17.5  Other childhood problems

Many children experience behavioural problems growing up, such as feeding difficulties, temper tantrums and sleep problems. These problems usually improve with time, so that no intervention is necessary. However, there are some serious childhood problems where more support may be needed. An example is conduct disorder.

Children with conduct disorder show persistent socially inappropriate behaviour that often involves breaking rules, such as damaging property or stealing. While most children will improve their behaviour when appropriately disciplined by their parents, children with conduct disorder are unresponsive to this. Common symptoms of conduct disorder include temper tantrums, defiance and aggression, irritability, lying and stealing. These children may come to your attention following accidents and injuries. You may be able to support the family of the child, but helping the child with conduct disorder requires more specialist input. If you suspect these problems you should therefore refer the child to the nearest next level health facility.

Children may also have emotional problems such as depression and anxiety (see Study Sessions 12 and 16). These children will appear unhappy and the family may tell you that they are often tearful. They may also have poor appetite, and if the emotional problems are severe the child may start to lose weight. If this happens, you need to refer the child. Emotional problems often develop in response to problems at home or in school. If you identify specific problems you can help the parents to address these. Simply explaining what you see to the parents and allowing the child to talk about their problems will often help. Medication is usually unnecessary unless there is some underlying health problem or the depression is severe.

There are two more conditions that we will mention briefly: autism and attention deficit hyperactivity disorder (ADHD). Children with autism have great difficulty with social interaction and communication, and often show repetitive behaviours (such as rocking or flapping their hands) or a very narrow range of interests and activities. Children with autism often also have ID and delay in their development, especially in their language development, may be one of the first problems noted by the parents.

ADHD is another common developmental condition. Children with ADHD are restless and experience difficulties concentrating on tasks at hand. They often have problems sitting through class, which may get them into trouble with their teachers. They also tend to do things impulsively, without thinking much about the possible consequences of their actions.

If you feel that a child has significant problems with either of these conditions, refer the child to the next level healthcare facility. Children with autism or ADHD are greatly helped by a clear structure in their lives. Their behavioural problems may improve if the children are given a strict daily routine without many unexpected changes or distractions, and by receiving clear instructions from their parents and teachers on what is expected of them.