What are the diagnostic criteria for enuresis?
- twice a week for 3 months or be accompanied by significant distress or impairment
- at least 5 years old
- can’t be due to a medical condition or diuretic
Compare and contrast the two types of enuresis
Diurnal:
- daytime
- wetting occurs during waking hours
- usually during early afternoon on school days
- more common in girls
- uncommon after age 9
- related to social anxiety or preoccupation with school event
Nocturnal:
- nighttime or during sleep
- typically occurs during first third of the night
- more common than diurnal
- affects ~7% of all 8 year olds
- affects boys more than girls
What are some common characteristics of enuresis?
- 13-33% of 5 year olds
- boys>girls
- prevalence declines with maturity
- higher prevalence among less educated, lower SES, & institutionalized children.
- Primary: if child never attained continence (80%)
- Secondary: if est. continence was lost (less common)
What are the causes and treatment for enuresis?
Causes:
- nocturnal is linked to deficiency in ADH
- primary may be associate with immature signaling mechanisms
Treatment:
- behavioral training methods (alarm & reinforcement)
- synthetic diuretic (high relapse rate and less effective than alarm)
What are the diagnostic criteria for encopresis?
- once per month for at least 3 months
- at least 4 years old
- can be primary or secondary
- can’t be due to a medical condition
What are the characteristics, causes, and treatment of encopresis?
Characteristics:
- occurs in 1.5%-3% of children
- 5-6 times more common in boys
- declines rapidly with age
- 20% of children with encopresis show psychological probs.
Causes:
- may be related to untreated constipation
- 50% of cases are associated with abnormal “defecation dynamics”
Treatment:
- fiber, enemas, laxatives, or lubricants to relieve constipation
- behavioral methods to reestablish healthy elimination
Why is sleep important?
- primary activity of brain during early development
- essential for brain development and regulation
- produces “uncoupling” of neurobehavioral systems, allowing for retuning of CNS components
What are some maturational changes that occur with regard to sleep?
Sleep patterns, needs, and problems change over course of maturation
- infants & toddlers: night-waking problems
- preschoolers: falling asleep problems
- young school age: going to bed problems
- adults & adolescents: difficulty going to sleep or staying asleep or not getting enough sleep.
What are some common complaints parents have about their children’s sleep patterns?
- bedtime resistance
- difficulty settling at bedtime
- night waking
- difficulty waking up
- fatigue
What are some problems comorbid with sleep problems?
- adhd
- anxiety
- depression
- conduct disorder
- bipolar disorder
- autism
Compare and contrast sleep deficits with ADHD.
not enough sleep can lead to
- less executive functioning
- impulsivity
- distractibility
- crankiness
- emotional lability
*not enough sleep messes with the pre-frontal cortext which is the part that has to do with ADHD so not enough sleep can look like ADHD
What is the difference between a dyssomnia and a parasomnia?
dyssomnia is difficulty going to sleep or maintaining sleep and parasomnia is events that intrude on ongoing sleep
What are some types of dyssomnias?
Insomnia Hypersomnia Narcolepsy Breathing-related sleep disorder Circadian rhythm sleep-wake disorder
Name the symptoms, prevalence rate, and treatment for insomnia.
Symptoms:
- difficulty initiating or maintaining sleep or sleep that is not restorative
- in infants, repetitive night waking and inability to fall asleep
Prevalence:
-25 to 50% of 1 to 3 year olds
Treatment: behavioral (sleep hygiene)
Name the symptoms, prevalence rate, and treatment for hypersomnia.
Symptoms:
-complaints of excessive sleepiness that is displayed as either prolonged sleep episodes or daytime sleep episodes
Prevalence:
-common in young children
Treatment:
-behavioral
Name the symptoms, prevalence rate, and treatment for narcolepsy.
Symptoms:
-irresistible attacks of refreshing sleep occurring daily, accompanied by brief episodes of loss of muscle tone.
Prevalence:
-<1% of children and adolescents
Treatment:
-structure, support, pychostimulants, antidepressants
Name the symptoms, prevalence rate, and treatment for breathing-related sleep disorder.
Symptoms:
-sleep disruptions leading to excessive sleepiness or insomnia that is caused by sleep-related breathing difficulties
Prevalence:
-1 to 2% of children;elementary school-age
Treatment:
-removal of tonsils and adenoids or losing weight
Name the symptoms, prevalence rate, and treatment for circadian rhythm sleep-wake disorder.
Symptoms:
- excessive sleepiness or insomnia due to mismatch between the sleep-wake schedule required by a person’s environment and their sleep cycle.
- late sleep onset
- difficulty waking
- sleeping a lot on weekends
Prevalence:
-7% of adolescence
Treatment:
-behavioral, chronotherapy
*resistant to change
What are some types of parasomnias?
Nightmare disorder & non-rapid eye movement sleep arousal
Name the symptoms, prevalence rate, and treatment for nightmare disorder.
Symptoms:
- repeated awakening with detailed recall of extended and extremely frightening dreams
- generally occurs during 2nd half of sleep
Prevalence:
-common between ages 3 and 8
Treatment
-no real treatment; comfort; reduce stress; dream re-structuring
Name the symptoms and treatment for sleep terrors.
Symptoms:
- recurrent episodes of abrupt awakening from sleep
- racing heart
- screaming
- glassy eyes
- hard to calm down
- usually occurs during first 3rd of major sleep
- no memory of episode
Treatment:
- reduce stress
- add late afternoon nap
- keep bed and wake time consistent
Name the symptoms and treatment for sleepwalking.
Symptoms:
- repeated episodes of arising from bed during sleep and walking for periods of 5 sec to 30 min.
- occurs during first 3rd of sleep
- poorly coordinated, difficult to arouse
- no memory
Treatment:
- safety precautions
- reduce stress & fatigues
- add late afternoon nap
How do eating patterns develop?
- problematic eating habits & limited food preferences
- 1/3 children described as picky
- societal norms & expectation affect girls more than boys
What are some developmental risk factors for eating disorders?
- predict later eating problems
- early childhood pica related to later onset of bulimia
- picky eating and digestive problems are risk factors for anorexia
