1. BEHAVIOURAL AND
PSYCHOLOGICAL
DISORDERS IN PEDIATRICS
Rania Hesham
Faculty of Medicine
Alexandria University

2. BEHAVIORAL AND PSYCHIATRIC
DISORDERS IN PEDIATRICS
Thumb suckling.
Nail biting
Enuresis .
Encopresis.
PICA
Breath Holding
Temper Tantrum

3. THUMB SUCKING
Definition:
Thumb sucking or finger sucking is a habit
disorder due to feeling of insecurity and
tension reducing activities.
“sleep pattern / new sibling /tension ”
Complicatio
n:
Teeth
Mastication & swallowing
Thumb
• Facial distortion
• Speech difficulty
•

4. THUMB SUCKING
Management:
Family
support
Praising
and
encouragi
ng
Thumb
busy
dentist and
speech
therapist

5. NAIL BITING
Definition:
Nail baiting is bad oral habit especially in school age children beyond 4
years old
(5 - 7 years). It is sign of tension and self punishment to cope with the
hostile feeling towards parents.
Cause:
Imitating the parent who also a nail biter.
Insecure feeling
Conflict
Hostility
Pressurized study at school or home.
Watching frightening violent scenes.

6. NAIL BITING
Busy hand
with activities
or play.
Praised for well
breaking the
habit.
Help the child to
overcome the
problem
Management:

7. ENURESIS ( BED WETTING )
Definition:
The repetitive involuntary passage of urine at inappropriate place
especially at bed,
during night time, beyond the age of 4 to 5 years. It is found
in 3 to 10 percent school children ♂ >
1. Primary (75%) 2. Secondary (25%)
Causes:
 Psychological factors
 Delayed maturation of the cortical mechanisms
 Sleep disorder-enuretic children
 Reduced antidiuretic hormone production at night
 Genetic factors
 Organic factors Constipation Infection
 Sleep apnea

8. ENURESIS ( BED WETTING )
 Small functional bladder
capacity
 Deep sleepers
 Nocturnal polyuria
 Genetic factors – (family
history)
 Delayed maturation of the
cortical mechanisms
 Reduced antidiuretic
hormone production at
night
 Diabetes insipidus
 psychological cause
 Urinary Tract Infection
 Constipation
 Diabetes (Mellitus &
Insipidis)
 Chronic Renal Failure
 Neurological causes
 Sleep disorder-enuretic
children
 OSA
Primary Enuresis Secondary enuresis
Causes:

9. ENURESIS ( BED WETTING )
Clinical Manifestations and Diagnosis:
 A careful history
 Medical History “Diseases”
 Family history
 A complete physical examination
 Urinanalysis “pus - Glu – sp.gravity”
 Bacteriuria
 Renal ultrasonogram

10. CLINICAL FEATURES OF ENURESIS
(DIAGNOSTIC CRITERIA)

11. ENURESIS ( BED WETTING )
Management:
 Organic causes - specific treatment.
 Non organic cause:
Emotion
al
support
Voidin
g
before
bedtim
e
-Encourag
e and
reward the
child for
dry
nights.
Auditory
or
vibrator
y alarm
*Desmopress
in acetatate
*Oxybutyin
choloride
*Impiramine

12. Encopresis (Soiling)
Definition:
Watery contents from proximal colon may leak around the hard fecal
mass and pass per-rectum involuntary , unperceived by the child
leading to soiling of his underwear . ♂ >
1.Retentive encopresis 2.Nonretentive encopresis
1.Primary 2. Secondary
Causes:
 Primary subtype: Developmental delay
 Secondary subtype: Psychosocial stressors - Conduct disorder
 Toilet Fears “avoiding”
 Metabolic “Hypothyroidism /Hypokalemia /Hypercalcemia/Dehydration”

13. Encopresis (Soiling)
Clinical Manifestations and Diagnosis:
 History “diet”
 Offensive odour
 Poor appetite
 Abdominal pain
 painful defecation in retentive encopresis
 Lethargy
 Physical examination
“Abdominal distention/Palpable stool masses/rectal examination
/Neurologic examination”
 Laboratory Barium enema Rectal biopsy Anorectal manometry Blood
tests

14. Encopresis (Soiling)
Management:
Toileting
Skills
Diet
and
exerci
se
Laxatives
or
enemas
Encoura
ge
&reward

15. Pica
Definition:
This eating disorder involves repeated or chronic ingestion of non-nutritive
substances, which may include plaster, charcoal, clay, wool, ashes, paint,
and earth
predisposing factors:
 Mental retardation
 autism and other brain-behavior disorders
 lack of parental nurturing
 Family disorganization
 Poor supervision
 lower socioeconomic classes

16. Pica
Children with pica are at an increased risk for:
 Lead poisoning
 Iron-deficiency anemia
 Soil-borne parasitic infections
 Morbidity includes choking, poisoning, infections
and intestinal obstruction.
 Dental abnormalities
 Affects Bone and Teeth “absorption of Ca++”
Physical examination :
 Manifestations of toxic ingestion
 Manifestations of infection or parasitic infestation
 Gastrointestinal (GI) manifestations
 Dental manifestations

17. Pica
Management:
Zinc
and
iron
Reinforceme
nt of other
behaviors
selective
serotonin
reuptake
inhibitors
(SSRIs)
A dentist
may be
consulte
d

18. Breath holding
Definition:
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.(n.6m-6yrs).
Types:
 A cyanotic spell is caused by a change in the child usual breathing
pattern, usually in response to feeling angry or frustrated.
 A pallid spell is caused by a slowing of the childs heart rate, usually in
response to pain.

19. Breath holding
Causes:
 change in the child breathing or a slowing of the heart rate
 by pain or by strong emotions “Fear – Confrontation”
 Breath holding spells can run in families
 genetic conditions, such as Riley-Day syndrome or Rett syndrome.
 Children with iron deficiency anemia
the body doesn’t produce a normal number of red blood cells

20. Breath holding
Clinical manifestations :
 Fainting (for less than a minute)
 Twitching muscles, a stiff body
Cyanotic spell Pallid spell
 breathe too fast or too
hard
 The skin red or blue-
purple “around the lips”
 short burst of intense
crying
 heartbeat may slow down
 Skin pale and sweaty.
 a single cry or no cry at
all.

21. Breath holding
Management :
help your child
feel secure
child on the
floor and keep
his or her
arms, legs, and
head from
hitting
anything hard
or sharp
No treatment
necessary
“no epilepsy
no brain
damage”

22. TEMPER TANTRUM
Definition:
A tantrum is the expression of a child's frustration with the physical, mental
or
emotional challenges of the moment ranges from crying to screaming ,
kicking ,
hitting and breath holding
Causes:
 Seeking attention
 Physical challenges :Tired , hungry or uncomfortable
 Mental challenges :child's difficulty learning
or performing a specific task, or difficulty using words to
express thoughts and feelings.

23. TEMPER TANTRUM
Ignore
the
tantru
m
Management:
stop what
you're doing
and remove
your child
from the
situation
discuss
with your
child the
behavior
you
preferred
Pretend that
you don't
even see
your child
during the
timeout, but
you can still
assure his or
her safety