IDENTIFICATION DATA:

NAME OF THE STUDENT: Ms. Shagun Mohan Sharma

NAME OF THE EVALUATOR: Ms. Sanjoli

SIZE OF THE GROUP: 2 students

GROUP OF STUDENT: M.Sc. (N) I year

SUBJECT: Child Health Nursing

TOPIC: Basic Behavioral Pediatric Principles, Common Behavioral Disorders and It’s Management

METHOD OF TEACHING: Lecture Cum Discussion

AV AIDS: Power Point Presentation and Chart

DURATION:

DATE OF PRESENTATION:

VENUE: Child health nursing lab

GENERAL OBJECTIVE:

After the completion of the class, students will be able to understand the basic behavioral pediatric, behavioral disorders, types, sign
and symptoms and causes of behavioral disorder.

SPECIFIC OBJECTIVE:

At the end of the class, students will be able to:

 Introduce the topic.

 Define behavioral disorders.
 Explain the basic behavioral pediatric principles.
 Enlist the causes of behavioral disorders.
 Enlist the warning sign of behavioral disorder.
 Describe the types and sign and symptoms of behavioral disorder and their management.
 Explain the role of nurse in behavioral disorder.
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1. 1min. To introduce SELF INTRODUCTION:

self
Good morning to all, myself
Shagun mohan Sharma student of
M.Sc. (N) I year going to present
my peer teaching on basic
behavioural pediatric principles
and common behavior problems
and its management.
2. 2 min. To introduce INTRODUCTION:
topic
Behavior disorders include many tension
reducing activities that appear during
childhood at various levels of
development. Some of these habits develop
from adults through imitation where as
other as purposeful movement. Behavior
disorder in children is a pattern of
disruptive, aggressive, or hostile behavior
that are not typical for their age and
persists over time.
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3. 2 min. To define DEFINITION: Student teacher will be able to What is

behavioral
When children cannot adjust to a complex define behavior disorders by behavioural
disorder
environment around them, they become lecture cum discussion with the disorder?
unable to behave in the socially accepted help of power point.
way resulting in exhibition of peculiar
behaviors and this is called behavioral
problems
4. 10min To explain BASIC PEDIATRIC PRINCIPLES: Student teacher will be able to What are the
the basic
. Basic behavioural principles in pediatric explain the basic pediatric basic
behavioral
pediatric are grounded in understanding and principles by lecture cum behavioural
principles
influencing child behavior through discussion with the help of power pediatric
reinforcement and other techniques. Here point. principles?
are some core principles:
 Positive Reinforcement:
encourage desirable behavior by
providing rewards. For example,
praising a child for completing
their homework can encourage
them to do it regularly.
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 Developmental appropriateness:
behavioral expectations and
interventions should align with the
child’s developmental stage.
 Clear communication: using age
appropriate language and
explanations to help children
understand instructions and
expectations.
 Consistency: applying rules and
expectations consistently helps
children understand what is
expected of them.
 Role modeling: demonstrating
appropriate behavior as children
often learn by observing adults.
 Empathy and understanding:
recognizing and validating a child’s
feelings and experiences to built
trust and rapport.
 Parental involvement: engaging
parents in the behavioral
management process to ensure
consistency and support at home.

These principles help create a supportive

environment conducive to healthy
behavioral development in children.
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5. 4 min. To enlist the CAUSES: Student teacher will be able to What are the
causes of Behavioral disorders are caused by enlist the causes of behavior causes of
behavioral multiple factors. No single event is disorders by lecture cum behavioral
disorders responsible for this condition. The discussion with the help of power disorder?
important contributing factors are; point.
 Faulty parental attitude
 Inadequate family environment
 Mentally and physically sick or
handicapped condition
 Influence of social relationship
 Influence of mass media
 Influence of social change

6. 4 min. To enlist the WARNING SIGNS: Student teacher will be able to What are the
warning sign
enlist the warning signs of warning sign of
of behavioral  Drastic changes in behavior or
disorder personality behavioral disorders by lecture behavioral
 Easily getting annoyed or nervous cum discussion with the help of disorder?
 Often appearing angry
 Blaming others power point.
 Having difficulty in handling
frustration
 Frequent tantrums and outbursts
 Feelings of sadness
 Social withdrawal and isolation
 Intensive worries or fears that impede
daily activities
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 Harming or threatening to hurt

themselves, other people or pets
 Damaging or destroying property
 Lying or stealing
 Not doing well in school, skipping
classes
 Early smoking, drinking, drug use or
sexual activity
 Consistent hostility toward authority
figures
 Fluctuations in weight
 Changes in appetite
 Neglecting personal hygiene and
appearance

7. 30min To explain TYPES OF BEHAVIOURAL Student teacher will be able to What are the
the types ,
DISORDER: explain the types, sign and types , sign and
sign and
symptoms of Behavioural disorder can be classified as: symptoms of behavioral disorders symptoms of
behavioral
disorders and  Habit disorder and it’s management by lecture behavioral
its  Speech disorder cum discussion with the help of disorders and its
management
 Eating disorder power point. management?

 Sleep disorder
 Personality disorder
 Learning disabilities
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 Learning disabilities
 Behavioral disorder according to age
1. Infancy
•
Impaired appetite or Resistance to
feeding
• Abdominal Colic
• Stranger Anxiety
1) HABIT DISORDER:
a) THUMB SUCKING:
Thumb sucking is defined as non-nutritive
sucking of fingers or thumb.

SIGN AND SYMPTOMS:

Continuous thumb sucking leads to many
ill effects. The main symptoms of this
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problem is shown by the teeth and they

are:

 Displacement of the child’s permanent

teeth due to the uneven forces placed
on the teeth by the thumb.
 The upper and lower front teeth may
not approximate with each other.
 The upper front teeth may flare out.
 The open bite or lack of approximation
of upper and lower front teeth may
result in speech difficulties during
pronunciation.
 As a result of the flared out or
protruding front teeth the child may
end up fracturing these teeth more
often.
 Protruding and uneven teeth change the
facial appearance. This can cause an
inferiority complex in the young mind.

MANAGEMENT:
 Divert the child’s attention. Engage
him in play activities.
 The hands and fingers of the child
should be kept busy in some interesting
activity like drawing.
 Offer praise and rewards to the child
for not sucking thumb.
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 Distract the child when he feels bored.

 Put gloves on child’s hand or wrap the
thumb with a cloth or bandage.
 Non toxic bitter tasting substances can
be applied on child’s thumb so that he
may not suck it.
 Encourage the child to socialize.
b) NAIL BITING:
Also known as Onychophagia. It is a
common oral compulsive habit in children
and adults. It is just a way of coping with
stress or comforting self.

SIGN AND SYMPTOMS:

 Feelings of anxiety or stress before

biting
 Feeling happy or relieved after a nail
biting
 Skin around the fingernails become
sore due to constant biting.
 Nail biting causes bacterial and fungal
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infection in the skin around the nails

and the nail bed is badly damaged.

 Teeth are affected during nail biting,

and fractures are observed in the front
teeth (incisors) as well as gingivitis or
infected gums.
 Disruption of social and family
relationships.

MANAGEMENT:

 The most common treatment, which is

cheap and widely available is
application of a clear, bitter-tasting nail
polish to the nail. The bitter flavor
discourages the nail biting.
 Address the child’s anxieties. Make the
child speak about his/her worries.
 Keep the fingernails of the child neatly
trimmed.
 Don’t pressurize the children to stop
nail biting, as this adds to their stress.
Reassure the child with love and
affection.
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c) ENURESIS:
Also known as bed betting. It is a disorder
of repetitive involuntary passage of urine
at inappropriate place especially at bed,
during night time, beyond the age of 4-5
years.

SIGN AND SYMPTOMS:

The main symptoms of enuresis include:

 Repeated bed-wetting
 Wetting in the clothes
 Wetting at least twice a week for
approximately three months
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MANAGEMENT:

For management of bed wetting, it is

essential to assess the home conditions of
the child, his/her socio-economic status
and family condition.
 Try to build the child’s self-confidence.
 Parents should be explained about the
factors related to bed betting.
 Parents should be asked not to scold,
threat or punish the child. Parents are
advised not to criticize the child for
bed wetting.
 The child should not be given any
liquid like tea or milk after 5 pm in the
evening.
 The child should be habitually made to
pass urine before going to bed.
 The parents should arouse the child
after 2-3 hours of sleep and persuade
him to walk unaided to toilet, to empty
bladder.
 The child is trained to hold urine for
longer time.
 Medication: in very resistant cases
tricyclic antidepressant like
imipramine, nortriptyline are given
orally.
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d) ENCOPRESIS:
Also known as paradoxical diarrhea.
Encopresis is the passage of feces into
inappropriate places after the age of 5
years, when the bowel control is normally
achieved.

SIGN AND SYMPTOMS:

 Not being able to hold their stool until

they get to a toilet.
 Passing stool in their clothes.
 Hiding bowel movements (poop) or
keeping them a secret.
 Hiding soiled clothes.
 Not having regular bowel movements.
 Feeling bloated or experiencing pain in
their abdomen or stomach.
 Loss of appetite

MANAGEMENT:

The management of encopresis focuses

on the following principles:
 Empty the colon of stool.
 Establish regular, soft and painless
bowel movement.
 Promote regular bowel habits.
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Behavior therapy for modification of

child’s behavior

c) TICS:
Involuntary and purposeless movements
that is sudden, spasmodic and repetitive.
These mostly involve muscles of eyes,
mouth, face and neck.
TYPES:
1. Motor tics

2. Vocal tics

SIGN AND SYMPTOMS:

 Nose wrinkling
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 Shoulder shrugging
 Coughing
 Screaming
 Throat clearing
 Grunting
 Wrist snapping

MANAGEMENT:
 It is the most effective when it is
combined with psychosocial therapy
such as behavior therapy, individual
therapy or family therapy.
 Medicines are the main treatment for
the motor and vocal tics. Medications
prescribed include:
o Haloperidol
o Pimozide
o Clonidine
2) SPEECH DISORDER:
a) STAMMERING/STUTTERING:
It is a speech disorder in which the flow of
speech is disrupted by involuntary
repetitions and prolongation of sounds,
words. Also there are involuntary silent
pauses or blocks.
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SIGN AND SYMPTOMS:

 Repeating sounds or syllables.

 Holding and drawing out certain
syllables or sounds
 Mid-word pauses.
 Blocking.
 Word switching.
 Overstressing.
 Repeating single-syllable words.
 MANAGEMENT:

 Treatment of children who stutter, aims

at teaching the child skills, strategies
and behaviors that help in oral
communication. This may include:
1. Fluency shaping therapy
2. Stuttering modification
therapy.
 Parents should not put undue pressure
on the child, regarding fluency of
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 speech during preschool age.

 Give child sufficient time to express
himself.
 Encourage the child to speak clearly by
teaching him/her songs and nursery
rhymes.

 Make the child feel that the parents are

interested in his talks

 b) CLUTTERING:

 Like stuttering, cluttering is a fluency
disorder; but, the two disorders are not the
same. Cluttering involves speech that
sounds rapid, unclear and/or disorganized.
The listener may hear excessive breaks in
the normal flow of speech that sound like
disorganized speech planning, talking too
fast or in spurts, or simply being unsure of
what one wants to say.

3) EATING DISORDER:
a) PICA:
Pica is characterized by eating non edible
substances such as clay, paints, chalk,
pencil, plaster from walls, hairs etc.
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SIGN AND SYMPTOMS:

 Lack of appetite
 Lots of hair collection in stomach
 Intestinal and parasitic infection
 Minerals and vitamin deficiencies

MANAGEMENT:
Pica may be managed by combination of
psychosocial, environmental, dietary and
family guidance approach.
 Discrimination training between edible
and non-edible items.
 Detect nutritional deficiencies and treat
them. For example, anemia,
hypocalcemia etc.
 Make meal times pleasant.
 Don’t leave the child alone.
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 Meet the emotional need of child.

 Keep the child busy, as boredom may
give him time for eating non-edible
substances.

b) ANOREXIA NERVOSA:
It is characterized by voluntary refusal to
eat, significant weight loss, an intense fear
of becoming over weight and a pronounced
disturbance of body image.

SIGN AND SYMPTOMS:Food or

weight-related symptoms can include:

 Changed body image

 Low body weight
 Extreme fear of becoming fat
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 Excessive physical activity

 Denial of hunger
 Fixation with making food
 Abnormal, obsessive, or ritualized
eating behaviors

Physical symptoms can include:

 Poor nutritional status

 Fluid loss (dehydration)
 Being very thin
 Stomach pain or bloating
 Constipation
 Lethargy or extreme tiredness (fatigue)
 Unable to handle cold temperatures
 Fine, downy body hair (called lanugo)
 Dry or yellowish skin
 Thinning hair
 Brittle nails
 Infertility

Emotional symptoms can include:

 Withdrawal from social situations

 Loss of interest in sex
 Grouchiness
 Mood changes
 Depression
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MANAGEMENT:
The initial goal of management is overall
improvement in body weight,
normalization of eating patterns and
restoration of physical health by weight
gain. These goals cannot be attained
unless, the disordered thinking is corrected
because the real issue is not food but issues
like poor self-esteem, need for perfection
and myth of slimming and dieting. So the
patient requires following interventions.
 Nutritional counseling
 Individual therapy
 Family therapy
 Antidepressant and selective
serotonin reuptake inhibitor
(SSRIs).
 Enhance self-esteem and self
worth.
c) BULIMIA NERVOSA:
Bulimia nervosa is a disorder of binge
eating, where the individual consumes
large amount of food with lack of control
followed by various compensatory
behaviors (like self-induced vomiting) to
control weight.
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SIGN AND SYMPTOMS:

These are the most common symptoms of

bulimia:

 Often a normal or above average body

weight
 Repeated episodes of binge eating and
fear of not being able to stop eating
 Self-induced vomiting (often in secret)
 Excessive exercise
 Excessive fasting
 Specific eating habits or rituals
 Misuse of laxatives or diuretics
 Irregular menstrual periods or no
periods at all
 Anxiety
 Discouraged feelings about themselves
and the way their body looks
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 Depression
 Fixation on food, weight, and body
shape
 Throat is always inflamed or sore
 Tiredness and less energy
 Dental problems due to erosion of tooth
enamel from vomiting

Most people with eating disorders also

share certain traits such as:

 Low self-esteem
 Feelings of helplessness
 Fear of getting fat
 Intense unhappiness with their body
shape and size.

MANAGEMENT:

 Behavior modification is used

 Cognitive therapy
 Dietary counseling
 SSRIs
4) SLEEP DISORDER:
d) SOMNAMBULISM:
It is a phenomenon of combined sleep and
wakefulness. In this sleep walking occurs
at a state of low consciousness and child
performs activities that are usually
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performed in full consciousness.

SIGN AND SYMPTOMS:

 Sitting up in the bed

 Walking to the bathroom and cleaning
it.
 Initiating hazardous activities like
cooking, driving etc.
 Homicide

MANAGEMENT:

 Set a schedule and routine for sleeping

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(experts call this good sleep hygiene).

 Make enough time for sleep and avoid

sleep deprivation if possible.
 Avoid alcohol, caffeine or other things
that might affect sleep quality.
 Manage your stress and anxiety.
 Meditate or do relaxation exercises.
 Avoid any kind of stimulation
(auditory or visual) prior to bedtime.

e) NIGHT MARES/ NIGHT

TERRORS :
 Night mares: in this the child gets
awakened due to a frightening bad
dream but the child is conscious
about the surrounding.
 Night terror: in this the child gets
awakened during sleep and sits up
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SIGN AND SYMPTOMS:

 Child suddenly awakes during sleep

periods.
 Child gets frightened and may not be
fully alert.
 May resist return to bed because of fear
of recurrence

MANAGEMENT:
 There is no specific treatment for night
terrors other than comforting the child.
Reassurance and education for the
parents or guardians are strongly
encouraged, especially to ensure the
safety of the child during a night terror.
 Psychotherapy or counseling may be
appropriate in some cases.

5. PERSONALITY DISORDERS:
a) BREATH-HOLDING SPELLS:
These are a brief periods for which young
children stop breathing for 1 minutes.
These spells often causes a child to lose
consciousness.
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It is of two 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:

 Fainting
 Stiff body
 Too fast or too hard breath
 Long pause brfore child takes another
breath
Red aur blue purple lips.
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MANAGEMENT:

 Usually, disappear if they are not

reinforced
 Advice parents in handling child anger
and frustration appropriately
 Try to diffuse the upset before it
worsens
 Counsel parents for the reduction of
sources of conflict
 Advice parents to be consistent in
discipline
 Parents should remain calm and not
give attention to the behavior
 Ask parents to do a video recording of
the event as it shall help in diagnosing
 If a child is anemic give supplemental
iron

If breath holding persists after 4 years of

age, along with self-injury and extreme
anger, refer a child to a psychiatrist.

b) TEMPER TANTRUM:
It is a sudden outburst or violent display
of anger, frustration and bad temper as
physical aggression or resistance such as
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rigid body, biting, kicking, throwing

objects, hitting, crying, rolling on floor,
screaming loudly, banging etc.

SIGN AND SYMPTOMS:

 Loud cry
 Shouting
 Kicking
 Biting
 Head banging
 Screaming
 Throwing and breaking objects
 Inflicting self injury

MANAGEMENT:

 Educate parents that tamer tantrum are

child’s way of releasing frustration so
they should ignor them.
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 Parents should talk to the child to find

out the cause of frustration.
 Provide adequate rest and sleep.
 Parents should be good role model for
the child.
 Parents should not be over protective
for the child though they should
provide security and support to the
child.

LEARNING DISABILITIES:

1) DYSGRAPHIA:

Dysgraphia is a term that refers to trouble

with writing.

Dysgraphia is a neurological condition in

which someone has difficulty turning their
thoughts into written language for their age
and ability to think.

2) DYSLAXIA:

A learning disorder characterized by

difficulty reading.
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3) DYSCALCULIA:

Dyscalculia is a learning disorder that

affects a person's ability to understand
number-based information and math.
People who have dyscalculia struggle with
numbers and math because their brains
don't process math-related concepts like
the brains of people without this disorder.

4) ATTENTION DEFICIT
HYPERACTIVITY DISORDER:

Attention deficit hyperactivity disorder

(ADHD) is the most common neuro-
behavioral disorder in children.

It is characterized by difficulty in paying

attention, difficulty in controlling
behaviour and hyperactivity.

MANAGEMENT:

Therapies :

 Psychotherapy
 Occupational therapy
 Special education
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BEHAVIORAL DISORDER
ACCORDING TO AGE:
INFANCY:
 Impaired appetite or Resistance
to feeding
Often develops at the time of weaning.
Infant may refuse new foods
 due to dislike of taste
 due to separation anxiety from
mother.
 due to forced feeding by the mother
 due to indigestion of new food &
abdominal colic.

• Abdominal Colic
A type of abdominal pain that comes
and goes in waves, most often starting
and ending suddenly and being of
severe intensity
• Stranger Anxiety
Mother is significant person during
infancy for satisfaction of needs,
feeding of comfort, pleasure &
security.
The infant does not belief any other
persons except mother, because they have
trust relationship with mothers only.
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8. 5min. To explain ROLE OF NURSE Student teacher will be able to What is the role
the role of
 Assessment of specific explain roll of nurse by lecture of nurse in
nurse in
behavioral problems of the child by cum discussion with the help of behavioral
disorder
appropriate history and power point. disorder?
detection of the responsible
factor.
 Informing the parents and
making them aware about
the causes of behavioral
problems of the child.
 Assisting the parents, teachers and
family members for necessary
modification of environmental at
home, school and community.
 Encourage the child for behavioral
modification as needed.
 Promoting healthy emotional
development of the child by adequate
physical, psychological and social
support.
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 Providing counseling services for

children and their parents to solve the
problems, whenever necessary.
 Participating in the management of the
problem child, as a member of health
along with pediatrician, psychologist
and social worker.
9. 1 min. To SUMMARY:
summarize
Today we discussed about:
the topic
 Definition of behavioral disorders
 The basic behavioral pediatric
principles
 Causes of behavioral disorders
 Types of behavioral disorder
 Sign of behavioural disorder
 Management of behavioral disorder
10. 1 min. To conclude CONCLUSION:
the topic.
Behavioural disorders in children are
common. They are often under-recognised
and under-treated. Improved recognition
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demands that a good assessment is being

carried out and a heightened index of
suspicion for the commoner behavior
disorder.

RESEARCH ARTICLE:

ABSTRACT:

Introduction:

Normal children are healthy, happy and well adjusted. This adjustment is developed by providing basic emotional needs along with
physical and physiological needs for their mental well being. Common behavioral problems of preschool children are destructiveness,
selfishness, temper tantrum, bed time problems, hurting others, thumb sucking, nail biting, enuresis, encopresis, disobedience, self
control, refusal to food and stuttering or stammering, delayed speech and attention deficit disorder. Behavior problems in preschool
children are due to parents negligence poor supervision or poor attention, family conflict and maladjustment. Behavioral problems
during preschool period is the strongest predictor of more serious problems later which includes delinquency, substance abuse,
antisocial behavior, academic failure, conduct problems and depression.

Objectives:

To assess the behavioral problems of preschool children (3-6 years) as expressed by mothers using Modified Jacqueline McGuire and
Naomi Richman Pre- School Behavior Checklist. To determine the association between behavioral problems of preschool children and
selected demographic variables. Methods: A Non-Experimental, Quantitative research approach and descriptive research design was
adopted to conduct the research study. Non probability consecutive sampling technique was used to collect the data. Tool used for the
present study was Socio-demographic data sheet, modified Jacqueline McGuire and Naomi Richman Preschooler Behavior Checklist.
Results:

The results of present study revealed that21% of subjects had behavior problems and 79% of subjects had no behavior problem.
Findings showed that behavioral problems were significantly associated with number of children in the family (0.001*, at df -3) at p
value (<0.05). No association was found with age, sex, religion, type of family, sibling order, residence and income of family.