Problems of Early Childhood

Question 1

Criteria for Enuresis

Answer 1

A) repeated voiding of urine in bed/clothes
B) at least 2x week for 3 months or clin sig distress
C) older than 5/dev equiv

Question 2

What are the specifiers of Enuresis?

Answer 2

nocturnal only, diurnal only or both

Question 3

What is the difference between primary and secondary enuresis?

Answer 3

Primary: never dry
Secondary: dry for 6 months then not again

Question 4

What is common cause of diurnal enuresis?

Answer 4

Physical (considered separate to nocturnal)

Question 5

What are causes of Secondary nocturnal enuresis?

Answer 5

Genetic
Psychological
Delay in maturation of mechanism for bladder control
Important to identify what has changed (phys, psych and situation)

Question 6

What are treatments for Enuresis?

Answer 6

Tricyclic antidepressants, fluid restriction, scheduled wakening, positive reward system. Enuresis alarms very effective

Question 7

What is the criteria for Encopresis?

Answer 7

A. Faecal soiling
B. At least one event each month for 3 months
C. Older than 4

Question 8

What are interventions for Encopresis?

Answer 8

Dietary modification and medical treatment, behavioural, psychotherapy

Question 9

What are night terrors and what can they reflect?

Answer 9

Sudden wakening from slow-wave with persistent fear or terror, screaming, sweating confusion, increased HR. Benign in childhood but in adults reflects stress

Question 10

What are interventions for night terrors?

Answer 10

Reduce stressing factors.

Waking child: usually at same time every night- wake 30min before talk for 5 then back to sleep

Question 11

What is reactive attachment disorder?

Answer 11

In first 5 years, persistent abnormalities in pattern of social relationships assoc with emotional disturbance and are reactive changes in env

Question 12

DSM 5 criteria for reactive attachment disorder

Answer 12

A. consistent inhibited, emotionally withdrawn behaviour toward caregivers (1. rarely seeking comfort, 2. not responding to comfort)
B. persistent social, emotional disturbance
C. extremes of insufficient care (neglect, changes of primary care)

Question 13

What are causes of reactive attachment disorder?

Answer 13

Parent/carer: abuse/neglect, depression, substance, ineffective/insensitive
Env: poverty, violence, lack support