembers episode
Night terrors: Rare Ages 2-8 M>F Non-REM (usually first hour of sleep) Child appears awake but isn't No memory of episode
Give examples of anxiety disorders in children
1) Separation anxiety disorder
2) Generalised anxiety disorder
3) Panic disorder
4) Simple and social phobias
5) PTSD
Ddx of anxiety in children
Child abuse
Depression
Treatment of anxiety in children
CBT = treatment of choice
Psychoeducation of child and family
Helping child to face fears by hierarchical desensitisation
Skills acquisition
Reserve medication for no response or incomplete response to psychological therapies
What is the prognosis for children with anxiety?
Untreated anxiety disorders increase likelihood of:
- Internalising conditions in girls (self harm)
- Externalising conditions in boys (acting out)
Short term outcomes of treatment is positive esp if in conjunction with parental support
List some features of attachment behaviours
Not seen before 6 months
- Proximity seeking to attachment figure, esp when threatened
- Separation leads to protest by infant
- Permanent separation eg bereavement affects capacity to feel secure and explore
- Maximal at 18-36 months
- Modulated by temperament of child
What is attachment disorder?
Pattern of behaviours which are the result of a lack of development of normal bonds with a primary caregiver in early childhood
Normal attachment results in a security which forms the base allowing a child to explore his/her environment, develop relationships, learn to deal with emotions and manage stressful situations
Describe two types of attachment disorders
1) Disinhibited attachment disorder
2) Reactive attachment disorder
What is disinhibited attachment disorder?
Likely from institutional style of care in early life i.e. care provided by a lot of people, no primary care giver.
- Become too friendly with strangers, not caring who is looking after him/her, superficial relationships formed easily
- Overactive, aggressive, emotional liability and poorly tolerate frustration
- No sensitivity towards social boundaries
What is reactive attachment disorder?
Likely due to parental abuse, neglect and severe maltreatment
- Child fails to respond appropriately to social interactions
- Displays fearfulness and hyper-vigilance
- Growth failure and withdrawn behaviour
- Tends not to seek comfort when distressed and not to respond to comfoft
What is the management of attachment disorders?
If abuse - move into stable foster home
Aim to improve child-carer relationship
List 4 types of attachment
1) Secure
2) Insecure avoidant
3) Insecure resistant
4) Disorganised
