Health Related Issues
Health Related Issues
1. Sleep problems
2. Elimination problems
3. Chronic Illnesses
Sleep Disorders
• The Regulatory Functions of Sleep
– main activity of brain in first years
– essential for brain development
– deprivation impairs functioning of the prefrontal
cortex, leading to
• decreased concentration
• diminished ability to control basic drives, impulses, and
emotions
Sleep Disorders (cont.)
• Maturational Changes
– change over the course of maturation
– adolescents often chronically sleep-deprived
Dyssomnias
• Disorders of initiating or maintaining sleep
• Quite common in childhood
• See chart in book (next slide)
Table 12.1 Dyssomnias
Parasomnias
• Disorders in which behavioral or
physiological events intrude upon ongoing
sleep
• Common afflictions of early to midchildhood; children typically grow out of
them
• Partial wakings during various sleep
cycles
Parasomnnias
1. Sleep terrors
•
•
Following stage IV sleep; early in night
Early childhood: crying, sobbing, thrashing, not
able to comfort
•
•
fatigue
Later childhood/adolesc.: screaming, panic, fear,
possible wild running
•
Psychological factors usually relevant
2. Nightmares- scary dreams; REM sleep; early
morning
•
Often reflect normal emotional struggles
3. Sleepwalking – see sleep terror
Table 12.2 Parasomnias
Reid et al. - Quiz
• A friend has a 2 year old that won’t go to
sleep at night by himself. Your friend has
to lie in bed with him until he finally falls
asleep, then she sneaks out of the room,
hoping that he will not wake up. If he does
wake up, she has to go through the whole
process again. She is quite tired and
frustrated. What would you suggest she
do? Be as specific as possible. Why do
you suggest what you suggest?
Sleep Disorders (cont.)
• Treatment
– Sleep hygiene
– behavioral interventions
– Night Terrors/Sleepwalking
– Nightmares:
• Provide comfort
• Reduce stress
Elimination Disorders
• Enuresis
– involuntary discharge of urine
• twice a week for three months or
• accompanied by significant distress or
impairment,
• 5 years old
– Ratio or girls/boys night/day
– Primary/secondary
Elimination Disorders (cont.)
• Enuresis
– Causes
• deficiency of antidiuretic hormone
• genetic predisposition
• immature signaling mechanism
– treatments
• behavioral training methods
• Bell and pad alarm
• medication
Elimination Disorders (cont.)
• Encopresis
– passage of feces into inappropriate places
• once per month for 3 months
• at least 4 years old
– 2 subtypes:
• with or without constipation and overflow
incontinence
– primary or secondary
– psychological problems likely result from,
rather than cause it
Elimination Disorders (cont.)
• Encopresis (cont.)
– causes
• untreated constipation
• abnormal defecation dynamics
Chronic Childhood Illness
• persists for more than 3 months or
requires hospitalization for more than 1
month
• DSM-IV categories have limited
applicability to children
• Adjustment Disorder
Chronic illnesses
• Affect 10% to 20% of child population
• Asthma most common
• Low incidence of psychological problems
but some increased risk of psychological
adjustment difficulties
Factors affecting adjustment
•
•
•
•
Parental stress and adjustment
Family resources
Social support
Illness conditions: severity, prognosis,
ability to function
Interventions
• Problem focused coping for family
• Reduce stress
• Coping skills for pain/procedure
management
Table 12.3 Estimated Population Prevalence of Selected Chronic Diseases
and Conditions in Children, Ages 0-20 in the United States