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1

 

 

Fifth stage 

Pediatric  

Lec. 2

 

 .د

بسام

 

6

2 /4/2017

 

 

Habit Disorders 

 

Enuresis (Bed Wetting): 

It is an involuntary emptying of the bladder of more than twice a week in more than 5 to 6 
years old child. 

It is either:  

- Diurnal if it occur during the day time when the child awake  

- Nocturnal if occur during sleep which is more common than the diurnal. 

Girls achieve bladder control earlier than boys. 

Also enuresis is either: 

  

Primary Enuresis: 

*The child had never achieved an appropriate period (about 6 months) of bladder   

  control. 

*There is a strong family history. 

*Boys more common than girls (2 to 1 ratio). 

*Have no underlying organic cause and it is thought to be due to delayed maturation    

 of bladder control mechanisms. 

 

Secondary enuresis: where enuresis recur again after a period (6 months) of good bladder 
control.  

In secondary a careful history and investigations are needed because of probable organic 
cause. 

 

 

 

 


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Possible organic causes of secondary enuresis 

*Renal tract:  urinary tract infection 

*Neurological: spina bifida 

*Endocrine: diabetes mellitus, diabetes insipidus 

*Behavioural problems   

*Child Abuse   

 

Treatment: 

*Restrict drinks during the last 1 hour before sleep. 

*Avoid punishment to the child. 

*Using the star charts to encourage and motivate the child. 

*Medications as Oxybutinin, Imipramin, Desmopressin. 

*Bladder exercises in case of small bladder. 

 

If the problem is resistant to the above treatments, other pathologies need to be 
considered as:- 

-Urinary outflow obstruction in boys.   

-Chronic constipation.   

-Neurodevelopmental problems.   

-Psychological problems. 

 

 

 

 

 

 

 

 

 


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Breath Holding Attacks: 

It occurs in infants and toddlers. They are usually precipitated by pain or frustration. 

It starts by loud crying, then suddenly there is stopping of breathing in expiration, 

becoming cyanosed, if inspiration does not quickly follow, the infant loose  

consciousness, becomes rigid, with back arched and extended limbs. He may have  

few convulsive twitches. 

Respiration always starts again with rapid recovery and there is no danger to   

life. 

These attacks cease spontaneously as the child matures usually before 5 years  

of age. 

EEG shows no abnormality.  

The parents need to be reassured about its harmless nature and natural course.  

No specific treatment is necessary apart from correction of anaemia if present. 

 

Pica: 

Pica is a persistent eating of nonnutritive, nonfood substances (e.g., paper, soap,  

plaster, charcoal, clay, wool, ashes, paint, stones or soil) over a period of at least 1 mo. 

It appears to be more common in those with intellectual disability  and  autism   

spectrum  disorders,  and  to  a  lesser  degree  in obsessive-compulsive and  

schizophrenic disorders, also can occur in emotionally deprived children, in those suffers 
emotional trauma and when there is parental neglect. 

Also, it can occur when there is some minerals deficiency  (e.g., iron, zinc, and calcium). 

Complications: 

Pica can result in lead poisoning due to ingestion of lead containing paints, also can 

cause gastric injury or gastrointestinal obstruction, or may result in parasitic infestation due 
to ingestion of soil contaminated with animal feces. 

 




رفعت المحاضرة من قبل: أحمد فارس الليلة
المشاهدات: لقد قام 3 أعضاء و 84 زائراً بقراءة هذه المحاضرة








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