Child Psychiatry Flashcards
(26 cards)
3 stages of acute separation response
1) Protest
2) Despair
3) Detachment
Psychological effects hospitalisation/ chronic illness
1) Anxiety
- emotional/ behavioural/ educational difficulty 2-3x more common in children with chronic illness than healthy children
2) Despair
- depression
- low self-esteem
- impaired self-image
3) Anger
- behavioural problems common
4) Developmental regression
- school dysfunction common
Food refusal O/E
Healthy, well-nourished child securely in centiles of growth chart OR
Thin, small child w faltering growth
Hx food refusal
What is parent most concerned about? Typical mealtimes: o Past history of force-feeding o Irregular meals, so child not predictably hungry o Unsuitable meals o Unreasonable large portions o Distractions: e.g. TV How much does child eat between meals? (sweets or crisps not always regarded as food) Food variety?
Advice food refusal mx
Impossible to force a child to eat, so avoid confrontation at meal times
Develop relaxed atmosphere
Use favourite foods as a reward. Introduce other rewards for compliance at mealtimes, e.g.extra TV time
Reduce eating btwn mealtimes if necessary (although many young kids prefer small, freq snacks)
Features anorexia nervosa
Self-induced wt loss -> low BMI (
Anorexia Nervosa O/E
Slow-to-relax tendon reflexes Reduced peripheral circulation Bradycardia Amenorrhoea Fine lanugo hair Doesn't lose pubic/ axillary hair but incompletely established puberty is delayed Ankle oedema (low plasma proteins) Proximal myopathy
AN bloods
Low T3
Sometimes low plasma proteins
Low FSH and LH (non-cyclical low levels)
Mx AN
Refeeding, aim for 0.5kg gain/wk in OPs
Psychological therapies (e.g. CBT, family therapy)
Small for age need hospitalisation
Disturbances of sleeping
Common in toddlers
Nightmares
Nightmares: Bad dreams that can be recalled by child.
normal, only need specialist if occur freq/ stereotyped in content
if kid scared of bed can leave door open/ nightlight on
Disturbances of sleeping advice
Create bedtime routine
Tell child to lie quietly in bed until they fall asleep
If unsuccessful, may need graded pattern of lengthening periods btwn tucking child into bed, leaving room before they fall asleep, so child learns to fall asleep alone.
If refractory may need specialist referral.
Night terrors
Night terrors: not common. Not part of dream sequence, occurs in 1st couple of hours.
Parents find child sitting up in bed, seemingly awake, obviously disorientated/ confused/ distressed/ unresponsive.
Parasomnia (rapid emergence from 1st period of deep, slow-wave sleep)
Child settles back to sleep, no memory in morning.
May be ass w sleepwalking
Will grow out. Waking before can help. Reassure parents
School refusal definition
Inability to attend school due to overwhelming anxiety - DISPROPORTIONATE to stresses from school
Anxiety may present as nausea, headache, otherwise not being well - confined to weekday, term-time mornings, clear up by midday
School refusal causes
1) Separation anxiety persisting from toddler years (typical children
School refusal mx
Tx any underlying emotional disorder
Gently promote increasing separation from parents (e.g. stay overnight at friend’s house)
Arrange early return to school
Reward child for returning to school
Address any bullying or educational difficulties
ADHD definition
persistent pattern of inattention, hyperactivity and impulsivity that is more freq and severe than in other people at a similar level of dvpmnt
ADHD epidemiology
Boys > girls (3:1)
Btwn 10-50/ 1000 children
ADHD Dx
Must show core sx of inattention, hyperactivity and impulsivity
Must be present before age 7 and persist for 6 months
Present in 2 settings (e.g. home and school)
ADHD Clin features
• Kids with ADHD have too much energy
- Can’t sit still, are restless and fidgety
• Difficulty in attending to one thing for long period and in following instructions
• Schoolwork disorganised, never finished, contains many careless errors
• Child tends to be forgetful, boisterous, reckless and accident prone
• All these problems -> low self-esteem and sometimes to disobedience, temper tantrums and other antisocial behaviour
- Dep mood common
- Behaviours vary in severity btwn places- e.g. Worse at school vs home
ADHD Mx
Preschool/ school-age, mild-moderate: behavioural interventions, refer to educational psychologist
More severe: medication, usually for children >6
Stimulants e.g. methylphenidate, dexamphetamine BUT can -> anorexia, wt loss, reduced growth, insomnia, headaches
Autism definition
Classically difficulties in 3 areas:
1) Social deficits
2) Communication deficits
3) Restricted/ repetitive interests and behaviours
Autism epidemiology
Prevalence 3-6/1000
M>F (4:1)
Autism clin features
Usually presents between 2-4 yrs
1) Social deficits - most specific to autism
- E.g. Babies that don’t like being held
- reduced eye contact
- lack of gestures
- unusual facial expressions
2) Communication deficits
- Speech completely absent in 30%
- Echolalia
- Odd prosody (unusual stress/ rhythm/ pitch/ intonation)
- Pronoun reversal (referring to themselves as he or she)
- Lack of reciprocity in conversations
3) Restricted/ repetitive interests and behaviours
- Deep interest in things others would find mundane, e.g. Washing machines, number plates
- “Obsessive desire for sameness” - autistic child has stereotyped behaviour and are distressed if there’s a change in their envt
- Odd motor behaviours, e.g. Running in circles, flapping hands repeatedly
- Repetitive behaviours, e.g. Lining up toys
If only some behaviours present, may be described as having autistic features but not full spectrum.
