Behavioral Problems, Pediatric

Description

Behavior that disrupts at least one area of psychosocial functioning. Commonly reported behavioral problems are as follows:

• Noncompliance: active or passive refusal to do as requested by parent or other authority figure
• Temper tantrums: loss of internal control that leads to crying, whining, breath holding, or aggressive behavior
• Sleep problems: difficulty going to sleep or staying asleep at night, nightmares, and night terrors
• Nocturnal enuresis: bed wetting that occurs in children >5 years of age for >3 months with no medical problems
  • Primary: children who have never been dry at night
  • Secondary: children dry at night for at least 6 months
  • Monosymptomatic enuresis: only have bedwetting
  • Nonmonosymptomatic enuresis: bedwetting in addition to daytime incontinence, urgency, voiding difficulties or voiding <4 or >7 times per day
• Functional encopresis: repeated involuntary fecal soiling that is not caused by organic defect or illness
• Problem eating: “picky eating,” difficult mealtime behaviors
• Thumb-sucking: can be problematic if persists past eruption of primary teeth as teeth alignment may be impacted

Epidemiology

• Noncompliance issues: manifest as children develop autonomy; slightly more common in males; decreases with age
• Temper tantrums: 5–7% of children between 1 and 3 years of age have temper tantrums lasting at least 15 minutes three or more times per week; 20% of 2-year-olds, 18% of 3-year-olds, and 10% of 4-year-olds have at least one temper tantrum every day (1).
• Sleep problems
  • Night waking in 25–50% of infants 6 to 12 months
  • Bedtime refusal in 10–30% of toddlers
  • Nightmares in 10–50% of preschoolers; peaks between ages 6 and 10 years
  • Night terrors in 1–6.5% early childhood; peaks between ages 4 and 12 years
  • Sleepwalking frequently in 3–5%; peaks between ages 4 and 8 years (2)
• Nocturnal enuresis
  • Common, 5–10% of 7 year olds and 3% of teenagers (3) wet the bed.
• Functional encopresis: rare before age 3 years, most common in 5- to 10-year-olds; more common in boys (4)
• Problem eating: Prevalence peaks at 50% at 24 months of age; no relation to sex/ethnicity/income (5)
• Thumb-sucking: decreases with age; most children spontaneously stop between 2 and 4 years (5).

Commonly Associated Conditions

• Noncompliance: If excessive or aggressive, rule out depression, compulsive patterns, adjustment disorder, inappropriate discipline.
• Temper tantrums: difficult child temperament, stress, normal development
• Sleep problems: inconsistent bedtime routine or sleep schedule, stimulating bedtime environment; can be associated with hyperactive behavior, poor impulse control, and poor attention in young children. Acute or chronic anxiety is associated with insomnia. Long-acting stimulant medications may disturb sleep quality.
• Enuresis: associated with constipation, heavy snoring, sleep apnea, and psychiatric conditions such as ADHD
• Functional encopresis: enuresis, UTIs, ADHD