Common Preschool Problems

Common Preschool Problems

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The appendix is a small structure that is attached to the large intestine and serves an unknown purpose. It can easily become inflamed, usually after a piece of stool or food is trapped inside. Once inflamed, the appendix will swell, become infected and cause pain. Bedtime Problems Preschool age children may have sleep problems, including trouble getting to sleep, frequent night waking in the middle of the night and having irregular sleep patterns. Remember that there are no definite right or wrong ways to put your child to sleep and that if you and your child are happy with your current routine then you should stick to it. However, it is not good if it is a struggle to put your child to bed, if she gets overly frustrated in the process, strongly resists being put to bed or if she is waking up so much that she or other family members end up not getting adequate sleep. To help prevent problems at bedtime you should develop a bedtime routine that you follow closely each night. This routine can include taking a bath, brushing her teeth, saying prayers, talking, and reading a book. A good way to end the routine is to read a book or story after your child is tucked into bed. You can warn her that bedtime is near after the story is finished and then end the routine by turning the light off and saying goodnight. Remind her that she is not allowed to leave her bed until morning. Ignore any further requests or questions. Once your child has been put to bed, you should be strict about the rule of not leaving the bedroom. If she does get up and comes out, quickly return her to her room and remind her that she has to sleep in her own bed. Ignore all protests or requests and keep your interactions with her to a minimum (no bedtime hug or kiss this time). If she continues to leave the room you can warn her that you will have to close the door. You should follow up on this warning if she keeps leaving the room. You can stand outside the door and let her know that you will open the door again if she gets back in bed and stays there.You should also consider closing the bedroom door if she continues to cry or protest going back to bed. Again, let her know that you will open it again if she quitely goes back to bed. You may need to lock the door if she is able to open the door and continues to come out. This is a necessary step to make sure that your child does not hurt herself while she is awake and able to wander around the house. While the first few nights of this treatment may be difficult and your child will probably cry and protest, she will quickly learn how to fall asleep on her own and sleep through the night. Other steps you can take to help with this process is to cut back on daytime sleeping and consider a later bedtime, since your child is less likely to protest or repeatedly wake up if she is very tired. And remember to praise your child when she does sleep through the night, stays in her own room or goes to bed without protesting. You should not feel guilty about letting your child cry or locking their bedroom door. Children usually have bedtime problems because they are trying to test your limits or because of poor sleep habits. Rarely are these problems caused by real fears, but you should comfort and reassure your child if she is truely afraid. Bedwetting While most children are potty trained by the time they are three to four years old, wetting the bed at night (nocturnal enuresis) is still a common problem for many six to eight year old children (affecting about 8% of eight year olds). It is more common in boys and in families in which one or both parents wet the bed as a child. Bedwetting may be caused by your child having a small bladder capacity (meaning it can not hold as much urine as children who do not wet the bed), not being able to tell when his bladder is full, or during times of stress. Very rarely is bedwetting caused by a disease or physical problem. Bedwetting is defined as being primary, children who have never had dry nights, or secondary, children who are now wetting the bed, but who had previously been dry for 3-6 months. About fifteen percent of children who wet the bed will mature out of this problem every year, but until he does, here are some steps you can take to try and increase the number of dry nights that he has: Reassure your child that this is normal at this age and not his fault and understand that he is not doing it on purpose. Also, do not punish or blame your child for wetting the bed and make sure that other family members do not tease him about it. Avoid letting your child drink large amounts of fluid two hours before bedtime. Have your child use the toilet just before going to bed. Protect the bed with a plastic cover between the sheets and mattress. Let your child help change the wet sheets. Consider practicing bladder-stretching exercises, in which your child will try and increase the time between urinating during the daytime so that the bladder can learn to stretch and hold more urine at night. Consider practicing an awakening routine, in which you wake your child to urinate two to three hours after he goes to bed, either at the parent's bedtime or after setting an alarm clock Bedwetting Alarms If the above methods do not work and your child is still wetting the bed after he is 7-8 years old we will consider using a bed wetting alarm that senses when your child has begun to wet the bed and sets off an alarm to wake them up. This helps to teach your child to respond to a full bladder and this method works in over 70% of children after two to three months.One such alarm is the Potty Pager, a self-contained silent alarm that uses a mechanical vibration to awaken your child when the alarm senses wetness. It is available for $49.95 from Ideas for Living, Inc. Call 800-497-6573 to order or for more info. Another type of alarm is the Sleep Dry alarm that also has a wetness sensor to detect when your child is wet and then wakes them with an audio alarm. It is available for $50.95 from StarChild Labs at 800-346-7283. Medicines for bedwetting The medicines that are currently available to treat bedwetting are Imipramine (an antidepressant) and DDAVP. They both can be effective in reducing the number of wet nights that your child has, but they only work as long as your child continues to use them. They also have possible side effects and relapses are common when you stop using them.In general, we reserve using medicines in select children when no other treatment works. They may also be beneficial for your child to take on special occasions, such as sleep overs, camping trips, etc. Important Reminders Be patient. This is a persistent and frustrating problem, but one that will usually resolve as your child gets older. Call your pediatrician if your child is also wetting himself during the day, complains of burning during urination, is losing weight, has blood in his urine, or if the problem is affecting your child's self esteem. Sleep Problems Like adults, children have dreams when they are in REM sleep. This occurs 4-5 times each night, and while most dreams aren't remembered, some are frightening enough to wake the child and make them summon their parents. Nightmares usually begin when a child is about three years old, they are most common between the ages of three and eight (when their fantasy life is more active) and they are most likely to occur later in the night. Unlike night terrors, your child will be wide awake and responsive after the nightmare and she may be able to recall the details of the nightmare the next morning.While an occasional nightmare is normal, an increase in the number of nightmares can be a response to stress or your child being anxious about something. Other triggers can be a change in her normal routine, like moving, starting a new school, or a death in the family. Or the nightmares may be a response to a violent or scary movie, television show or story. When your child has an occasional nightmare, you should reassure her that it was just a dream and isn't real. Give her lots of hugs and be supportive. You may need to search her room with her to reassure her that their aren't any monsters or whatever the nightmare was about. It is probably best to wait until the next morning to really talk about the details of the dream, at which time she should be calmer. And try to figure out if there was a specific event or stressor that may have triggered the nightmares. Did she see a television show or movie or read a story in which this may have occurred? Have you recently moved or had another big change in your home situation? Is she on any new medications that may be affecting her sleep? Tips to decrease nightmares include: Decreasing stress in her life. Avoid television at least an hour before bedtime. Avoid telling her scary bedtime stories. Let her sleep with a night light. Talk about the nightmare the next day. Suggest that she draw a picture of the dream to help her talk about it. While an occasional nightmare is normal, you should seek professional help if the nightmares are also associated with changes in her daytime personality or behavior. If she is under a lot of stress or seems very anxious and the nightmares are increasing, then she may need professional counseling. Otherwise, with a lot of reassurance, she should outgrow them. Night terrors are more frightening for parents, but can also be normal. They usually occur a few hours after your child has gone to sleep, at which time you may wake up to your child's crying or screaming. When you go to him, he will NOT be alert and won't recognize you, even though he may seem like he is awake. He will usually seem like he is terrified and may have a rapid heart beat and rapid breathing. Night terrors occur as your child moves through different stages of sleep and they represent a partial awakening. Since your child isn't really awake, there is nothing that you can do to reassure him. You should see that he is safe and do not try to wake him up. He will usually settle himself down after a few minutes. Sleepwalking is similar to night terrors, in that they represent a partial awakening. They also occur a few hours after your child goes to sleep. Although your child may be walking around the house, he is not awake and isn't aware of what he is doing. It is not necessary to wake a child up that is sleepwalking. Instead, you should just make sure that he can't hurt himself and maybe return him to bed. If sleepwalking occurs often and you are worried about your child's safety, you can try and wake him up yourself, before the time that he typically wakes up. This treatment can disrupt the cycle and decrease his sleepwalking. Some children grind or clench their teeth while sleeping. This is calledbruxism and is usually not a concern, unless it is leading to damage of his teeth. Children with bruxism should be evaluated by a pediatric dentist, who may recommend a plastic mouth guard to prevent damage. EMOTIONAL PROBLEM OF THE PRE SCHOOL This study examined how well private-practice pediatricians can identify emotional/behavioral problemsamong preschool children. Children aged 2 through 5 (N = 3876) were screened during a visit to 1 of 68 pediatricians who rendered an opinion about the presence ofemotional/behavioral problems. Subsequently, children who scored above the 90th percentile for behavioralproblems on the Child Behavior Checklist, along with children matched on age, sex, and race who had screened low, were invited for an intensive second-stage evaluation. There were 495 mothers and children who participated in that evaluation, which included a behavioral questionnaire, maternal interview, play observation, and developmental testing. Two PhD-level clinical child psychologists rendered independent opinions about the presence of an emotional/behavioral disorder. The psychologists identified significantly higher rates of problems overall—13.0% when the criterion was independent agreement that the child had an emotional/behavioral problem and a regular psychiatric diagnosis was assigned, vs 8.7% based on pediatricians' ratings. Prevalence rates based on psychologists' independent ratings were significantly higher than pediatricians' for both sexes, 4- through 5-year-olds, and whites, but not for 2- through 3-year-olds, African-Americans, and all minorities. Prevalence rates based on psychologists' ratings were significantly higher than the pediatricians' for all subgroups when V-code diagnoses were included in the psychologists' ratings. Overall, pediatricians' sensitivity was 20.5%, and specificity was 92.7%. At least 51.7% of the children who had anemotional/behavioral problem based on the psychologist's independent agreement had not received counseling, medication, or a mental health referral from the pediatrician. It is concluded that a substantial number of preschool children with behavior problems in primary care are not being identified or treated.