TABLE 6-10 Emotional Disturbances in Children

Stage Disturbance Assessment: Symptoms or Characteristics Analysis: Behavior Related To: Plan/Implementation:

Oral (birth-1 year)
Feeding disturbances
Refusal of food.
  1. Rigid feeding schedule.
  2. Psychological stress.
  3. Incompatible formula.
  4. Physiological: pyloric stenosis.
  • Pediatric evaluation, especially if infant is not gaining weight or is losing weight.
  • Rule out physiological etiology or incompatible formula.
  • Evaluate feeding style of caretaker. Is baby on demand feeding? Is caretaker sensitive to infant's needs or communications about holding, hunger, or satiation?

  • Colic. Crying is usually confined to one part of day and starts after a feeding.
  • Commonly lasts from first to third month.
  • Periodic tension in infant’s immature nervous system, causing gas and sharp intestinal pains.
  • Reassure parents and teach about condition and how to relieve it with hot water bottle, rocking, rubbing back, pacifier, which may soothe infant.

Sleeping disturbances
  • Infant resists being put down for sleep or going to sleep.
  1. Need for parental attention.
  2. A pattern formed during period of colic or other.
  3. Emotional disturbance related to anxiety.
  • If it is attention-getting strategy, suggest parental lack of response for a few nights to break pattern. If emotional disturbance is suspected, evaluate infant-caretaker interaction and refer for psychotherapeutic intervention.

Failure to thrive
  • Infant does not grow or develop over a period of time.
  1. Psychological: inadequate caretaking.
  2. Physiological: heart, kidneys, central nervous system (CNS) malfunction.
  • If it is attention-getting strategy, suggest parental lack of response for a few nights to break pattern. If emotional disturbance is suspected, evaluate infant-caretaker interaction and refer for psychotherapeutic intervention.

Severe disturbances
  • Autistic psychosis: Very early onset; lack of response to others; bizarre, repetitive behavior; normal to above normal intelligence; failure to develop language or use communicative speech. Autism is one of the most severe and debilitating psychiatric disturbances.
  1. Uncertain etiology; regression or fixation at earlier developmental stage, before child differentiates “me” from “not me.”
  2. A “nature versus nurture” controversy over the causative factors. These are variously thought to be:
    • Environment only: Infant is tabula rasa and all disturbance is directly attributable to the environment (primarily the parenting).
    • Heredity only: For genetic, biochemical, or other predetermined reasons, some infants will be psychotic regardless of the environment.
  • The severely disturbed child requires intensive psychotherapy and often milieu therapy available in residential or day care programs.
  • Therapy is usually indicated for parents also.
  • Nurses can work on a primary level of prevention by assessing parenting skills of prospective parents and teaching them these skills.
  • On a secondary level of prevention, nurses can be knowledgeable about and teach others the early signs of childhood psychosis, making appropriate referrals. The earlier the intervention, the better the prognosis.

  • Combination of environment and heredity plus the interaction between them: A susceptible infant, less than optimal parenting, and negative interaction between parent and infant will combine to produce disturbance.
  • On a tertiary level of prevention, nurses work with severely disturbed children and their families in child guidance clinics and residential and day care settings.
  • Health teaching would include play activities that foster support, acceptance, and a nonthreatening mode of communication and interaction with a significant other.

  • Symbiotic psychosis: Identified later than autistic type, usually between 2 and 5 years of age. These children seem to be unable to function independently of the caregiving parent. A situational stress, such as hospitalization of parent or child or entry into school, may precipitate a psychotic break in the child.
  • The same "nature versus nurture" controversy with respect to the origin of symbiotic psychosis. The child progresses beyond the selfabsorbed autistic stage to form an object relationship with another (usually the mother). Having progressed to this stage, the child then fails to differentiate his or her own identity from that of the mother.