Board Review Note

Psychosocial Issues and Problems

From Board Review Questions

Behavioral response of children to the divorce of their parents

• Preschool (3 to 5 years) - development regression,
• Early school-age (6 to 8 years) - grieving
• Later school-age (9 to 12 years) - anger
• Adolescence - depression

Children response to grief

• Preschoolers - developmental regression, temper tantrums, and un-control behaviors.
• School-age - somatic complaints, conversion reaction, sleep disturbances, and school performance deterioration.
• Adolescents - depression, conversion reaction, and delinquent behaviors

Sequence of emotional reactions of parents to the birth of a child who has a birth defect

1. Shock or fear
2. Denial or disbelief
3. Sadness and anger
4. Accept and care

Sequence of children and adults who respond to the death of a loved one

1. Denial.
2. Grieving and anger
3. Bargaining
4. Depression,
5. Acceptance

Development

Breath-holding spells: cyanotic and pallid

Head banging

Infant crying /colic

Night terrors and nightmares

Separate anxiety

Temper tantrum

Thumb sucking: usually resolves by 4 years of age, no intervention before 4 years old typically

Toilet training

• 75% of children are fully toilet trained by 36 months.
• Nocturnal enuresis occurs in 15% to 20% at age 5
• Spontaneously resolve in approximately 15% of the involved children every year thereafter
• 1% not grow out at age 15
• Males 3:1 females

Parenting and when to refer to mental health service

Single parent

Premier

Child with severe medical problems or birth defects

Child with significant behavior problems (e.g. aggression, started a fire, or animal harsh…)

Parental anxiety regarding a child’s health and development is normal

AAP guideline

TV view

No TV viewing for children younger than 2 years old

Limit viewing to no more than 1 to 2 hours per day for children 2 years and above

Parents monitor their child's television viewing

Parents discuss with their children about the content of television shows.

ADHD

Autism and autism spectrum disorders

Child Abuse

Family risk factors for child abuse

• Family discord and crisis
• Parental depression
• Parental or caretaker alcoholism and drug abuse
• Parental history of abuse as a child
• Parental or caregiver immaturity and unrealistic
• Poverty
• Social isolation and financial burdens
• Violence in the home

Child characteristics as risk factors for child abuse or neglect

• Prematurity
• Developmental delay
• Congenital abnormalities, chronic sick, and handicapping condition
• Potential triggering behavior such as persistent crying or feeding difficulties
• Siblings of abused children are at increased risk of abuse.

Protective factors for siblings living with child having chronic illnesses or disabilities

• Adequate financial resources,
• Harmonious relationships
• Stable marriage.
• A large family also seems to be protective for well siblings.
• Larger age spacing between the disabled child and the well sibling also is protective.

Key history and physical exam features suggestive of abuse

• Inconsistent history
• Inappropriate history
• History changes
• No history or only a partial history is given for an injury
• Delay in seeking care
• Family risk factors
• Child characteristics as risk factors

Fractures

Fractures that are more likely to be due to intentional trauma include

• Multiple fractures
• In different stages of healing.

Fractures commonly found in nonaccidental injury include

• Posterior rib fractures
• Multiple, bilateral rib fractures
• Spinous process fractures
• Scapular fractures

• Spiral fractures in infants (due to twisting)
• Sternal fractures
• Metaphyseal lesions, including bucket handle and corner fractures, which are due to pulling extremity.
• Skull fractures that are multiple, complex, occipital, or posterior parietal

Fractures commonly found in accidental injury, with a consistent history

• Clavicle fractures,
• Long bones fractures
• Nondisplaced linear skull fractures.
• Supracondylar fractures of the humerus
• Tibia fractures
• Buckle fractures of the radius and ulna

Skin Lesion

Skin findings can be confused with child abuse.

• Congenital vascular malformations or port-wine stains.
• Hemangiomas
• Urticaria pigmentosa with Darier sign.
• Mongolian spots
• Coin-shaped and linear bruising on the back

Bruise: Shape, marks, patterns, and stages of healing.

Hot water burns: distinct border, sparing of interdigital areas, uniform depth

Cigarette burns: uniform, circular lesions, 6 mm in diameter, well-defined border

Sexual abuse