Child Psychiatry

Dr. Fidia Mumtahana

 NORMAL CHILD DEVELOPMENT

-Process of growing to maturity.

-Refers to process of biological and psychological

changes in human being between birth and end of
adolescence as the individual progresses from
dependency to autonomy.
WHAT IS THE RATIONALE BEHIND THE
KNOWLEDGE OF NORMAL DEVELOPMENTAL
PROCESS ?

• For the practice of childhood psychiatry.

• To identify whether the observed emotional,

social, or intellectual function is abnormal as it
has to be compared with the corresponding
normal range for the age group.
 General issues:

• Child psychiatry deals with assessment and

treatment of children's emotional and behavioral
problem.
• Prevalence- ~ 10%

• Suicide significant cause of death

• 8 out of 10 children-do not receive care.

AGE RELATED DEVELOPMENTAL PERIODS

 Newborn or neonate (age 0–1 month)

 Infant (age 1 month – 1 year)

 Toddler (age 1–3 years)

 Preschooler (age 3–5years)

 School-aged child (age 6–10 years)

 Adolescent (age 11–19 years)

 DIMENSIONS OF DEVELOPMENT

 Physical growth and motor skills

 Temperament (attitude, behavior & mood of a

person)
 Cognition and intelligence

 Language

 Social relations and attachment

 MILESTONES OF MOTOR DEVELOPMENT

Pull self up Walk well

Lift head to stand alone

Remain
sitting without
Roll from assistance Walk holding
stomach once up on to furniture

Birth 2 4 6 8 10 12 14 16
months
Pull up with Stand holding Walk
assistance on to furniture backward

Push chest Sit up without Stand well

up with arms assistance alone
MOTOR SKILLS-SUMMARY
Age 2-up stairs w/o help

Age 3-tricycle, copies circle

Age 4- jumps, copies square

Age 5-skips, copies triangle

 SOCIAL DEVELOPMENT
Learn to develop sense, so that they can think and relate their
experiences in other situation.
• 3 mth- shows pleasure appropriately
• 6 mth- interested, alert- still friendly with strangers
• 9 mth- distinguishes stranger/apprehensive

• 1yr- cooperates with dressing, waves “bye, bye”

• 1.5 yr.- demands constant mothering

• 2 yr.- indicates toilet needs

• 3 yr. - dry by night (not soiling), undress with help
• 4 yr.- undress and dress alone
 COGNITIVE DEVELOPMENT
 Includes capacity to learn, remember, recognize, solve
problems and organize the environment.
• Newborn- learns to suck

• 8-12 mths- plays peek-a-boo

• 2yrs- knows animal sounds, names of objects

• 3-4yrs – knows colors

• 5-6yrs- understands humor

• 7-11yrs- thinks logically, personal sense of right and wrong

 CHILD AND ADOLESCENT PSYCHIATRY
 Differences of Child psychiatry from adult psychiatry:
• The child’s existence and emotional development depends on
the family or care givers - cooperation with family members;

• Children are less able to express themselves in words

• The child who suffers by psychiatric problems in childhood can

be an emotionally stable person in adulthood, but some of the
psychic disturbances can change whole life of the child and
his family.

• Use of pharmacotherapy is less common in comparison to

adult psychiatry
 ETIOLOGICAL CONSIDERATIONS OF DEVELOPMENT:

• I. Constitutional:
• Genetic
• intra-uterine disease/damage
• birth trauma
• Temperament- neurotic traits (anxiety, anger, guilt, and
depressed mood)

• II. Environmental (stress):

• family
• school
• surrounding ( peer)

• III. Physical illness/ damage : neurological conditions

Major developmental

&
behavioral disorders
 Disorders
 Attention deficit hyperactivity disorder (ADHD)
 Autistic disorders
 Learning disability-dyslexia
 Language delay &disorders of communications
 Mental retardation
 Tic Disorder
 School phobia
 Temper tantrums
 Breath holding spells
 Pica
 Enuresis
 Encopresis
 Attention deficit hyperactivity disorder
(ADHD)
 Commonest neurodevelopmental disorder of
childhood affecting 3-5% of school-aged children.

 3 times commoner in boys

 Clinical Features –
• Inattentive
• Impulsivity
• Constantly in motion & hyperactivity
• Difficulty with planning and organizing task
 Attention deficit hyperactivity disorder
(ADHD)
• Easily distracted, forget things
• Difficulty in maintaining focus on one task
• Become bored with a task after only a few minutes,
• Become easily confused
• Have trouble understanding minute details
• Struggle to follow instructions
• Talking nonstop
• Very impatient
 Management

 The management of ADHD should begin with

educating the parents about the effect of ADHD on
child’s learning, behavior and social skills and helping
them in setting.

• Behavioral therapy
 Behavioral therapy
 Describe clearly to the child about the desirable and non desirable
behavior & give instructions accordingly.

 Positive influence of desirable behavior by praise or small rewards.

 Punishment strategies like verbal disapproval, non-verbal gestures

or “time out” for undesirable behavior.

 Systematic ignoring of undesirable behavior- what may concerns

him

 Providing a well structured and organized routine for the child at

home as well as school is helpful.
 Behavioral therapy
 At school-

 Giving brief and consistent instruction to the child

 Clear and consistent response to the child’s behavior

 Seating in an area with few distraction

 Move from place periodically may helpful

 Allowing the child to change activities periodically

 Medications
 Stimulants:- first line treatment
 Methylphenidate and its derivatives
 Amphetamine and its derivatives.

 Antidepressants:- second line drugs, especially in the

presence of co-morbid depression.
 Imipramine (TCA)
 Bupropione (NDRI)
 Autistic Disorder (AD)
 It is characterized by a qualitative impairment in
verbal and nonverbal communication, in imaginative
activity and in social interactions that develops
usually before the age of 3 years.
 There is a marked male preponderance.

 Other neurological disorders that can co-occur with

AD - epilepsy, tuberous sclerosis ...
 Clinical Feature
 Children with AD are diagnosable by the 18 months
of age by their-

• Poor eye contact

• Inability to engage- socially or emotionally with
caregivers
• Delayed speech, inappropriate speech or cry
• Different body movements
• Preference for solitary play
 Clinical Feature
• Oversensitive or under sensitive to sounds.
• Older children also show bizarre or unusual
obsession & severe impairment in socialization.
 Clinical Feature
 Seizures develop by adolescence in up to one-third
of affected patients.

 Intelligence is variable in children with AD, though

most children fall in the functionally retarded
category by conventional psychological testing.

 Some children show isolated remarkable talent.

 Management

 The primary management is through “intensive

behavioral therapy” starting before 3 years of age,

applied at home as well as school focusing on speech

and language development and good behavioral

control.
 Management at school
• Teaching one-on-one, using primary reward such as
food as motivation.
• Teaching in small increments with repetitions.
• Using “total communication” i.e teaching with range
of techniques such as
spoken language,
symbols and visual tools.
Management- behavioral modification at home

• Identifying the manageable problems.

• Finding a reward that works for the child

• Trying to modify the behavior consistently and

repeatedly.
 Management

 Older children and adolescents with relatively higher

intelligence but poor social skills and psychiatric

symptoms (e.g. depression, anxiety, OCD) may

require drug management.

 Prognosis

 Better prognosis depends on the followings-

• Early diagnosis

• Higher intelligence

• Presence of functional speech

 Learning Disabilities

 Learning disabilities are considered to arise from specific

neurodevelopmental dysfunctions that prevent
expectable learning in one or more academic areas.
Dyslexia
 It is the commonest learning disability.
 It is characterized by difficulty in accuracy and fluency in
word recognition, poor spelling and word decoding
abilities..
 Dyslexia
 Children with dyslexia shows that the
temporoparieto-occipital region of cerebral
hemisphere do not function properly during reading
compared to normal children.
 Clinical Manifestation

 Reading mistakes

 Difficulty in reading.

 They also have difficulty in spelling

 Listening comprehension is typically normal.

 Dyslexia may co-occur with ADHD in 15-40%

children.
 Management
 The affected children are best taught in small groups,
by teachers trained in the principles of phonics
(speech sounds).

 The children are taught how letters are linked to

sounds.

 One or two phonics are taught at a time with

sufficient time spent on reading and writing words
using those phonics.
 Management
 For older children- use of laptop-computers with
spell-check, recorded books and giving extra time for
writing test or multiple choice questions (MCQ) type
of tests.

 Usually the results of these programs vary

 Language delay and disorder of
communication
Stuttering
 It is a defect in speech characterized by hesitation or
spasmodic repetition of some syllables with pauses.

 There is difficulty in pronouncing the initial of words

caused by spasm of lingual and palatal muscles.

 It is a common problem affecting up to 5% of

children.
 Management
 Parents of a young child with primary stuttering
should be reassured that stuttering during the phase
of non-fluent speech between the age of 2-5 years
usually resolves on its own.
 Making the child conscious of his stutter or
pressurizing him to repeat the word without
stuttering will further increase the stress and the
stutter.
 Management

 Children who continue to have stuttering, referral to

a speech therapist should be advised.

 In older children with late onset of stuttering, the

help of a child psychologist should also be needed.
 Mental Retardation
Mental Retardation is defined as significantly sub
avarage general intellectual functioning, associated
with significant deficit or impairment in adaptive
functioning, which manifests during the
developmental period.

Sufficient lack of intelligence to interfere with social

and vocational performance.
 Classification of Mental Retardation
by IQ

Mental Retardation level IQ

Mild 50-70
Moderate 35-50
Severe 20-35
Profound <20
 Mild Mental Retardation
– Commonest type of mental retardation, accounting for 85
– 90% of all cases.

– In the pre school period these children often develop like

other children

– They often progress up to 6th grade and can achieve

vocational and social self sufficiency with a little support

– Supervised care is needed only under stressful conditions.

– They are referred to as ‘educable’.

Moderate Mental Retardation
– About 10% of all persons with mental retardation.

– They often drop out of school after the 2nd grade.

– They can be trained to support themselves by performing

semi- skilled work under supervision.

– A mild stress can destabilize them from their adaptation.

– This group has been referred to as ‘trainable’.

 Severe Mental Retardation
– Severe mental retardation is often recognized
early in life with poor motor development
(significantly delayed developmental milestones)
and absent or delayed speech.

– They can perform simple tasks under close

supervision.

– They are termed as ‘ dependent’.

Profound Mental Retardation
– In this subtypes associated physical disorder
often contribute to mental retardation.

– They need nursing care.

 Causes of Mental Retardation
• Genetic (5%)—
1.Chromosomal abnormalities- Down syndrome,
Turner’s syndrome, Klinefelter’s syndrome…

2.Inborn errors of metabolism- Phenylketonuria,

Galactosemia, Glycogen storage disease….

3.Neurofibromatosis, Tuberous sclerosis.

4.Cranial anomalies- Microcephaly.

 Causes of Mental Retardation
• Peri-natal causes (10%)—
1. Infections- Syphilis, Rubella, Toxoplasmosis,
CMV infection…
2.Prematurity
3.Birth trauma
4.Hypoxia
5.IUGR
6. Kernicterus
7.Drug effects during first trimester.
 Causes of Mental Retardation
• Physical disorders in childhood-
- Encephalopathy
- Cretinism
- Trauma
- Cerebral palsy
• Psychiatric cause-
– Infantile autism
– childhood onset schizophrenia.
 Sign and Symptoms
• Failure to achieve developmental milestones.

• Difficulty in cognitive functioning such as inability to follow

commands and directions.

• Intellectual failure

• Reduced ability to learn or to meet academic demands.

• Psychomotor skill deficits.

• Irritable when frustrated or upset.

• Lack of curiosity.
 Management
 Primary prevention:
• Improvement in socio-economic condition of society at
large, aiming at elimination of malnutrition, prematurity
and perinatal factors.

• Medical measures for good perinatal medical care to

prevent infections, trauma, excessive use of medications
and obstetrical complications.

• Universal immunization of children

• Genetic counseling of risk parents, e.g. in Down

syndrome….
 Management
 Secondary prevention:
• Early detection and treatment of preventable disorders,
e.g. Phenylketonuria (low phenylalanine diet),
Hypothyroidism (thyroxine).

• Early treatment of correctable disorders e.g. infections

(antibiotics), skull configuration anomalies (surgical
correction).

• Individuals with mental retardation should be integrated

with normal individuals in the society and any kind of
discrimination should be avoided
 Management
 Tertiary prevention:
• Adequate management of psychological and
behavioral problems.

• Behavioral modification.

• Rehabilitation in vocational, physical and social areas.

• Parental counseling.

• Institutionalization.
 Tic Disorders
 Tic disorders are characterised by the presence of tics.
 Tic is an abnormal involuntary movement which occurs
suddenly, repetitively, rapidly and is purposeless in nature.
 Types
 It is of two types:
1. Motor tic, characterised by repetitive motor movements.
2. Vocal tic, characterised by repetitive vocalisations.

 Tic disorders can be either transient or chronic.

 Transient tic disorders are more common in boys and can
occur in 5-20% of children.

 Tics are easily worsened by stressful life situations, fatigue

and/or use stimulants such as caffeine and nicotine. A vast
majority of these disappear by adulthood.
 Tourette’s disorder
 A special type of chronic tic disorder is Tourette’s disorder.
 Tourette’s disorder is typically characterised by:
1. Multiple motor tics.
2. Multiple vocal tics.
3. Duration of more than 1 year.
4. Onset usually before 11 years of age and almost always before
21 years of age.

The disorder is usually more common in males

 Motor Tics
• The motor tics in Tourette’s disorder can be simple or
complex.

i. Simple motor tics: These may include eye blinking,

grimacing, shrugging of shoulders, tongue protrusion.

ii. Complex motor tics: These are facial gestures,

stamping, jumping, hitting self, squatting, twirling,
echokinesis (repetition of observed acts), co-
propraxia
 Vocal Tics
 The vocal tics in Tourette’s disorder can also be simple or
complex.
i. Simple vocal tics: Simple vocal tics include coughing, barking,
throat-clearing, sniffing and clicking.

ii. Complex vocal tics: though not always present, symptoms of

Tourette syndrome; for example, echolalia (repetition of
vocalizations made by another person), palilalia (repetition of
words, or phrases by the same person), coprolalia (use of
obscene words).

 Obsessions and Compulsions are often the associated

symptoms.
 Treatment
 Pharmacotherapy is usually the preferred mode of treatment
though there is lack of clear evidence of efficacy.

• Antipsychotics are often helpful in small doses

 Haloperidol
 Olanzapine
 Quetiapine
 Aripiprazole
 Risperidone
 Ziprasidone
 Sulpiride
 Treatment
• Treatment options are often chosen based on adverse effect
profile of each drug (which adverse effects to avoid).

• SSRIs such as Fluoxetine have been used for the treatment of

co-morbid obsessive compulsive symptoms.

• In the resistant cases or in case of severe side effects,

pimozide or clonidine can be used under expert supervision.

• Behaviour therapy can sometimes be used, as an adjunct.

 School phobia
 School phobia is persistent and abnormal fear of
going to school.

 It is emotional disorder of the children who are

afraid to leave the parents, especially mother and
prefer to remain at home and refuse to go to school
profusely.
 Causes
 There appears to be a genetic component to anxiety
disorders

 School phobia is often associated with other anxiety

disorders such as agoraphobia or other mental
health disorders such as depression.
  Agoraphobia
A person avoids a number of otherwise ordinary
activities and places, including some that the
person used to enjoy before the trouble started.
This avoidance usually develops in response to
panic attack.
 Causes
 Another possible cause of school refusal is traumatic
and prolonged separation from the primary caregiver
in early childhood.
 Stressful events or a dysfunctional family can cause
children to feel compelled to stay home.
 With school avoidance, the child usually tries to avoid
a particular situation, such as taking a test or changing
clothes for physical education…
 Causes
 To avoid an unpleasant situation at school.

 In older children, or if school refusal comes on

suddenly, it may be related to avoiding a distressing
situation at school such as bullying, teasing, or it may
following a humiliating event such as throwing up
from class.
 Clinical features

 Recurrent physical complaints like abdominal pain,

headaches which subside if allowed to remain at
home.
 Again the complaints

reappear in next morning.

 Clinical features

 Behavioral symptoms include- temper tantrums,

crying and threats to hurt themselves
 Management
 The most effective form of treatment is a combination of
behavioral and cognitive behavioral therapy for an average
period of six months.

 Behavioral therapy involves teaching both parents and

children strategies for overcoming certain stressful behaviors
and may involve desensitization by gradual exposure to the
stressful event.
 Management
 Cognitive behavioral therapy (CBT) teaches children to
redirect their thoughts and actions into a more flexible
and  confident  pattern.
 
 Family therapy may also be used
to help resolve family issues that
may be affecting the child.
 Management
• Drugs- Depending on the diagnosis, children may also be
treated with drugs to help them from depression, panic
and anxiety, or other mental health disorders.
• Assessment of health status of the child to detect any
health problems for necessary interventions.
• Improvement of school environment & teachers should be
also helpful in class.
 TEMPER TANTRUMS
 From the age of 18 months to 3 years, the child
begins to develop autonomy and starts separating
from primary caregivers.
 When they can’t express their thoughts, they
become frustrated and angry.
 Some of them show their frustration with physical
aggression such as biting, crying, kicking, throwing
objects, hitting and head banging. This kind of
physical aggressive behaviour is known as Temper
tantrum.
TEMPER TANTRUMS
 ETIOLOGY
 
• Parental Factors
• Child personality
• Other Factors

Precipitants
• Not meeting demands
• Interruption of play
• Threat of abandonment
• Anxiety, criticism
• Imitation
 MANAGEMENT
• Temper tantrums often cease with age.

• Remove underlying insecurity of the child, over

protection and faulty parental attitude.

• During an attack, the child should be protected from

injuring himself and the others.

• Deviating his attention from the immediate cause

and changing the environment can reduce the
tantrum.
 MANAGEMENT

• Parents should be calm, loving, firm and consistent and

such behaviour should not allow the child to take
advantage of gaining things.

• Some temper tantrums result from the child’s frustration

at failing to manage a task. These can be managed by
distracting the child and permitting success in more
manageable activity.
 MANAGEMENT
• Ignoring is an effective way to avoid reinforcing
tantrums although young children should be held till
they regain control.

• “Time out procedure”- In using time out procedure,

parents should not attempt to inflict a fixed number of
minutes of isolation. The goal should be to help the child
develop self regulation.
 BREATH HOLDING SPELLS

 It is an episode in which the child stops breathing and

loses consciousness for a short

period immediately after a

frightening or emotionally upsetting

event or a painful experience.

 BREATH HOLDING SPELLS
 Breath holding spells most often occur when a child
becomes suddenly upset or surprised.

 The child makes a short gasp, exhales, and stops

breathing.

 The child's nervous system slows the heart rate or

breathing for a short amount of time.

 Breath holding spells are not thought to be a willful act,

even though they often occur with temper tantrums.
 BREATH HOLDING SPELLS
 Clinical features can include:

• Crying, then no breathing

• Blue or pale skin

• Unconsciousness

• Jerky movements
 Management
 No proper management- history is enough to
diagnose the case. But if need then a thorough
examination is done.
 Counseling with parents
 During a spell, make sure child is in a safe place
where they will not fall or be hurt.
 After the spell parents should avoid giving too much
attention to the child.
 Avoid situations that cause a child's temper
tantrums.
 ENURESIS
• Enuresis is a disorder of involuntary micturation in
children who are beyond the age when normal
bladder control should have been acquired.

• Enuresis refers to the wetting of one’s clothes or

one’s bed past the age of 3
years.

• It is common during 4
years to 12 years age group.
 TYPES OF ENURESIS

 Primary- child has never been dry at night

 Secondary- child begins bedwetting after remaining

continent for 6 months or more.
 Again can be divided into-
 Nocturnal- involuntary voiding occurs only during
sleep at night
 Diurnal- involuntary voiding occurs during daytime
also while child is awake.
 Primary enuresis

• A strong family history.

• Boys more commonly than girls.
• 15% of 5-yr-olds, 5% of 10-yr-olds, and 1% of 16-yr-olds
have not established total bladder control and will wet
the bed once a week or more.
• Majority of cases have no underlying organic cause and it
is thought to be due to delayed maturation of bladder
control mechanisms.
 Secondary enuresis
 Needs careful history and investigations because of
probable organic cause.
Causes of secondary enuresis
 Urinary tract infection
 Neurological: spina bifida
 Endocrine: diabetes mellitus, diabetes insipidus
 Behavioural problems
 Abuse
 History
 History:
Assess pattern and types of drink consumed:
 Often limited fluid in the day
 Drink after school and evening
 May have sugary drinks
 Voiding habits:
 Infrequent (<4 daily)
 Frequent (>7 daily)
 Dysfunctional/inappropriate place of voiding
 Investigations

 Urine testing:
• Culture
• Urinalysis
 US of the renal tract:
•Assess pre- and post-micturition bladder urine
residual volume
• Underlying anatomical abnormalities
 Management
 No treatment is recommended in children below 6
years of age because of high spontaneous cure rate.

 1st line treatment is non-pharmacological-

motivational therapy.
 Child should assume active responsible role-
 Keep diary of wet & dry nights
 Void before going to bed
 Child will change wet cloths & bedding
 Management
 Restrict fluids, especially caffeinated drinks like tea,
coffee, soda in evening
 Punishment & angry parental responses to be
avoided
 Positive reinforcements to be given for each dry
night
 Alarm therapy- An alarm is attached to the child’s
collar & a sensor which is attached to the child’s
undergarments. As soon as child starts micturating –
sensor activates the alarm.
 Management
 If above mentioned measures are not working then
drugs are used.
 Imipramine
 Oxybutinin
 Desmopressin
All these drugs have serious side effects on the growing
body.
 Encopresis
 Encopresis refers to passage of faeces into
inappropriate places at age

when bowel control should

have been established.

 Etiology
• Inefficient intestinal motility during defecation (improper
defecation- urge of defecation can come later without any notice)

• Aggressive and prolonged medical management for

constipation (laxatives, enemas, suppositories)
• Dietary manipulation for perceived constipation
• Anal fissures (improper defecation)
• Surgical procedures for imperforate anus (may less proper
control on anal sphincter)

• Psychosocial stresses or illness

 Management
• Counseling with child & parents both.

• Giving the child laxatives in proper dose or enemas to

remove dry, hard stool.

• Diet should contain high fibers (fruits, vegetables, whole

grains) and plenty of fluids to keep the stools soft and
comfortable.
 Management
• Taking flavored mineral oil for a short period of time.

• May need to go to a pediatric gastroenterologist

when these treatments aren't enough.

• The doctor may teach the parents

and child how to manage
encopresis, proper toilet training
 Management

 May need to go to a psychotherapist to help the

child deal with associated shame, guilt, or loss of

self-esteem.

 May need some behavioral modification.

 PICA
 Pica is a habit disorder of eating non edible
substances such as clay, paint, chalks, paper, pencil,
plaster from wall, wool, soap, etc.
 Causes
 Parental neglect, poor attention of the caregiver,
inadequate love and affection, mental health conditions
like mental retardation and OCD etc.

 Nutritional deficiencies.

 Children of poor socio economic status family,

malnourished children….
 Clinical Features
• Anaemia

• Chronic diarrhoea

• Stunted growth

• Perverted appetite

• Intestinal parasitosis

• Vitamins and mineral deficiency

 Clinical Features
 Abdominal pain, nausea, and bloating caused by
blockage in the stomach or intestine
 Fatigue, behavior problems, school problems and
other findings of lead poisoning or poor nutrition
 Trichotillomania (irresistible urges to pull out hair
from own scalp, eyebrows …)
 Trichobezoar (eating of hair) etc.
 Diagnosis

• Blood investigations

• According to the DSM IV classification, a person is

said to have pica, only if:
 Persistent eating of non nutritive substances for a
period of at least one month
 Diagnosis
 Does not meet the criteria for either having autism,
schizophrenia, or Kleine-Levin syndrome.

 The eating behavior is not culturally sanctioned.

 If the eating behavior occurs exclusively during the

course of another mental disorder
 Complications
 Certain items, such as paint chips, may contain lead or
other toxic substances and eating them can lead to
poisoning, increasing the child's risk of complications
including learning disabilities and brain damage.

 Eating non-food objects can interfere with eating healthy

food, which can lead to nutritional deficiencies.
 Complications
 Eating objects that cannot be digested, such as
stones, can cause constipation or blockages in the
digestive tract. Also, hard or sharp objects
(paperclips) can cause tears in the lining of the
esophagus or intestines.
 Bacteria or parasites from dirt or other objects can
cause serious infections. Some infections can
damage the vital organs.
 Co-existing developmental disabilities can make
treatment difficult.
 Treatment
 Combined behavioral, social, and medical approaches
are generally indicated for pica.

 Assessment for neglect and family supervision combined

with a psychiatric assessment for co-occurring mental
disorders and developmental delay are important in
developing an effective intervention strategy for pica.
 Treatment
 Behavioral treatment interventions, particularly in
patients with intellectual disability or autistic disorders,
have shown being helpful.
 The sequelae related to an ingested item can require
specific treatment (e.g., lead toxicity, iron-deficiency
anemia, parasitic infestation).
 Ingestion of hair may require surgical intervention for a
gastric Trichobezoar
 Nice to know
Kleine-Levin Syndrome Lead poisoning
 AKA, "Sleeping Beauty  Symptoms in children-
syndrome" is a sleep  Developmental delay, Learning
difficulties
disorder characterized be
 Irritability, Loss of appetite, Weight
hypersomnia with cognitive loss
or mood change.  Sluggishness and fatigue, Abdominal
pain
 Vomiting, Constipation, Hearing loss
 Also may be associated with  Treatment-
hyperphagia, hypersexuality  Chelation therapy
 Treatment of iron, calcium, and zinc
(in case of adolescent) & deficiencies
other symptoms.  Lead-containing materials are in GIT-
whole bowel irrigation, surgical
removal…