Pediatric Developmental, Behavioral, and Mental Health Concerns

Why are DBMH concerns hard to diagnose?

Development is not always linear

There a wide range of what is considered normal

Leads to delayed tx → Early intervention = better outcomes

When do pediatric mental/developmental concerns become a problem?

When it interfered with home, school, or social interactions

Ex. parent can’t go to store, kids kicked out of daycare

Risk factors for peds depression

Bullying → victim and aggressor

Arguments w parents/peers/family

Rejection by groups → started in elementary

Engaging in risk behaviors

Ex of risky behaviors in peds

Smoking

Stealing

Not wearing helmet/seatbelt

Expected findings for peds depression

Temper tantrums

Sadness

Changes in appetite

Solitary play

Aggression

Risky behaviors

Poor school performance

Suicidal ideation/attempts

Peds anxiety

Anxiety that makes it unable for the child to function normally within their spheres

Interferes w normal growth and development

Separation anxiety disorder

School phobia/fear of being alone

May coexist with depression

May happen after a stressor

May progress to panic disorder

May experience psychosomatic symptoms

Peds comorbities to impulse control and conduct disorders

ADHD, depression, anxiety, substance abuse

Peds neurodevelopmental disorders

Typically improve w age

Dx difficult due to overlapping s/s

• ADHD

• Autism

• Intellectual developmental disorder

• Specific learning disorder

• Communication disorder

Diagnosis of ADHD

Symptoms develop before 12 and must be present in more than one setting

Vanderbilt form

Screening for ADHD, comorbidities and other behaviors

Interventions for ADHD, ODD and CD

Safety!!

Calm, firm approach

Model acceptable behavior

Clear limits

Help develop a reward system

Positive feedback

ADHD first line tx

Short acting stimulant

Methylphenidate

Autism medications

Tricyclic antidepressants → clomipramine

Atypical antipsychotics → risperidone

SSRIs → Sertraline (must be tapered!!)

Intellectual developmental disorder

Range from mild-severe

Deficit with mental abilities

Impaired ability to maintain independence → requires sped

Specific Learning Disorder

Dyslexia, dysgraphia, dyscalculia

May need Individualized Education Program (IEP)

Communications disorders

Persistent problems related to language and speech skills

Ex. stuttering, difficulty w conversational skills

Interventions for IDD, SLD, and communication disorders

Referral for psychoeducational evaluation

Encourage 504 or IEP

Give child positive feedback

Physical assessments w eating disorders

Decreased BP, HR and temp

Less than 85% expected normal weight w anorexia

Normal weight w bulimia

Lanugo hair, yellow skin

Pallor

Russell’s sign

Cavities

Amenorrhea (anorexia)

Russell’s sign

Marks in knuckles from self-induced vomiting

Eating disorder require acute treatment!

Weight loss of 20% expected body weight

Unsuccessful weight gain in outpatient facility

VS not stable

ECG changes

Severe depression, psychosis, suicidal behaviors

Eating disorders lab findings

Hypokalemia

Anemia

Impaired kidney function

Abnormal thyroid function

Abnormal blood sugar

Decreased bone density

ECG - QT prolongation

Eating disorders complications

Cardiac dysrhythmias

Hypotension

Bradycardia

• Continuous cardiac monitoring

• Frequent VS

Refeeding syndrome

Potentially fatal

Nutrition is given w severe malnourishment

Refeeding syndrome s/s

Confusion, constipation, seizures