BSc Nursing 3rd Year Child Health Nursing Chapter 6 Management Of Behavioural And Social Problems In Children Question And Answers

Management Of Behavioural And Social Problems in Children Short Answer Questions

Question 1. Behavior disorders
Answer:

Behavior Disorders:

Behavior problems are viewed as discrepancies between the child’s behavior and demands placed on him by his parents, teachers, and colleagues.

Types of Behavior Disorders:

Behavior disorders can be classified as:

1. Habit disorders:

• Thumb sucking
• Nail biting
• Tics
• Enuresis
• Encopresis
• Stealing
• Telling lie

Read And Learn More: Bsc Nursing 3rd Year Child Health Nursing Previous year Question And Answers

2. Speech Disorders:

• Stammering/stuttering
• Phonation and articulation problems

3. Eating Disorders:

• Pica
• Anorexia Nervosa
• Bulimia Nervosa

4. Sleep Disorders:

• Somnambulism
• Somniloquy
•  Nightmares/Night Terrors:

5. Personality disorders:

• Juvenile delinquency
• Temper tantrums
• Shyness

Question 2.Thumb Sucking
Answer:

Thumb Sucking Definition:

Thumb sucking is defined as the non-nutritive sucking of fingers or thumb.

It Is a Habit Disorder: Age of Occurrence:

• Thumb sucking is common in the oral stage (0-1 year) as the babies have a natural urge to suck.
• This usually decreases after the age of 6 months. Many babies continue to suck their thumbs to soothe themselves. Most children stop thumb-sucking between 3-6 years of age.

Thumb Sucking Causes:

1. Parental causes:

•  Overprotection by parents
• Neglect by parents
• Strictness of parents
• Disharmony between parents

2. Due to teachers:

• Excessive strictness
• Excessive punitive attitude of teachers

3. Due to siblings and friends:

• Excessive competition
• Separation from a close friend or sibling

4. Other causes:

•  Loneliness and boredom
• Tiredness
• Frustration and anxiety
• Separation from parents

Thumb Sucking Problems:

• Thumb sucking in children younger than 4 is not a problem, but if it continues up to 5 years or above, it indicates the presence of an emotional problem.
• Prolonged thumb sucking may lead to dental problems like malaligned teeth or sometimes malformation of the upper palate of the mouth.
• The child may also develop speech problems like mispronouncing ‘T’ and alphabet ‘D’, lisping, and thrusting out the tongue while talking. A child with this type of problem needs to be evaluated by a doctor.

Thumb Sucking Management:

• Usually, thumb sucking can be managed at home and includes parents setting rules and providing distractions.
• Many experts recommend ignoring thumb-sucking in children as most children stop it on their own.

The following measures should be adopted by parents:

Do’s:

• Divert the child’s attention. Engage him in play activities.
• The hands and fingers of the child should be kept busy with some interesting activities like drawing.
• Offer praise and rewards to the child for not sucking their thumb.
• Distract the child when he feels bored.
• Put gloves on the child’s hands or wrap the thumb with a cloth or bandage.
• A non-toxic bitter-tasting substance can be applied to a child’s thumb so that he may not suck it.
• Take help of elder children for explanation to younger siblings.
• Encourage the child to socialize.
• If the child is sucking their thumb due to anxiety or distress, address the cause of discomfort.
• Talk to the child and reassure him.

Don’ts:

• Do not scold the child punish him or forcefully remove his thumb from the mouth.
• Do not tie the child’s thumb and fingers.
• Do not nag, scold, or beat the child.
• Do not leave the child repeatedly cold, wet, or hungry.

Question 3. Enuresis
Answer:

Enuresis Definition:

• Enuresis or bed betting is a disorder of involuntary micturition in children who are beyond the age when normal bladder control is acquired.
• Bladder control is normally acquired by the age of 2 ½-3 years. If it is not acquired beyond 4-5 years of age, it is abnormal. When bedwetting occurs repeatedly, it is called ‘Enuresis’.

Enuresis Types:

Enuresis may be of the following types:

1. Primary enuresis: It refers to the condition in which children have never been successfully trained to control urination. There may be a delay in maturation
2. Secondary enuresis: It refers to the condition in which children have been successfully trained, but revert to bed wetting in response to some stress. It may be due to parent-child maladjustment.

Another classification is based on the time of bedwetting:

• Nocturnal enuresis: It means bed wetting during the night.
• Diurnal enuresis: It means bed wetting during the daytime.
• Mixed enuresis: It includes a combination of both nocturnal and diurnal types.

Enuresis Causes :

1. Inappropriate toilet training:

• The age at which toilet training is started has an important impact on children.
• If toilet training is started very early, it produces stress on the child.

2. Neurological developmental delay:

• This is the most common cause of bedwetting. There is delayed development in the ability to stay dry.
• Bedwetting may be due to a delay in the nervous system’s ability to process the feeling of a full bladder.

3. Genetics:

• Bedwetting has a strong genetic component. Children whose parents were not wetting their bed have only a 15% incidence of bed wetting.
• When one or both parents were bedwetters, the rates jumped to 44% and 77% respectively.
• Genetic research shows that bedwetting is associated with genes on chromosome 13 Question and 12q.

Emotional factors:

Emotional and psychological disturbance due to death in the family, extreme bullying, severe punishment or scolding, jealousy or sibling rivalry and feeling of being rejected create internal tension in the child which may lead to secondary enuresis. Emotional sexual abuse

Emotional  Organic causes:

Enuresis may occur due to anatomical defects of the urinary tract and bladder, diabetes insipidus, urinary tract infection, etc.

Emotional  Management:

1. For the management of bedwetting, it is essential to assess the home conditions of the child, his/her socioeconomic status, and family conditions.
2. Reassure the child and parents.
3. Try to build the child’s self-confidence.
4. Parents should be explained about the factors related to bed wetting.
5. Parents should be asked not to scold, threaten, or punish the child. Parents are advised not to nag, criticize, or reprimand the child for bed wetting.
6. The child should not be given any liquids like tea or milk after 5 PM.
7. The child should be habitually made to pass urine before going to bed.
8. The parents should arouse the child after 2-3 hours of sleep and persuade him to walk unaided, to the toilet, to empty his bladder.
9. The child is trained to hold urine for a longer time. This may be done by making the child drink a large quantity of water during the day and persuading him to delay emptying the bladder as long as possible.
10. Bed wetting alarms: Physicians frequently suggest bed wetting alarms, which produce a loud tone on sensing moisture. This helps the child to wake at the sensation of a full bladder.
11. 1Medications: In very resistant cases Tricyclic Antidepressants like amitriptyline, imipramine, and nortriptyline are given orally, at night for 2 months.

Question 4. Pica
Answer:

Pica Definition:

Pica is characterized by an appetite for substances largely non-nutritive (such as clay or chalk) and the habit must persist for more than one month, at an age when eating such objects is considered developmentally inappropriate. ‘Pica’ is the eating of non-edible substances such as chalk, clay, coal, mud, etc. It is Eating Disorders

Pica Types:

The subtypes of pica are characterized by the substance eaten, for example:

• Amylophagia: Consumption of starch
• Coprophagy: Consumption of Animal feces
• Geophagy: Consumption of soil, clay or chalk
• Hyalophagia: Consumption of glass
• Pagophagia: Pathological consumption of ice
• Trichophagia: Consumption of hair or wool
• Urophagia: Consumption of urine

This pattern of eating should last for at least 1 month to be diagnosed as pica.

Pica Causes:

• Pica may occur due to acquired taste or neurological mechanisms like iron deficiency or chemical imbalance. Pica is also linked to mental disability.
• Stressors such as maternal deprivation, family issues, parental neglect, pregnancy, poverty, and a disorganized family structure are strongly linked to pica.
• Recent research suggests that pica is a disorder of specific appetite caused by mineral deficiency, in many cases iron deficiency, which at times is the result of hookworm infestation.

Pica Management:

Pica may be managed by a combination of psychosocial, environmental, dietary, and family guidance approaches. For pica that appears to be of psychotic etiology, therapy and medications such as SSRIs have been used successfully.

Other treatment techniques are as follows:

• Presentation of attention, food, or toys is not contingent on pica being attempted.
• Discrimination training between edible and non-edible items.
• Detect nutritional deficiencies and treat them. E.g. Anemia, Hypocalcemia, etc.
• Make mealtimes pleasant.
• Meet the emotional needs of the child.
• Don’t leave the child alone.
• Keep the child busy, as boredom may give him time for eating non-edible substances.

Question 5. Temper Tantrums
Answer:

It Is A Personality Disorder

Temper Tantrums Definition:

A temper tantrum is a behavior problem, where children assert their independence by violently objecting to discipline through the display of anger at the uncontrollable level.

Temper tantrums are seen mainly in toddlers. The toddlers express their anger by lying on the floor, kicking or stamping their feet, screaming, and sometimes hurting themselves. Few may become stiff and few may have ‘breath-holding spells’ or banging of head.

Temper Tantrums Causes:

• Emotional insecurity
• Lack of sleep and fatigue
• Imitation of adults
• Frustration
• Unmet needs
• Attention seeking

Temper Tantrums Management:

• Educate the parents that temper tantrums are a child’s way of releasing frustration so they should ignore them.
• Parents should talk to the child to find out the cause of frustration.
• Provide adequate rest and sleep to the child.
• Parents should show the child that he is loved even though his behavior is disapproved
• Parents should not be overprotective of the child though they should provide security and support to the child.
• Parents should be good role models.

Question 6. Child Guidance Clinics
Answer:

Child Guidance Clinics Introduction:

• Child Guidance Clinics were started in 1922, as a part of a program sponsored by a private organization ‘Common Wealth Fund’s Programme’ for the prevention of Juvenile Delinquency.
• Concept of Child Guidance Clinics For the all-around development of a child the child’s physical and physiological functioning and the environment to which he is exposed at home and school should be taken care of.
• All this is possible through interaction with and counseling of the child and his family by a health care team including a pediatrician, neuropsychologist, behavioral therapist, speech therapist, and special teachers trained in dealing with handicapped children. This is the basic concept of child guidance clinics.

Child Guidance Clinics Definition:

Child guidance clinics are specialized clinics that deal with children of normal and abnormal intelligence, exhibiting a range of behaviors and psychological problems which are summed up as maladjustments.

Child Guidance Clinics Objectives:

The objectives of the child guidance clinic are

1. Providing help for children with behavioral problems like pica, bed-wetting, sleepwalking, speech defects, etc. It includes:

• Interviewing and interacting with the child and his parents.
• Giving appropriate advice and counseling to both the child and his parents.
• Behavior modification therapy, if needed.

2. Providing care and guidance for children with mental retardation including

• Counseling of parents regarding the mental subnormality of their children.
• Providing medical and physical rehabilitation services.
• Advise regarding placement of the child in appropriate schools or vocational training centers.
• Forming peer support groups.

Question 7. Providing care for children with learning difficulties, which include

Early identification of the cause and type of learning difficulty in the child. Complete physical (including vision and hearing), developmental and neurophysiological assessment.

Services Provided by Child Guidance Clinics:

1. Managing behavioral problems
2. Managing learning difficulties
3. Managing emotional problems
4. Managing adjustment problems
5. Managing developmental problems
6. Managing intellectual deficits
7. Managing socio-legal issues.