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Habit Disorders

(3-31-15)

Elimination Disorders in Youth

(3-31-15)

  • Enuresis
    • “functional bladder incontinence”
      The category of enuresis typically excludes any cases with clear biological etiology (structural abnormalities or diseases which would account for failure of urinary control).
    • “incontinence” refers to loss of bladder control due to organic factors.
    • Children suspected of enuresis should receive medical screening to rule out possible biological factors (sickle cell anemia, juvenile onset diabetes, urinary or bladder infections, etc.)
  • Diagnosis of enuresis involves consideration of age and frequency of incidents.
    • A minimum age or mental age required.
    • A minimum frequency of difficulty required.
  • Within the population of children with enuresis it is possible to distinguish different patterns:
    • nocturnal, diurnal, mixed patterns
    • primary (continuous, chronic) vs.
    • secondary (discontinuous, acute) patterns
  • The most common presentation seen is a male child who has always wet the bed at night (male, primary pattern, nocturnal enuresis).
    • Treatment of enuresis:
      • urine alarm (bell-and-pad device)
      • medication
  • Encopresis
    • As with enuresis, considerations of possible organic etiology, pattern of occurrence, pattern of history, sex distribution, minimal age/mental age and frequency requirements are pertinent.
    • In contrast to enuresis–an association of fecal soiling with biological problems is more pronounced with cases of perpertied encopresis. A history of constipation in common. Medical screening to rule out physiological problems is important.
    • Modal presentation of encopresis is a male child, who has resumed soiling after a period of control of defecation, and who soils during the day (male, secondary, diurnal soiling).
    • Treatment of encopresis: careful medical evaluation, treatment of any associated medical difficulties, behavior modification.

Sleep Disorders

(3-31-15)

  • Dyssomnias
    • problems with initiating or maintaining sleep–problems with the amount of sleep:
      • insomnia
      • hypersomnia
  • Parasomnias
    • problems with the quality of sleep–abnormal behaviors during sleep
    • narcolepsy
    • restless leg syndrome
    • night terrors
      • incubus nocturnis: nightmares, “bad dreams”, REM stage dreaming
        • child can be awakened
        • immediate recall of dream good
        • little motor activity (motor system “off line” during REM stage sleep)
        • brief (only feelings like forever)
      • pavor nocturnis: sleep terror, non-REM stage sleep disturbance
        • difficult to awaken child
        • amnesia for incident
        • frantic motor activity
        • long duration (possibly up to 15-20 minutes)
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