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Management of Common Behavioral

Disorders

CHILD HEALTH NURSING

PREPARED BY:

MR. PREM PRAKASH

ASSISTANT PROFESSOR

JIET CON, JODHPUR

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Breath Holding Spells

Definition:- Breath holding spell may occur in children between

6 months to 5 years of age.

  • It is observed in response to frustration or anger during disciplinary conflict.
  • Begins before 18 months of age; Common in girls and those

from lower social class and nuclear families

Types

It is of 2 types

  • Cyanotic Spell :- It is caused by a change in child’s usual breathing pattern, usually in response to feeling angry or frustrated.
  • Pallid Spell :- It is caused by slowing of child’s heart rate usually in response to pain.

Sign And Symptoms

  • Stiff body
  • Too fast or too hard breath
  • Red or blue purple lips
  • Long pause before child takes another breath

Management

  • Repeated attacks of the spells need to be evaluated with careful history, physical examination and necessary investigations to exclude convulsive disorders or any other problems.
  • During the episode, make the child lay down in floor and prevent his/her arms or legs from hitting any sharp object.
  • After the episode, child starts breathing immediately after 1

min. But if the child does not breathes then call emergency.

  • Give plenty of rest.

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Encopresis

Definition:- Encopresis also known as paradoxical diarrhea is involuntary fecal soiling in children who are past the age of toilet training.

Encopresis is the passage of feces into inappropriate places after the age of 5 years, when the bowel control is normally achieved.

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Etiology and Risk factors

  • Inefficient intestinal motility
  • Aggressive and prolonged medical management (laxatives, enemas, suppositories)
  • Dietary manipulation for perceived constipation
  • Anal fissures and rashes
  • Surgical procedures for imperforate anus
  • Psychosocial stresses or illness
  • Using medications that may cause constipation, such as cough suppressants
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism spectrum disorder
  • Anxiety or depression

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Signs and symptoms

  • Leakage of stool or liquid stool on underwear, which can be mistaken for diarrhea
  • Constipation with dry, hard stool
  • Passage of large stool that clogs or almost clogs

the toilet

  • Avoidance of bowel movements
  • Long periods of time between bowel movements
  • Lack of appetite
  • Abdominal pain
  • Problems with daytime wetting or bedwetting (enuresis)
  • Repeated bladder infections, typically in girls

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Management

  • The management of encopresis focus on the following principles:
  • Empty the colon of stool
  • Establish regular, soft and painless bowel

movement.

  • Promote regular bowel habits.
  • Behavior therapy for modification of child’s

bebavior.

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Cont….

  • A combination of medical and behavior therapy, works best in evacuation of hard stool from the colon. Evacuation can be accomplished in the following manner.
  • Administer enema or series of enemas, as it crates pressure within the rectum and gives the child an urge to pass stool.
  • Suppositories and laxatives can also be used

to promote bowel evacuation.

  1. Establish a regular toilet routine.
  2. Behavioral techniques:- offer age appropriate positive reinforcement for developing regular toilet habits.
  3. Training:- children may respond to teaching about appropriate use of muscles and other physical responses during defecation. This may help them learn how to recognize the urge to defecate. Children are taught how to use their abdominal, pelvic and anal sphincter muscles which they have so often used to retain stool.