COMMON BEHAVIOURAL

DISORDERS IN CHILDREN

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DYSFUNCTIONAL
BEHAVIOURS

WHAT CAN AFFECT BEHAVIOUR IN

A CHILD?
Heredity

Environment
Learning

Conditioning
Positive reinforcements

HABIT DISORDERS
1. Repetitive Behaviors
2. Finger (thumb) sucking
3. Pica
4. Nail biting
5. Teeth grinding (Bruxism)
6. Breath holding spasms
7. Temper tantrums
8. Tics

1. Repetitive Behaviors

Benign & self-limiting

Begin between 6 10 yrs

Eg. Body rocking, Head banging

Head banging

In 5-20% of children during infancy & toddler years

Can result in callus formation, abrasions, contusions

Tt.

Assurance
Teach parents to ignore as concern and
punishment can reinforce it.
Padding

2.FINGER (THUMB) SUCKING & NAIL

BITING
Sensory solace for child (internal
stroking) to
cope with stressful situation in infants
and toddlers.
Reinforced by attention from parents.
Predisposing factors:

Developmental delay
Neglect

2.FINGER (THUMB) SUCKING & NAIL

BITING
Most give up by 2 yrs
If continued beyond 4 yrs number of
squelae
If resumed at 7 8 yrs : sign of Stress
Adverse Effects
Malocclusion open bite
Mastication difficulty
Speech difficulty (D and T)
Lisping
Paronychia and digital abnormalities

2.FINGER (THUMB) SUCKING & NAIL BITING

MANAGEMENT

Reassure parents that its transient.

Improve parental attention / nurturing.
Teach parent to ignore; and give more
attention to positive aspects of childs
behavior.
Provide child praise / reward for
substitute behaviors.
Bitter salves, thumb splints, gloves may
be used to reduce thumb sucking.

3.TEMPER TANTRUMS
In 18 months to 3 yr. olds due to
development of sense of autonomy.
Child displays defiance, negativism /
oppositionalism by having temper tantrums.
Normal part of child development.
Gets reinforced when parents respond to it
by punitive anger.
Child wrongly learns that temper tantrums
are a reasonable response to frustration.

3.TEMPER TANTRUMS
Precipitating factors

Hunger
Fatigue
Lack of sleep
Innate personality of child
Ineffective parental skills
Over pampering
Dysfunctional family / Family violence
School aversion

3.TEMPER TANTRUMS
MANAGEMENT
In general, parents advised to:

Set a good example to child

Pay attention to child
Spend quality time
Have open communication with child
Have consistency in behavior

During temper tantrum:

Parents to ignore child and once child is calm, tell

child that such behavior is not acceptable
Verbal reprimand should not be abusive
Never beat or threaten child
Impose Time Out - if temper tantrum is disruptive,
out of control and occurring in public place.

4.EVENING COLIC
Intermittent episodes of abdominal
pain and
severe crying in normal infants
Begins at 1-2 wks age and persists till 34 mo.
Crying usually in late afternoon or
evening
Diagnosis :

Infant cries for > 3 hrs per day for > 3 day

per week for > 3 weeks

4.EVENING COLIC
Cause

Not known
More likely if the child is over active and
parents are over anxious
Could be a manifestation of
hunger,
aerophagia,
cows milk intolerance,
immaturity of intestine,
overfeeding,
intake of food with high CHO content

4.EVENING COLIC
Attack

Begins suddenly with a loud cry

Crying continuous lasts for several
hours mostly in the late afternoon or
evenings
Face becomes red and legs drawn up on
the abdomen
Abdomen becomes tense
Attack terminates after exhaustion or after
passage of flatus or feces

4.EVENING COLIC
Management
During Episode

Hold the child erect or prone

Avoid drugs
No much role to antispasmodics, carminatives,
simethicone, suppositories or enemas

Counseling - Coping with the parents

Reassure the parents that infant is not sick

They need to soothe more with repetitive
sound and stimulate less with decrease in
picking up and feeding with every cry

5.STRANGER REACTION / ANXIETY

By

6-7 months age infant can differentiate from

primary care givers and others
At this age they develop fear of others.
This may last for a few months to peak around 1315 months
If infant on approach of stranger behaves with
more intense discomfort such as continuous
crying, vomiting, refusal to socialize : Stranger
anxiety.
It might be an indication for later development of
behavioural problem as separation anxiety.

5.STRANGER REACTION / ANXIETY

Management:

Teach relaxation technique such as slowly

exposing them to stranger,
initially from a distance
Asking them to greet and slowly
advance

Reassure the parents that the behaviour

gradually declines
But if persists, refer to child psychiatrist

6.PICA
Repeated or chronic ingestion of nonnutritive substances.
Examples: mud, paint, clay, plaster,
charcoal, soil.
Its an eating disorder.
Normal in infants and toddlers.
Passing phase.

6.PICA
Coprophagia:

Consumption of feces
Urophagia: Consumption of urine
Trichophagia: Consumption of hair
Xylophagia: Consumption of wood
Amylophagia: Consumption of starch
Hyalophagia: Consumption of glass
Pagophagia: Consumption of ice
Geophagia: Eating of mud, soil, clay,
chalk, etc.

6.PICA
Pica after 2nd yr. of life needs investigation
Predisposing factors :

Parental neglect
Poor supervision
Mental retardation
Lack of affection Psychological neglect,
orphans)
Family disorganization
Lower socioeconomic class
Autism

6.PICA
Screening indicated for:

Iron deficiency anemia

Worm infestations
Lead poisoning
Family dysfunction

Treat cause accordingly.

Usually remits in childhood but can
continue into adolescence

7.BREATH HOLDING SPASMS

Behavioral problem in infants and toddlers.
Child cries and then holds breath until
limp.
Cyanosis may occur.
Sometimes, loss of consciousness, or even
seizure can occur.
It is childs attempt to control environment:
parents /caregivers.
Benign condition: no risk of epilepsy
developing in later life.

7.BREATH HOLDING SPASMS

Management:

Referral to Child Guidance Clinic:

Referral to Child Psychologist

If BHS accompanied with head banging or highly

aggressive behavior

8.STUTTERING / STAMMERING
Defect speech
Stumbling and spasmodic repetition of
some syllables with pauses
Difficulty in pronouncing consonants
Caused by spasm of lingual and palatal
muscles

8.STUTTERING / STAMMERING
Usually begins between 2 5 yrs.
Reminding and ridiculing aggravate
Child loses self confidence and become
more hesitant
They can often sing or recite poems
without stuttering

8.STUTTERING / STAMMERING
Management:

Parents should be reassured

They should not show undue concern and
accept his speech without pressurizing him
to repeat
Children should be given emotional
support
Older children with secondary stuttering
should be referred to speech therapist

SHYNESS
Causes: Genetic & Environment

Management
Assess
Talk

Provide

exposure
Dont compare child
Dont criticize
Reward
Encourage
Help
Dont force

Thank
Q