Common Behavioral Concerns: Infancy to Adolescence

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Common Behavioral ConcernsInfancy to Adolescence

• Lisa Harless, MSN, RN, CNS

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INFANCY

• Teething
• Thumb Sucking
• Pacifier Use
• Head Banging
• Constipation
• Loose Stools

• Colic
• Spitting Up
• Diaper Dermatitis
• Baby Bottle Tooth Decay
• Obesity

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Teething

• Signs Symptoms
• Treatment
• Safety

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Thumb Sucking

• Begins in utero
• Sucking reflex Peak
• Thumb sucking Peak
• Dental concerns
• Treatment

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Pacifier Use

• Is it okay to use a pacifier?
• Sucking needs
• Increased incidence of OM
• Cleanliness issue
• When to wean

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Head Banging

• When is it okay?
• Why?

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Constipation

• Need a good history
• Dont mistake for normal pushing/grunting
• If 1 week check for anal fissures or other
  underlying disease
• Interventions
• If appropriate age, consider adding bulk (fruits,
  veggies)
• Other- rectal stimulation with thermometer or
  glycerin suppositories

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Loose Stools in the Infant

• Need a good history
• Formula or Breast Feeding assessment?
• Any solid foods?
• Associated S/S?
• Is the infant developing normally?
• Risk for dehydration

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Colic

• Paroxysmal abd pain that generally occurs in
  infants
• S/S?
• Cause?
• History?
• Interventions for parent and infant!

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Spitting Up

• ALL INFANTS SPIT UP
• Get a good history
• Any associated S/S?
• Normal vs GERD?
• Interventions

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Diaper Dermatitis

• Urine left in the diaper too long breaks down
  into ammonia
• Interventions
• Treatment
• Yeast
• Miliaria

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Diaper Dermatitis

• Severe yeast diaper dermatitis
• Treat with topical antifungal (Nystatin)
• Leave open to air no diaper!

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Baby Bottle Tooth Decay

• CHOs ferment to organic acids that demineralize
  the tooth enamel

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Obesity

• 90-95 on growth chart
• Excess fat cells are likely to remain through
  childhood and into adulthood
• Risk of anemia

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TODDLER

• Toilet Training
• Ritualistic Behavior
• Negativism
• Discipline
• Separation Anxiety
• Temper Tantrums

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Toilet Training

• Biggest task of toddlerhood
• Individualized for each child
• Developmentally appropriate
• Teach parents!

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Ritualistic Behavior

• My washcloth! My spoon! Set more limits!

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Negativism

• NO!
• Very distressful for parents
• Normal development
• Phrase your statements differently
• Give choices only when there is one

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Discipline

• Discipline is different than punishment
• Instill early in life
• Purpose?
• Be consistent
• Timeout

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Separation Anxiety

• 6mo through pre-school
• Try to use consistent caregivers
• Prolonged goodbyes DO NOT help the child
• Sneaking out can strengthen the fear

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Temper Tantrum

• Kicking, screaming, stomping, shouting, flailing,
  banging head, holding breath
• Normal development
• What do you do?
• Assessment?
• Intervention?

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PRE-SCHOOL

• Fears
• Telling Tall Tales
• Imaginary Friends
• Difficulty Sharing
• Regression
• Sibling Rivalry
• Broken Fluency Swearing

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FEARS

• Dark
• Mutilation
• Separation or Abandonment

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Telling Tall Tales

• Telling tall tales IS NOT lying
• Imagination

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Imaginary Friends

• Normal creative play
• Often leave as quickly as they are created
• Expose child to real playmates

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Difficulty Sharing

• Kids dont understand sharing until around 3
• Mine Yours Ours

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Regression

• Reverting to behaviors they outgrew
• Usually related to stress
• Help the parent understand

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Sibling Rivalry

• Provide each child something they can call their
  own
• Individual time with parents
• Socialize together
• Birth order

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Broken Fluency !_at_!

• Secondary stuttering
• Developing language ages 2-6
• Child is unaware unless drawn attention to

• Unemotionally correct the child
• They likely dont know the value of the word

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SCHOOL-AGE

• School anxiety
• Latchkey children
• Sex Education
• Stealing

• Violence Terrorism
• Bullying
• Recreational Drug Use
• Obesity

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School-Anxiety

• 1st day of school big task for 6yo
• Can develop physical S/S
• Determine the cause

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• Without adult supervision for part of each
  weekday
• Working parents
• At risk children
• Box 31-3 page 897 addresses safety
• After school programs

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Sex Education

• Developmentally appropriate
• Variety of methods to teach and learn
• Puberty
• School or community related restrictions

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Stealing

• Early school-age children may begin to steal
  from parents
• No moral value yet
• Correct child non-emotionally

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Violence Terrorism

• Current generation
• Children generally view their world as safe
  until something threatens it
• Bad people do bad things
• No stereotypes
• Family disaster plan

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BULLYING

• Common today
• Traits
• School programs/campaigns

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Recreational Drugs

• Drugs are readily available by 7-8th grade
• ETOH, Inhalants, Cigarettes common
• Inhalants have serious side effects

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OBESITY

• 50 obese by BMI standards
• Pre-pubertal natural weight gain?
• BMI results to parents effective?
• Long term effects
• Interventions Treatment

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ADOLESCENCE

• HTN
• Poor Posture
• Body Piercing
• Fatigue
• Acne
• Obesity
• Sexual Activity

• Stalking
• Substance Abuse
• Suicide
• Runaways
• Eating Disorders
• Anxiety / Depression

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Hypertension

• Above the 95 for age
• 127/81 16yo F 131/81 M
• Two consecutive readings independently
• BP should be taken yearly after 3 yoa
• Primary or Secondary HTN

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Poor Posture

• Stand up straight!
• Imbalance of growth
• Bones growing faster than muscles
• Slouch to avoid being noticed
• Scoliosis screening

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Body Piercing Tattoos

• Teach S/S infection
• Communicable Disease Transmission

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Fatigue

• Investigate as legitimate S/S
• Diet
• Sleep habits
• Activity schedules
• Blood tests

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Acne

• Self-limiting inflammatory disease involving the
  sebaceous glands of face and shoulders
• Girls 14-17
• Boys 16-19
• Treatment/Meds

• Peeling agent
• Benzoyl Peroxide
• Retin A
• Tetracycline
• Anti-inflammatory
• Accutane

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Sexual Activity

• Pre-marital sex widely accepted
• Confidentiality with healthcare provider
• Teaching
• Abstinence doesnt work (realistically)

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Stalking

• Repetitive Intrusive
• Behavior can begin in adolescence

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Substance Abuse

• 50 of H.S. Sr.s report having experimented with
  some sort of drug
• Rebellion, peer pressure
• Research indicates they want to
• Relax
• Feel intoxicated
• Stay awake
• Enhance an activity
• Alleviate a depressed mood

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Substance Abuse ctd.

• Limited Access
• Family members meds
• Inhalants
• Tobacco
• ETOH
• Anabolic Steroids

• Marijuana
• Amphetamines
• Cocaine
• Hallucinogens
• Opiates
• Assessment

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Suicide Depression

• Factors that contribute
• Abuse
• Incest
• Chemical Dependency
• Marital Instability
• Poor problem solving

• Assessment
• Anorexia
• Excessive fatigue
• Weight loss
• Behavior Problems
• Isolation vs. Too much activity

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Suicide Depression ctd.

• Suicide Warning Signs page 931
• Crisis Intervention
• Counseling
• Find what is important to them
• Work on problem-solving skills
• Allow them to speak honestly
• Need observation and pharmacologic therapy

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Runaway

• Ages 10-17 24 hours without permission
• Most dont go far and dont stay long
• Need to assess and teach problem solving
• If seek healthcare, do what you can in one visit
• Refer to National Youth Crisis Hotline

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Eating Disorders

• Anorexia
• Refusal to maintain normal body weight
• Perception disturbance
• Severely restrict calories OR binge/purge
• Lack of nutrition leads to starvation/acidosis

• Bulimia
• Recurrent binge/purge
• Awareness
• May abuse laxatives and/or diuretics
• Erosion of tooth enamel
• Weight near normal