Emotional and Behavioural

Question 1

List some reasons for a crying baby

Answer 1

1) Wet / dirty nappy
2) Too hot or cold
3) Hungry
4) Wind
5) Colic
6) Environmental stress
7) Reflux
8) Teething

Question 2

What is infantile colic?

Answer 2

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

Question 3

What is the rule of 3s for infantile colic?

Answer 3

Cries >3hrs/day
Occurs >3 days/week
Presents for >3weeks

Question 4

What is the management of infantile colic?

Answer 4

Screen for abuse - “how is your child to get along with?”

Keep upright with frequent burping

Should resolve by 3 months of age

Question 5

What may be the cause of sudden and severe crying in a baby? (3)

Answer 5

1) OM
2) Intussusception
3) Strangulated inguinal hernia

Question 6

How may a temper tantrum present? What is the peak age?

Answer 6

Screaming
Hitting
Biting
Breath-holing attacks

Peak age = 18-36 months - terrible twos

Question 7

What advice may be given to parents complaining of children with temper tantrums?

Answer 7

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)

Question 8

What advice may be given to parents complaining of children with feeding problems?

Answer 8

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

Question 9

By what age can most children sleep through the night?

Answer 9

3 months

Question 10

What advice may be given to parents to help sleep hygiene?

Answer 10

Routine at bedtime eg book

Do not rock baby

Crib hygiene - on back, not too many pillows, sleep alone

Question 11

What is SIDS?

Answer 11

Sudden infant death syndrome = cot death

Question 12

What increases risk of SIDS?

Answer 12

Baby sleep on their stomachs
Soft mattresses eg memory foam
Additional bedding eg pillows

Question 13

Compare nightmares to night terrors:
Common
Age
M:F
REM?
Awaken?
Remember?

Answer 13

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

Question 14

Give examples of anxiety disorders in children

Answer 14

1) Separation anxiety disorder
2) Generalised anxiety disorder
3) Panic disorder
4) Simple and social phobias
5) PTSD

Question 15

Ddx of anxiety in children

Answer 15

Child abuse

Depression

Question 16

Treatment of anxiety in children

Answer 16

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

Question 17

What is the prognosis for children with anxiety?

Answer 17

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

Question 18

List some features of attachment behaviours

Answer 18

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

Question 19

What is attachment disorder?

Answer 19

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

Question 20

Describe two types of attachment disorders

Answer 20

1) Disinhibited attachment disorder

2) Reactive attachment disorder

Question 21

What is disinhibited attachment disorder?

Answer 21

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

Question 22

What is reactive attachment disorder?

Answer 22

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

Question 23

What is the management of attachment disorders?

Answer 23

If abuse - move into stable foster home

Aim to improve child-carer relationship

Question 24

List 4 types of attachment

Answer 24

1) Secure
2) Insecure avoidant
3) Insecure resistant
4) Disorganised