TABLE 6-10 Emotional Disturbances in Children

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

Oedipal (3-6 years)
Excessive fears
Child will be frightened even in nonthreatening situations. Nightmares and other sleep disturbances occur. Usually, child will be very “clingy" with parents in an attempt to gain reassurance.
    Anxiety as the causative factor. Anxiety can be induced by many things, such as:
  1. Parental failure to set appropriate limits.
  2. Physical or psychological abuse.
  3. Illness
  4. Fear of mutilation.
  5. Imaginary worries that are common at this age; e.g., a 4-year-old who is suddenly afraid of the dark, or dogs, or fire engines is not necessarily suffering from excessive fears.
  • If possible, identify and deal with the factors that are producing the anxiety. Offer child calm reassurance. Nightlight and open doors can help allay night fears, but counsel parents that it is unwise to allow the child to sleep with the parents, which may make the child feel that the oedipal retaliation has succeeded.
  • With the hospitalized child, the nurse needs to be aware of and work with the mutilation fears common at this age. Fears around certain procedures (e.g., injections) can often be resolved by helping the child play out fears.

Excessive masturbation
Touching and fondling of sometimes in a preoccupied or absentminded manner.
  1. Insecurity.
  2. Exploration and stimulation of the genital area, which is normal and common in this age group. However, if it is compulsive, the behavior is a signal that the child is insecure.
  • Assess the child’s masturbating activity. When does it occur and why? Then help the child develop other strategies for coping with anxiety.
  • Answer questions about sexuality in an open manner.

  • Occasionally, a specific fear. For example, a boy viewing a baby sister’s genitals may have castration fears. These can be dealt with directly.
  • Counsel parents that threats and shaming are contraindicated, and help parents deal with their feelings about masturbation.

Regression
  • Resumption of activities (such as thumb sucking, soiling and wetting, baby talk) characteristic of earlier developmental levels.
  1. Child’s attempt to regain a more comfortable, previous level of development in response to a threatening situation (such as a new baby), or
  2. A response to difficulty resolving oedipal conflicts.
  • Counsel parents not to make an issue of behavior.
  • Offer child emotional support and acceptance, though not approval of regressive behavior.

Stuttering
  • Articulation difficulty characterized by many stops and repetitions in speech pattern.
  1. Anxiety.
  2. Frustration.
  3. Insecurity.
  4. Excitement.
    5. Stuttering ususally occurs when the affected child feels anxious, frustrated, insecure, or excited. Parental concerns and attention to stuttering focuses attention on it and increases anxiety. The origins of stuttering are not understood. It is common around 2-3 years of age and is not a cause for concern at that time.

  • Speech therapy is usually indicated.
  • Psychotherapy may also be indicated, if stuttering is an expression of anxiety and conflict, persisting beyond age 6.