Mental Health and psychosocial concerns in children

Anxiety in children

Combination of worry and dread that can impact all aspects of a child’s daily life

affects 1 out of 8 children

if untreated young people with anxiety disorders are

• at higher risk to struggle in school and in their relationships with adults and peers

• more likely to underachieve and miss out on important social experiences

• more likely to engage in substance abuse

therapy, medication to treat

Depression

depressed or irritable mood, along with other signs, for at least 2 weeks

may also lose interest or pleasure in normal activities

cognitive-behavior therapy

medications

• very cautious about meds because they have many bad side effects

Suicide risks

family history

depression

substance or alcohol abuse

overwhelming life stressors

access to methods

• firearms

• meds

history of arrests or incarceration

LGBTQ+

Warning signs of suicide

help immediately

provide education to families of kids with depression….red flag of imending doom 

talking to others or posting on social media about 

• suicide or wanting to die

• feeling hopeless, trapped or like they are a “burden” to others

Looking for ways to kill themselves

• gathering meds, sharp objects or firearms

• searching online for ways to end their life

expressing unbearable emotional pain

visiting or calling people to say “goodbye”

giving away prized possessions

suddenly becoming calm or cheerful after a long period of depression

Safe environment for SI 

ensure that potentially harmful objects are inaccessible (perscription drugs locked in cabinets, guns locked away and secured)

Crisis plan SI

step-by-step approach at dealing with situation, emotions, and behavior until he or she feels safe

should include a “no self-harm” contract

• not going to act until we talk to someone “i hear what you’re saying and lets pause

Other interventions SI

identify trigger events and strategies to avoid or manage these events

explore coping strategies to be used when impulses arise

avoid isolation

collaborate with the treatment team 

LGBTQI considerations

many LGBT children and adolescents have

• seriously considered attempting suicide or attempt suicide

• symptoms of anxiety and depression

• lack of access to resources

Respect for patient is our major concern

• nurses should try to make patients feel comfortable 

• names and pronouns are important

PTSD

symptoms

• reliving the event over and over in though or in play 

• nightmares and sleep problems 

• intense ongoin fear or sadness

• irritability and angry outbursts

• constantly looking for possible threats, being easily startled

• denying that the event happened or feeling numb

• avoiding places or people associated with event

Treatment

• cognitive behavior therapy, medicaitons

Conduct disorder

disregard basic social standards and rules

Oppositional defiant disorder

uncooperative, defiant, and hostile toward peers, parents, teacher, and other authority figures

ADHD

developmentally inappropriate degrees of inattention

overactivity

impulsivity

Goal of behavioral disorders

reduce the frequency and severity of behaviors

• pharmacotherapy in conjunction with family therapy 

• lessen symptoms and maximize life

Cognitive behavior therapy

focuses on changing the thougts and emotions that can affect a child’s behavior negativity

therapist helps the child

• become aware of their thoughts and feelings

often works directly with the child, but can also include parents

Behaviors indicating possible substance abuse

irregular school attendance

low grades or poor school performance 

aggressive or rebellious behavior 

excessive dependence on peer influence 

deterioration of relationships with family 

rapid or extreme changes in behavior or mood

loss of interest in favorite activities or sports

changes in eating or sleeping patterns

Anorexia Nervosa

refusal to maintain a body weight that exceeds minimum weight for height

distored body image 

misperception of internal and external stimuli 

amenorrhea, lanugo, dry or flaky skin, dull brittle hair, muscle wasting 

Bulima Nervosa

recurrent episodes of rapid, convulsive binge eating and purging

a senes of lack of control over eating behavior

use of strategies to prevent weight gain

Nutrition therapy ed

a dietitian creates an eating plan to help the child gain weight and maintain a healthy weight 

refeeding syndrome

conseling ED

specialized therapy

discuss disorders relation to need for control

medicine ED

a psychiatrist may prescribe an antidepressant

hospitalization ed

if patient is unstable, may require a hosptial stay

strict policies/contracts for these patients

Inpatient guidelines for ED

blind weights

strick I and O

monitor for purging

monitor the patient for 60 minutes post meal

lock bedroom/bathroom door to prevent access to toilet 60 minutes post meal, where possible 

calorie counts 

restricted to unit and reduce physical activity

Physical abuse assessment

explanation of injury does not make sense

signs that child has been hurt before

child hasn’t recieved medical care for his or her injury 

other factors of physcial abuse 

Habitual absence from or lateness to school without credible reason

• parents may keep a child at home until physical evidence of abuse has healed 

a child comes to school wearing long-sleeved or high collared clothing on hot days 

• hiding injuries

awkward movements or difficulty walking 

• a child in pain or suffering from the affereffects of repeated injuries 

signs of sexual abuse

mental health issues

sexualized behaviors

behavioral problems

Child neglect

delibeate failure to provide for a childs needs

• physical 

• inadequate weight gain 

• failure to thrive 

• child looks physically unwell

• emotional

delays in physical and emotional developmnet 

• regression

Medical chlid abuse (munchausen syndrome by proxy)

any situation in which a child receives unnecessary and harmful medical care at the instigation of a caretaker

falsification of symptoms about the child by the caregiver

parent exaggerates, fabricates or induces illness in a child

can result in legal action

Abusive head trauma

also known as shaken baby syndrome

caused by vigorous shaking of the baby while being held 

results in intracranial and retinal bleeding 

called coup/contrecoup injury

lifelong brain injury 

Abuse considerations

mandatory reporting

documentation is important

• use quotes from parent is needed 

resources

• center for family safety and healing 

Autism spectrum disorder

broad range of conditions characterized by challenges with

• social skills 

• repetitive behaviors

• speech delays 

• nonverbal communication

• self-injury

Usually appear by age 2

sensory sensitivites

medical issues such as GI disorders, seizures, or sleep disorders

mental health challenegs such as anxiety, depression and attention issues

signs of autism

issues with communcation

child doesn’t respond to her name

prefers to be alone

trouble interpreting what others feel

repetitive movements or speech patterns

avoiding eye contact 

sensitive to loud noises 

encentric way of moving

Autism treatments

health education from credible sources

• no googling

early recognition for access to resources

behavior therapy 

medications for symptoms 

support groups

Developmental delay

when a child’s progression through predictable developmental phases slows, stops, or reverses

symptoms include slower-than-normal development of motor, cognitiv, social, and emotional skills

can be a result of hospitalization, prematurity, prenatal exposures, malnutrition, child abuse, genetics, etc

Interventions for developmental delay

Tons of therapy

• a hearing specialist

• a speech therapist

• a developmental pediatrician

• a neurologist

• a provider of early intervention services

• family centered care

Fetal alcohol spectrum disorder

includes

• persistent symmetric growth retardation

• malformations of face and skull

• skeletal and cardiac malformation

• CNS deficits, including intellectual and developmental disabilities

maternal alcohol consumption

prenatal alcohol exposure is thought to affect protein syntheiss, influencing growth and development of the brain and other tissues

• can result in decreased number of brain cells, diminished intelligence, and brain malformation

Clinical manifestations of fetal alchol syndrome

prenatal and postnatal growth deficiency

microcephaly 

joint anomalies during childhood and periods of growth 

mild to moderate intellectual disability presents in early childhood

termulousness in the neonatal period

irritability

hyperactiivty 

abnormal facial features

• short palpebral fissures

• smooth philtrum

• thin upper lip

Interventions for FASD

family requires assistance in coping with the diagnosis of FASD and caring for a child who may be difficult to soothe or experience feeding problems

particular attention must be given to involving the parents in caring for the infant 

early intervention will maximize the developmental potential and functional ability of the child

Down syndrome

most common chromosone abnormality

nonfamilisl trisomy 21

maternal age

• age 35: risk 1 per 350 births

• age 40: risk of 1 per 100 births

Down syndrome diagnostic eval

clinical manifesations

• square head with upward slant eyes

• flat nasal bridge, protruding tongue

• hypotonia

chromosme analysis

physical problems

• congenital heart disease

• hypthyroidism 

• leukemia

Down syndrome therapeutic management

surgey to correct congenital anomalies

eval of hearing and signt

periodic testing of thyroid function

care management

• supporting childs family at time of diagnosis 

• preventing of physical problems 

• assist in prenatal diagnosis and genetic counseling

Hearing impairment

more common in premmie infants

slight to moderately severe

• residual hearing with the use of an aid

severe to profound hearing loss

• cannot process linguistic information

Hearing screen in newborns

OAE test

• microphone placed into babys ears detect nearby sounds

• the sounds should echo in the ear canal

• if there is no echo, it is a sign of hearing loss

• some kids fail initally, just do it again

Hearing impairment etiology

anatomic malformation

family history 

low birth weight 

ototoxic drugs 

chronic ear infections

perinatal infections

cerebral palsy

Hearing impairment manifesations in infancy

lack of startle reflex

absence of reaction to auditiory stimuli

absence of well-formed syllabus by age 11 months

general indifference to sound

lack of response to spoken word

profound deafness: likely to be diagnosed in infancy

hearing impairment manifestations in childhood

identified upon entry into school

abnormalities in speech development

learning disabilities

Hearing impairment care management

lipreading

sign language 

speech langaueg therapy 

socialization 

support child and family

Hearing impairement: care for child during hospitalization

reassess

• reassess understanding of instructions given

supplement 

• supplement with visual and tactile media-

Provide

• commuication devices

• ipad picture board with common words

• assistance of child life specialist

• utilizing speech pathologist 

Visual impairment

common problem during childhood

5% to 10% of all preschoolers

identified through vistion screening programs

partially sighted

• 20/70 to 20/20

legally blind 

• 20/200 or pooerer

• legal and medical term

Visual impairment etiology

prenatal or postnatal infections

retinopathy of prematurity 

trauma

postnatal infections

other disorders

• sickle cell disease

• juvenile RA

• tay-sachs disease

Visual impairment care management

nursing assess

• identify child at risk 

• observe for behaviors that indicate a vision loss

• screen all children

promote parent-child attachment

promote childs optimal development

development and independence 

play and socialization

education

• braille

• audio books and learning material

Visual impairment hospitalization of affected child

provide a safe environment

provide reassurance during all treatment

orient child to surroundings

encourgae independence

treatment team memebrs should be consistent