Friday, June 25, 2010

Diagnosing and Thinking About Behavioral and Discipine Problems

This is a lot of material circulating about dealing with children's behavioral problems, so we wanted to discuss here the issue of health and well-being in a child's ability to be self-disciplined.

Here is a short sample from the Center for Disease Control's website that addresses lead poisoning. While lead poisoning is only one of many factors that can influence a child's health and behavior, this case study is great for getting one to think outside of the classroom discipline box:

"A 5-year-old boy is brought to your office by his mother, who is concerned that her child is hyperactive. At a parent teacher conference last week, the kindergarten teacher said that the boy seems impulsive and has trouble concentrating, and recommended evaluation by a physician as well as by the school psychologist. The mother states that he has always seemed restless and easily distracted, but that these first 6 months in kindergarten have been especially trying.

Family history reveals that the boy lives with his sister, mother, and maternal grandparents in an older suburb of your community. The child's monthly weekend visits to his father's house are working out fine. However, he seems to be fighting more with his sister, who has an attention-deficit disorder and is repeating first grade. Since the mother moved in with her parents after her divorce 4 years ago, she has worked with the grandfather in an automobile radiator repair shop, where her children often come to play after school. She was just laid off, however, and expressed worry about increasing financial dependence on her parents. She also worries that the grandfather, who has gout and complains increasingly of abdominal pain, may become even more irritable when he learns that she is pregnant. Her third child is due in 4 months.

On chart review, you see that the boy was last seen in your clinic for his preschool physical 1 year ago, results of which were normal. A note describes a very active 4-year-old who could dress himself without help but could not correctly name the primary colors. His vision was normal, but hearing acuity was below normal, and speech and language were slightly delayed. Immunizations are up to date.

Further history on that visit indicated adequate diet, with no previous pica. Spun hematocrit was diminished at 30%. Peripheral blood smear showed hypochromia and microcytosis. There was no evidence of blood loss, and stool examination was negative for occult blood. The diagnosis was "mild iron deficiency anemia," and iron therapy was prescribed. The family failed to keep several follow-up appointments, but the child did apparently complete the prescribed 3-month course of iron supplements. He receives no medications at this time and has no known allergies.

On physical examination today, you note that the boy is in the tenth percentile for height and weight. His attention span is very short, making him appear restless, and he has difficulty following simple instructions. Except for language and social skills, he has reached most important developmental milestones..."

We encourage everyone to read the rest of the case studies along with the answers.

Lead poisoning is an extreme situation. The most common situation we see in the classroom is that a child has had a poor breakfast or none at all. More in our upcoming post on nutrition...

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