Pica of infancy and childhood

Pica of infancy and childhood

Pica is a disorder that occurs when children persistently eat one or more non-food substances over the course of at least one month. Pica may not sound like a dangerous problem, but when you consider that the non-food substances, that are ingested are frequently toxic or otherwise harmful to the human body, the potential for illness and even death becomes clear. Pica may result in serious medical problems, such as intestinal blockage, poisoning, parasitic infection, and sometimes death.This disorder has been described as one of the most serious forms of self-injurious behavior (i.e., deliberate self-harm) because of the high risk of death from this type of behavior.

The typical non-food substances that children with pica ingest tend to vary with age. Younger children with Pica frequently eat paint,plaster, string, hair, or cloth. In contrast, older children with Pica tend to eat animal droppings, sand, insects, leaves, or pebbles. Adolescents affected by the disorder often consume clay or soil substances.

Cause

Theorized causes of Pica include iron-deficiency (anemia), zinc deficiency,mental retardation, developmental delays, and a family history of Pica.Other theories suggest that Pica is caused by oral fixations, a lack of appropriate stimulation, or a lack of parental attention. In other words, the reasons why Pica occurs are not definitively known at this time.

Pica is more common among children and adolescents with other developmental disabilities such as Autism and Mental Retardation. For example, the prevalence of Pica appears to increase with the severity of retardation. Approximately 15% of adults with severe Mental Retardation also have Pica. Information about the overall prevalence rates for Pica is limited, however.

Management

Treatment involves behavior and development, environmental, and family education approaches.Other successful treatments include associating the pica behavior with bad consequences or punishment (mild aversion therapy) followed by positive reinforcement for eating the right foods.

Medications may help reduce the abnormal eating behavior, if pica occurs as part of a developmental disorder such as mental retardation.

Separation Anxiety Disorder of Childhood

Separation anxiety disorder is a mental health disorder that begins in childhood and is characterized by worrying that is out of proportion to the situation of temporarily leaving home or otherwise separating from loved ones.Approximately4%-5%of children and adolescents suffer from separation anxiety disorder.

Symptoms of separation anxiety disorder may include

 repeated excessive anxiety about something bad happening to loved ones or losing them;
 heightened concern about either getting lost or being kidnapped;
 repeated hesitancy or refusal to go to day care or school or to be alone or without loved ones or other adults who are important to the anxious child;
 persistent reluctance or refusal to go to sleep at night time without being physically close to adult loved ones;
 repeated nightmares about being separated from the people who are important to the sufferer;
 and/or recurrent physical complaints, such as headaches or stomachaches,when separation either occurs or is expected.

To qualify for the diagnosis of separation anxiety disorder, a minimum of three of the above symptoms must persist for at least a month and cause significant stress or problems with school, social relationships, or some other area of the sufferer’s life.Also, the disorder is not considered to be present if symptoms only take place when the child is suffering from certain other mental-health problems, such as schizophrenia or from a specific kind of developmental disability called pervasive developmental disorder. School refusal, also called school phobia,maybe a symptom of separation anxiety disorder, but it  can also occur as a symptom of other anxiety disorders and is not a diagnosis by itself.

Cause

Separation anxiety disorder (as with most mental-health conditions) is likely caused by the combination of genetic and environmental vulnerabilities rather than by any one thing.

In addition to being more common in children with family histories of anxiety, children whose mothers were stressed during pregnancy with them tend to be more at risk for developing this disorder.

A majority of children with separation anxiety disorder have school refusal as a symptom and up to 80%of children who refuse school qualify for the diagnosis of separation anxiety disorder.Approximately 50%-75%of children who suffer from this disorder come from homes of low socio economic status.

Management

Counseling, rather than medication, is the treatment of choice for separation anxiety disorder that is mild in severity. For children who either have not improved with counseling alone, suffer from more severe symptoms, have other emotional problems in addition to separation disorder, treatment should consist of a combination of approaches.

Psychotherapy,medication, and parent counseling are three interventions that have been found to be effective for the treatment of separation anxiety disorder, particularly in combination.

Habit Disorders

These are stereotyped disorders which are intentionally and repetitively produced but serve no constructive or socially acceptable function. The common habit disorders include thumb sucking, nail biting, pulling out of hair, head banging, masturbation, teeth grinding, nose picking, biting parts of the body, skin scratching, body rocking,breath holding etc.These habits range from normal to abnormal,depending on the severity of occurrences and the time of presentation during the developmental period (what is normal in infancy,maybe abnormal in later childhood).

Many of the habit disorders, particularly those which are self stimulating in nature, are called as gratification habits and are considered by some masturbatory equivalents. Also, these habit disorders tend to be commoner in mentally retarded individuals.

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