If you find yourself stressing over your toddler throwing a tantrum or acting out, or your infant crying so hard that he forgets to breathe and turns blue, you might find this article useful. Breath-holding spells, temper tantrums, pica, thumb-sucking are some of the common behavioral problems that trouble the parents more than they effect the children. This article aims at educating the parents about thesenormal behaviors and to make them understand the danger signs that distinguish these problems from the pathological behaviors.

  1. BREATH HOLDING SPELLS-
  • Breath-holding spells are involuntary cessation of breathing lasting for few seconds to a minute.
  • It occurs commonly in the age group of 6-18 months, but may occur in children upto 6 years of age.
  • Common triggers for a breath holding spell are fear, pain, traumatic events, upsetting events. They may occur at the end of a tantrum as well.
  • What does a breath holding spell look like?
  • After an upsetting event, child takes a short gasp, exhales and stops breathing. It is characterized by blue (cyanotic) or pale (pallid breath holding spells) skin.
  • Loss of consciousness or decreased alertness may occur
  • They may have jerky movements that mimic seizures.
  • What needs to be done?
  • Calm down and take a deep breath: Breath holding spells are a benign behavior problem that most of the time does not require any intervention.
  • Parents should avoid triggering events to prevent these spells.
  • In case of a toddler, they should not pay much attention to the child at the time of the spell to discourage the behavior.
  • Iron therapy should be initiated in consultation with a doctor as these spells are found to be associated with iron deficiency anemia.
  • When to seek help?
  • Head banging or high levels of aggression with each episode
  • Prolonged episodes with no response to external stimulus
  • More frequent episodes causing distress to the family.
  1. TEMPER TANTRUMSor Acting-Out Behaviors
  • Temper tantrums are emotional outbursts, unpleasant or disruptive behaviors that are inappropriate and noticeably unexpected in normal circumstances.
  • Child wrongly learns that temper tantrums are a reasonable response to unmet desires and frustration. It could be a way of seeking attention in some children, especially in case of sibling rivalry.
  • It commonly starts in toddlers between 12-18 monthswhen they cannot vocalize or converse to put forward their desires and complaints in words, and subsides by 4 years of age.
  • It is reinforced by parents’ punitive anger
  • Few common precipitating factors are hunger, lack of sleep, fatigue, over-pampered children, dysfunctional families and school aversion.
  • What needs to be done?
  • Parents should not respond to the temper tantrums by punitive anger, verbal or physical punishment, pampering or consolation.
  • Child should be ignored at the time of such temper tantrums.
  • Imposing a time-out makes the child understand that the behavior is not acceptable.
  • Open communication with the child after the tantrum subsides is extremely important to find out the reason for such an outburst so that it can be prevented henceforth.
  • These episodes can be prevented by empowering your child by giving him choices and accepting his demands wherever possible. For example, allowing him to choose his clothes or go to play with his friends under supervision, but at the same time denying the demands like driving a car or going out to the mall alone.
  • Using an upbeat tone, instead of giving an order. For example, “only if you finish your milk will we be able to go to play.”
  • When to seek help?
  • If tantrums persist for more than 4 years of age.
  • If the child becomes aggressive to inflict injury to self or to others around him.
  • If it is associated with nightmares, reversal of toilet training (secondary enuresis), or physical symptoms like abdominal pain or headaches.
  • Complaints of hyperactivity or disruptive behavior from school.
  • PICA
  • Pica is a eating disorder that involves persistent eating of non-nutritive, non-food substances like earth, paper, paint, clay etc, over a period of 1 month
  • This eating behavior is not a part of culturally supported or socially normative practice.
  • Infants and toddlers develop mouthing or tasting of objects as a part of normal development, and hence to avoid over-diagnosis, the minimum age for diagnosis is suggested to be 2 years.
  • Who is at risk?
  • Nutritional deficiencies (iron, calcium, zinc)
  • Low socio-economic factors (eg, lead paint exposure)
  • Child abuse and neglect
  • Family disorganization
  • Learned behavior
  • Mental disorders like intellectual diability, autism spectrum disorder and OCD and schizophrenia to lesser extent
  • Why is pica dangerous?
  • It usually remits in childhood but may continue till adolescent.
  • Pica can be dangerous based on the substances ingested.
  • These children are at increased risk of lead poisoning, iron deficiency anemia, mechanical intestinal obstruction, intestinal perforation, dental injury and parasitic infections
  • What needs to be done?
  • Combined behavioral, social, and medical approaches are generally indicated.
  • Behavioral assessment of the child for coexisting psychological disorders and analysis of dysfunctional families are done to rule out pathological pica.

These are few of the most common behavioral disorders in children that the parents should be familiar with. Though, doctor’s advice should be sought at any point parents are in doubt and hassled about their child’s behavior.

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