CHILD HEALTH NURSING

1. BEHAVIOURAL
PROBLEMS
AND
BEHAVIOURAL
DISORDER
HARSHITA
M.SC 1ST YEAR

2. BEHAVIOURAL PROBLEMS
WHEN CHILDREN CANNOT ADJUST TO A COMPLEX
ENVIRONMENT AROUND THEM, THEY BECOME UNABLE
TO BEHAVE IN THE SOCIALLY ACCEPTABLE WAY
RESULTING IN EXHIBITION OF PECULIAR BEHAVIORS
AND THIS IS CALLED AS BEHAVIOURAL PROBLEMS

3. CAUSES
• FAULTY PARENTAL ATTITUDE
• INADEQUATE FAMILY ENVIRONMENT
• MENTALLY AND PHYSICALLY SICK OR HANDICAPPED
CONDITIONS
• INFLUENCE OF SOCIAL RELATIONSHIPS
• INFLUENCE OF MASS MEDIA

4. CLASSIFIACTATION
AGE
NATURE
CLASSIFICATION
OF
BEHAVIOURAL
DISORDER

5. ON THE BASIS OF AGE
INFANCY CHILDHOOD ADOLESCENCE

6. ON THE BASIS OF NATURE
• MOVEMENT
• HABIT
• TOILETING
• SPEECH
• SCHOOL
• SLEEP
• EATING

8. INFANCY PROBLEMS
• IMPAIRED APPETITE OR RESISTANCE TO FEEDING
• ABDOMINAL COLIC
• STRANGER ANXIETY

9. CHILDHOOD PROBLEMS
• TEMPER TANTRUMS
• BREATH HOLDING SPELL
• THUMB SUCKING
• NAIL BITING
• ENURESIS OR BED WETTING

10. CHILDHOOD PROBLEMS
• ENCOPRESIS
• TICS OR HABIT SPASM
• SCHOOL PHOBIA
• ATTENTION DEFICIT HYPER ACTIVITY DISORDER

11. CHILDHOOD PROBLEMS
TYPES OF PICA OR GEOPHAGIA
• AMYLOPHAGIA:
• COPROPHAGY:
• GEOPHAGY
• HYALOPHAGIA
• MUCOPHAGIA

12. CHILDHOOD PROBLEMS
• PAGOPHAGIA
• SELF-CANNIBALISM
• TRICHOPHAGIA
• UROPHAGIA.
• XYLOPHAGIA

13. CHILDHOOD PROBLEMS
SPEECH PROBLEMS
• STUTTERING OR STAMMERING
• CLUTTERING
• DELAYED SPEECH
• DYSLALIA

14. CHILDHOOD PROBLEMS
SLEEP DISORDERS
• SLEEP WALKING
• SLEEP TALKING
• BRUXISM
• NIGHT MARES
• NIGHT TERRORS

15. ADOLESCENCE PROBLEMS
• MASTURBATION
• JUVENILE DELINQUENCY
• SUBSTANCE ABUSE ANOREXIA NERVOSA
• BULIMIA NERVOSA

17. PROBLEMS OF MOVEMENTS
• HEAD BANGING
• BREATH HOLDING SPELLS

18. PROBLEMS OF HABIT
• THUMB SUCKING
• NAIL BITING
• PICA
• TEMPER TANTRUMS
• TICS

19. PROBLEMS OF TOILET TRAINING
• ENURESIS
• ENCOPRESIS

20. PROBLEMS OF SPEECH
• STUTTERING OR STAMMERING
• CLUTTERING
• DELAYED SPEECH
• DYSLALIA

21. PROBLEMS AT SCHOOL
• SCHOOL PHOBIA

22. SLEEP DISORDERS
SLEEP DISORDERS
• SLEEP WALKING
• SLEEP TALKING
• BRUXISM
• NIGHT MARES
• NIGHT TERRORS

23. EATING DISORDER
• ANOREXIA NERVOSA
• BULIMIA NERVOSA

25. RESISTANCE TO FEEDING OR
IMPAIRED APPETITE
• DURING INFANCY FEEDING PROBLEMS OFTEN DEVELOP AT
THE TIME OF WEANING. INFANT MAY REFUSE NEW FOOD
DUE TO DISLIKE OF TASTE OR DUE TO SEPARATION
ANXIETY FROM MOTHERS. IT MAY BE DUE TO DUE TO
FORCED FEEDING BY THE MOTHER OR MAY BE DUE TO
INDIGESTION OF NEW FOOD AND ABDOMINAL COLIC. THE
INFANT MAY HAVE PAINFUL ULCER IN THE MOUTH OR SORE
THROAT CAUSING DIFFICULTY IN SWALLOWING. THERE
MAY BE NASAL CONGESTION OR ANY OTHER
PATHOLOGICAL CAUSE WHICH NEED TO BE EXCLUDED.

26. RESISTANCE TO FEEDING OR
IMPAIRED APPETITE
• MOTHER USUALLY BECOME FRUSTRATED AND ANXIOUS
WITH THIS SITUATION, SO THEY NEED REASSURANCE AND
GUIDANCE IN RESCHEDULING THE FEEDING TIME AND
CHANGE FOOD ITEMS.
• PROBLEMS LIKE MOUTH ULCER, NASAL CONGESTION, SORE
THROAT OR ANY OTHER CONDITIONS TO BE TREATED
ACCORDINGLY.
• MOTHER SHOULD BE ENCOURAGED TO PROVIDE TENDER
LOVING CARE TO HER INFANT AND TO AVOID SEPARATION.

27. ABDOMINAL COLIC
ABDOMINAL COLIC IS AN IMPORTANT CAUSE OF CRYING IN
THE CHILDREN. SOME INFANT MAY CRY CONTINUOUSLY FOR
VARIABLE PERIODS. THIS PROBLEM USUALLY STARTS WITHIN
THE FIRST WEEK AFTER BIRTH REACHES THE PEAK BY THE
AGE OF 4 TO 6 WEEKS AND IMPROVES AFTER 3 TO 4
MONTHS. THE INFANT MAY CRY LOUDLY WITH CLENCHED
FISTS AND FLEXED LEGS.

28. ABDOMINAL COLIC
THE CAUSE IS NOT NEARLY UNDERSTOOD. IT OCCURS
COMMONLY IN :-
• OVERACTIVE INFANTS WHO ARE OVER STIMULATED BY
PARENTS.
• DUE TO HUNGER OR IMPROPER FEEDING TECHNIQUE OR
PHYSIOLOGICAL IMMATURITY OF THE INTESTINE OR COWS
MILK ALLERGY
• EXCESSIVE CARBOHYDRATE IN FOOD MAY LEAD TO
INTESTINAL FERMENTATION AND ACCUMULATION OF GAS
WHICH MAY CAUSE ABDOMINAL DISTENTION AND PAIN.

29. ABDOMINAL COLIC
ABDOMINAL COLIC OF THE BABY INCREASES ANXIETY AND
TENSION OF THE MOTHER. SHE REQUIRE EXPLANATION AND
HELP FOR SOLVING THE PROBLEMS. BABY SHOULD BE PLACED
IN UPRIGHT POSITION AND BURPING CAN BE DONE TO
REMOVE SWALLOWED AIR.
• PSYCHOLOGICAL BONDING WITH INFANT NEED TO BE
IMPROVED. PRESENCE OF ANY ORGANIC CAUSE TO BE
EXCLUDED AND NECESSARY ARRANGEMENTS TO BE MADE.
• ANTISPASMODIC DRUG CAN BE ADMINISTERED TO RELIEF
COLIC. FREQUENT SMALL AMOUNT FEEDING AND
MODIFICATION OF FEEDING TECHNIQUE IS VERY IMP.

30. STRANGER ANXIETY
THE INFANT DOES NOT BELIEF ANY OTHER PERSON EXCEPT
MOTHER, BECAUSE THEY HAVE TRUST RELATIONSHIP WITH
MOTHER ONLY. IN ABSENCE OF MOTHER, IF ANY NEW
PERSON APPROACHES, THE CHILD WILL CRY DUE TO FEELING
OF INSECURITY, FEAR AND ANXIETY. THIS CRYING MAY
UPSET THE PARENT, BUT IT IS AN INDICATION THAT PARENT
HAVE DONE A GREAT JOB IN THE EMOTIONAL DEVELOPMENT

31. STRANGER ANXIETY
SEPARATION ANXIETY IS VITAL STEPS OF EMOTIONAL
DEVELOPMENT AND MAY CONTINUE UP TO 13 TO 15
MONTHS OF AGE. THIS ANXIETY USUALLY REDUCES WHEN
THE STRANGERS GRADUALLY APPROACH FROM DISTANCE IN
A FAMILIAR PLACE SPECIALLY IN PRESENCE OF MOTHER AND
FATHER. IN THE ABSENCE OF PARENTS LOVING CONCERN OF
STRANGER IS VERY IMPORTANT.

32. TEMPER TANTRUM

33. TEMPER TANTRUM
TEMPER TANTRUM IS A SUDDEN OUTBURST OR VIOLENT
DISPLAY OF ANGER, FRUSTRATION, AND BAD TEMPER AS
PHYSICAL AGGRESSION OR RESISTANCE SUCH AS RIGID
BODY, BITING, KICKING, THROWING OBJECTS, HITTING,
CRYING, ROLLING ON FLOOR, SCREAMING LOUDLY, BANGING
LIMBS ETC.

34. TEMPER TANTRUM
• TEMPER TANTRUM IN MALADJUSTED CHILDREN. THE ACTIVITY
IS DIRECTED TOWARDS THE ENVIRONMENT NOT TO ANY
PERSON OR ANYTHING.
• IT IS NORMAL IN TODDLER, MAY CONTINUE TO PRE-SCHOOL
PERIOD AND BECOME MORE SEVERE INDICATING LOW
FRUSTRATION TOLERANCE. IT IS FOUND USUALLY IN BOYS,
SINGLE CHILD AND PAMPERED CHILD. IF TEMPER TANTRUM
CONTINUES, THE CHILD NEEDS PROFESSIONAL HELP FROM
CHILD GUIDANCE CLINIC. PARENT SHOULD BE AWARE ABOUT
THE BEGINNING OF TEMPER TANTRUM AND WHEN THE CHILD
LOSES CONTROL.

35. TEMPER TANTRUM
• PARENT SHOULD PROVIDE ALTERNATE ACTIVITY AT THAT FEELING IS
NORMAL BUT CONTROLLING ANGER IS AN IMPORTANT ASPECT OF
GROWING UP.
• THE CHILD SHOULD BE PROTECTED FROM SELF-INJURY OR DOING
INJURY TO OTHERS. PHYSICAL RESTRAIN USUALLY INCREASE
FRUSTRATION AND BLOCK THE OUTLET OF ANGER.
• FRUSTRATION CAN BE REDUCED BY CALM AND LOVING APPROACH.
• OVERINDULGENCE SHOULD BE AVOIDED. AFTER TEMPER TANTRUM IS
OVER THE CHILD’S FACE AND HAND SHOULD BE WASHED AND PLAY
MATERIALS TO BE PROVIDED FOR DIVERSION. THE CHILD TENSION BE
RELEASED BY VIGOROUS EXERCISE AND PHYSICAL ACTIVITIES. PARENT
MUST BE FIRM AND CONSISTENT IN BEHAVIOUR.

36. BREATH HOLDING
SPELLS

37. BREATH HOLDING SPELLS
BREATH-HOLDING SPELLS ARE BRIEF PERIODS WHEN YOUNG
CHILDREN STOP BREATHING FOR UP TO 1 MINUTE. THESE
SPELLS OFTEN CAUSE A CHILD TO PASS OUT (LOSE
CONSCIOUSNESS).
IT MAY OCCUR IN CHILDREN BETWEEN 6 MONTHS TO 5
YEARS OF AGE

38. BREATH HOLDING SPELLS
• PARENTS AND FAMILY MEMBERS BECOME VERY ANXIOUS WITH
THE ATTACK. ATTEMPT TO PREVENT THE SPELL IS USUALLY
NOT SUCCESSFUL.
• PARENTS NEED TO ASSURE THE HARMFUL EFFECTS OF THE
ATTACK AND SHOULD BE TOLERANT CALM AND QUIET.
IDENTIFICATION AND CORRECTION OF PRECIPITATING FACTORS
ARE ESSENTIAL APPROACH. REPEATED ATTACK OF THE SPELLS
NEED TO BE EVALUATED WITH CAREFUL HISTORY, PHYSICAL
EXAMINATION AND NECESSARY INVESTIGATIONS TO EXCLUDE
CONVULSIVE DISORDERS OR ANY OTHER PROBLEMS.

39. THUMB SUCKING

40. THUMB SUCKING
THUMB SUCKING IS A COMMON, GENERALLY HARMLESS
CHILD BEHAVIOUR WHOSE PERSISTENT PRACTICE
OCCASIONALLY LEADS TO DENTAL, DERMATOLOGICAL,
ORTHOPAEDIC, AND PSYCHOLOGICAL PROBLEMS.

41. THUMB SUCKING
• THUMB SUCKING OR FINGER SUCKING IS A HABIT DISORDER
DUE TO FEELING OF INSECURITY AND TENSION REDUCING
ACTIVITIES.
• IT MAY DEVELOP DUE TO INADEQUATE ORAL
SATISFACTION DURING EARLY INFANCY BECAUSE OF POOR
BREAST FEEDING.
• IN OLDER CHILDREN, THIS HABIT MAY DEVELOP WHEN
THEY ARE TIRED, BORED, FRUSTRATED, OR AT BED AND
WANT TO SLEEP, BUT FEEL LONELY.

42. THUMB SUCKING
• IF THIS CONDITION CONTINUES BEYOND 4 YRS. OF AGE
THEN COMPLICATION MAY ARISE AS MALOCCLUSION AND
MALALIGNMENT OF TEETH, DIFFICULTY IN MASTICATION
AND SWALLOWING.
• IT MAY CAUSE DEFORMITY OF THUMB, FACIAL DISTORTION
OF SPEECH DIFFICULTIES WITH CONSONANTS (D AND T)
AND GI TRACT INFECTIONS. IF THIS CONDITION
CONTINUES THIS IS THE SIGN OF STRESS.

43. THUMB SUCKING
• PARENTS AND FAMILY MEMBERS NEED SUPPORT AND TO BE
ADVICE NOT TO BECOME IRRITABLE, ANXIOUS, AND TENSE.
PRAISING AND ENCOURAGING CHILD FOR BREAKING THE
HABIT.
• DISTRACTION DURING BORED TIME OR ENGAGING THE
THUMB OR FINGER FOR OTHER ACTIVITY TO BE PRACTICED
TO KEEP HAND BUSY. CONSULTATION WITH DENTIST AND
SPEECH THERAPIST MAY BE REQUIRED TO CORRECT THE
COMPLICATION

44. NAIL BITING

45. NAIL BITING
• NAIL BITING IS THE BAD ORAL HABIT ESPECIALLY IN
SCHOOL AGE CHILDREN BEYOND 4 YRS. OF AGE (5 TO 7
YRS.).
• IT IS THE SIGN OF TENSION AND SELF-PUNISHMENT OF TO
COPE WITH THE HOSTILE FEELING TOWARDS PARENTS. IT
MAY OCCUR AS IMITATING THE PARENT WHO IS ALSO A
NAIL BITTER. IT IS CAUSED BY FEELING OF INSECURITY,
CONFLICT AND HOSTILITY.
• IT MAY BE DUE TO PRESSURIZED STUDY AT SCHOOL OR
HOME DUE TO WATCHING FRIGHTENING VIOLENT SCENES.
IT MAY CONTINUE UPTO ADOLESCENCE.

46. NAIL BITING
• THE CHILD MAY BITE ALL 10 FINGER NAILS OR ANY
SPECIFIC ONE. THE BITE MAY INCLUDE FINGER CUTICLE
OR SKIN MARGIN OF ALL NAIL BEDS OR SURROUNDING
TISSUE.

47. NAIL BITING
• THE CAUSE OF NAIL BITING TO BE IDENTIFIED BY THE
PARENTS WITH THE HELP OF CLINICAL PSYCHOLOGIST AND
STEPS TO BE TAKEN TO REMOVE BAD HABIT.
• THE CHILD SHOULD BE PRAISED FOR WELL-KEPT HAND BY
BREAKING THE HABIT TO MAINTAIN SELF-CONFIDENCE.
• THE CHILD’S HAND TO BE KEPT BUSY WITH CREATIVE
ACTIVITIES OR PLAY.
• PUNISHMENT TO BE AVOIDED. PARENTS NEED
REASSURANCE AND ASSISTANCE TO ACCEPT THE
SITUATION AND TO HELP THE CHILD TO OVERCOME THE
PROBLEM.

48. BED
WETTING

49. BED WETTING
• BED WETTING IS THE REPETITIVE INVOLUNTARY PASSAGE
OF URINE AT IN APPROPRIATE PLACE ESPECIALLY AT BED,
DURING NIGHT TIME, BEYOND THE AGE OF 4 TO 5 YRS.
• THE MOST FREQUENT CAUSE IS SMALL BLADDER CAPACITY,
IMPROPER TOILET TRAINING AND DEEP SLEEP WITH
INABILITY TO RECEIVE THE SIGNALS FROM DISTENDED
BLADDER TO EMPTY IT.
• THE EMOTIONAL FACTOR RESPONSIBLE FOR THIS IS
HOSTILE OR DEPENDENT PARENTS- CHILD RELATIONSHIP,
DOMINANT PARENTS, PUNISHMENT, SIBLING RIVALRY,
EMOTIONAL DEPRIVATION DUE TO INSECURITY OR
PARENTAL DEATH

50. BED WETTING
• THE OTHER FACTOR INCLUDES THE CHILD WITH
EMOTIONAL CONFLICT AND TENSION, DESIRES TO GAIN
CARE AND ATTENTION OF PARENTS AS IN INFANCY.
• ENVIRONMENTAL FACTOR MAY INCLUDE – DARK PASSAGE
TO THE TOILET OR COLD OR FEARS OF TOILET OR TOILET
AT DISTANCE FROM BED ROOM MAY CAUSE BED WETTING
AT NIGHT.

51. BED WETTING
• THE ASSOCIATED ORGANIC CAUSE MAY PRESENT E.G. SPINA
BIFIDA, NEUROGENIC BLADDER, JUVENILE DIABETES MELLITUS,
SEIZURES DISORDER ETC. AND NEED TO BE EXCLUDED.
ENURESIS MAY BE PRIMARY AND SECONDARY IN TYPE
• PRIMARY: - CHARACTERISED BY DELAYED MATURATION OF
NEUROLOGICAL CONTROL OF URINARY BLADDER, WHEN
CHILD ACHIEVED NORMAL BLADDER CONTROL USUALLY DUE
TO ORGANIC CAUSE.
• SECONDARY: - NORMAL BLADDER CONTROL IS DEVELOPED
FOR SEVERAL MONTHS AFTER WHICH CHILD AGAIN STARTS
BED WETTING AT NIGHT USUALLY DUE TO REGRESSIVE
BEHAVIOUR LIKE ILLNESS AND HOSPITALIZATION DUE TO ANY
EMOTIONAL DEPRIVATION.

52. BED WETING
MANAGEMENT DEPENDS UPON THE SPECIFIC CAUSE.
• ASSESSMENT OF EXACT CAUSE IS VERY ESSENTIAL BY
THROUGH HISTORY, CLINICAL EXAMINATION AND
NECESSARY INVESTIGATIONS.
• THE ORGANIC CAUSES ARE MANGED WITH SPECIFIC
TREATMENT.
• NON-ORGANIC CAUSES ARE MANAGED WITH SPECIFIC
TREATMENT. THEY ARE MANAGED PRIMARILY WITH
EMOTIONAL SUPPORT TO THE CHILD AND PARENTS ALONG
WITH ENVIRONMENT MODIFICATION
• THE CHILD NEEDS REASSURANCE, RESTRICTION OF FLUID
AFTER DINNER, VOIDING BEFORE BED TIME AND ARISING
THE CHILD TO VOID, ONCE OR TWICE, THREE TO FOUR

53. BED WETTING
• THE CHILD SHOULD BE FULLY WAKENING UP BY THE
PARENT AND MADE AWARE OF PASSING OF URINE AT
NIGHT. THE CHILD CAN ASSUME RESPONSIBILITY FOR
CHANGING THE BED CLOTHES. PARENTS SHOULD NOT BE
WORRIED ABOUT THE PROBLEM
• PARENTS SHOULD ENCOURAGE AND REWARD THE CHILD
FOR DRY NIGHTS.
• PUNISHMENT AND CRITICISM MAY LEAD TO
EMBARRASSMENT AND FRUSTRATION, OF THE CHILD,
BLADDER STRETCHING DURING DAY TIME TO BE DONE TO
INCREASE HOLDING TIME OF URINE, USING POSITIVE
REINFORCEMENT AND DELAYING VOIDING SOMETIME.

54. BED WETTING
• DRUG THERAPY TRICYCLIC ANTIDEPRESSANT(IMIPRAMINE)
ARE USEFUL.
• CONDITION THERAPY BY USING ELECTRIC ALARM BELL
MATTRESS IS A EFFECTIVE AND SAFEST METHOD WHEN
CHILD WAKES UP AS SOON AS BED IS WET.
• SUPPORTIVE PSYCHOTHERAPY IS EFFECTIVE. TO CHANGE
THE HOME ENVIRONMENT

55. ENCOPORESI
S

56. ENCOPORESIS
• ENCOPRESIS IS THE PASSAGE OF FECES INTO
INAPPROPRIATE PLACES AFTER THE AGE OF 5 YRS., WHEN
THE BOWEL CONTROL IS NORMALLY ACHIEVED.
• IT IS MORE SERIOUS FORM OF EMOTIONAL DISTURBANCE
DUE TO UNCONSCIOUS ANGER, STRESS AND ANXIETY.
• IT CAN BE PRIMARY OR SECONDARY ENCOPRESIS LIKE BED
WETTING. ASSOCIATION PROBLEMS ARE CHRONIC
CONSTIPATION, PARENTAL OVER CONCERN, OVER
AGGRESSIVE TOILET TRAINING, TOILET FEAR, ATTENTION
DEFICIT DISORDERS, POOR SCHOOL ATTENDANCE AND
LEARNING DIFFICULTIES MAY BE FOUND WITH ENCOPRESIS.

57. ENCOPORESIS
ASSESSMENT OF THIS CONDITION HISTORY OF BOWEL
TRAINING, USE OF TOILETS AND ASSOCIATED PROBLEMS. THE
CHILD NEED HELP IN THE ESTABLISHMENT OF REGULAR
BOWEL HABIT, BOWEL TRAINING, DIETARY INTAKE OF
ROUGHAGE AND INTAKE OF ADEQUATE FLUID. PARENTERAL
SUPPORT, REASSURANCE AND HELP FROM PSYCHOLOGIST
FOR COUNSELLING OF CHILD AND PARENTS MAY BE
ESSENTIAL IN PERSISTENT PROBLEMS.

58. PICA

59. PICA
• AN EATING DISORDER WHICH IS CHARACTERIZED BY
CONSUMING NON-EDIBLE SUBSTANCES IS KNOWN AS PICA
DISORDER. A PERSON WITH THIS CONDITION CRAVES FOR
NON-NUTRITIVE SUBSTANCES LIKE SOIL, CHALK PIECE,
CLAY, MUCUS, PAPER, SOAP ETC
• IT IS SEEN IN ALMOST ALL THE AGE GROUPS. IT IS VERY
COMMON AMONG PREGNANT WOMEN, YOUNG KIDS AND
CHILDREN WITH DEVELOPMENTAL DISABILITIES

60. PICA
• AMYLOPHAGIA: A COMPULSIVE CONSUMPTION OF PURIFIED
STARCH IN EXCESSIVE AMOUNTS IS KNOWN AS AMYLOPHAGIA.
IT IS MOSTLY SEEN AMONG PREGNANT WOMEN.
• COPROPHAGY: AN EATING DISORDER CHARACTERIZED BY
EATING FECES IS CALLED COPROPHAGY. IT IS SEEN AMONG
ANIMALS AND IS UNCOMMON IN HUMAN BEINGS.
• GEOPHAGY: IT IS AN ABNORMAL CRAVING FOR SOIL-LIKE OR
EARTHY SUBSTANCES CLAY, CHALK, SOIL ETC. IT IS COMMON
AMONG CHILDREN AND PREGNANT WOMEN.
• HYALOPHAGIA: PICA DISORDER IN WHICH THE PERSON EATS
GLASS OBJECTS IS CALLED HYALOPHAGIA. THIS IS USUALLY
USED AS A PERFORMANCE TECHNIQUE BY PERFORMERS.
• MUCOPHAGIA: A DISORDER OF FEEDING ON THE MUCUS OF
THE INVERTEBRATES AND FISHES IS CALLED MUCOPHAGIA.

61. PICA
• PAGOPHAGIA: A FORM OF PICA IN WHICH THE PERSON CONSUMES
EXCESSIVE AMOUNTS OF ICE CUBES OR ICED DRINKS IS KNOWN AS
PAGOPHAGIA. THIS CONDITION IS ASSOCIATED WITH THE IRON
DEFICIENCY.
• SELF-CANNIBALISM: IT IS THE SELF-EATING PRACTICE. SELF-
CANNIBALIAM IS ALSO CALLED AUTOCANNIBALISM OR
AUTOSARCOPHAGY.
• TRICHOPHAGIA: THIS CONDITION IS CHARACTERIZED BY EATING
HAIR, MOSTLY ONE’S OWN. THE LONG HAIR IS FIRST CHEWED
WITHOUT PULLING THEM FROM THE SCALP AND THEM SWALLOWED.
SOMETIMES THE PATIENT MIGHT ALSO EAT OTHER PEOPLE’S HAIR.
• UROPHAGIA: THE PRACTICE OF CONSUMING URINE IS CALLED
UROPHAGIA. THE REASON FOR THIS MIGHT BE HEALTH CONCERNS AS
URINE IS REGARDED, BY SOME, EARTHY AND WITH HEALING
PROPERTIES.
• XYLOPHAGIA: THIS KIND OF PICA DISORDERS INVOLVES THE
CONSUMPTION OF WOOD. PEOPLE USUALLY EAT THINGS MADE OF
WOOD LIKE PENCIL, PAPER, WOOD BARK ETC. THIS IS SEEN MOSTLY
AMONG CHILDREN.

62. PICA
• IT IS COMMON IN POOR SOCIOECONOMIC FAMILY AND IN
MALNOURISHED AND MENTALLY SUBNORMAL CHILDREN.
CHILDREN WITH PICA MAY HAVE INTESTINAL PARASITIZES,
LEAD POISONING, VITAMINS AND MINERAL DEFICIENCY.
• MANAGEMENT IS DONE BY PSYCHOTHERAPY OF THE CHILD
AND THE PARENTS.

63. TICS

64. TICS
• A TIC IS A SUDDEN, REPETITIVE, NONRHYTHMIC MOTOR
MOVEMENT OR VOCALIZATION INVOLVING DISCRETE
MUSCLE GROUPS.
• TICS CAN BE INVISIBLE TO THE OBSERVER, SUCH AS
ABDOMINAL TENSING OR TOE CRUNCHING.
• COMMON MOTOR AND PHONIC TICS ARE, RESPECTIVELY,
EYE BLINKING AND THROAT CLEARING.
• IT OCCURS MOSTLY IN SCHOOL CHILDREN FOR DISCHARGE
OF CHILDREN IN MALADJUSTED EMOTIONALLY CHILD. IT IS
OUTLET OF SUPPRESSED ANGER AND WORRY ABOUT
CONTROL OF AGGRESSION.

65. TICS
• TICS CAN BE MOTOR OR VOCAL. MOTOR TICS CAN BE
FOUND AS EYE BLINKING; GRIMACING SHRUGGING
SHOULDER, TONGUE PROTRUSION, FACIAL GESTURE. ETC.
VOCAL TICS ARE FOUND AS THROAT CLEARING,
COUGHING, BARKING, SNIFFING.
• A SPECIAL TYPE OF CHRONIC TIC IS FOUND AS ‘GILLES DE
LA TOURETTE’S SYNDROME’ CHARACTERIZED BY MULTIPLE
MOTOR TICS AND VOCAL TICS. IT SEEMS TO BE A GENETIC
DISORDER WITH ONSET AT 11 YEARS OF AGE
• PARENTERAL REASSURANCE AND COUNSELLING OF THE
CHILD AND PARENTS USUALLY USEFUL TO MANAGE SIMPLE
MOTOR AND VOCAL TICS.

66. SPEECH PROBLEM

67. SPEECH PROBLEM
• SPEECH DISORDER IS COMMON IN CHILDHOOD. THESE CAN BE FOUND
AS DISTURBANCES OF VOICE, ARTICULATION, AND FLUENCY.
• STUTTERING OR STAMMERING
• STUTTERING, ALSO KNOWN AS STAMMERING, IS A SPEECH
DISORDER IN WHICH THE FLOW OF SPEECH IS DISRUPTED BY
INVOLUNTARY REPETITIONS AND PROLONGATIONS OF SOUNDS,
SYLLABLES, WORDS OR PHRASES AS WELL AS INVOLUNTARY SILENT
PAUSES OR BLOCKS IN WHICH THE PERSON WHO STUTTERS IS UNABLE
TO PRODUCE SOUNDS.
• MANAGEMENT OF STAMMERING INCLUDES BEHAVIOUR MODIFICATION
AND RELAXATION THERAPY TO RESOLVE THE CONFLICT AND
EMOTIONAL STRESS.
• PARENTS NEED TO BE COUNSELLED TO RATIONALIZE THEIR
EXPECTATION. THE CHILD SHOULD BE REASSURED AND HELP IN
BREATH CONTROL EXERCISE AND SPEECH THERAPY. CRITICISM MAKE
CHILD MORE HANDICAPPED

68. SPEECH PROBLEM
CLUTTERING
IT IS CHARACTERIZED BY UNCLEAR AND HURRIED SPEECH IN
WHICH WORD TUMBLE OVER EACH OTHER. THERE ARE
AWKWARD MOVEMENTS OF HAND; FEET AND BODY. THESE
CHILDREN HAVE ERRATIC AND POORLY ORGANIZED
PERSONALITY AND BEHAVIOR PATTERN. THEY NEED
PSYCHOTHERAPY.

69. SPEECH PROBLEM
• DELAYED SPEECH
DELAYED SPEECH BEYOND 3 TO 3.5 YEARS CAN BE
CONSIDERED AS ORGANIC CAUSES LIKE AUTISM, MENTAL
RETARDATION, HEARING DEFECTS OR SEVERAL EMOTIONAL
PROBLEMS. THE EXACT CAUSE MUST BE EXCLUDED FOR
NECESSARY INTERVENTIONS.

70. SPEECH PROBLEM
DYSLALIA
MOST COMMON DISORDER OF DIFFICULTY IN ARTICULATION.
IT CAN BE CAUSED BY ABNORMALITIES OF TEETH, JAW,
PALATE OR DUE TO EMOTIONAL DEPRIVATION. TREATMENT
OF STRUCTURAL ABNORMALITIES AND SPEECH THERAPY
SHOULD BE DONE ADEQUATELY.

71. SLEEP DISORDER

72. SLEEP DISORDER
SLEEP DISORDER ARE COMMON IN CHILDREN WITH ANXIETY,
TENSION, AND OVERACTIVITY. THESE PROBLEMS ARE
PRESENT WITH OR WITHOUT PHYSICAL SYMPTOMS OF
BEHAVIOURAL DISORDERS. DISTURBANCE OF SLEEP USUALLY
OCCUR IN DEEP SLEEP, I.E. STAGE 3 OR 4 OF NREM (NON-
RAPID EYE MOVEMENT) SLEEP. THE COMMON SLEEP
PROBLEMS ARE DIFFICULTY TO FALL ASLEEP, NIGHT MARES,
NIGHT TERRORS, SLEEP WALKING (SOMNAMBULISM), SLEEP
TALKING (SOMILILOQUY), BRUXISM (TEETH GRINDING), ETC.

73. SLEEP DISORDER
• IN NIGHT MARES, THE CHILD AWAKENS FROM A
FRIGHTENING BAD DREAM AND IS CONSCIOUS OF
SURROUNDINGS.
• IN NIGHT TERRORS, THE CHILD AWAKENS DURING SLEEP,
SITS UP WITH SCREAMING AND TERRIFIED TO RECOGNIZE
THE SURROUNDING AND AFTER SOMETIMES SLEEPS AGAIN.
• SLEEPWALKING USUALLY OCCURS ONE TO TWO HOURS
AFTER FALLING ASLEEP AT NIGHT. RARELY, IT MAY
INVOLVE UNUSUAL BEHAVIOURS, SUCH AS CLIMBING OUT
OF A WINDOW OR URINATING IN A WARDROBE.

74. SLEEP DISORDER
• SOMNILOQUY OR SLEEP-TALKING IS A PARASOMNIA THAT
REFERS TO TALKING ALOUD WHILE ASLEEP. IT CAN BE
QUITE LOUD, RANGING FROM SIMPLE MUMBLING SOUNDS
TOO LOUD SHOUTS AND LONG, FREQUENTLY
INARTICULATE SPEECHES, AND CAN OCCUR MANY TIMES
DURING A SLEEP CYCLE.
• SLEEP BRUXISM IS CONSIDERED A SLEEP-RELATED
MOVEMENT DISORDER. PEOPLE WHO CLENCH OR GRIND
THEIR TEETH (BRUX) DURING SLEEP ARE MORE LIKELY TO
HAVE OTHER SLEEP DISORDERS, SUCH AS SNORING AND
PAUSES IN BREATHING (SLEEP APNEA).

75. SLEEP DISORDER
• IN ALL THESE PROBLEMS, THE CHILD SHOULD HAVE LIGHT
DIET IN DINNER AND PLEASANT STORIES OR SCENE AT BED
TIME.
• NO EXCITING GAMES AND PICTURES AND FRIGHTENING
STORIES.
• PARENTS SHOULD ALLOW RELAX COMFORTABLE BED AND
EMOTIONALLY HEALTHY ENVIRONMENT.
• IN CASE OF SLEEP WALKING DOORS AND WINDOWS TO BE
KEPT CLOSED AND DANGEROUS OBJECTS TO BE REMOVED
• IN ADVANCED AND PROLONGED PROBLEMS CONSULTATION
WITH DOCTORS AND PSYCHOLOGIST IS ESSENTIAL FOR
SPECIFIC DRUG THERAPY AND PSYCHOTHERAPY.

76. SCHOOL PHOBIA

77. SCHOOL PHOBIA
• SCHOOL PHOBIA IS PERSISTENT AND ABNORMAL FEAR OF
GOING TO SCHOOL. IT IS COMMON IN ALL SOCIAL GROUP.
IT IS EMOTIONAL DISORDER OF THE CHILDREN WHO ARE
AFRAID TO LEAVE THE PARENTS.
• IT IS SYMPTOM OF CRISIS SITUATION OF DEVELOPMENT
STAGES AND CRY FOR HELP WHICH NEEDS SPECIAL
ATTENTION.
• CONTRIBUTING FACTORS ARE ANXIETY, UNCONGENIAL
SCHOOL ENVIRONMENT LIKE TEASING BY OTHER
STUDENTS, POOR STUDENT TEACHER RELATIONSHIP,
UNHYGIENIC ENVIRONMENT FEAR OF EXAMINATION.

78. SCHOOL PHOBIA
• THE CHILD MAY COMPLAIN OF RECURRENT PHYSICAL
COMPLAINTS LIKE ABDOMINAL PAIN, HEADACHES WHICH
SUBSIDES IF THE CHILD IS ALLOWED TO REMAIN AT HOME.
• THE PROBLEM CAN BE MANAGED BY HABIT FORMATION
FOR REGULAR SCHOOL ATTENDANCE; PLAY SESSION AND
OTHER RECREATIONAL ACTIVITIES AT SCHOOL,
IMPROVEMENT OF SCHOOL ENVIRONMENT AND
ASSESSMENT OF HEALTH STATUS .OF THE CHILD TO
DETECT ANY HEALTH PROBLEMS FOR NECESSARY
INTERVENTION.

80. ADHD
ADHD OFTEN BEGINS IN CHILDHOOD AND CAN PERSIST INTO
ADULTHOOD. IT MAY CONTRIBUTE TO LOW SELF-ESTEEM,
TROUBLED RELATIONSHIPS AND DIFFICULTY AT SCHOOL OR
WORK. SYMPTOMS INCLUDE LIMITED ATTENTION AND
HYPERACTIVITY. IT IS CHARACTERIZED BY PROBLEMS PAYING
ATTENTION, EXCESSIVE ACTIVITY, OR DIFFICULTY
CONTROLLING BEHAVIOUR WHICH IS NOT APPROPRIATE FOR
A PERSON'S AGE. THE SYMPTOMS APPEAR BEFORE A PERSON
IS TWELVE YEARS OLD, ARE PRESENT FOR MORE THAN SIX
MONTHS, AND CAUSE PROBLEMS IN AT LEAST TWO SETTINGS
(SUCH AS SCHOOL, HOME, OR RECREATIONAL ACTIVITIES).

81. ADHD
• MOST ADHD CASES ARE OF UNKNOWN CAUSES. IT IS
BELIEVED TO INVOLVE INTERACTIONS BETWEEN GENETICS,
THE ENVIRONMENT, AND SOCIAL FACTORS. CERTAIN
CASES ARE RELATED TO PREVIOUS INFECTION OF OR
TRAUMA TO THE BRAIN. PREDISPOSING FACTOR CAN BE
PREMATURITY OR LBW.
• THE MANIFESTATION MAY BE COMBINATION OF READING
AND ARITHMETIC DISABILITY, IMPAIRED MEMORY, POOR
LANGUAGE AND SPEECH DEVELOPMENT, INAPPROPRIATE
UNDERSTANDING OF SPOKEN WORDS ETC. THE CHILD IS
USUALLY OVERACTIVE, AGGRESSIVE, EXITABLE, IMPULSIVE
AND INATTENTIVE.

82. ADHD
• MANAGEMENT IS DONE BY TEAM APPROACH INCLUDING
PEDIATRICIAN, PSYCHOLOGIST, PSYCHIATRIST, PEDIATRIC
NURSE SPECIALIST, SCHOOL HEALTH NURSE, TEACHERS,
SOCIAL WORKERS AND PARENTS.
• APPROACHES INCLUDE BEHAVIOR MODIFICATION,
COUNSELLING, AND GUIDANCE OF PARENTS AND
APPROPRIATE TRAINING AND EDUCATION OF CHILD. DRUG
THERAPY CAN HELP TO IMPROVE THE CNS DYSFUNCTION
OR OTHER ASSOCIATED PROBLEMS.

84. MASTURBATION
• MASTURBATION OR GENITAL STIMULATION BY HANDLING
THE GENITALS GIVES PLEASURE TO THE CHILDREN. THE
INFANT AND TODDLER DO THIS OUT OF CURIOSITY. THE
OLDER CHILDREN MASTURBATE OUT OF ANXIETY OR
SEXUAL FEELING. BOYS DURING TEEN YEARS MOSTLY
ENGAGE WITH THESE PRACTICES.
• ADOLESCENT EXPERIENCE SEXUAL EXCITEMENT AND
ERECTION OF PENIS OR CLITORIS.
• PARENTS SHOULD BE INFORMED THAT MASTURBATION IS
NORMAL RESPONSE DURING PRE-PUBESCENT AND
PUBESCENT STAGE AND HAS A ROLE IN PHYSICAL AND
EMOTIONAL DEVELOPMENT. IT PROVIDES A VARIETY OF
SEXUAL EXPERIENCES.

85. MASTURBATION
• IN CASE OF EXCESSIVE MASTURBATION THE CHILD NEEDS
SPECIAL ATTENTION, FACILITIES FOR RECREATION AND
DIVERSION, SEX EDUCATION AND COUNSELLING. PARENTS
SHOULD BE EXPLAINED TO PROVIDE LOVE AND AFFECTION
AND ATTENTION TO THE OLDER CHILDREN WITH SPECIFIC
CONCERN ABOUT THEIR FEELING.

86. JUVENILE
DELIQUENCY

87. JUVENILE DELIQUENCY
• JUVENILE DELINQUENCY MEANS INDULGENCE IN AN OFFENCE
BY A CHILD IN THE FORM OF PREMEDIATED, PURPOSEFUL,
UNLAWFUL ACTIVITIES DONE HABITUALLY AND REPEATEDLY.
USUALLY THESE CHILDREN BELONGS TO BROKEN FAMILY OR
EMOTIONALLY DISTURBED FAMILY WITH OVERCROWDED
UNHEALTHY ENVIRONMENT AND HAVING FINANCIAL OR
LEGAL PROBLEMS.
• FACTORS :- URBANIZATION, CHANGING LIFE STYLE, MASS
MEDIA, CHANGE IN MORAL STANDARDS, LACK OF
EDUCATIONAL OPPORTUNITIES, POOR ECONOMY, UNHEALTHY
STUDENT-TEACHER RELATIONSHIP AND LACK OF DISCIPLINE.

88. JUVENILE DELIQUENCY
• THIS BEHAVIOUR INCLUDE LYING, THEFT, BURGLARY, TRUANCY FROM
SCHOOL, RUN AWAY FROM HOME, HABITUAL DISOBEDIENCE, FIGHTS,
ANTISOCIAL GANG, CRUELTY TO ANIMALS.
• PREVENTION IS BY ELIMINATION OF CONTRIBUTING FACTOR. THE
PROBLEM DELINQUENT BEHAVIOURS IS NOW INCREASING IN INDIA
AND OTHER COUNTRIES.
• PREVENTIVE MEASURES TO BE EMPHASIZED BY HEALTHY FAMILY AND
SCHOOL ENVIRONMENT.
• HEALTHY PARENT CHILD RELATIONSHIP
• THE CHILD MUST BE REFERED TO CHILD GUIDANCE CLINIC. A TEAM
APPROACH IS NECESSARY IN MANAGEMENT OF THIS CONDITION
INCLUDING SOCIAL WORKERS, PSYCHOLOGISTS, PSYCHIATRISTS,
PAEDIATRICIAN, COMMUNITY HEALTH NURSE, SCHOOL TEACHERS,
FAMILY MEMBERS AND PARENTS.

89. SUBSTANCE ABUSE

90. SUBSTANCE ABUSE
SUBSTANCE ABUSE OR DRUG ABUSE IS AN THREATENING
SOCIAL PROBLEM OF SCHOOL GOING ADOLESCENT AGE
GROUP. IT IS PERIODIC OR CHRONIC INTOXICATION BY
REPEATED INTAKE OF HABIT FORMING AGENTS. IT IS
PERSISTENT OR SPORADIC USE OF DRUGS OR SUBSTANCE
INCONSISTENT WITH UNRELATED TO MEDIAL AND SOCIAL
WITHIN A GIVEN CULTURE.

91. SUBSTANCE ABUSE
• THE ABUSED AGENTS ARE MAINLY TOBACOO, ALCOHOL
SLEEPING PILL, TRANQUILLIZERS, MOOD ELEVATORS
STIMULANTS, OPIATES, LSD, COCAINE HERION AND
CANNABIS.
• THE CHILDREN WITH THIS BEHAVIOURAL DISORDERS ARE
HAVING FRUSTRATION, EMOTIONAL CONFLICTS AND
DISTRIBUTED FAMILY AND SCHOOL RELATIONSHIP. THEY
ARE VICTIM OF GANG ACTIVITIES, WRONG ADVENTURE,
POOR PARENTAL GUIDANCE AND LACK OF RECREATION
AND EDUCATION.

92. SUBSTANCE ABUSE
PREVENTION:-
• PROVISION OF ADEQUATE FACILITIES FOR RECREATION
AND ENTERTAINMENT, ESPECIALLY IN THE HOSTELS
• INCULCATION OF THE DANGERS OF DRUG ABUSE AMONG
STUDENTS , THEIR TEACHERS AND FAMILY MEMBERS.
• STRICT IMPLEMENTATION OF DRUG CONTROL MEASURES.
• THE ADDICTED CHILDREN NEED PSYCHOTHERAPY,
DEADDICTION, WHEREVER NECESSARY

93. ANOREXIA NERVOSA

94. ANOREXIA NERVOSA
• ANOREXIA NERVOSA IS A EATING DISORDER OCCUR MOST
OFTEN IN ADOLESCENT GIRLS. THE PROBLEM IS FOUND AS
REFUSAL OF FOOD TO MAINTAIN NORMAL BODY WEIGHT
BY REDUCING FOOD INTAKE ESPECIALLY FATS AND
CARBOHYDRATES. THE AFFECTED ADOLESCENT GIRL
PRACTICES VIGOROUS EXERCISE FOR WEIGHT REDUCTION
OR INDUCE VOMITING BY STIMULATING GAG REFLEX TO
REMAIN SLIM
• THERE IS NO SPECIFIC ORGANIC CAUSE OF ANOREXIA
NERVOSA. THE AFFECTED ADOLESCENT MAY HAVE
ASSOCIATED CONDITIONS LIKE DISEASE OF LIVER, KIDNEY,
HEART OR DIABETES.

95. ANOREXIA NERVOSA
• PARENT OF AFFECTED ADOLESCENT MAY BE ANORECTIC
AND HAVING CONFLICT IN RELATIONSHIP WITH THE CHILD
OR OVERPROTECTIVE WHICH LEAD TO DEVELOPMENT OF
IMMATURITY, ISOLATION AND EXCESSIVE DEPENDENCE.
• THE AFFECTED ADOLESCENT IS CHARACTERIZED BY UNDER
NUTRITION, MARKED WEIGHT LOSS, BIZZARE FOOD INTAKE
PATTERNS, DRYNESS OF SKIN, HYPOTHERMIA,
HYPOTENSION, BRADYCARDIA AMENORRHEA
CONSTIPATION ETC

96. BULIMIA
NERVOS
A

97. BULIMIA NERVOSA
• BULIMIA NERVOSA IS A SERIOUS, POTENTIALLY LIFE-
THREATENING EATING DISORDER CHARACTERIZED BY A
CYCLE OF BINGEING AND COMPENSATORY BEHAVIORS
SUCH AS SELF-INDUCED VOMITING DESIGNED TO UNDO OR
COMPENSATE FOR THE EFFECTS OF BINGE EATING.
SYMPTOMS
• FREQUENT EPISODES OF CONSUMING VERY LARGE AMOUNT
OF FOOD FOLLOWED BY BEHAVIORS TO PREVENT WEIGHT
GAIN, SUCH AS SELF-INDUCED VOMITING.
• A FEELING OF BEING OUT OF CONTROL DURING THE
BINGE-EATING EPISODES.
• SELF-ESTEEM OVERLY RELATED TO BODY IMAGE.

98. BULIMIA NERVOSA
• TREATMENT FOR BULIMIA INVOLVES PSYCHOLOGICAL
COUNSELING AND SOMETIMES MEDICINES SUCH AS
ANTIDEPRESSANTS. TREATMENT DOES NOT USUALLY
REQUIRE STAYING IN THE HOSPITAL, ALTHOUGH THIS IS
SOMETIMES NEEDED. BOTH PROFESSIONAL COUNSELING
AND ANTIDEPRESSANT MEDICINE CAN HELP REDUCE
EPISODES OF BINGING AND PURGING

99. NURSING
RESPONSIBILITI
ES
Assessment of specific problem
of the child by appropriate
history and detection of the
responsible factors.
Informing the parents and
making them aware above
about the causes of behavioural
problems of the particular child
Assisting the parents, teachers
and family members for
necessary modification of
environment at home, school
and community.
Encouraging the child for
behaviour modification, as
needed.

100. NURSIN
G
RESPON
SIBILITIE
S
Promoting healthy emotional development of the child
by adequate physical, psychological and social support.
Promoting
Creating awareness about psychosocial disturbances
which may lead to behavioural problems during
developmental stages.
Creating
Providing counselling services for children and their
parents to solve problems
Providing
Referring the children with behavioural problems for
necessary management.
Referring