Common Behavioural Disorders in Children

•C.S.N.Vittal 


Common 

Common 

Behavioural Behavioural Disorders 

Disorders 

in 

Children 

Children 

Dysfunctional Behaviours 

1. Habit Disorders 


2. Conduct Disorders 

3. Emotional Disorders 

1. Habit Disorders 

1. Repetitive Behaviors 

2. Finger (thumb) sucking 

3. Pica 

4. Nail biting 

5. Teeth grinding (Bruxism) 

6. Breath holding spasms 

7. Temper tantrums 

8. Tics 




Definition 

A young person is said to have a 

behaviour disorder 

when he or she demonstrates behaviour that is 

noticeably different from that expected in the 

school or community. 

A child who is not doing what adults 

want him to do at a particular time. 

What can affect Behaviour in a child? 

• Heredity 

• Environment 

• Learning Conditioning 

• Positive reinforcements 

1. Repetitive Behaviors 

• Benign & self-limiting 

• Begin between 6 – 10 yrs 

– Eg. Body rocking, Head banging 

Head banging 

– In 5-20% of children during infancy & toddler years 

– Can result in callus formation, abrasions, contusions 

• Tt. 

– Assurance 

– Teach parents to ignore – as concern and punishment 

can reinforce it. 

– Padding 

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2.Finger (Thumb) sucking & Nail Biting 

• Sensory solace for child 

(“internal stroking”) to 

cope with stressful 

situation in infants and 

toddlers. 

• Reinforced by attention 

from parents. 

• Predisposing factors: 

Developmental delay 

Neglect 


Management 

• Reassure parents that it’s transient. 

• Improve parental attention / nurturing. 

• Teach parent to ignore; and give more 

attention to positive aspects of child’s 

behavior. 

• Provide child praise / reward for substitute 

behaviors. 

• Bitter salves, thumb splints, gloves may be 

used to reduce thumb sucking. 

3.Temper Tantrums 

Precipitationg factors 

• Hunger 

• Fatigue 

• Lack of sleep 

• Innate personality of child 

• Ineffective parental skills 

• Over pampering 

• Dysfunctional family / Family violence 

• School aversion 



• Most give up by 2 yrs 

• If continued beyond 4 yrs – 

number of squelae 

• If resumed at 7 – 8 yrs : sign of 

Stress 

• Adverse Effects 

– Malocclusion – open bite 

– Mastication difficulty 

– Speech difficulty (D and T) 

– Lisping 

3.Temper Tantrums 

– Paronychia and digital 

abnormalities 

• In 18 months to 3 yr olds due to 

development of sense of autonomy. 

• Child displays defiance, negativism / 

oppositionalism by having temper tantrums. 

• Normal part of child development. 

• Gets reinforced when parents respond to it 

by punitive anger. 

• Child wrongly learns that temper tantrums 

are a reasonable response to frustration. 



3.Temper Tantrums – 

Management 

• In general, parents advised to: 

Set a good example to child 

Pay attention to child 

Spend quality time 

Have open communication with child 

Have consistency in behavior 

• During temper tantrum: 

Parents to ignore child and once child is calm, tell child 

that such behavior is not acceptable 

Verbal reprimand should not be abusive 

Never beat or threaten child 

Impose “Time Out” - if temper tantrum is disruptive, out 

of control and occurring in public place. 

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4.Evening Colic 

• Intermittent episodes of abdominal pain and 

severe crying in normal infants 

• Begins at 1-2 wks age and persists till 3-4 mo. 

• Crying usually in late afternoon or evening 

• Diagnosis : 

“ Infant cries for > 3 hrs per day for > 3 day 

per week for > 3 weeks” 


Attack 

• Begins suddenly with a loud cry 

• Crying continuous – lasts for several 

hours – mostly in the late afternoon or 

evenings 

• Face becomes red and legs drawn up 

on the abdomen 

• Abdomen becomes tense 

• Attack terminates after exhaustion or 

after passage of flatus or feces 

5.Stranger Reaction / Anxiety 

By 6-7 months age infant can differentiate from 

primary care givers and others 

At this age they develop fear of others. 

This may last for a few months to peak around 

13-15 months 

If infant on approach of stranger behaves with 

more intense discomfort – such as 

continuous crying, vomiting, refusal to 

socialize : Stranger anxiety. 

It might be an indication for later development of 

behavioural problem as separation anxiety. 





Cause 

• Not known 

• More likely if the child is over active and 

parents are over anxious 

• Could be a manifestation of 

• hunger, 

• aerophagia, 

• cow’s milk intolerance, 

• immaturity of intestine, 

• overfeeding, 

• intake of food with high CHO content 


Management 

During Episode 

– Hold the child erect or prone 

– Avoid drugs 

– No much role to antispasmodics, carminatives, 

simethicone, suppositories or enemas 

Counseling - Coping with the parents 

– Reassure the parents that infant is not sick 

– They need to soothe more with repetitive sound 

and stimulate less with decrease in picking up and 

feeding with every cry 

5.Stranger Reaction / Anxiety 

Management 

• Teach relaxation technique such as 

slowly exposing them to stranger, 

– initially from a distance 

– Asking them to greet and slowly 

advance 

• Reassure the parents that the 

behaviour gradually declines 

– But if persists, refer to child psychiatrist 

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6.Pica 

Repeated or chronic ingestion of 

non-nutritive substances. 

– Examples: mud, paint, clay, plaster, 

charcoal, soil. 

• It’s an eating disorder. 

• Normal in infants and toddlers. 

• Passing phase. 

6.Pica 

Pica after 2nd yr of life needs investigation 

• Predisposing factors : 

Parental neglect 

Poor supervision 

Mental retardation 

Lack of affection Psychological neglect, 

orphans) 

Family disorganization 

Lower socioeconomic class 

Autism 

7.Breath Holding Spasms 

• Behavioral problem in infants and 

toddlers. 

• Child cries and then holds breath 

until limp. 

• Cyanosis may occur. 

• Sometimes, loss of consciousness, 

or even seizure can occur. 

• It is child’s attempt to control 

environment: parents /caregivers. 

• Benign condition: no risk of epilepsy 

developing in later life. 



6.Pica 

Geophagia 

Pagophagia 

Hyalophagia 

Amylophagia 

Xylophagia 

Trichophagia 

Urophagia 

Coprophagia 

6.Pica 


Eating of mud, soil, clay, chalk, etc. 

Consumption of ice 

Consumption of glass 

Consumption of starch 

Consumption of wood 

Consumption of hair 

Consumption of urine 

Consumption of feces 

• Screening indicated for: 

Iron deficiency anemia 

Worm infestations 

Lead poisoning 

Family dysfunction 

• Treat cause accordingly. 

• Usually remits in childhood but can 

continue into adolescence 

7.Breath Holding Spasms 

Management 

• Referral to Child Guidance Clinic: 

• Referral to Child Psychologist 

– If BHS accompanied with head 

banging or highly aggressive 

behavior 

4



8.Stuttering / Stammering 

• Defect speech 

• Stumbling and spasmodic 

repetition of some syllables with 

pauses 

• Difficulty in pronouncing 

consonants 

• Caused by spasm of lingual and 

palatal muscles 


Management 

• Parents should be reassured 

• They should not show undue concern 

and accept his speech without 

pressurizing him to repeat 

• Children should be given emotional 

support 

• Older children with secondary 

stuttering should be referred to speech 

therapist 



• Usually begins between 2 – 5 yrs 

• Reminding and ridiculing 

aggravate 

• Child loses self confidence and 

become more hesitant 

• They can often sing or recite 

poems without stuttering 

Thank Thank Thank Thank QQ 

QQ 

• CSN Vittal 

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Common Behavioural Disorders in Children

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