Psychologist's Agree Prisoners Need More Access To Therapy, UK
The British Psychological Society welcomes and supports the recent report from Sainsbury Centre for Mental Health (SCMH), 'From the inside', on the urgent need to address the mental health issues of prison inmates. The report states that prisoners need access to psychological therapy to help them to overcome the trauma and abuse many of them have experienced. Professor Peter Kinderman, Chair of the Society's Standing Committee of Psychologists in Health and Social Care stated; "There is a deplorable discrepancy between the demand for mental health services in prison and the availability of mental health practitioners to meet that need. We agree with SCMH on the two key issues: There is an urgent need to address mental health in prisons and that expanding access to psychological therapies is at least part of the answer." The British Psychological Society has many members working as clinical and forensic psychologists in prisons and more widely in the criminal justice system. The Society recognises the huge gap between what is required and what is available. As the SCMH report makes clear, mental health problems are a very significant issue in prisons and more widely in the forensic field, and the services available simply fail to meet these needs. Furthermore, comprehensive and holistic offender management is required, together with more community programmes and reoffender management. Psychological science can do much to help in this respect. Psychology and psychologists can assist with policy development, strategic issues, workforce redesign and measurable targets. Much could be learnt from the Government's new, but successful Improving Access to Psychological Therapies (IAPT) programme, which is designed significantly to improve the provision of Cognitive Behavioural Therapy in mental health services. A replication of the IAPT programme in prison settings could do much to reduce the inadequacy of services. Dr Kinderman continued; 'Due to the nature of the mental health problems in prisons three areas need addressing urgently: mental health issues which might benefit from psychological therapies, addressing reoffending using psychological interventions that have been proven to work and employment. Psychologists have a huge amount to offer on all of these issues.' British Psychological Society
6/27/2008
Leicester Professor Wins Psychology Award
Professor Ray Bull from the University of Leicester was awarded the Senior Forensic Psychologist Award 2008 on the 26 June at the British Psychological Society's Division of Forensic Psychology Annual Conference held at Edinburgh Conference Centre, Heriot-Watt University. Professor Bull has been given the award based on his work in investigative interviewing. He has published research regarding the following topics: - A specialised technique called "cognitive interviewing" that helped children being interviewed by the police to recall information more accurately. - Validity of abuse confessions given whilst undertaking therapy. - Ethical issues relating to the use of polygraph tests when managing, supervising and treating offenders. - Police interview techniques. In 1991 he was commissioned by the Home Office (together with a Law Professor) to write the first working draft of the Memorandum of Good Practice on Video Recorded Interviews with Child Witnesses for Criminal Proceedings. He was part of the small team commissioned by the Home Office in 2000 to write the 2002 government document Achieving Best Evidence in Criminal Proceedings: Guidance for Vulnerable or Intimidated Witnesses, Including Children (ABE) He has advised a large number of police forces in several countries on the interviewing of witnesses and of suspects, and he has testified as an Expert Witness in a number of trials. In 2005 he received a Commendation from the London Metropolitan Police for "Innovation and professionalism whilst assisting a complex rape investigation". Professor Bull said; '"I am honoured to receive this prestigious award. Since 1971 I have conducted research (often with talented, younger collaborators) on investigative interviewing, witness memory, and policing which has led to improvements in professional practice and thus in the administration of justice. This award recognises the great importance of such work.' British Psychological Society
Obsessive-Compulsive Disorder in Children
OCD in Children
What Is Life Like For Children Who Have OCD?
OCD can make daily life very difficult and stressful for children. OCD symptoms often take up a great deal of a child's time and energy. This makes it difficult to complete tasks such as homework or household chores. Children worry that they are "crazy" because they are aware their thinking is different than their friends and family. A child's self-esteem can be negatively affected because the OCD has led to embarrassment or has made the child feel "bizarre" or "out of control."
Mornings And Evenings Can Be Especially Difficult For Children With OCD
In the morning, they feel they must do their rituals right, or the rest of the day will not go well. Meanwhile, they are rushed to be on time for school. This combination of factors leads to feeling pressured, stressed, and irritable. In the evenings, they feel compelled to finish all of their compulsive rituals before they go to bed. They know they must get their homework done and take care of any household chores and responsibilities. Some children stay up late because of their OCD, and are often exhausted the following day.
Children with OCD frequently don't feel well physically. This may be due to the stress of having the disorder, or it may be poor nutrition or the loss of sleep. Obsessions and compulsions related to food are common, and these can lead to irregular or "quirky" eating habits. Many children with OCD are prone to stress-related ailments such as headache, or an upset stomach.
Children with OCD have episodes in which they are extremely angry with their parents. This is because the parents have become unwilling (or are unable!) to comply with the child's OCD-related demands. For example, children with obsessions about germs may insist that they be allowed to shower for hours, or demand that their clothes be washed numerous times or a particular way. Even when parents set reasonable limits, children with OCD can become anxious and angry. However, this anger does not justify physical or verbal abuse between parent and child. If violence or abuse occurs within the home, it should not be tolerated. Professional help should be sought.
Friendships and peer relationships are stressful for those with OCD because they try hard to conceal their rituals from peers. When the disorder is severe, this becomes impossible, and the child may get teased or ridiculed. Even when the OCD is not severe, it affects friendships because of the time spent preoccupied with obsessions and compulsions, or because friends react negatively to unusual OCD-related behaviors.
Children with OCD appear more likely to have additional psychiatric problems than those who do not have the disorder. Comorbidity means having two (or more) separate psychiatric diagnoses at the same time. Below is a list of psychiatric conditions that frequently occur along with OCD:
Additional anxiety disorders (such as panic disorder or social phobia)
Depression/dysthymia
Disruptive behavior disorders (such as oppositional defiant disorder, or attention-deficit hyperactivity disorder)
Learning disorders
Tic disorders/Tourette's syndrome
Trichotillomania (hair pulling)
Body dysmorphic disorder (imagined ugliness) Sometimes comorbid disorders can be treated with the same medication prescribed to treat the OCD. Depression, additional anxiety disorders, and trichotillomania may improve when a child takes anti-OCD medication.
On the other hand, ADHD, tic disorders, and disruptive behavior disorders usually require additional treatments, including medications that are not specific to OCD. A booklet of this size cannot address all the possible comorbid conditions a child with OCD could have, nor all the possible medication approaches used for these comorbid disorders.
In general, using the smallest amount of medication effective in controlling symptoms, starting low and going slow are common sense approaches. In unusually complicated situations, or in situations where the OCD appears resistant to drug treatment, a consultation with an expert in the area of childhood OCD is warranted.
What Are The Chances That My Child Will Inherit OCD?
OCD often runs in families. However, it appears that genes are only partially responsible for causing the disorder. If the development of OCD were completely determined by genetics, pairs of identical twins would both have the disorder, or both not have it. For example, eye color is entirely determined by genes and identical twins always have the same color eyes. If one identical twin has the disorder, there is a 13 percent chance that the other twin will not be affected. This supports the idea that genes are only part of the cause of OCD. Other factors are also important. No one really knows what that other factor might be, although some have suggested that it may be a viral infection that occurs at a critical point in a child's development, or perhaps an exposure to an environmental toxin.
Some experts speculate that there may be different types of OCD. Some types are inherited while other types are not. There is evidence that OCD that begins in childhood may be different from OCD that begins in adulthood. Individuals with childhood-onset OCD appear more likely to have blood relatives that are affected with the disorder than are those whose OCD first appears when they are adults.
If a parent is affected with OCD we can estimate how likely it will be that their child will also have the disorder. If one parent has OCD, the likelihood the child will be affected is about 2 to 8 percent. It is important to remember that this statistic is an approximation. Several other factors should be considered when attempting to estimate the risk of a child developing OCD. One factor is whether or not the parents themselves have a family history of OCD. If a parent who has OCD has blood relatives with the disorder, the risk for the child increases. Conversely, if a parent has OCD but none of their blood relatives are affected, then the risk decreases. Another factor is whether the parent has OCD that began when they were an adult or began when they were a child. If the parent's OCD did not start until adulthood, there is probably a decreased likelihood that his or her offspring will be affected. Conversely, if the parent's OCD is the "variety" that starts in childhood, the chances of passing the disorder on are increased.
Another factor is the family history of tic disorders (such as Tourette's syndrome) or other anxiety disorders. If a child has parents or other blood relatives with tic disorders or anxiety disorders, then the child is probably at increased risk for OCD. Besides, having blood relatives with OCD means that not only does the child have increased risk for OCD, but may also have an increased risk for developing a different anxiety disorder or a tic disorder. In summary, having blood relatives with OCD, anxiety disorders, and tic disorders all increase a child's risk of developing any of these same disorders.
As the above information indicates, it is difficult to estimate the chances that a parent will pass OCD on genetically to their child. This is an area of active research, and new developments appear frequently. Prospective parents may wish to consult with a genetics counselor prior to attempting to conceive a child. This can help assure that they have the most up-to-date information available.
Acknowledgment
This information was compiled by J. Jay Fruehling, M.A. Information Specialist and The Child Psychopharmacology Information Service University of Wisconsin-Madison, Department of Psychiatry [www.psychiatry.wisc.edu] and was edited by Hugh F. Johnston, M.D., University of Wisconsin, Madison and John S. March, M.D., Duke University, Durham, North Carolina and was funded in part by donations from the Daphne Seybold Culpepper Memorial Fund, Ticking Hearts, Mr. and Mrs. Irwin Lancer, The Andrade family, Meryl and Christoper Lewis, Annoymous, Robert Selig, and Stephen Josephson, Ph.D.
This information was commissioned by the Obsessive-Compulsive Foundation (OCF) as a service for children with Obsessive-Compulsive Disorder (OCD) and for those who care for them. Its purpose is to provide concise information about the drug treatment of childhoodOCD, and to deliver answers to many of the frequently asked questions about this treatment.
The views expressed represent the opinions of the author They are based on the medical literature as well as the clinical experience of Drs. March and Johnston. Each child is unique and because OCD can manifest itself in many different ways, it is difficult to make blanket recommendations regarding the medication treatment of childhood OCD.
Because of this, the goal of this information is to provide drug treatment information and recommendations, but it is not a blueprint for treatment. This information is best utilized in fostering effective communication and collaboration with a doctor familiar with the diagnosis and treatment of childhood OCD.
What Is Obsessive-Compulsive Disorder?
About OCD
What is OCD?
If you or someone you care about has been diagnosed with Obsessive-Compulsive Disorder (OCD), you may feel you are the only person facing the difficulties of this illness. But you are not alone. In the United States, 1 in 50 adults have OCD, and twice that many have had it at some point in their lives. Today very effective treatments for OCD are now available to help you regain a more satisfying life. Here are answers to the most commonly asked questions about OCD.
What Is Obsessive-Compulsive Disorder?
Worries, doubts, superstitious beliefs are common in everyday life. However, when they become so excessive such as hours of hand washing or driving around and around the block to check that an accident didn't occur then a diagnosis of OCD is made. In OCD, the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a case of mental hiccups that won't go away. OCD is a medical brain disorder that causes problems in information processing. It is not your fault or the result of a "weak" or unstable personality.
Before the arrival of modern medications and cognitive behavior therapy, OCD was generally thought to be untreatable. Most people with OCD continued to suffer, despite years of ineffective psychotherapy. Today, luckily, treatment can help most people with OCD. Although OCD is usually completely curable only in some individuals, most people achieve meaningful and long-term symptom relief with comprehensive treatment.
What are the symptoms of Obsessive-Compulsive Disorder?
OCD involves having both obsessions and compulsions. A person with OCD may sometimes have one or the other.
Common obsessions are: contamination fears of germs, dirt, etc. imagining having harmed self or others, imagining losing control or aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts A need to have things "just so" A need to tell, ask, confess common compulsions: washing repeating checking touching counting
OCD symptoms can occur in people of all ages. Not all Obsessive-Compulsive behaviors represent an illness. Some rituals (e.g., bedtime songs, religious practices) are a welcome part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as when someone in the family is sick or dying. Only when symptoms persist, make no sense, cause much distress, or interfere with functioning do they need clinical attention.
ObsessionsObsessions are thoughts, images, or impulses that occur over and over again and feel out of your control. The person does not want to have these ideas. He finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD worry excessively about dirt and germs and become obsessed with the idea that they are contaminated or contaminate others. They may have obsessive fears of having inadvertently harmed someone else even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just so."
CompulsionsPeople with OCD try to make their obsessions go away by performing compulsions. Compulsions are acts the person performs over and over again, often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.
Other features of Obsessive-Compulsive DisorderOCD symptoms cause distress, take up time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships. Most individuals with OCD recognize that their obsessions are coming from their own minds and are not just excessive worries about real problems. They realize that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.
When does Obsessive-Compulsive Disorder begin?
OCD starts at any time from preschool age to adulthood (usually by age 40). One third to one half of adults with OCD report that it started during childhood.
Unfortunately, OCD often goes unrecognized. On average, people with OCD see three to four doctors and spend 9 years seeking treatment before they receive a correct diagnosis. Studies find that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.
OCD tends to be underdiagnosed and undertreated for a number of reasons. People with OCD are secretive about their symptoms or lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Some people don't have access to treatment resources. This is unfortunate because earlier diagnosis and proper treatment, including finding the right medications, can help people avoid the suffering associated with OCD. This lessens the risk of developing other problems, such as depression, marital and work problems.
Is Obsessive-Compulsive Disorder Inherited?
No specific genes for OCD have been identified. Research suggests that genes do play a role in the development of the disorder. Childhood-onset OCD runs in families (sometimes in association with tic disorders). When a parent has OCD, there is a slightly increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the general nature of OCD is inherited, not specific symptoms. Thus a child may have checking rituals, while his mother washes compulsively.
What causes Obsessive-Compulsive Disorder?
There is no proven cause of OCD. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.
Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy. Although it seems clear that reduced levels of serotonin play a role in OCD, there are no laboratory tests for OCD. The diagnosis is made based on an assessment of the person's symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.
What other problems are sometimes confused with OCD?
Some disorders that closely resemble OCD and may respond to some of the same treatments. They are trichotillomania (compulsive hair pulling), body dysmorphic disorder (imagined ugliness), and habit disorders, such as nail biting or skin picking. While they share superficial similarities, impulse control problems, such as substance abuse, pathological gambling, or compulsive sexual activity, are probably not related to OCD in any substantial way.
The most common conditions that resemble OCD are the tic disorders (Tourette's disorder and other motor and vocal tic disorders). Tics are involuntary motor behaviors (such as facial grimacing) or vocal behaviors (such as snorting) that often occur in response to a feeling of discomfort. More complex tics, like touching or tapping tics, resemble compulsions. Tics and OCD occur together much more often when the OCD or tics begin during childhood.
Depression and OCD often occur in adults, and, less commonly, in children and adolescents. However, unless depression is present, people with OCD are not sad or lacking in pleasure. People who are depressed but do not have OCD rarely have the kinds of intrusive thoughts that are characteristic of OCD. Stress can make OCD worse. Although most people with OCD report that the symptoms can come and go on their own.
OCD is easy to distinguish from a condition called posttraumatic stress disorder, because OCD is not caused by a terrible event. Schizophrenia, delusional disorders, and other psychotic conditions are usually easy to distinguish from OCD. Unlike psychotic individuals, people with OCD have a clear idea of what is real and what is not. OCD may worsen or cause disruptive behaviors in children and adolescents, exaggerate a pre-existing learning disorder, cause problems with attention and concentration, or interfere with learning at school. In many children with OCD, these disruptive behaviors are related to the OCD and will go away when the OCD is successfully treated.
Individuals with OCD often have substance-abuse problems, as a result of attempts to self-medicate. Specific treatment for the substance abuse is usually needed. Children and adults with pervasive developmental disorders (autism, Asperger's Disorder) are extremely rigid and compulsive. They have stereotyped behaviors that often resembles very severe OCD. Those with pervasive developmental disorders have extremely severe problems relating to and communicating with other people, which do not occur in OCD.
Only a small number of those with OCD have the collection of personality traits called Obsessive Compulsive Personality Disorder (OCPD). Despite its similar name, OCPD does not involve obsessions and compulsions, but rather is a personality pattern that involves a preoccupation with rules, schedules, and lists; perfectionism; an excessive devotion to work; rigidity; and inflexibility. However, when people have both OCPD and OCD, the successful treatment of the OCD often causes a favorable change in the person's personality.
What is OCD?
If you or someone you care about has been diagnosed with Obsessive-Compulsive Disorder (OCD), you may feel you are the only person facing the difficulties of this illness. But you are not alone. In the United States, 1 in 50 adults have OCD, and twice that many have had it at some point in their lives. Today very effective treatments for OCD are now available to help you regain a more satisfying life. Here are answers to the most commonly asked questions about OCD.
What Is Obsessive-Compulsive Disorder?
Worries, doubts, superstitious beliefs are common in everyday life. However, when they become so excessive such as hours of hand washing or driving around and around the block to check that an accident didn't occur then a diagnosis of OCD is made. In OCD, the brain gets stuck on a particular thought or urge and just can't let go. People with OCD often say the symptoms feel like a case of mental hiccups that won't go away. OCD is a medical brain disorder that causes problems in information processing. It is not your fault or the result of a "weak" or unstable personality.
Before the arrival of modern medications and cognitive behavior therapy, OCD was generally thought to be untreatable. Most people with OCD continued to suffer, despite years of ineffective psychotherapy. Today, luckily, treatment can help most people with OCD. Although OCD is usually completely curable only in some individuals, most people achieve meaningful and long-term symptom relief with comprehensive treatment.
What are the symptoms of Obsessive-Compulsive Disorder?
OCD involves having both obsessions and compulsions. A person with OCD may sometimes have one or the other.
Common obsessions are: contamination fears of germs, dirt, etc. imagining having harmed self or others, imagining losing control or aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, forbidden thoughts A need to have things "just so" A need to tell, ask, confess common compulsions: washing repeating checking touching counting
OCD symptoms can occur in people of all ages. Not all Obsessive-Compulsive behaviors represent an illness. Some rituals (e.g., bedtime songs, religious practices) are a welcome part of daily life. Normal worries, such as contamination fears, may increase during times of stress, such as when someone in the family is sick or dying. Only when symptoms persist, make no sense, cause much distress, or interfere with functioning do they need clinical attention.
ObsessionsObsessions are thoughts, images, or impulses that occur over and over again and feel out of your control. The person does not want to have these ideas. He finds them disturbing and intrusive, and usually recognizes that they don't really make sense. People with OCD worry excessively about dirt and germs and become obsessed with the idea that they are contaminated or contaminate others. They may have obsessive fears of having inadvertently harmed someone else even though they usually know this is not realistic. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust, doubt, or a sensation that things have to be done in a way that is "just so."
CompulsionsPeople with OCD try to make their obsessions go away by performing compulsions. Compulsions are acts the person performs over and over again, often according to certain "rules." People with an obsession about contamination may wash constantly to the point that their hands become raw and inflamed. A person may repeatedly check that she has turned off the stove or iron because of an obsessive fear of burning the house down. She may have to count certain objects over and over because of an obsession about losing them. Unlike compulsive drinking or gambling, OCD compulsions do not give the person pleasure. Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions.
Other features of Obsessive-Compulsive DisorderOCD symptoms cause distress, take up time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships. Most individuals with OCD recognize that their obsessions are coming from their own minds and are not just excessive worries about real problems. They realize that the compulsions they perform are excessive or unreasonable. When someone with OCD does not recognize that their beliefs and actions are unreasonable, this is called OCD with poor insight. OCD symptoms tend to wax and wane over time. Some may be little more than background noise; others may produce extremely severe distress.
When does Obsessive-Compulsive Disorder begin?
OCD starts at any time from preschool age to adulthood (usually by age 40). One third to one half of adults with OCD report that it started during childhood.
Unfortunately, OCD often goes unrecognized. On average, people with OCD see three to four doctors and spend 9 years seeking treatment before they receive a correct diagnosis. Studies find that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment.
OCD tends to be underdiagnosed and undertreated for a number of reasons. People with OCD are secretive about their symptoms or lack insight about their illness. Many healthcare providers are not familiar with the symptoms or are not trained in providing the appropriate treatments. Some people don't have access to treatment resources. This is unfortunate because earlier diagnosis and proper treatment, including finding the right medications, can help people avoid the suffering associated with OCD. This lessens the risk of developing other problems, such as depression, marital and work problems.
Is Obsessive-Compulsive Disorder Inherited?
No specific genes for OCD have been identified. Research suggests that genes do play a role in the development of the disorder. Childhood-onset OCD runs in families (sometimes in association with tic disorders). When a parent has OCD, there is a slightly increased risk that a child will develop OCD, although the risk is still low. When OCD runs in families, it is the general nature of OCD is inherited, not specific symptoms. Thus a child may have checking rituals, while his mother washes compulsively.
What causes Obsessive-Compulsive Disorder?
There is no proven cause of OCD. Research suggests that OCD involves problems in communication between the front part of the brain (the orbital cortex) and deeper structures (the basal ganglia). These brain structures use the chemical messenger serotonin. It is believed that insufficient levels of serotonin are involved in OCD. Drugs that increase the brain concentration of serotonin often help improve OCD symptoms.
Pictures of the brain at work also show that the brain circuits involved in OCD return toward normal in those who improve after taking a serotonin medication or receiving cognitive-behavioral psychotherapy. Although it seems clear that reduced levels of serotonin play a role in OCD, there are no laboratory tests for OCD. The diagnosis is made based on an assessment of the person's symptoms. When OCD starts suddenly in childhood in association with strep throat, an autoimmune mechanism may be involved, and treatment with an antibiotic may prove helpful.
What other problems are sometimes confused with OCD?
Some disorders that closely resemble OCD and may respond to some of the same treatments. They are trichotillomania (compulsive hair pulling), body dysmorphic disorder (imagined ugliness), and habit disorders, such as nail biting or skin picking. While they share superficial similarities, impulse control problems, such as substance abuse, pathological gambling, or compulsive sexual activity, are probably not related to OCD in any substantial way.
The most common conditions that resemble OCD are the tic disorders (Tourette's disorder and other motor and vocal tic disorders). Tics are involuntary motor behaviors (such as facial grimacing) or vocal behaviors (such as snorting) that often occur in response to a feeling of discomfort. More complex tics, like touching or tapping tics, resemble compulsions. Tics and OCD occur together much more often when the OCD or tics begin during childhood.
Depression and OCD often occur in adults, and, less commonly, in children and adolescents. However, unless depression is present, people with OCD are not sad or lacking in pleasure. People who are depressed but do not have OCD rarely have the kinds of intrusive thoughts that are characteristic of OCD. Stress can make OCD worse. Although most people with OCD report that the symptoms can come and go on their own.
OCD is easy to distinguish from a condition called posttraumatic stress disorder, because OCD is not caused by a terrible event. Schizophrenia, delusional disorders, and other psychotic conditions are usually easy to distinguish from OCD. Unlike psychotic individuals, people with OCD have a clear idea of what is real and what is not. OCD may worsen or cause disruptive behaviors in children and adolescents, exaggerate a pre-existing learning disorder, cause problems with attention and concentration, or interfere with learning at school. In many children with OCD, these disruptive behaviors are related to the OCD and will go away when the OCD is successfully treated.
Individuals with OCD often have substance-abuse problems, as a result of attempts to self-medicate. Specific treatment for the substance abuse is usually needed. Children and adults with pervasive developmental disorders (autism, Asperger's Disorder) are extremely rigid and compulsive. They have stereotyped behaviors that often resembles very severe OCD. Those with pervasive developmental disorders have extremely severe problems relating to and communicating with other people, which do not occur in OCD.
Only a small number of those with OCD have the collection of personality traits called Obsessive Compulsive Personality Disorder (OCPD). Despite its similar name, OCPD does not involve obsessions and compulsions, but rather is a personality pattern that involves a preoccupation with rules, schedules, and lists; perfectionism; an excessive devotion to work; rigidity; and inflexibility. However, when people have both OCPD and OCD, the successful treatment of the OCD often causes a favorable change in the person's personality.
Obsessive-Compulsive Disorder
Definition
Obsessive-compulsive disorder (OCD) is a potentially disabling anxiety disorder. The person afflicted with OCD becomes trapped in a pattern of repetitive senseless thoughts and behaviors that are very difficult to overcome. A person's level of OCD can be anywhere from mild to severe, but if severe and left untreated, it can destroy a person's capacity to function at work, at school or even to lead a comfortable existence in the home.
For many years, mental health professionals thought of OCD as a rare disease because only a small minority of their patients admitted to having the condition. The disorder often went unrecognized because many of those afflicted with OCD, ashamed of their repetitive thoughts and behaviors, failed to seek treatment. This led to underestimates of the number of people with the illness. However, a survey conducted in the early 1980s by the National Institute of Mental Health (NIMH) provided new knowledge about the prevalence of OCD. The NIMH survey showed that OCD affects more than 2 percent of the population, meaning that OCD is more common than such severe mental illnesses as schizophrenia, bipolar disorder or panic disorder. OCD strikes people of all ethnic groups. Males and females are equally affected.
Although OCD symptoms typically begin during the teen years or early adulthood, research shows that some children may even develop the illness during preschool. Studies indicate that at least one-third of cases of adult OCD began in childhood. Suffering from OCD during early stages of a child's development can cause severe problems for the child. It is important that the child receive evaluation and treatment as soon as possible to prevent the child from missing important opportunities because of this disorder.
Symptoms
Obsessions
Unwanted repetitive ideas or impulses frequently well up in the mind of the person with OCD. Persistent paranoid fears, an unreasonable concern with becoming contaminated or an excessive need to do things perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." These thoughts are intrusive, unpleasant and produce a high degree of anxiety.
Compulsions
In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are checking and washing. Other compulsive behaviors include repeating, hoarding, rearranging, counting (often while performing another compulsive action such as lock-checking). Mentally repeating phrases, checking or list making are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals: Performing things the same way each time may give the person with OCD some relief from anxiety, but it is only temporary.
People with OCD show a range of insight into the uselessness of their obsessions. They can sometimes recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Most people with OCD struggle to banish their unwanted thoughts and compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are engaged at school or work. But over time, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives and make it impossible for them to have lives outside the home.
OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when the symptoms are mild, but for most individuals with OCD, the symptoms are chronic.
Causes
The old belief that OCD was the result of life experiences has become less valid with the growing focus on biological factors. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis. For that reason, OCD is no longer attributed only to attitudes a patient learned in childhood -- inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. The search for causes now focuses on the interaction of neurobiological factors and environmental influences, as well as cognitive processes.
OCD is sometimes accompanied by depression, eating disorders, substance abuse, a personality disorder, attention deficit disorder or another of the anxiety disorders. Coexisting disorders can make OCD more difficult both to diagnose and to treat. Symptoms of OCD are seen in association with some other neurological disorders. There is an increased rate of OCD in people with Tourette's syndrome, an illness characterized by involuntary movements and vocalizations. Investigators are currently studying the hypothesis that a genetic relationship exists between OCD and the tic disorders.
Other illnesses that may be linked to OCD are trichotillomania (the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair), body dysmorphic disorder (excessive preoccupation with imaginary or exaggerated defects in appearance) and hypochondriasis (the fear of having -- despite medical evaluation and reassurance -- a serious disease). Researchers are investigating the place of OCD within a spectrum of disorders that may share certain biological or psychological bases. It is currently unknown how closely related OCD is to other disorders such as trichotillomainia, body dysmorphic disorder and hypochondriasis.
There are also theories about OCD linking it to the interaction between behavior and the environment, which are not incompatible with biological explanations.
A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of people sometimes called "compulsive" for being perfectionists and highly organized. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.
Treatment
Clinical and animal research sponsored by NIMH and other scientific organizations has provided information leading to both pharmacological and behavioral treatments that can benefit the person with OCD. One patient may benefit significantly from behavior therapy, yet another will benefit from pharmacotherapy. And others may benefit best from both. Others may begin with medication to gain control over their symptoms and then continue with behavior therapy. Which therapy to use should be decided by the individual patient in consultation with his or her therapist.
Medication
Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. The first of these serotonin re-uptake inhibitors (SRIs) specifically approved for the use in the treatment of OCD was the tricyclic anti-depressant clomipramine (Anafranil). It was followed by other SRIs that are called "selective serotonin re-uptake inhibitors" (SSRIs). Those that have been approved by the Food and Drug Administration for the treatment of OCD are flouxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil). Another that has been studied in controlled clinical trials is sertraline (Zoloft).
Large studies have shown that more than three-quarters of patients are helped by these medications at least a little. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer. If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow.
Behavior Therapy
Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time the patient is strongly encouraged to refrain from ritualizing, with support and structure provided by the therapist, and possibly by others whom the patient recruits for assistance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, and then urged to avoid washing for several hours until the anxiety provoked has greatly decreased. Treatment then proceeds on a step-by-step basis, guided by the patient's ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.
Studies of behavior therapy for OCD find it to be a successful treatment for the majority of patients who complete it, and the positive effects endure once treatment has ended, if there are follow-up sessions and other relapse-prevention components. According to studies, more than 300 OCD patients who were treated by exposure and response prevention, an average of 76 percent showed lasting results from 3 months to 6 years after treatment.
One study provides new evidence that cognitive-behavioral therapy may prove an effective aid for those with OCD. This variant of behavior therapy emphasizes changing the OCD sufferer's beliefs and thinking patterns. Further studies are required before cognitive-behavioral therapy can be adequately evaluated.
Self-Care and Family Support
People with OCD will do best if they attend therapy, take all prescribed medications, seek support of family, friends, and a discussion group. When a family member suffers from obsessive-compulsive disorder it's helpful to be patient about their progress and acknowledge any successes, no matter how small.
Sources:
Diagnostic and Statistical Manual, Fourth Edition
National Institutes of Mental Health
National Library of Medicine
Obsessive-compulsive disorder (OCD) is a potentially disabling anxiety disorder. The person afflicted with OCD becomes trapped in a pattern of repetitive senseless thoughts and behaviors that are very difficult to overcome. A person's level of OCD can be anywhere from mild to severe, but if severe and left untreated, it can destroy a person's capacity to function at work, at school or even to lead a comfortable existence in the home.
For many years, mental health professionals thought of OCD as a rare disease because only a small minority of their patients admitted to having the condition. The disorder often went unrecognized because many of those afflicted with OCD, ashamed of their repetitive thoughts and behaviors, failed to seek treatment. This led to underestimates of the number of people with the illness. However, a survey conducted in the early 1980s by the National Institute of Mental Health (NIMH) provided new knowledge about the prevalence of OCD. The NIMH survey showed that OCD affects more than 2 percent of the population, meaning that OCD is more common than such severe mental illnesses as schizophrenia, bipolar disorder or panic disorder. OCD strikes people of all ethnic groups. Males and females are equally affected.
Although OCD symptoms typically begin during the teen years or early adulthood, research shows that some children may even develop the illness during preschool. Studies indicate that at least one-third of cases of adult OCD began in childhood. Suffering from OCD during early stages of a child's development can cause severe problems for the child. It is important that the child receive evaluation and treatment as soon as possible to prevent the child from missing important opportunities because of this disorder.
Symptoms
Obsessions
Unwanted repetitive ideas or impulses frequently well up in the mind of the person with OCD. Persistent paranoid fears, an unreasonable concern with becoming contaminated or an excessive need to do things perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." These thoughts are intrusive, unpleasant and produce a high degree of anxiety.
Compulsions
In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are checking and washing. Other compulsive behaviors include repeating, hoarding, rearranging, counting (often while performing another compulsive action such as lock-checking). Mentally repeating phrases, checking or list making are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals: Performing things the same way each time may give the person with OCD some relief from anxiety, but it is only temporary.
People with OCD show a range of insight into the uselessness of their obsessions. They can sometimes recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.
Most people with OCD struggle to banish their unwanted thoughts and compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are engaged at school or work. But over time, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives and make it impossible for them to have lives outside the home.
OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when the symptoms are mild, but for most individuals with OCD, the symptoms are chronic.
Causes
The old belief that OCD was the result of life experiences has become less valid with the growing focus on biological factors. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis. For that reason, OCD is no longer attributed only to attitudes a patient learned in childhood -- inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. The search for causes now focuses on the interaction of neurobiological factors and environmental influences, as well as cognitive processes.
OCD is sometimes accompanied by depression, eating disorders, substance abuse, a personality disorder, attention deficit disorder or another of the anxiety disorders. Coexisting disorders can make OCD more difficult both to diagnose and to treat. Symptoms of OCD are seen in association with some other neurological disorders. There is an increased rate of OCD in people with Tourette's syndrome, an illness characterized by involuntary movements and vocalizations. Investigators are currently studying the hypothesis that a genetic relationship exists between OCD and the tic disorders.
Other illnesses that may be linked to OCD are trichotillomania (the repeated urge to pull out scalp hair, eyelashes, eyebrows or other body hair), body dysmorphic disorder (excessive preoccupation with imaginary or exaggerated defects in appearance) and hypochondriasis (the fear of having -- despite medical evaluation and reassurance -- a serious disease). Researchers are investigating the place of OCD within a spectrum of disorders that may share certain biological or psychological bases. It is currently unknown how closely related OCD is to other disorders such as trichotillomainia, body dysmorphic disorder and hypochondriasis.
There are also theories about OCD linking it to the interaction between behavior and the environment, which are not incompatible with biological explanations.
A person with OCD has obsessive and compulsive behaviors that are extreme enough to interfere with everyday life. People with OCD should not be confused with a much larger group of people sometimes called "compulsive" for being perfectionists and highly organized. This type of "compulsiveness" often serves a valuable purpose, contributing to a person's self-esteem and success on the job. In that respect, it differs from the life-wrecking obsessions and rituals of the person with OCD.
Treatment
Clinical and animal research sponsored by NIMH and other scientific organizations has provided information leading to both pharmacological and behavioral treatments that can benefit the person with OCD. One patient may benefit significantly from behavior therapy, yet another will benefit from pharmacotherapy. And others may benefit best from both. Others may begin with medication to gain control over their symptoms and then continue with behavior therapy. Which therapy to use should be decided by the individual patient in consultation with his or her therapist.
Medication
Clinical trials in recent years have shown that drugs that affect the neurotransmitter serotonin can significantly decrease the symptoms of OCD. The first of these serotonin re-uptake inhibitors (SRIs) specifically approved for the use in the treatment of OCD was the tricyclic anti-depressant clomipramine (Anafranil). It was followed by other SRIs that are called "selective serotonin re-uptake inhibitors" (SSRIs). Those that have been approved by the Food and Drug Administration for the treatment of OCD are flouxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil). Another that has been studied in controlled clinical trials is sertraline (Zoloft).
Large studies have shown that more than three-quarters of patients are helped by these medications at least a little. And in more than half of patients, medications relieve symptoms of OCD by diminishing the frequency and intensity of the obsessions and compulsions. Improvement usually takes at least three weeks or longer. If a patient does not respond well to one of these medications, or has unacceptable side effects, another SRI may give a better response. For patients who are only partially responsive to these medications, research is being conducted on the use of an SRI as the primary medication and one of a variety of medications as an additional drug (an augmenter). Medications are of help in controlling the symptoms of OCD, but often, if the medication is discontinued, relapse will follow.
Behavior Therapy
Traditional psychotherapy, aimed at helping the patient develop insight into his or her problem, is generally not helpful for OCD. However, a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. At the same time the patient is strongly encouraged to refrain from ritualizing, with support and structure provided by the therapist, and possibly by others whom the patient recruits for assistance. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, and then urged to avoid washing for several hours until the anxiety provoked has greatly decreased. Treatment then proceeds on a step-by-step basis, guided by the patient's ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.
Studies of behavior therapy for OCD find it to be a successful treatment for the majority of patients who complete it, and the positive effects endure once treatment has ended, if there are follow-up sessions and other relapse-prevention components. According to studies, more than 300 OCD patients who were treated by exposure and response prevention, an average of 76 percent showed lasting results from 3 months to 6 years after treatment.
One study provides new evidence that cognitive-behavioral therapy may prove an effective aid for those with OCD. This variant of behavior therapy emphasizes changing the OCD sufferer's beliefs and thinking patterns. Further studies are required before cognitive-behavioral therapy can be adequately evaluated.
Self-Care and Family Support
People with OCD will do best if they attend therapy, take all prescribed medications, seek support of family, friends, and a discussion group. When a family member suffers from obsessive-compulsive disorder it's helpful to be patient about their progress and acknowledge any successes, no matter how small.
Sources:
Diagnostic and Statistical Manual, Fourth Edition
National Institutes of Mental Health
National Library of Medicine
Mental Retardation
Definition
Mental Retardation (MR) refers to below-average general intellectual functioning with associated deficits in adaptive behavior that occurs before age 18. Onset usually occurs in infancy or prior to birth. When onset occurs at age 18 or after, it is called dementia, which can coexist with an MR diagnosis. Intelligence level as determined by individual standard assessment is below 70, and the ability to adapt to the demands of normal life is impaired. This is important because it distinguishes a diagnosis of MR from individuals with low IQ scores who are able to adapt to the demands of everyday life. Education, job training, support from family, and individual characteristics such as motivation and personality can all contribute to the ability of individuals with MR to adapt.
Other behavioral traits associated with MR (but not deemed criteria for an MR diagnosis) include aggression, dependency, impulsivity, passivity, self-injury, stubbornness, low self-esteem, and low frustration tolerance. Some may also exhibit mood disorders such as psychotic disorders and attention difficulties, though others are pleasant, otherwise healthy individuals. Sometimes physical traits, like shortness in stature and malformation of facial elements, can set individuals with MR apart, while others may have a normal appearance.
Mental retardation affects about 1 percent to 3 percent of the population.
Symptoms
Failure to meet intellectual developmental markers
Persistence of infantile behavior
Lack of curiosity
Decreased learning ability
Inability to meet educational demands of school
Deviations in normal adaptive behaviors depend on the severity of the condition. Mild retardation may be associated with a lack of curiosity and quiet behavior. Severe mental retardation is associated with infantile behavior throughout life.
Causes
Causes of mental retardation are numerous, but a specific reason for mental retardation is determined in only 25 percent of cases.
Failure to adapt normally and grow intellectually may become apparent early in life or, in the case of mild retardation, may not become recognizable until school age or later. An assessment of age-appropriate adaptive behaviors can be made by the use of developmental screening tests. The failure to achieve developmental milestones is suggestive of mental retardation.
A family may suspect mental retardation if motor skills, language skills, and self-help skills do not seem to be developing in a child or are developing far more slowly than among the child's peers.
The degree of impairment from mental retardation ranges widely, from profound impairment to mild or borderline retardation. Less emphasis is now placed on degree of retardation and more on the amount of intervention and care required for daily life.
Causes of mental retardation can be roughly broken down into several categories:
unexplained (the largest category)
trauma (prenatal and postnatal)
infection (congenital and postnatal)
chromosomal and genetic abnormalities
metabolic disorders
toxins
nutritional deficits
environment
Treatment
The primary goal of treatment is to develop the person's potential to the fullest. Special education and training may begin as early as infancy. Attention is given to social skills to help the person function as normally as possible.
It is important for a specialist to evaluate the person for coexisting affective disorders that may require treatment. Behavioral approaches are important in understanding and working with mentally retarded individuals.
Sources:
National Institutes of Health
National Library of Medicine
Mental Retardation (MR) refers to below-average general intellectual functioning with associated deficits in adaptive behavior that occurs before age 18. Onset usually occurs in infancy or prior to birth. When onset occurs at age 18 or after, it is called dementia, which can coexist with an MR diagnosis. Intelligence level as determined by individual standard assessment is below 70, and the ability to adapt to the demands of normal life is impaired. This is important because it distinguishes a diagnosis of MR from individuals with low IQ scores who are able to adapt to the demands of everyday life. Education, job training, support from family, and individual characteristics such as motivation and personality can all contribute to the ability of individuals with MR to adapt.
Other behavioral traits associated with MR (but not deemed criteria for an MR diagnosis) include aggression, dependency, impulsivity, passivity, self-injury, stubbornness, low self-esteem, and low frustration tolerance. Some may also exhibit mood disorders such as psychotic disorders and attention difficulties, though others are pleasant, otherwise healthy individuals. Sometimes physical traits, like shortness in stature and malformation of facial elements, can set individuals with MR apart, while others may have a normal appearance.
Mental retardation affects about 1 percent to 3 percent of the population.
Symptoms
Failure to meet intellectual developmental markers
Persistence of infantile behavior
Lack of curiosity
Decreased learning ability
Inability to meet educational demands of school
Deviations in normal adaptive behaviors depend on the severity of the condition. Mild retardation may be associated with a lack of curiosity and quiet behavior. Severe mental retardation is associated with infantile behavior throughout life.
Causes
Causes of mental retardation are numerous, but a specific reason for mental retardation is determined in only 25 percent of cases.
Failure to adapt normally and grow intellectually may become apparent early in life or, in the case of mild retardation, may not become recognizable until school age or later. An assessment of age-appropriate adaptive behaviors can be made by the use of developmental screening tests. The failure to achieve developmental milestones is suggestive of mental retardation.
A family may suspect mental retardation if motor skills, language skills, and self-help skills do not seem to be developing in a child or are developing far more slowly than among the child's peers.
The degree of impairment from mental retardation ranges widely, from profound impairment to mild or borderline retardation. Less emphasis is now placed on degree of retardation and more on the amount of intervention and care required for daily life.
Causes of mental retardation can be roughly broken down into several categories:
unexplained (the largest category)
trauma (prenatal and postnatal)
infection (congenital and postnatal)
chromosomal and genetic abnormalities
metabolic disorders
toxins
nutritional deficits
environment
Treatment
The primary goal of treatment is to develop the person's potential to the fullest. Special education and training may begin as early as infancy. Attention is given to social skills to help the person function as normally as possible.
It is important for a specialist to evaluate the person for coexisting affective disorders that may require treatment. Behavioral approaches are important in understanding and working with mentally retarded individuals.
Sources:
National Institutes of Health
National Library of Medicine
Delirium
Definition
A condition of severe confusion and rapid changes in brain function, usually the result of treatable physical or mental illness. It may also be referred to as acute confusional state or acute brain syndrome.
Delirium involves a rapid alternation between mental states (for example, from lethargy to agitation and back to lethargy), with attention disruption, disorganized thinking, disorientation, changes in sensation and perception and other symptoms.
Symptoms
Attention disturbance
Inability to maintain goal-directed thinking
Inability to concentrate
Disorganized thinking
Incoherent speech
Inability to stop speech patterns or behaviors
Disorientation to time or place
Changes in sensation and perception
Illusions or hallucinations
Altered level of consciousness or awareness
Altered sleep patterns, drowsiness
Alertness may vary
Decrease in short-term memory and recall
Unable to recollect events since the onset of delirium or past events
Changes in motor activities, movement
Movements triggered by changes in the nervous system
Anxiety
Anger
Apathy
Depression
Euphoria
Irritability
Complications
Inability to function or care for self
Loss of ability to interact
Stupor or coma
Side effects from the medications used to treat the disorder
Other complications vary, depending on the causative disorder
Causes
Acute confusional states are usually the result of a physical or mental illness and are usually temporary and reversible.
Disorders that cause delirium are numerous and varied. They may include conditions that deprive the brain of oxygen or other substances. Delirium may be caused by diseases of body systems other than the brain, by poisons, by fluid/electrolyte or acid/base disturbances and by other serious, acute conditions.
Neurologic examination may reveal abnormalities, including atypical reflexes and unusual levels of normal reflexes. Psychologic studies and tests of sensation, cognitive function and motor function may be abnormal.
Treatment
The goal of treatment is to control or reverse symptoms. Treatment varies with the specific condition causing delirium. The person should be in a pleasant, comfortable, nonthreatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time.
The cause should be identified and treated.
Stopping or changing medications that worsen confusion, or that are not essential to the care of the person, may improve cognitive functioning even before treatment of the underlying disorder. Medications that may exacerbate confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine and other medications.
Disorders that contribute to confusion should be treated. These may include heart failure, decreased oxygen (hypoxia), excessive carbon dioxide levels (hypercapnia), thyroid disorders, anemia, nutritional disorders, infections, kidney failure, liver failure and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning.
Medications may be required to control aggressive or agitated behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required.
Medications that may be considered for use include:
Thiamine, sedating medications such as clonazepam or diazepam, serotonin-affecting drugs (trazodone, buspirone), dopamine blockers (such as haloperidol, olanzapine, risperidol, clozapine) and fluoxetine, imipramine, celexa (may help stabilize mood).
Formal psychiatric treatment may be necessary. Behavior modification might be helpful for some people to control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.
Acute disorders that cause delirium may coexist with chronic disorders that cause dementia. Acute brain syndromes are potentially reversible with treatment of the underlying cause. Delirium often lasts only about one week, although it may take several weeks for cognitive function to return to normal levels. Full recovery is common.
Source: National Institutes of Health
A condition of severe confusion and rapid changes in brain function, usually the result of treatable physical or mental illness. It may also be referred to as acute confusional state or acute brain syndrome.
Delirium involves a rapid alternation between mental states (for example, from lethargy to agitation and back to lethargy), with attention disruption, disorganized thinking, disorientation, changes in sensation and perception and other symptoms.
Symptoms
Attention disturbance
Inability to maintain goal-directed thinking
Inability to concentrate
Disorganized thinking
Incoherent speech
Inability to stop speech patterns or behaviors
Disorientation to time or place
Changes in sensation and perception
Illusions or hallucinations
Altered level of consciousness or awareness
Altered sleep patterns, drowsiness
Alertness may vary
Decrease in short-term memory and recall
Unable to recollect events since the onset of delirium or past events
Changes in motor activities, movement
Movements triggered by changes in the nervous system
Anxiety
Anger
Apathy
Depression
Euphoria
Irritability
Complications
Inability to function or care for self
Loss of ability to interact
Stupor or coma
Side effects from the medications used to treat the disorder
Other complications vary, depending on the causative disorder
Causes
Acute confusional states are usually the result of a physical or mental illness and are usually temporary and reversible.
Disorders that cause delirium are numerous and varied. They may include conditions that deprive the brain of oxygen or other substances. Delirium may be caused by diseases of body systems other than the brain, by poisons, by fluid/electrolyte or acid/base disturbances and by other serious, acute conditions.
Neurologic examination may reveal abnormalities, including atypical reflexes and unusual levels of normal reflexes. Psychologic studies and tests of sensation, cognitive function and motor function may be abnormal.
Treatment
The goal of treatment is to control or reverse symptoms. Treatment varies with the specific condition causing delirium. The person should be in a pleasant, comfortable, nonthreatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time.
The cause should be identified and treated.
Stopping or changing medications that worsen confusion, or that are not essential to the care of the person, may improve cognitive functioning even before treatment of the underlying disorder. Medications that may exacerbate confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine and other medications.
Disorders that contribute to confusion should be treated. These may include heart failure, decreased oxygen (hypoxia), excessive carbon dioxide levels (hypercapnia), thyroid disorders, anemia, nutritional disorders, infections, kidney failure, liver failure and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning.
Medications may be required to control aggressive or agitated behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required.
Medications that may be considered for use include:
Thiamine, sedating medications such as clonazepam or diazepam, serotonin-affecting drugs (trazodone, buspirone), dopamine blockers (such as haloperidol, olanzapine, risperidol, clozapine) and fluoxetine, imipramine, celexa (may help stabilize mood).
Formal psychiatric treatment may be necessary. Behavior modification might be helpful for some people to control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.
Acute disorders that cause delirium may coexist with chronic disorders that cause dementia. Acute brain syndromes are potentially reversible with treatment of the underlying cause. Delirium often lasts only about one week, although it may take several weeks for cognitive function to return to normal levels. Full recovery is common.
Source: National Institutes of Health
Toilet Training Your Child
When should I start toilet training my child?
Do not start toilet training until both you and your child are ready. You are ready when you are able to devote the time and energy necessary to encourage your child on a daily basis for at least 3 months.Your child is ready when he or she can signal that the diaper is wet or soiled, or when your child is able to say that he or she would like to go to the potty. This usually occurs when a child is 18 to 24 months of age. However, it is not uncommon for a child to still be in diapers at 2 and a half to 3 years of age.
How should I prepare my child for toilet training?
Allow your child to be present when you go to the bathroom and make your child feel comfortable in the bathroom. Allow your child to see urine and bowel movements in the toilet. Let your child play with flushing the toilet.Before toilet training your child, place a potty chair in your child's normal living and play area so that your child will become familiar with the potty. Consider placing a potty chair on each floor of the house if you live in a multilevel home. Allow your child to observe, touch and become familiar with the potty chair.Tell your child that the potty chair is his or her own chair. Allow your child to sit fully clothed on the potty chair, as if it were a regular chair. Allow your child to leave the potty chair at any time. Do not force your child to spend time sitting on the chair.After your child has become used to the potty chair and sits on it regularly with his or her clothes on, try having your child sit on the potty without wearing pants and a diaper. Let your child become comfortable with sitting on the potty without wearing pants and a diaper.The next step is to show your child how the potty chair is used. Place stool from a dirty diaper into the potty chair. Allow your child to observe the transfer of the bowel movement from the potty chair into the toilet. Let your child flush the toilet and watch the bowel movement disappear down the toilet.
How do I teach my child to use the toilet?
After your child has become comfortable with flushing the toilet and sitting on the potty chair, you may begin teaching your child to go to the bathroom. Keep your child in loose, easily removable pants.Place your child on the potty chair whenever he or she signals the need to go to the bathroom. Your child's facial expression may change when he or she feels the need to urinate or to have a bowel movement. Your child may stop any activity he or she is engaged in when he or she feels the need to go to the bathroom.Most children have a bowel movement once a day, usually within an hour after eating. Most children urinate within an hour after having a large drink.In addition to watching for signals that your child needs to urinate or have a bowel movement, place your child on the potty at regular intervals. This may be as often as every 1and a half to 2 hours.Stay with your child when he or she is on the potty chair. Reading or talking to your child when he or she is sitting on the potty may help your child relax. Praise your child when he or she goes to the bathroom in the potty chair, but do not express disappointment if your child does not urinate or have a bowel movement in the potty. Be patient with your child.Once your child has learned to use the potty chair, your child can begin using an over-the-toilet seat and a step-up stool.
Do not start toilet training until both you and your child are ready. You are ready when you are able to devote the time and energy necessary to encourage your child on a daily basis for at least 3 months.Your child is ready when he or she can signal that the diaper is wet or soiled, or when your child is able to say that he or she would like to go to the potty. This usually occurs when a child is 18 to 24 months of age. However, it is not uncommon for a child to still be in diapers at 2 and a half to 3 years of age.
How should I prepare my child for toilet training?
Allow your child to be present when you go to the bathroom and make your child feel comfortable in the bathroom. Allow your child to see urine and bowel movements in the toilet. Let your child play with flushing the toilet.Before toilet training your child, place a potty chair in your child's normal living and play area so that your child will become familiar with the potty. Consider placing a potty chair on each floor of the house if you live in a multilevel home. Allow your child to observe, touch and become familiar with the potty chair.Tell your child that the potty chair is his or her own chair. Allow your child to sit fully clothed on the potty chair, as if it were a regular chair. Allow your child to leave the potty chair at any time. Do not force your child to spend time sitting on the chair.After your child has become used to the potty chair and sits on it regularly with his or her clothes on, try having your child sit on the potty without wearing pants and a diaper. Let your child become comfortable with sitting on the potty without wearing pants and a diaper.The next step is to show your child how the potty chair is used. Place stool from a dirty diaper into the potty chair. Allow your child to observe the transfer of the bowel movement from the potty chair into the toilet. Let your child flush the toilet and watch the bowel movement disappear down the toilet.
How do I teach my child to use the toilet?
After your child has become comfortable with flushing the toilet and sitting on the potty chair, you may begin teaching your child to go to the bathroom. Keep your child in loose, easily removable pants.Place your child on the potty chair whenever he or she signals the need to go to the bathroom. Your child's facial expression may change when he or she feels the need to urinate or to have a bowel movement. Your child may stop any activity he or she is engaged in when he or she feels the need to go to the bathroom.Most children have a bowel movement once a day, usually within an hour after eating. Most children urinate within an hour after having a large drink.In addition to watching for signals that your child needs to urinate or have a bowel movement, place your child on the potty at regular intervals. This may be as often as every 1and a half to 2 hours.Stay with your child when he or she is on the potty chair. Reading or talking to your child when he or she is sitting on the potty may help your child relax. Praise your child when he or she goes to the bathroom in the potty chair, but do not express disappointment if your child does not urinate or have a bowel movement in the potty. Be patient with your child.Once your child has learned to use the potty chair, your child can begin using an over-the-toilet seat and a step-up stool.
Enuresis (Bed-Wetting)
What is enuresis?
Enuresis (say "en-yur-ee-sis") is the medical term for bed-wetting during sleep. Bed-wetting is fairly common. About 5 million to 7 million children wet the bed. It's more common among boys than girls.
What causes bed-wetting?
Some of the causes of bed-wetting include the following:
Genetic factors (it tends to run in families)
Difficulties waking up from sleep
Slower than normal development of the central nervous system--this reduces the child's ability to stop the bladder from emptying at night
Hormonal factors (not enough antidiuretic hormone--this hormone reduces the amount of urine made by the kidneys)
Urinary tract infections
Abnormalities in the urethral valves in boys or in the ureter in girls or boys
Abnormalities in the spinal cord
Inability to hold urine for a long time because of small bladder
Bed-wetting isn't caused by drinking too much before bedtime. It's not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom. And children do not wet the bed on purpose or to irritate their parents.
When do most children achieve bladder control?
Children achieve bladder control at different ages. By the age of 5 years, most children no longer urinate in their sleep. Bed-wetting up to the age of 5 is not unusual, even though it may be frustrating to parents. Treating a child for bed-wetting before the age of 5 is not necessary and may even be harmful to the child.
How can my family doctor help?
First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis). Although most children who wet the bed are healthy, your doctor will also check for problems in the urinary tract and the bladder.The doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will ask about your family life, because treatment may depend on changes at home.
What are the treatments for bed-wetting?
Most children outgrow bed-wetting without treatment. However, you and your doctor may decide your child needs treatment. There are 2 kinds of treatment: behavior therapy and medicine. Behavior therapy helps teach your child not to wet the bed. Some behavioral treatments include the following:
An alarm system that rings when the bed gets wet and teaches the child to respond to bladder sensations at night.
A reward system for dry nights.
Asking your child to change the bed sheets when he or she wets.
Bladder training: having your child practice holding his or her urine for longer and longer times.
What kinds of medicines are used to treat bed-wetting?
Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy hasn't worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects.
How can I help my child not feel so bad about wetting the bed?
Bed-wetting can lead to behavior problems because of the guilt and embarrassment a child feels. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn't be made to feel guilty about something he or she can't control. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem.It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child).
6/26/2008
Turner Syndrome
Turner syndrome is a medical disorder that affects about one in every 2,500 girls. Dr. Henry Turner, an endocrinologist, first described the condition in 1938, when he observed a set of common physical features in some of his female patients. It wasn't until 1960 that a chromosomal abnormality associated with the condition was actually described.
What Is Turner Syndrome?
Turner syndrome results from a chromosomal abnormality in which a female infant is born with only one X chromosome (instead of the usual two) or is missing part of one X chromosome. In most cases, untreated females with this disorder are typically short in stature (average final adult height is 4 feet 7 inches [140 centimeters]) and may have a variety of associated physical features and medical problems.
Because females with Turner syndrome (TS) don't have proper ovarian development, they usually don't develop all of the secondary sexual characteristics expected during adolescence and are infertile as adults. However, advances in medical technology, including hormonal therapy and in vitro fertilization, can help women with this condition.
Other health problems that may occur with Turner syndrome include kidney and heart abnormalities, high blood pressure, obesity, diabetes mellitus, cataracts, thyroid problems, and arthritis.
Girls with Turner syndrome usually have normal intelligence, but some may experience learning difficulties, particularly in mathematics. Many also have a problem with tasks requiring spatial skills, such as map reading or visual organization. Hearing problems are also more common in girls with Turner syndrome.
Although they aren't at increased risk for psychological problems, some girls do have problems with body image or self-esteem. Children with this disorder may also be hyperactive.
Despite the physical differences and other problems that can occur in Turner syndrome, with appropriate medical care, early intervention, and ongoing support, a person with Turner syndrome can lead a normal, healthy, and productive life.
How Is Turner Syndrome Diagnosed?
Upon physical examination, a doctor may note certain physical features of Turner syndrome, which may include:
short stature
"webbing" of the skin of the neck (extra folds of skin extending from the tops of the shoulders to the sides of the neck)
a low hairline at the back of the head
low-set ears
abnormal eye features, including drooping of the eyelids
abnormal bone development, especially the bones of the hands and elbows
a lack of breast development at the expected age (usually by age 13)
an absence of menstruation (amenorrhea)
a larger than usual number of moles on the skin
People who have Turner syndrome may vary widely in their characteristics or symptoms of the disorder. Some may have many features or symptoms, whereas others may experience only a few.
A special blood test that looks at a person's chromosomes - called a karyotype - is used to diagnose Turner syndrome. Several physical characteristics may be noted at birth, which can alert your child's doctor to the possibility of TS and cause him or her to order a karyotype. A karyotype test that indicates Turner syndrome reveals 45 chromosomes (only one X chromosome), instead of the normal 44 autosomes and 2 X chromosomes (XX) typically found in females. In some girls with TS, two X chromosomes are present, but one is misshapen or missing a piece.
Treating Turner Syndrome
Because Turner syndrome is a chromosomal disorder, there's no cure for the condition. However, there are a number of treatments that can help.
Growth hormone, either alone or with other hormone treatment, may improve growth and will usually increase final adult height - often into the normal range if treatment is started early enough. The U.S. Food and Drug Administration (FDA) has approved growth hormone for the treatment of Turner syndrome, and most insurance plans now cover this special treatment.
Estrogen replacement therapy is often started when the child reaches 12 or 13 years of age to stimulate the development of secondary sexual characteristics (breast development and menstrual periods). This therapy will not reverse infertility, however.
Cardiac surgery may be necessary to correct specific heart defects.
Recently developed reproductive technologies can help women with Turner syndrome become pregnant. Fertilized donor eggs can be used to create embryos, which can be inserted into the uterus of a woman with Turner syndrome. With the help of hormone treatment, the woman can carry a developing fetus to term.
Learning Differences
Most girls with Turner syndrome have normal intelligence. However, there are some who have learning problems. Early consultation with a developmental pediatrician may help these patients.
Girls with Turner syndrome can be screened to determine whether cognitive problems may affect their education. Also, a special battery of tests called psychoeducational evaluation can be used to identify specific problems. Your daughter's doctor can help you determine whether this type of testing is appropriate for your child.
The Turner Syndrome Society of the United States stresses the importance of assessing your child's intellectual, learning, and motor skills and social maturity before enrolling her in kindergarten. If learning problems are identified, early preventive and intervention strategies, if needed, can be implemented in a timely fashion.
Helping Your Child
Although your daughter may have specific medical problems and different physical characteristics caused by Turner syndrome, there are many things you can do to help her develop her daily living skills and cope with new or challenging situations:
Follow her lead in how much information she wants to share with others. Make sure she knows the facts and then allow her to explain Turner syndrome to her friends and family members, if she wants.
Treat her according to her age (not her size) when considering the amount of responsibility given to her and the types of social activities in which she engages.
Arrange your home environment so that it's comfortable for her (provide sturdy footstools in the bathroom and kitchen and easy access to clothing, closets, personal care items, and other necessities). Kitchen chairs or stools that have rungs are especially helpful, as it can be tiring for your daughter if her feet don't reach the floor.
Carefully assess your child's classroom environment. Ask for help from your daughter's teachers to provide appropriate accommodations in the classroom so that she can reach water fountains, classroom materials, and supplies. The same suggestions apply to the school's library and gymnasium.
Assist your child in coping with other new environments. Encourage her to ask friends for help in dealing with new situations.
Compliment her often on her strengths and coping skills. Be patient, positive, and open to discussions about her limitations and fears.
Allow your child to try on different clothing styles until she finds what flatters her or suits her personality. This can help build a more positive body image and self-esteem.
Encourage your child's participation in activities in which height isn't an issue, such as skating, diving, horseback riding, babysitting, or volunteer work. Volunteer work, in particular, can be an immense confidence booster.
If your daughter is depressed or having problems with her self-esteem, consider counseling and treatment by a mental health professional. Don't ignore your gut instinct if you think she's sad or withdrawn.
Take care of yourself. You won't be able to provide good care for your daughter if you neglect your own needs. Your community may offer Turner syndrome support groups, or you may want to join the Turner Syndrome Society of the United States. Or consider starting your own support group for parents.
Keep in mind that although Turner syndrome can affect your daughter in many ways, it's only a small part of her total physical, emotional, and intellectual being. Don't hesitate to enlist the help of your child's doctor, developmental pediatrician, or other medical specialists and mental health professionals. And don't let your daughter's diagnosis or medical problems define who she is.
Reviewed by: Judith Ross, MD, and Steven Dowshen, MD
About Epilepsy
If your child has epilepsy, he or she is not alone — 2.5 million Americans have this disorder.
Anyone can get epilepsy at any age, but the majority of new diagnoses are in kids. About two-thirds of all kids with epilepsy outgrow the seizures that accompany it by the time they're teens.
About Epilepsy
Epilepsy is a nervous system condition that causes electrical signals in the brain to misfire. These disruptions cause temporary communication problems between nerve cells, leading to seizures. One seizure is not considered epilepsy — kids with epilepsy have multiple seizures over a period of time.
Epilepsy:
is not the only cause of childhood seizures
is not a mental illness
does not usually affect intelligence
is not contagious
does not typically worsen over time
Causes of Epilepsy
In about half the cases of epilepsy, there is an identifiable cause. These include:
infectious illness (such as meningitis or encephalitis)
brain malformation during pregnancy
trauma to the brain (including lack of oxygen) during birth or an accident
underlying metabolic disorders
brain tumors
blood vessel malformation
strokes
chromosome disorders
The other half of epilepsy cases are idiopathic (the cause is unknown). In some of these, there may be a family history of epilepsy — a child who has a parent or other close family member with the condition is more likely to have it too. Researchers are working to determine what specific genetic factors are responsible.
Understanding Seizures
Seizures vary in severity, frequency, and duration (they typically last from a few seconds to several minutes). There are many different kinds of seizures, and what occurs during one depends on where in the brain the electrical signals are disrupted.
The two main categories of seizures are generalized seizures, which involve the whole brain, and partial seizures, which involve only part of the brain. Some people with epilepsy experience both kinds.
Seizures can be scary — a child may lose consciousness or jerk or thrash violently. Milder seizures may leave a child confused or unaware of his or her surroundings. Some seizures are so small that only an experienced eye could detect them — a child may simply blink or stare into space for a moment before resuming normal activity.
During a seizure, it's very important to stay calm and keep your child safe. Be sure to:
Lay your child down away from furniture, stairs, or radiators.
Put something soft under his or her head.
Turn your child on his or her side so fluid in the mouth can come out.
Never stick anything in your child's mouth or try to restrain him or her.
Do your best to note how often the seizures take place, what happens during them, and how long they last and report this to your doctor. Once a seizure is over, watch your child for signs of confusion. He or she may want to sleep and you should allow that. Do not give extra medication unless the doctor has prescribed it.
Kids who suffer from partial seizures may be frightened or confused by what has happened. Offer plenty of comfort and reassure your child that you're there and everything is OK.
Most seizures are not life-threatening, but if one lasts longer than 5 minutes or your child seems to have trouble breathing afterward, call 911 for immediate medical attention.
Diagnosis
Talk to your doctor if your child has seizures, staring spells, confusion spells, shaking spells, or unexplained deterioration of school performance. The doctor can refer you to a pediatric neurologist, who will take a patient medical history and examine your child, looking for findings that suggest problems with the brain and the rest of the neurologic system.
If the doctor suspects epilepsy, tests will be ordered, which may include:
electroencephalography (EEG), which measures electrical activity in the brain via sensors secured to the scalp while the child lays on a bed. Usually the doctor will ask that a child be sleep-deprived (put to bed late and awakened early) before this painless test, which takes about 1 hour.
a magnetic resonance imaging (MRI) test or a computerized tomography (CT) scan, both of which look at images of the brain
Treating Epilepsy
Your doctor will use the test and exam results to determine the best form of treatment. Medication to prevent seizures is usually the first type of treatment prescribed for epilepsy management. Many kids can be successfully treated with one medication — and if the first doesn't work, the doctor will usually try a second or even a third before resorting to combinations of medications.
Although medications often work, if your child is unresponsive after the second or third attempts, it's less likely that subsequent medications will be effective. In this case, surgery to remove the affected part of the brain may be necessary. Epilepsy surgery is done in less than 10% of seizure patients, and only after an extensive screening and evaluation process.
Additional treatments can be used for epilepsy that is unresponsive to medications. The doctor may implant a vagus nerve stimulator in the neck, or recommend a ketogenic diet, a high-protein, high-fat, low-carbohydrate diet that can be very successful in helping to manage seizures.
Even people who respond successfully to medication sometimes have seizures (called "breakthrough seizures"). These don't mean your child's medication needs to be changed, although you should let the doctor know when they occur.
Living With Epilepsy
To help prevent seizures, make sure your child:
takes medication(s) as prescribed
avoids triggers (such as fever and overtiredness)
sees the neurologist as recommended — about two to four times a year — even if responding well to medication
Keeping your child well-fed, well-rested, and non-stressed are all key factors that can help manage epilepsy. You should also take common-sense precautions based on how well-controlled the epilepsy is. For example:
Younger kids should have only supervised baths, and older kids should take showers — and only when there is someone else in the house.
Swimming or bike-riding alone are not good ideas for kids with epilepsy (although they can certainly enjoy these activities with other people). A helmet is required during bicycling, as for all kids.
With some simple safety precautions, your child should be able to play, participate in sports or other activities, and generally do what other kids like to do. State driving laws vary, but teens with epilepsy will probably be able to drive with some restrictions, as long as the seizures are controlled.
It's important to make sure that other adults who care for your child — family members, babysitters, teachers, coaches, etc. — know that your child has epilepsy, understand the condition, and know what to do in the event of a seizure.
Offer your child plenty of support, discuss epilepsy openly, and answer questions honestly. Kids with epilepsy may be embarrassed about the seizures, or worry about having one at school or with friends. Consider having your child talk with a mental health counselor or psychologist if he or she struggles with these feelings.
Reviewed by: Michael H. Goodman, MD
Anyone can get epilepsy at any age, but the majority of new diagnoses are in kids. About two-thirds of all kids with epilepsy outgrow the seizures that accompany it by the time they're teens.
About Epilepsy
Epilepsy is a nervous system condition that causes electrical signals in the brain to misfire. These disruptions cause temporary communication problems between nerve cells, leading to seizures. One seizure is not considered epilepsy — kids with epilepsy have multiple seizures over a period of time.
Epilepsy:
is not the only cause of childhood seizures
is not a mental illness
does not usually affect intelligence
is not contagious
does not typically worsen over time
Causes of Epilepsy
In about half the cases of epilepsy, there is an identifiable cause. These include:
infectious illness (such as meningitis or encephalitis)
brain malformation during pregnancy
trauma to the brain (including lack of oxygen) during birth or an accident
underlying metabolic disorders
brain tumors
blood vessel malformation
strokes
chromosome disorders
The other half of epilepsy cases are idiopathic (the cause is unknown). In some of these, there may be a family history of epilepsy — a child who has a parent or other close family member with the condition is more likely to have it too. Researchers are working to determine what specific genetic factors are responsible.
Understanding Seizures
Seizures vary in severity, frequency, and duration (they typically last from a few seconds to several minutes). There are many different kinds of seizures, and what occurs during one depends on where in the brain the electrical signals are disrupted.
The two main categories of seizures are generalized seizures, which involve the whole brain, and partial seizures, which involve only part of the brain. Some people with epilepsy experience both kinds.
Seizures can be scary — a child may lose consciousness or jerk or thrash violently. Milder seizures may leave a child confused or unaware of his or her surroundings. Some seizures are so small that only an experienced eye could detect them — a child may simply blink or stare into space for a moment before resuming normal activity.
During a seizure, it's very important to stay calm and keep your child safe. Be sure to:
Lay your child down away from furniture, stairs, or radiators.
Put something soft under his or her head.
Turn your child on his or her side so fluid in the mouth can come out.
Never stick anything in your child's mouth or try to restrain him or her.
Do your best to note how often the seizures take place, what happens during them, and how long they last and report this to your doctor. Once a seizure is over, watch your child for signs of confusion. He or she may want to sleep and you should allow that. Do not give extra medication unless the doctor has prescribed it.
Kids who suffer from partial seizures may be frightened or confused by what has happened. Offer plenty of comfort and reassure your child that you're there and everything is OK.
Most seizures are not life-threatening, but if one lasts longer than 5 minutes or your child seems to have trouble breathing afterward, call 911 for immediate medical attention.
Diagnosis
Talk to your doctor if your child has seizures, staring spells, confusion spells, shaking spells, or unexplained deterioration of school performance. The doctor can refer you to a pediatric neurologist, who will take a patient medical history and examine your child, looking for findings that suggest problems with the brain and the rest of the neurologic system.
If the doctor suspects epilepsy, tests will be ordered, which may include:
electroencephalography (EEG), which measures electrical activity in the brain via sensors secured to the scalp while the child lays on a bed. Usually the doctor will ask that a child be sleep-deprived (put to bed late and awakened early) before this painless test, which takes about 1 hour.
a magnetic resonance imaging (MRI) test or a computerized tomography (CT) scan, both of which look at images of the brain
Treating Epilepsy
Your doctor will use the test and exam results to determine the best form of treatment. Medication to prevent seizures is usually the first type of treatment prescribed for epilepsy management. Many kids can be successfully treated with one medication — and if the first doesn't work, the doctor will usually try a second or even a third before resorting to combinations of medications.
Although medications often work, if your child is unresponsive after the second or third attempts, it's less likely that subsequent medications will be effective. In this case, surgery to remove the affected part of the brain may be necessary. Epilepsy surgery is done in less than 10% of seizure patients, and only after an extensive screening and evaluation process.
Additional treatments can be used for epilepsy that is unresponsive to medications. The doctor may implant a vagus nerve stimulator in the neck, or recommend a ketogenic diet, a high-protein, high-fat, low-carbohydrate diet that can be very successful in helping to manage seizures.
Even people who respond successfully to medication sometimes have seizures (called "breakthrough seizures"). These don't mean your child's medication needs to be changed, although you should let the doctor know when they occur.
Living With Epilepsy
To help prevent seizures, make sure your child:
takes medication(s) as prescribed
avoids triggers (such as fever and overtiredness)
sees the neurologist as recommended — about two to four times a year — even if responding well to medication
Keeping your child well-fed, well-rested, and non-stressed are all key factors that can help manage epilepsy. You should also take common-sense precautions based on how well-controlled the epilepsy is. For example:
Younger kids should have only supervised baths, and older kids should take showers — and only when there is someone else in the house.
Swimming or bike-riding alone are not good ideas for kids with epilepsy (although they can certainly enjoy these activities with other people). A helmet is required during bicycling, as for all kids.
With some simple safety precautions, your child should be able to play, participate in sports or other activities, and generally do what other kids like to do. State driving laws vary, but teens with epilepsy will probably be able to drive with some restrictions, as long as the seizures are controlled.
It's important to make sure that other adults who care for your child — family members, babysitters, teachers, coaches, etc. — know that your child has epilepsy, understand the condition, and know what to do in the event of a seizure.
Offer your child plenty of support, discuss epilepsy openly, and answer questions honestly. Kids with epilepsy may be embarrassed about the seizures, or worry about having one at school or with friends. Consider having your child talk with a mental health counselor or psychologist if he or she struggles with these feelings.
Reviewed by: Michael H. Goodman, MD
Autism and Other Pervasive Developmental Disorders
The term pervasive developmental disorders (PDDs) refers to a group of developmental conditions that affect children and involve delays or impairments in communication and social skills. Autism is the most well-known of the pervasive developmental disorders, so PDDs also are known as autism spectrum disorders.
PDDs also include Asperger syndrome and two less common conditions called childhood disintegrative disorder and Rett syndrome. Typically, PDDs are first diagnosed during infancy, toddlerhood, or early childhood.
All pervasive developmental disorders affect communication and social skills, as well as cognitive skills and behavior. All PDDs have things in common, but each has specific characteristics that set it apart from the others.
What Are the Signs of a PDD?
Signs of a PDD are usually recognizable before a child is 3 years old. However, symptoms can range from severe to so subtle that they seem to be normal aspects of a young child's development. For that reason, it may take a few years for a PDD to be fully identified.
Early signs of a PDD can include:
trouble interacting, playing with, or relating to others
avoiding eye contact; not looking at people
not pointing to objects to direct a parent's attention to things
unusual movements, such as hand flapping, spinning, or tapping
delays in developmental milestones or loss of milestones already achieved
playing with the same toy in a way that seems odd or repetitive
not using or understanding language
not exploring environment with curiosity or interest
Children who show a pattern of these behaviors should be evaluated by their doctor. There are no blood tests or brain tests (such as MRIs) that diagnose PDDs, although such tests may be used to check for other conditions besides a PDD.
A diagnosis is made by a doctor with expertise in PDDs, such as a pediatric neurologist, developmental pediatrician, pediatric psychiatrist, or pediatric psychologist. Parent questionnaires, educational and cognitive assessments, language assessments, or play and behavior assessments might be used to help diagnose a PDD.
What Causes PDDs?
Causes of pervasive developmental disorders are not yet well understood. Scientists believe they are complex neurobiological (brain biology) problems, which may have a genetic basis like other conditions that stem from abnormalities in the chromosomes a child inherits.
Some studies have suggested that PDDs might stem from a host of causes, including food allergies, excessive amounts of yeast in the digestive tract, and exposure to environmental toxins. However, these theories have not been scientifically proven.
The weight of scientific evidence indicates that there is not a link between vaccines — or any of their ingredients — and autism. All in all, the risks of serious reactions to vaccinations are small compared with the health risks associated with the often-serious diseases they're intended to prevent. But if you have concerns about any vaccine for your child, don't hesitate to talk to your doctor. Ask about the benefits and risks of each vaccine and why they're so important for kids of all ages.
It's also important to remember that PDDs are not caused by parenting or bad experiences. Earlier notions that suggested this have been debunked.
Treating PDDs
Although there's no cure for children with PDDs, early intervention and treatment can help them develop skills and achieve their best potential. No medications can cure PDDs, but sometimes they're used to treat certain symptoms, such as aggressive behavior toward self or others, problems of inattention, obsessive-compulsive behaviors, and mood swings.
Individually tailored programs can include behavior modification, and educational interventions can help shape a child's behaviors and improve speech and communication.
Therapy should be individualized because each child's disorder is distinct and presents specific needs, and PDDs can range from mild to severe. Some kids do well in small classes with lots of one-on-one attention. Others do well in standard classrooms with support.
The goal of treatment is to get kids with PDDs to a point where they can be mainstreamed into a regular classroom, although they also might require special programs and support services, including speech-language therapy.
Gluten-free and casein-free diets have been reported to show some positive results in treating some children with PDD, although more research needs to be done. Other vitamin and herbal remedies have not been scientifically proven, although they may have value for some kids. Families who are considering using these or other treatments will want to discuss any possible benefits or risks with their doctor before beginning.
Helping Your Child
Once you learn your child has a PDD, it's important to get help. Kids with disabilities are entitled to free preschool services at 3 years of age under the Individuals with Disabilities Education Act (IDEA). Check out the services offered by your local school district, Intermediate Unit, or organizations such as Easter Seals and the United Cerebral Palsy Association. Also under the IDEA, states provide services for children with disabilities from birth through age 2 years through federally mandated early intervention programs.
Because the needs of kids with pervasive development disorders vary, any education program must be tailored to the individual child. You can set up an individualized education plan (IEP) for your child though your local school district. An IEP should incorporate social skills and communication and have a high degree of structure. Maximized speech and language intervention is important, as is the use of behavior modification and rewards to try to stop problem behaviors and to encourage all types of communication. For children younger than age 3, parents will work with the state's early intervention program to develop an Individualized Family Service Plan (IFSP) instead of an IEP.
As with all developmental concerns, talk with your doctor about how to find local resources for the services your child needs.
Support your child with hugs and verbal praise. Use rewards that stimulate social interaction (like a trip to the playground). If your child is in school, talk with his or her teachers to find out what rewards and behavior modification techniques help in the classroom and try using some of these at home. That way, your child will get a consistent message at home and at school.
Reviewed by: Anne M. Meduri, MD, and D'Arcy Lyness, PhDDate reviewed: April 2008
PDDs also include Asperger syndrome and two less common conditions called childhood disintegrative disorder and Rett syndrome. Typically, PDDs are first diagnosed during infancy, toddlerhood, or early childhood.
All pervasive developmental disorders affect communication and social skills, as well as cognitive skills and behavior. All PDDs have things in common, but each has specific characteristics that set it apart from the others.
What Are the Signs of a PDD?
Signs of a PDD are usually recognizable before a child is 3 years old. However, symptoms can range from severe to so subtle that they seem to be normal aspects of a young child's development. For that reason, it may take a few years for a PDD to be fully identified.
Early signs of a PDD can include:
trouble interacting, playing with, or relating to others
avoiding eye contact; not looking at people
not pointing to objects to direct a parent's attention to things
unusual movements, such as hand flapping, spinning, or tapping
delays in developmental milestones or loss of milestones already achieved
playing with the same toy in a way that seems odd or repetitive
not using or understanding language
not exploring environment with curiosity or interest
Children who show a pattern of these behaviors should be evaluated by their doctor. There are no blood tests or brain tests (such as MRIs) that diagnose PDDs, although such tests may be used to check for other conditions besides a PDD.
A diagnosis is made by a doctor with expertise in PDDs, such as a pediatric neurologist, developmental pediatrician, pediatric psychiatrist, or pediatric psychologist. Parent questionnaires, educational and cognitive assessments, language assessments, or play and behavior assessments might be used to help diagnose a PDD.
What Causes PDDs?
Causes of pervasive developmental disorders are not yet well understood. Scientists believe they are complex neurobiological (brain biology) problems, which may have a genetic basis like other conditions that stem from abnormalities in the chromosomes a child inherits.
Some studies have suggested that PDDs might stem from a host of causes, including food allergies, excessive amounts of yeast in the digestive tract, and exposure to environmental toxins. However, these theories have not been scientifically proven.
The weight of scientific evidence indicates that there is not a link between vaccines — or any of their ingredients — and autism. All in all, the risks of serious reactions to vaccinations are small compared with the health risks associated with the often-serious diseases they're intended to prevent. But if you have concerns about any vaccine for your child, don't hesitate to talk to your doctor. Ask about the benefits and risks of each vaccine and why they're so important for kids of all ages.
It's also important to remember that PDDs are not caused by parenting or bad experiences. Earlier notions that suggested this have been debunked.
Treating PDDs
Although there's no cure for children with PDDs, early intervention and treatment can help them develop skills and achieve their best potential. No medications can cure PDDs, but sometimes they're used to treat certain symptoms, such as aggressive behavior toward self or others, problems of inattention, obsessive-compulsive behaviors, and mood swings.
Individually tailored programs can include behavior modification, and educational interventions can help shape a child's behaviors and improve speech and communication.
Therapy should be individualized because each child's disorder is distinct and presents specific needs, and PDDs can range from mild to severe. Some kids do well in small classes with lots of one-on-one attention. Others do well in standard classrooms with support.
The goal of treatment is to get kids with PDDs to a point where they can be mainstreamed into a regular classroom, although they also might require special programs and support services, including speech-language therapy.
Gluten-free and casein-free diets have been reported to show some positive results in treating some children with PDD, although more research needs to be done. Other vitamin and herbal remedies have not been scientifically proven, although they may have value for some kids. Families who are considering using these or other treatments will want to discuss any possible benefits or risks with their doctor before beginning.
Helping Your Child
Once you learn your child has a PDD, it's important to get help. Kids with disabilities are entitled to free preschool services at 3 years of age under the Individuals with Disabilities Education Act (IDEA). Check out the services offered by your local school district, Intermediate Unit, or organizations such as Easter Seals and the United Cerebral Palsy Association. Also under the IDEA, states provide services for children with disabilities from birth through age 2 years through federally mandated early intervention programs.
Because the needs of kids with pervasive development disorders vary, any education program must be tailored to the individual child. You can set up an individualized education plan (IEP) for your child though your local school district. An IEP should incorporate social skills and communication and have a high degree of structure. Maximized speech and language intervention is important, as is the use of behavior modification and rewards to try to stop problem behaviors and to encourage all types of communication. For children younger than age 3, parents will work with the state's early intervention program to develop an Individualized Family Service Plan (IFSP) instead of an IEP.
As with all developmental concerns, talk with your doctor about how to find local resources for the services your child needs.
Support your child with hugs and verbal praise. Use rewards that stimulate social interaction (like a trip to the playground). If your child is in school, talk with his or her teachers to find out what rewards and behavior modification techniques help in the classroom and try using some of these at home. That way, your child will get a consistent message at home and at school.
Reviewed by: Anne M. Meduri, MD, and D'Arcy Lyness, PhDDate reviewed: April 2008
Occupational Therapy
Ten-year-old Jason was in an accident while riding on his bicycle. Although he survived the accident, it left him with a brain injury. To improve some of his cognitive (thinking) skills, comprehension skills, and coordination, Jason's doctors recommended that he receive occupational therapy (OT).
At first, his parents were slightly skeptical about whether occupational therapy could benefit their son. They had never heard of OT and wondered if it was more appropriate for adults. But after watching the activities and Jason's improvements, his parents felt hopeful that Jason was on the road to recovery.
What Is Occupational Therapy and Who Might Need It?
Occupational therapy — a treatment that focuses on helping people achieve independence in all areas of their lives — can offer kids with various needs positive, fun activities to improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; children, after all, do not have occupations. But a child's main job is playing and learning, and an occupational therapist can evaluate a child's skills for play activities, school performance, and activities of daily living and compare them with what is developmentally appropriate for that age group.
According to the American Occupational Therapy Association (AOTA), in addition to dealing with an individual's physical well-being, OT practitioners address psychological, social, and environmental factors that may hinder an individual's functioning in different ways. This unique approach makes occupational therapy a vital part of health care for some kids.
So who might use an occupational therapy practitioner? According to AOTA, kids with the following medical problems may benefit from OT:
birth injuries or birth defects
sensory processing/integrative disorders
traumatic injuries (brain or spinal cord)
learning problems
autism
pervasive developmental disorders
juvenile rheumatoid arthritis
mental health or behavioral problems
broken bones or other orthopedic injuries
developmental delays
post-surgical conditions
burns
spina bifida
traumatic amputations
cancer
severe hand injuries
multiple sclerosis, cerebral palsy, and other chronic illnesses
One of the activities that occupational therapists can address to meet children's needs is working on fine motor skills so that kids can grasp and release toys and develop good handwriting skills. Occupational therapists also address hand–eye coordination to improve play skills, such as hitting a target, batting a ball, or copying from a blackboard.
An occupational therapist can also:
help kids with severe developmental delays learn some basic tasks, such as bathing, getting dressed, brushing their teeth, and feeding themselves
help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, the children would learn positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
teach kids with physical disabilities the coordination skills required to feed themselves, use a computer, or increase the speed and legibility of their handwriting
evaluate each child's needs for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
work with kids who have sensory and attentional issues to improve focus and social skills
Are Physical Therapy and Occupational Therapy the Same?
Although both types of therapy help kids improve the quality of their lives, there are differences. Physical therapy deals with the issues of pain, strength, joint range of motion, endurance, and gross motor functioning, whereas occupational therapy deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.
Who Are Occupational Therapy Practitioners?
There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA). Since 2007, an occupational therapist (OT) is required to complete a master's degree program. Before 2007, only a bachelor's degree was required. An occupational therapist assistant is only required to complete an associate's degree program. OTAs are able to carry out treatment plans developed by the occupational therapist but can't complete evaluations.
All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. Most states also require a license to practice and require occupational therapy practitioners to take continuing education classes throughout their careers to maintain that licensure.
Occupational therapists work in a variety of settings, including:
hospitals
schools
rehabilitation centers
mental health facilities
private practices
children's clinics
nursing homes
How Can I Find Care for My Child?
If you think your child may benefit from occupational therapy, talk to your doctor, who can usually refer you to individual specialists who are best suited to your child's condition. The school nurse or guidance counselor also may be able to recommend specialists based on your child's academic or social performance.
You can also consult your local yellow pages or contact a nearby hospital or rehabilitation center for referrals. A list of specialists may also be available through your state's occupational therapy association.
However you find an occupational therapist for your child, make sure that your health insurance company covers the program you select.
Reviewed by: Kimberly S. Pierson, OTR/L
At first, his parents were slightly skeptical about whether occupational therapy could benefit their son. They had never heard of OT and wondered if it was more appropriate for adults. But after watching the activities and Jason's improvements, his parents felt hopeful that Jason was on the road to recovery.
What Is Occupational Therapy and Who Might Need It?
Occupational therapy — a treatment that focuses on helping people achieve independence in all areas of their lives — can offer kids with various needs positive, fun activities to improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment.
Some people may think that occupational therapy is only for adults; children, after all, do not have occupations. But a child's main job is playing and learning, and an occupational therapist can evaluate a child's skills for play activities, school performance, and activities of daily living and compare them with what is developmentally appropriate for that age group.
According to the American Occupational Therapy Association (AOTA), in addition to dealing with an individual's physical well-being, OT practitioners address psychological, social, and environmental factors that may hinder an individual's functioning in different ways. This unique approach makes occupational therapy a vital part of health care for some kids.
So who might use an occupational therapy practitioner? According to AOTA, kids with the following medical problems may benefit from OT:
birth injuries or birth defects
sensory processing/integrative disorders
traumatic injuries (brain or spinal cord)
learning problems
autism
pervasive developmental disorders
juvenile rheumatoid arthritis
mental health or behavioral problems
broken bones or other orthopedic injuries
developmental delays
post-surgical conditions
burns
spina bifida
traumatic amputations
cancer
severe hand injuries
multiple sclerosis, cerebral palsy, and other chronic illnesses
One of the activities that occupational therapists can address to meet children's needs is working on fine motor skills so that kids can grasp and release toys and develop good handwriting skills. Occupational therapists also address hand–eye coordination to improve play skills, such as hitting a target, batting a ball, or copying from a blackboard.
An occupational therapist can also:
help kids with severe developmental delays learn some basic tasks, such as bathing, getting dressed, brushing their teeth, and feeding themselves
help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, the children would learn positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
teach kids with physical disabilities the coordination skills required to feed themselves, use a computer, or increase the speed and legibility of their handwriting
evaluate each child's needs for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
work with kids who have sensory and attentional issues to improve focus and social skills
Are Physical Therapy and Occupational Therapy the Same?
Although both types of therapy help kids improve the quality of their lives, there are differences. Physical therapy deals with the issues of pain, strength, joint range of motion, endurance, and gross motor functioning, whereas occupational therapy deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.
Who Are Occupational Therapy Practitioners?
There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA). Since 2007, an occupational therapist (OT) is required to complete a master's degree program. Before 2007, only a bachelor's degree was required. An occupational therapist assistant is only required to complete an associate's degree program. OTAs are able to carry out treatment plans developed by the occupational therapist but can't complete evaluations.
All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. Most states also require a license to practice and require occupational therapy practitioners to take continuing education classes throughout their careers to maintain that licensure.
Occupational therapists work in a variety of settings, including:
hospitals
schools
rehabilitation centers
mental health facilities
private practices
children's clinics
nursing homes
How Can I Find Care for My Child?
If you think your child may benefit from occupational therapy, talk to your doctor, who can usually refer you to individual specialists who are best suited to your child's condition. The school nurse or guidance counselor also may be able to recommend specialists based on your child's academic or social performance.
You can also consult your local yellow pages or contact a nearby hospital or rehabilitation center for referrals. A list of specialists may also be available through your state's occupational therapy association.
However you find an occupational therapist for your child, make sure that your health insurance company covers the program you select.
Reviewed by: Kimberly S. Pierson, OTR/L
Cerebral Palsy
Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). Cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.
CP is usually caused by brain damage that occurs before or during a child’s birth, or during the first 3 to 5 years of a child’s life. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition.
What Is Cerebral Palsy?
Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. About 500,000 children and adults of all ages in the United States have the condition.
The three types of CP are:
spastic cerebral palsy — causes stiffness and movement difficulties
athetoid cerebral palsy — leads to involuntary and uncontrolled movements
ataxic cerebral palsy — causes a disturbed sense of balance and depth perception
Cerebral palsy affects muscle control and coordination, so even simple movements — like standing still — are difficult. Other vital functions that also involve motor skills and muscles — such as breathing, bladder and bowel control, eating, and learning — are also affected when a child has CP. Cerebral palsy does not get worse over time.
Causes of Cerebral Palsy
The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, or something else that interferes with oxygen reaching the fetal brain. Problems during labor and delivery can cause CP in some cases.
Premature babies — particularly those who weigh less than 3.3 pounds (1,510 grams) — have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets.
Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained.
Diagnosing Cerebral Palsy
CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. Doctors, such as pediatricians and developmental and neurological specialists, usually follow these kids closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate CP.
In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose the disorder in the first year of life. Often doctors aren’t able to diagnose CP until they see a delay in normal developmental milestones — such as reaching for toys by 4 months or sitting up by 7 months — which can be signs of CP. Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear can also be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler.
Preventing Cerebral Palsy
In many cases the causes of CP are unknown, so there’s no way to prevent it. But if you’re having a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus lowering the risk that your baby will have CP.
Before becoming pregnant, it’s important to maintain a healthy diet and make sure that any medical problems are managed properly. As soon as you know you’re pregnant, proper prenatal medical care is vital.
Controlling diabetes, anemia, hypertension, and nutritional deficiencies during pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy.
Once your baby is born you can lower the risk of brain damage, which could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain damage. If you’re riding in a car, make sure your baby is properly strapped into an infant car seat that’s correctly installed — if an accident occurs, the baby will be as protected as possible. Be aware of lead exposure in your house, as lead poisoning can lead to brain damage.
How Cerebral Palsy Affects Development
Children with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected.
Associated medical problems may include visual impairment or blindness, hearing loss, food aspiration (the sucking of food or fluid into the lungs), gastroesophageal reflux (spitting up), speech problems, drooling, tooth decay, sleep disorders, osteoporosis (weak, brittle bones), and behavior problems. Seizures, speech and communication problems, and mental retardation are also common among kids with CP. Many have problems that may require ongoing therapy and devices such as braces or wheelchairs.
Treatment of Cerebral Palsy
Currently there's no cure for cerebral palsy, but if your child is diagnosed with it, a variety of resources and therapies can provide help and improve the quality of your child’s life.
Therapies can help kids with CP achieve maximum potential in growth and development. As soon as CP is diagnosed, a child can begin therapy for movement, learning, speech, hearing, and social and emotional development. In addition, medication, surgery, and braces can help improve muscle function. Surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump (the baclofen pump) implanted under the skin.
If your child has CP, a team of professionals will work with you to meet your child's medical needs. That team may include therapists, psychologists, educators, nurses, and social workers.
Many resources are available to help and support you in caring for your child. Talk to your doctor about finding those in your area.
Reviewed by: Steven J. Bachrach, MD
CP is usually caused by brain damage that occurs before or during a child’s birth, or during the first 3 to 5 years of a child’s life. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition.
What Is Cerebral Palsy?
Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. About 500,000 children and adults of all ages in the United States have the condition.
The three types of CP are:
spastic cerebral palsy — causes stiffness and movement difficulties
athetoid cerebral palsy — leads to involuntary and uncontrolled movements
ataxic cerebral palsy — causes a disturbed sense of balance and depth perception
Cerebral palsy affects muscle control and coordination, so even simple movements — like standing still — are difficult. Other vital functions that also involve motor skills and muscles — such as breathing, bladder and bowel control, eating, and learning — are also affected when a child has CP. Cerebral palsy does not get worse over time.
Causes of Cerebral Palsy
The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, or something else that interferes with oxygen reaching the fetal brain. Problems during labor and delivery can cause CP in some cases.
Premature babies — particularly those who weigh less than 3.3 pounds (1,510 grams) — have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets.
Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained.
Diagnosing Cerebral Palsy
CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. Doctors, such as pediatricians and developmental and neurological specialists, usually follow these kids closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate CP.
In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose the disorder in the first year of life. Often doctors aren’t able to diagnose CP until they see a delay in normal developmental milestones — such as reaching for toys by 4 months or sitting up by 7 months — which can be signs of CP. Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear can also be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler.
Preventing Cerebral Palsy
In many cases the causes of CP are unknown, so there’s no way to prevent it. But if you’re having a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus lowering the risk that your baby will have CP.
Before becoming pregnant, it’s important to maintain a healthy diet and make sure that any medical problems are managed properly. As soon as you know you’re pregnant, proper prenatal medical care is vital.
Controlling diabetes, anemia, hypertension, and nutritional deficiencies during pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy.
Once your baby is born you can lower the risk of brain damage, which could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain damage. If you’re riding in a car, make sure your baby is properly strapped into an infant car seat that’s correctly installed — if an accident occurs, the baby will be as protected as possible. Be aware of lead exposure in your house, as lead poisoning can lead to brain damage.
How Cerebral Palsy Affects Development
Children with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected.
Associated medical problems may include visual impairment or blindness, hearing loss, food aspiration (the sucking of food or fluid into the lungs), gastroesophageal reflux (spitting up), speech problems, drooling, tooth decay, sleep disorders, osteoporosis (weak, brittle bones), and behavior problems. Seizures, speech and communication problems, and mental retardation are also common among kids with CP. Many have problems that may require ongoing therapy and devices such as braces or wheelchairs.
Treatment of Cerebral Palsy
Currently there's no cure for cerebral palsy, but if your child is diagnosed with it, a variety of resources and therapies can provide help and improve the quality of your child’s life.
Therapies can help kids with CP achieve maximum potential in growth and development. As soon as CP is diagnosed, a child can begin therapy for movement, learning, speech, hearing, and social and emotional development. In addition, medication, surgery, and braces can help improve muscle function. Surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump (the baclofen pump) implanted under the skin.
If your child has CP, a team of professionals will work with you to meet your child's medical needs. That team may include therapists, psychologists, educators, nurses, and social workers.
Many resources are available to help and support you in caring for your child. Talk to your doctor about finding those in your area.
Reviewed by: Steven J. Bachrach, MD
Physical Therapy
Doctors often recommend physical therapy for kids who have been injured or have movement problems from an illness, disease, or disability.
Physical therapists are often able to relieve pain and help kids resume daily activities. After an injury, physical therapists teach kids exercises designed to help them regain strength and range of motion, and also show them how to prevent a recurring injury.
When Is Physical Therapy Needed?
Physical therapy (PT) may be needed any time a child has difficulty moving in such a way that it limits daily activities.
Doctors may recommend PT for kids with:
developmental delays
cerebral palsy
genetic disorders
orthopedic disabilities
heart and lung conditions
birth defects (such as spina bifida)
effects of in-utero drug or alcohol exposure
acute trauma
head injury
limb deficiencies
muscle diseases
What Physical Therapists Do
Physical therapists often use a variety of treatments to help build strength, improve movement, and strengthen skills needed to complete daily activities.
Physical therapists might guide kids through:
developmental activities such as crawling and walking
weightlifting to build strength around an injury
flexibility exercises to increase range of motion
balance and coordination activities
adaptive play
aquatic (water) therapy
safety and prevention programs
instruction on how to avoid injuries
improving circulation around injuries by using heat, cold, exercise, electrical stimulation, massage, and ultrasound
During a visit, a physical therapist may:
measure the child's flexibility and strength
analyze the way the child walks and runs (a child's gait)
identify potential and existing problems
consult with other medical, psychiatric, and school personnel about an individual education plan
provide instructions for home exercise programs
recommend when returning to sports is safe
Qualifications to Look for in a Physical Therapist
Physical therapists must earn a master's degree or receive a doctoral degree in physical therapy (a DPT) from an accredited college program. Physical therapists also must pass a state-administered national exam.
States also may impose their own regulations for practicing PT. You can find out more information about any other requirements for local physical therapists by contacting your state's licensure board.
Finding a Physical Therapist
Physical therapists tend to work in hospitals, private practices, fitness centers, and rehabilitation and research facilities. Ask your doctor for recommendations or contact your state's physical therapy association for names of local licensed physical therapists. Coaches or phys-ed teachers at your child's school also might be able to recommend a physical therapist.
Reviewed by: Karen Manternach, MSPTDate reviewed: January 2008
Physical therapists are often able to relieve pain and help kids resume daily activities. After an injury, physical therapists teach kids exercises designed to help them regain strength and range of motion, and also show them how to prevent a recurring injury.
When Is Physical Therapy Needed?
Physical therapy (PT) may be needed any time a child has difficulty moving in such a way that it limits daily activities.
Doctors may recommend PT for kids with:
developmental delays
cerebral palsy
genetic disorders
orthopedic disabilities
heart and lung conditions
birth defects (such as spina bifida)
effects of in-utero drug or alcohol exposure
acute trauma
head injury
limb deficiencies
muscle diseases
What Physical Therapists Do
Physical therapists often use a variety of treatments to help build strength, improve movement, and strengthen skills needed to complete daily activities.
Physical therapists might guide kids through:
developmental activities such as crawling and walking
weightlifting to build strength around an injury
flexibility exercises to increase range of motion
balance and coordination activities
adaptive play
aquatic (water) therapy
safety and prevention programs
instruction on how to avoid injuries
improving circulation around injuries by using heat, cold, exercise, electrical stimulation, massage, and ultrasound
During a visit, a physical therapist may:
measure the child's flexibility and strength
analyze the way the child walks and runs (a child's gait)
identify potential and existing problems
consult with other medical, psychiatric, and school personnel about an individual education plan
provide instructions for home exercise programs
recommend when returning to sports is safe
Qualifications to Look for in a Physical Therapist
Physical therapists must earn a master's degree or receive a doctoral degree in physical therapy (a DPT) from an accredited college program. Physical therapists also must pass a state-administered national exam.
States also may impose their own regulations for practicing PT. You can find out more information about any other requirements for local physical therapists by contacting your state's licensure board.
Finding a Physical Therapist
Physical therapists tend to work in hospitals, private practices, fitness centers, and rehabilitation and research facilities. Ask your doctor for recommendations or contact your state's physical therapy association for names of local licensed physical therapists. Coaches or phys-ed teachers at your child's school also might be able to recommend a physical therapist.
Reviewed by: Karen Manternach, MSPTDate reviewed: January 2008
Soiling (Encopresis)
If your child who has bowel movements (BMs) in places other than the toilet, you know how frustrating it can be. Many parents assume that kids who soil their pants are simply misbehaving or that they're too lazy to use the bathroom when they have the urge to go.
The truth is that many kids beyond the age of toilet teaching (generally older than 4 years) who frequently soil their underwear have a condition known as encopresis. They have a problem with their bowels that dulls the normal urge to go to the bathroom — and they can't control the accidents that typically follow.
Although encopresis is estimated to affect 1% to 2% of kids under the age of 10, problems with encopresis and constipation account for more than 25% of all visits to pediatric gastroenterologists (doctors who specialize in disorders of the stomach and intestines).
Most encopresis cases (90%) are due to functional constipation — that is, constipation that has no medical cause. The stool (or BM) is hard, dry, and difficult to pass when a person is constipated. Many kids "hold" their BMs to avoid the pain of constipation, which sets the stage for having a poop accident.
Well-intentioned advice from family members and friends isn't always helpful because many people mistakenly believe that encopresis is a behavioral issue — a simple lack of self-control. Frustrated parents, grandparents, and caregivers may advocate various punishments and consequences for the soiling — which only leaves the child feeling even more alone, angry, depressed, or humiliated. Up to 20% of kids with encopresis experience feelings of low self-esteem that require the intervention of a psychologist or counselor.
Punishing or humiliating a child with encopresis will only make matters worse. Instead, talk to your doctor, who can help you and your child through this challenging but treatable problem.
Encopresis and Its Causes
Three to six times more common in boys, encopresis isn't a disease, but rather a symptom that may have different causes. To understand encopresis, it's important to understand constipation.
There's a wide range of normal when it comes to having a BM. The frequency of BMs varies with a person's age and individual nature. "Normal" pooping might range from one or two BMs per day to only three or four per week. Some kids don't poop on a regular basis, but a child who passes a soft BM without difficulty every 3 days is not constipated. However, a child who passes a hard BM (small or large) every other day is. Other kids may go every day, but they only release little, hard balls and there's always poop left behind in the colon.
So, what causes the hard poop in the first place? Any number of things, including diet, illness, decreased fluid intake, fear of the toilet during toilet teaching, or limited access to a toilet or a toilet that's not private (like at school). Some kids may develop chronic constipation after stressful life events such as a divorce or the death of a close relative. Whatever the cause, once a child begins to hold his or her BMs, the poop begins to accumulate in the colon and a vicious cycle begins.
The colon's job is to remove water from the poop before it's passed. The longer the poop is stuck there, the more water is removed — and the harder it is to push the large, dry poop out. The large poop also stretches out the colon, weakening the muscles there and affecting the nerves that tell a child when it's time to go to the bathroom. Because the flabby colon can't push the hard poop out, and it's painful to pass, the child continues to avoid having a BM, often by dancing, crossing the legs, making faces, or walking on tiptoes.
Eventually, the lower part of the colon becomes so full that it's difficult for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial BMs may pass through, causing the child to soil his or her pants. Softer poop may also leak out around the large mass of feces and stain the child's underwear when the sphincter relaxes. The child can't prevent the soiling — nor does he or she have any idea it's happening — because the nerves aren't sending the signals that regulate defecation (or pooping).
At first, parents may think their child has a simple case of diarrhea. But after repeated episodes, it becomes clear that there's another problem — especially because the soiling occurs when the child isn't sick.
Parents are often frustrated by the fact that their child seems unfazed by these accidents, which occur mostly during waking hours. Denial may be one reason for the child's nonchalance — kids just can't face the shame and guilt associated with the condition (some even try to hide their soiled underpants from their parents). Another reason may be more scientific: Because the brain eventually gets used to the smell of feces, the child may no longer notice the odor.
When to Call the Doctor
Although rectal surgery or birth defects such as Hirschsprung disease and spina bifida can cause constipation or encopresis without constipation, these are uncommon.
Call the doctor if your child shows any of the following symptoms:
poop or liquid stool in the underwear when your child isn't ill
hard poop or pain when having a BM
toilet-stopping BM
abdominal pain
loss of appetite
Treating Encopresis
As the colon is stretched by the buildup of stool, the nerves' ability to signal to the brain that it's time for a BM is diminished. If untreated, not only will the soiling get worse, but kids with encopresis may lose their appetites or complain of stomach pain.
A large, hard poop may also cause a tear in the skin around the anus that will leave blood on the stools, the toilet paper, or in the toilet. Constipation is also associated with wetting and urinary tract infections (UTI). If you think your child has encopresis, call your doctor.
Most cases of encopresis can be managed by your doctor, but if initial efforts fail, you may be referred to a gastroenterologist.
Treatment is done in three phases:
The first phase involves emptying the colon of hard, retained poop. Different doctors might have different ways of helping kids with encopresis. Depending on the child's age and other factors, the doctor may recommend medicines, including a stool softener (such as mineral oil), laxatives, and/or enemas. (Laxatives and enemas should be given only under the supervision of a doctor; never give these treatments at home without first checking with your doctor.) As unpleasant as this first step sounds, it's necessary to clean out the bowels to successfully treat the constipation and end your child's soiling.
After the large intestine has been emptied, the doctor will help the child begin having regular BMs with the aid of stool-softening agents, most of which aren't habit-forming. At this point, it's important to continue using the stool softener to give the bowels a chance to shrink back to normal size (the muscles of the intestines have been stretched out, so they need time to be toned without the poop piling up again). Parents will also be asked to schedule potty times twice daily after meals (when the bowels are naturally stimulated), in which the child sits on the toilet for about 5 to 10 minutes. This will help the child learn to pay attention to his or her own urges. It's especially helpful for parents to keep a record of their child's daily BMs.
As regular BMs become established, your doctor will reduce the child's use of stool softeners.
Keep in mind that relapses are normal, so don't get discouraged if your child occasionally becomes constipated again or soils his or her pants during treatment, especially when trying to wean the child off of the medications.
A good way to keep track of your child's progress is by keeping a daily poop calendar. Make sure to note the frequency, consistency (i.e., hard, soft, dry), and size (i.e., large, small) of the BMs.
Patience is the key to treating encopresis. It may take anywhere from several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again.
In the meantime, diet and exercise are extremely important in keeping stools soft and BMs regular. Also, make sure your child gets plenty of fiber-rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber cereal.
Because kids often cringe at the thought of fiber, try these creative ways to incorporate it into your child's diet:
Bake cookies or muffins using whole-wheat flour instead of regular flour. Add raisins, chopped or pureed apples, or prunes to the mix.
Add bran to baking items such as cookies and muffins, or to meatloaf or burgers, or sprinkled on cereal. (The trick is not to add too much bran or the food will taste like sawdust.)
Serve apples topped with peanut butter.
Create tasty treats with peanut butter and whole-wheat crackers.
Top ice cream, frozen yogurt, or regular yogurt with high-fiber cereal for some added crunch.
Serve bran waffles topped with fruit.
Make pancakes with whole-grain pancake mix and top with peaches, apricots, or grapes.
Top high-fiber cereal with fruit.
Sneak some raisins or pureed prunes or zucchini into whole-wheat pancakes.
Add shredded carrots or pureed zucchini to spaghetti sauce or macaroni and cheese.
Add lentils to soup.
Make bean burritos with whole-grain soft-taco shells.
And don't forget to have your child drink plenty of fluids each day, including water and 100% fruit juices like pear, peach, and prune to help draw water into the colon. Try mixing prune juice with another drink to make it a little tastier. Also be sure to limit your child's total daily dairy intake (including cheese, yogurt, and ice cream) to 24 ounces or less.
Successful treatment of encopresis depends on the support the child receives. Some parents find that positive reinforcement helps to encourage the child throughout treatment. Provide a small incentive, such as a star or sticker on the poop calendar, for having a BM or even just for trying, sitting on the toilet, or taking medications.
Whatever you do, don't blame or yell — it will only make your child feel bad and it won't help manage the condition. Show lots of love and support and, assure your child that he or she isn't the only one in the world with this problem. With time and understanding, your child can overcome encopresis.
Reviewed by: Mary L. Gavin, MDDate reviewed: May 2008Originally reviewed by: Wendy Kutz, MSN, RN
The truth is that many kids beyond the age of toilet teaching (generally older than 4 years) who frequently soil their underwear have a condition known as encopresis. They have a problem with their bowels that dulls the normal urge to go to the bathroom — and they can't control the accidents that typically follow.
Although encopresis is estimated to affect 1% to 2% of kids under the age of 10, problems with encopresis and constipation account for more than 25% of all visits to pediatric gastroenterologists (doctors who specialize in disorders of the stomach and intestines).
Most encopresis cases (90%) are due to functional constipation — that is, constipation that has no medical cause. The stool (or BM) is hard, dry, and difficult to pass when a person is constipated. Many kids "hold" their BMs to avoid the pain of constipation, which sets the stage for having a poop accident.
Well-intentioned advice from family members and friends isn't always helpful because many people mistakenly believe that encopresis is a behavioral issue — a simple lack of self-control. Frustrated parents, grandparents, and caregivers may advocate various punishments and consequences for the soiling — which only leaves the child feeling even more alone, angry, depressed, or humiliated. Up to 20% of kids with encopresis experience feelings of low self-esteem that require the intervention of a psychologist or counselor.
Punishing or humiliating a child with encopresis will only make matters worse. Instead, talk to your doctor, who can help you and your child through this challenging but treatable problem.
Encopresis and Its Causes
Three to six times more common in boys, encopresis isn't a disease, but rather a symptom that may have different causes. To understand encopresis, it's important to understand constipation.
There's a wide range of normal when it comes to having a BM. The frequency of BMs varies with a person's age and individual nature. "Normal" pooping might range from one or two BMs per day to only three or four per week. Some kids don't poop on a regular basis, but a child who passes a soft BM without difficulty every 3 days is not constipated. However, a child who passes a hard BM (small or large) every other day is. Other kids may go every day, but they only release little, hard balls and there's always poop left behind in the colon.
So, what causes the hard poop in the first place? Any number of things, including diet, illness, decreased fluid intake, fear of the toilet during toilet teaching, or limited access to a toilet or a toilet that's not private (like at school). Some kids may develop chronic constipation after stressful life events such as a divorce or the death of a close relative. Whatever the cause, once a child begins to hold his or her BMs, the poop begins to accumulate in the colon and a vicious cycle begins.
The colon's job is to remove water from the poop before it's passed. The longer the poop is stuck there, the more water is removed — and the harder it is to push the large, dry poop out. The large poop also stretches out the colon, weakening the muscles there and affecting the nerves that tell a child when it's time to go to the bathroom. Because the flabby colon can't push the hard poop out, and it's painful to pass, the child continues to avoid having a BM, often by dancing, crossing the legs, making faces, or walking on tiptoes.
Eventually, the lower part of the colon becomes so full that it's difficult for the sphincter (the muscular valve that controls the passage of feces out of the anus) to hold the poop in. Partial BMs may pass through, causing the child to soil his or her pants. Softer poop may also leak out around the large mass of feces and stain the child's underwear when the sphincter relaxes. The child can't prevent the soiling — nor does he or she have any idea it's happening — because the nerves aren't sending the signals that regulate defecation (or pooping).
At first, parents may think their child has a simple case of diarrhea. But after repeated episodes, it becomes clear that there's another problem — especially because the soiling occurs when the child isn't sick.
Parents are often frustrated by the fact that their child seems unfazed by these accidents, which occur mostly during waking hours. Denial may be one reason for the child's nonchalance — kids just can't face the shame and guilt associated with the condition (some even try to hide their soiled underpants from their parents). Another reason may be more scientific: Because the brain eventually gets used to the smell of feces, the child may no longer notice the odor.
When to Call the Doctor
Although rectal surgery or birth defects such as Hirschsprung disease and spina bifida can cause constipation or encopresis without constipation, these are uncommon.
Call the doctor if your child shows any of the following symptoms:
poop or liquid stool in the underwear when your child isn't ill
hard poop or pain when having a BM
toilet-stopping BM
abdominal pain
loss of appetite
Treating Encopresis
As the colon is stretched by the buildup of stool, the nerves' ability to signal to the brain that it's time for a BM is diminished. If untreated, not only will the soiling get worse, but kids with encopresis may lose their appetites or complain of stomach pain.
A large, hard poop may also cause a tear in the skin around the anus that will leave blood on the stools, the toilet paper, or in the toilet. Constipation is also associated with wetting and urinary tract infections (UTI). If you think your child has encopresis, call your doctor.
Most cases of encopresis can be managed by your doctor, but if initial efforts fail, you may be referred to a gastroenterologist.
Treatment is done in three phases:
The first phase involves emptying the colon of hard, retained poop. Different doctors might have different ways of helping kids with encopresis. Depending on the child's age and other factors, the doctor may recommend medicines, including a stool softener (such as mineral oil), laxatives, and/or enemas. (Laxatives and enemas should be given only under the supervision of a doctor; never give these treatments at home without first checking with your doctor.) As unpleasant as this first step sounds, it's necessary to clean out the bowels to successfully treat the constipation and end your child's soiling.
After the large intestine has been emptied, the doctor will help the child begin having regular BMs with the aid of stool-softening agents, most of which aren't habit-forming. At this point, it's important to continue using the stool softener to give the bowels a chance to shrink back to normal size (the muscles of the intestines have been stretched out, so they need time to be toned without the poop piling up again). Parents will also be asked to schedule potty times twice daily after meals (when the bowels are naturally stimulated), in which the child sits on the toilet for about 5 to 10 minutes. This will help the child learn to pay attention to his or her own urges. It's especially helpful for parents to keep a record of their child's daily BMs.
As regular BMs become established, your doctor will reduce the child's use of stool softeners.
Keep in mind that relapses are normal, so don't get discouraged if your child occasionally becomes constipated again or soils his or her pants during treatment, especially when trying to wean the child off of the medications.
A good way to keep track of your child's progress is by keeping a daily poop calendar. Make sure to note the frequency, consistency (i.e., hard, soft, dry), and size (i.e., large, small) of the BMs.
Patience is the key to treating encopresis. It may take anywhere from several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again.
In the meantime, diet and exercise are extremely important in keeping stools soft and BMs regular. Also, make sure your child gets plenty of fiber-rich foods such as fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, and high-fiber cereal.
Because kids often cringe at the thought of fiber, try these creative ways to incorporate it into your child's diet:
Bake cookies or muffins using whole-wheat flour instead of regular flour. Add raisins, chopped or pureed apples, or prunes to the mix.
Add bran to baking items such as cookies and muffins, or to meatloaf or burgers, or sprinkled on cereal. (The trick is not to add too much bran or the food will taste like sawdust.)
Serve apples topped with peanut butter.
Create tasty treats with peanut butter and whole-wheat crackers.
Top ice cream, frozen yogurt, or regular yogurt with high-fiber cereal for some added crunch.
Serve bran waffles topped with fruit.
Make pancakes with whole-grain pancake mix and top with peaches, apricots, or grapes.
Top high-fiber cereal with fruit.
Sneak some raisins or pureed prunes or zucchini into whole-wheat pancakes.
Add shredded carrots or pureed zucchini to spaghetti sauce or macaroni and cheese.
Add lentils to soup.
Make bean burritos with whole-grain soft-taco shells.
And don't forget to have your child drink plenty of fluids each day, including water and 100% fruit juices like pear, peach, and prune to help draw water into the colon. Try mixing prune juice with another drink to make it a little tastier. Also be sure to limit your child's total daily dairy intake (including cheese, yogurt, and ice cream) to 24 ounces or less.
Successful treatment of encopresis depends on the support the child receives. Some parents find that positive reinforcement helps to encourage the child throughout treatment. Provide a small incentive, such as a star or sticker on the poop calendar, for having a BM or even just for trying, sitting on the toilet, or taking medications.
Whatever you do, don't blame or yell — it will only make your child feel bad and it won't help manage the condition. Show lots of love and support and, assure your child that he or she isn't the only one in the world with this problem. With time and understanding, your child can overcome encopresis.
Reviewed by: Mary L. Gavin, MDDate reviewed: May 2008Originally reviewed by: Wendy Kutz, MSN, RN
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