BEHAVIOURAL DISORDERS IN

CHILDREN
DEFINITION:-
BEHAVIOURAL PROBLEMS: Behavioural
problems include disorders that represent
significant deviation from the normal behavior.
The root of the problem usually is traceable to
the home or school environment.
CAUSES OF BEHAVIORAL PROBLEMS IN
CHILDREN:-

Inadequate Family Environment

Faulty Parental Attitude
Mentally and Physically Sick or Handicapped Conditions
Influence of Social Relationship
Influence of Mass Media
Influence of Social Change
 INFANCY AND TODDLER
1. REPETITIVE BEHAVIOR:
Head Banging:-
 This involves rhythmic hitting of the head against a solid
surface often the Crib mattress.
 This occurs 5-6% of children during infancy and toddler
years. It can cause callus formation, abrasions and
contusions but no intracranial injury.

1
Treatment:
Assurance to the parents.
Teach parents to ignore- as concern and punishment can
reinforce it.
Padding of bed rails to prevent injury.
Body Rocking:-
It is characterized by rhythmic forward and backward
swaying of the trunk most frequently in sitting position.
Treatment:
 Reassure the parent that it will resolve with time.
 If the child has neuropsychiatric disorder, identity the
dysfunctional behavior and consult psychiatrist.
2. BREATH HOLDING SPELLS:
A breath holding spell is an involuntary pause in breathing,
sometimes accompanied by loss of consciousness. It usually
occurs in response to an upsetting or surprising situation. Breath
holding spells appear to be a response to fear, pain, or a traumatic
event.
Types:
1. Blue spells
2. Pale spells
Treatment:
• During the episode, lie them on their side and watch them, do
not put anything in their mouth or splash with water.
• No special medical treatment is required.
• Avoiding situations that provoke temper tantrums can help
reduce the number of spells.
3.THUMBSUCKING :
Thumb Sucking is a natural habit of infants and young children. They
do it to soothe themselves. Children most Often suck their thumb when
they are hungry or tired. When older children continue to suck their
thumb, it could mean they are bored or feel insecure.
Adverse Effects :
 Malocclusion
 Speech difficulty
 Lisping
Treatment:
 Ignore.
 Use positive reinforcement.
 Identify triggers.
 Talk to The child openly about the effects of thumb sucking.
 Put gloves on the child's hands.
 Use a special nontoxic, bitter-tasting nail coating.
4. NAIL BITING:
Nail biting is another habit disorder in toddler and preschool children.
Causes:
 Anxiety
 Parental neglect
 Stress of exam
Treatment :
 Remove precipitants
 Behavior modification techniques
 Play therapy
 Parental reassurance
5. EVENING COLIC :
Colic is characterized by intermittent episodes of abdominal pain or severe
crying in young infants who are otherwise well. Colic start happening with
in few weeks after birth, reach a peak by 4-6 weeks and subside by 3-4
months of age.
Clinical Features :
 Sudden loud cry in the late afternoon or evening.
 Face is red and legs are drawn to the abdomen.
 Stops when completely exhausted.
The diagnosis is conformed when the infant cries for
more than 3 hours per day for more than 3 days per
week for more than 3 weeks. Counseling is the most
effective method for helping parents. No treatment is
required.
6. STRANGER ANXIETY :
By about 6-7 months, the infant can differentiate between the primary
care giver and others. Thus at this age develop fear of unfamiliar
people or strangers. When approached by some unfamiliar person, the
child turns away even cry or runs towards the primary caregiver.
Treatment :
 Teach relaxation technique such as slowly exposing them to
stranger initially from as a distance and asking them to greet
and slowly advance.
 Reassure the parents
7. TEMPER TANTRUM:
It is sudden outburst or violent display of frustration and anger as physical aggression or
resistance. Biting, throwing objects, crying, rolling on floor, or banging limbs are
common activities during temper tantrum.
Precipitating Factors :
 Hunger
 Fatigue
 Lack of sleep
 Ineffective parental skills
 Over pampering
Treatment:
 In general, parents are advised to:
 Set a good example to child.
 Pay attention to child
 Spend quality time with the child
 Have open communication with child
During temper tantrum:
 Parents should ignore the 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.
 PRESCHOOL
1. STUTTERING:
It is characterized by the defect in speech like stumbling and spasmodic repetition of
some syllables with pauses. It begins in 2­­_5 year’s age and more common in males.
 Treatment:
 Parents should be reassured. They should not show undue concern and should
accept his speech without pressurizing him to repeat.
 Children should be given emotional support.
 Older children with secondary stuttering should referred to speech therapist.
 Stammer suppressors, psychotherapy, and drug therapy may be required in some
case.
2. PICA:
It is a habit disorder characterized repeated or chronic ingestion of non-nutritive
substances. Examples: mud, paint, clay, plaster, charcoal, soil, etc.
Predisposing Factors:
• Parental neglect
• Lack of affection
• Psychological neglect, orphans
• Lower socioeconomic class
Treatment:
• Screening indicated for iron deficiency anemia, worm, infestations, lead poisoning,
• Treat cause accordingly.
• Usually remits in childhood but can continue into adolescence.
3.TIC DISORDER:
Tic is a problem in which a part of the body moves repeatedly, quickly, suddenly, and
uncontrollably. Example include grimacing, yawning, grunting, wrinkling scratching
nose or thigh rubbing.
Causes:
• Genetic
• Over expecting, over protecting parents
• Neglect, tension, frustration.
Treatment:
• Comprehensive assessment
• Behavior modification technique
• Conducive learning environment
4. ENURESIS:
Enuresis is defined as the repeated voiding of urine into the bed or clothes at least at
twice per week for at least three consecutive months in a child who is at least 5 years
of age. It is considered normal at until at least age 6.
Etiology:
 Genetic
 Psychological
 Physiological
Investigations:
 Full medical history
 Genital and neurological examination
 Urinalysis for albumin, sugar, microscopy, and culture
Treatment:
 Pharmacologic: two drugs have been used to treat enuresis, DDAVP and
imipramine.
 Non-Pharmacologic:
 Behavior Modification
 Parental Counselling
 Bladder Exercises
5. ENCOPRESIS:
Encopresis is defined as repeated passage of feces into as inappropriate places (e.g.,
clothing or floor) at least once or a month for at least 3 months after chronological
or developmental age of at least 4 year’s.
Diagnosis :
 Complete history and physical examination
 Developmental screening
 Abdominal X-rays
 Neurological examination
 Rectal examination for fecal impaction
Management:
 Bowel training
 Needs help in establishment of regular bowel habit, bowel training, dietary
intake of roughage and intake of adequate fluid.
 Parental support
 Reassurance and help from psychologist for counseling of child and parents
may be essential in persistent problems.
6. SLEEP DISORDERS:
Disturbances of sleep usually occur in deep sleep. The common sleep problems
are difficulty to fall asleep, night mares, night terrors, sleep walking, sleep
talking , bruxism (teeth grinding), etc.
Management:
 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 (ghost, murder,
accidents) should not be allowed at night.
 In case of sleep walking, door and windows to be kept closed and
dangerous objects to be removed.
7. MASTURBATION:-
• Masturbation is self-stimulation of the genitals for pleasure and self-comfort.
• Children may rub themselves with a hand or other object... Occasional
Masturbation is a normal behavior of many Toddlers and preschoolers. Up to a
third of Children in this age group discover Masturbation while exploring their
bodies.
• The older children masturbate due to anxiety or sexual feeling.
• Boys during teen years mostly engage with this practice.
• Parents should explain children that masturbation is not a social activity and it
should not be practiced in public.
 SCHOOL
1. SCHOOL PHOBIA:
Definition:
• School phobia is persistent and abnormal fear of going to school.
• It is emotional disorder of the children who are afraid to leave the parents,
especially mother and prefer to remain at home and refuse to go to school
profusely.
Signs and Symptoms:
Recurrent physical complaints like abdominal pain, headaches which subside if
allowed to remain at home.
Management:
 Habit formation
 Improvement of school environment
 Assessment of health status of the child to detect any health problems for
necessary interventions.
 Family counselling
 Behavior techniques
 Drugs
2. CONDUCT DISORDER:
Conduct disorder is a serious behavioral and emotional disorder that can occur in
children and teens. A child with this disorder may display a pattern of disruptive and
violent behavior.
Symptoms of Conduct Disorder:
 Aggressive Conduct
 Destructive behavior
Risk Factors:
 • Parental rejection and Neglect
 • Difficult infant temperament
 • Physical or sexual abuse
 • Lack of supervision
Treatment:
 • Parent management training -Social, cognitive and problem solving
skills training
 • Peer and school-based interventions
 • Family therapy
 • Medication
3.OPPOSITIONAL DEFIANT DISORDER:
It is defined as a pattern of negativistic, hostile, and defiant behavior lasting at least
6 months, during which 4 or more of the followings are present:
• Often loses temper
•Often argues with adults
•Often actively defies with adults or refuses to comply requests or rules
•Often deliberately annoys people
•Often blames others for his/her mistakes
•Often touchy or easily Annoyed by others
•Often angry
Treatment:
 Parent training
 Build on positives, give praise and reinforcement when child shows flexibility
and cooperation.
 Child individual therapy to develop efficient anger management, decrease
negativity and improve social skills.
 Family therapy to improve communication.
 ADOLESCENCE
1.ANOREXIA NERVOSA:
Definition:
Anorexia Nervosa is an eating disorder found as a refusal of food to maintain
normal body weight by reducing food intake, especially fats and carbohydrates.
Symptoms include:
 Refusal to eat enough food, despite extreme hunger.
 An intense fear of becoming 'fat' and of losing control.
 A disturbance of perception of body image in that people may regard themselves
as fat, overestimating body size.
 Absence of menstrual periods.
Causes:
 Genetic
 Biochemical or hormonal imbalances
 Personal - Changes in life circumstances, such as the onset of adolescence, breakdown of
relationships, childbirth, or death of a loved one.
 Social-media, internet, etc.
Treatment:
 Restore weight with psychological support
 Nutritional/physical rehabilitation
 Family therapy: Parents involved in meal planning, reduce criticism (understanding
seriousness of anorexia)
 Drug: Antidepressants, Tricyclic antidepressants (amitriptyline), SSRIs (fluoxetine),
antihistamines (cyproheptadine),antipsychotics (pimozide)
BULIMIA NERVOSA:
Definition:
Bulimia nervosa is characterized by episodes of binge eating followed by
feelings of guilt, humiliation, depression and self-condemnation.
Its symptoms include:
 Eating binges that involve consumption of large amounts of calorie-rich foods,
during which the person feels a loss of personal control and self-disgust.
 Purging attempts to compensate for binges and to avoid weight gain by self-
induced vomiting, and/or misuse of laxatives and fluid tablets.
 A combination of restricted eating and compulsive exercise so that control of
weight dominates the person's life.
Etiology:
 • More common in first degree, biological relatives of people with bulimia.
 • Society's emphasis on appearance and thinness.
 • Family disturbances or conflict.
 • Sexual abuse.
 • Learned maladaptive behavior.
Treatment:
 • Cognitive behavioral therapy (CBT) and use of anti-depressants.
 • Encourage eating 3 or more balanced meals a day.
 • Reduce rigid food rules and body image concerns.
2. JUVENILE DELINQUENCY:
•According to Dr. Sethna, Juvenile delinquency involves wrong doing by a child or
a young person who is under an age specified by the law of the place concerned.
•A juvenile delinquent is a person who is below 16 years of age (18 years in case
of a girl) who indulges in antisocial activity.
Causes:
• Social Causes
• Psychological causes
• Economic Causes
• Physical
Management:
 Reform of Juvenile Delinquents
 Probation
 Reformatory Institutions
 Psychological Techniques
 Play Therapy
 Finger Painting
 Psychodrama
RESEARCH INPUT:
This study is conducted by Anindya Kumar Gupta, Monica Mongia, and Ajoy
Kumar Garg.
Aim: Behavioral problems among school going children are of significant
concern to teachers and parents. These are known to have both immediate and
long-term unfavorable consequences.
Methods: Five hundred children aged 6-18 years were randomly selected from a
government school in Kanpur, Uttar Pradesh, and assessed for cognitive,
emotional, or behavioral problems using standardized tools.
Result: About 22.7% of children showed behavioral, cognitive, or emotional
problems. Additional screening and evaluation tools pointed toward a higher
prevalence of externalizing symptoms among boys than girls.
Conclusion: The study highlights the importance of regular screening of school
children for preventive as well as timely remedial measures.
SUMMARY
CONCLUSION
BIBLIOGRAPHY:
1.Wilson David, Hockenberry J. Marilyn; Wong’s Essential of PEDIATRIC
NURSING; First South Asia Edition; page no.416-419.

2.Datta Parul; PEDIATRIC NURSING; second edition ; JAPEE BROTHERS

Medical publishers; page no.188-194.

3.Panchali Pal :Textbook of PEDIATRIC NURSING: Paras Medical Publisher:

Page no.498-505.
4.http:/www.ncbi.nlm.nih.gov