Category: Education

Presentation Description

Behavioral problems in our pediatric population have increased in occurrence and as prehospital care providers we need to have a better understanding of what is going on. Care of specific behavioral disorders is paramount to appropriate understanding and treatment ease.


Presentation Transcript

Terrible Two’s The Least of Your Worries:

Terrible Two’s The Least of Your Worries Pediatric Behavior Problems Jennifer L. Knapp NREMT-P, PI


Dedication Don Hess Instructor Mentor & Friend


Objectives Define behavioral emergencies Explain causes of behavioral emergencies Overview behavioral problems in pediatrics Emergent behavioral situations presented EMS behavioral interventions

Slide 4:

What is a behavioral emergency? An alteration in behavior that cannot be tolerated by the patient or other members of society. Usually requires immediate attention


Causes Intrapsychic Interpersonal and Environmental Organic

Intrapsychic Causes:

Intrapsychic Causes Underlying psychiatric condition Range of behaviors Withdrawal, catatonia Violence or homicidal acts Suicidal acts Paranoia Phobias D isorientation

Interpersonal and Environmental Causes:

Interpersonal and Environmental Causes Reactions to stimuli Overwhelming and stressful situations Link to a specific incident or set of incidences Range of behavior is broad and tied to stressor

Organic Causes:

Organic Causes Disturbance in patient’s physical or biochemical state Alcohol and substance abuse Trauma or medical illnesses Dementia Consider organic causes in ALL behavioral emergencies!

Pediatric Behavioral Problems:

Pediatric Behavioral Problems ADHD Asperger’s Autism Depression Oppositional Defiance Disorder PTSD TBI Schizophrenia Bipolar Disorder Learning Disability Panic Disorder OCD Eating Disorders Angelman’s Disorder Fetal Alcohol Syndrome


ADHD Attention Deficit Hyperactivity Disorder 5% of school aged children Genetic Due to lack of brain stimulation not over Distractibility Forgetfulness Poor organizational skills Difficulty listening or attending details Interrupts


Asperger’s/Autism 1 in 110 people Neurologic Disorder Genetic base probable Social and behavioral issues Indifference Hand flapping or other stimming Meltdowns


Depression Up to 1 in 33 kids Change in sleeping/eating patterns Low self esteem Lonely Death themes in play Developmental regression Clingy behavior Anger and resentment Unusual or excessive crying or sadness

Oppositional Defiance Disorder:

Oppositional Defiance Disorder Up to 16% Low or inflated self esteem Swearing Arguing Aggression Bullying Cruelty to Animals Disregard for rules and feelings


PTSD Post Traumatic Stress Disorder Repeated episodes of nightmares Dwelling on the incident in play and otherwise Physical symptoms Worrying over death at early age Lack of concentration Sudden and extreme emotional reactions Irritability and outbursts


TBI Traumatic Brain Injury Headache Nausea Confusion Personality changes Coma


Schizophrenia Hallucinations Odd/Eccentric behavior Confusing television and reality Paranoia Confusion Withdrawn Decline in hygiene Behaviors remain for 6 months Rare in pediatrics …. Diagnosis typical in 20’s

Bipolar Disorder:

Bipolar Disorder 25 out of 100,000 (2.5%) Genetic Unusual shifts in energy, mood and function Disregard of risk Hyper-sexuality Decreased sleeping Increased energy

Learning Disability:

Learning Disability Consistently score lower than development Low self esteem Difficulty maintaining friendships 40% drop out rate

Panic Disorder:

Panic Disorder 3% and adult rate is 5% Intense fearfulness Racing/Pounding heartbeat Sense of unreality Dizziness Fear of dying Trembling or shaking Shortness of breath/feeling suffocated


OCD Obsessive Compulsive Disorder 1 in 200 kids Preoccupation with orderliness Inflexible Adhere to rules excessively Intolerance

Eating Disorders:

Eating Disorders Genetic probability Linked to other psychiatric problems Anorexia nervosa Bulimia nervosa Binge-eating Wide range of health complications Prevalence increases near adulthood

Angelman’s Disorder:

Angelman’s Disorder 1 in 10 to 20,000 births Developmental delay Non-verbal to slightly verbal Receptive and non-verbal skills higher Flat back of head Large head Heat sensitive Tongue thrusting Seizures, onset before 3 years age

Fetal Alcohol Syndrome:

Fetal Alcohol Syndrome 0.5 to 2 cases in 1,000 births Growth slowed Thin upper lip Heart and liver abnormalities Language problems ADD Microcephaly

Physical Manifestations:

Physical Manifestations Cutting/Self Injury Suicide Substance Abuse Sexual Promiscuity Fighting Withdrawal

Legal Concerns:

Legal Concerns Safety and Legal Concerns Indiana Code 12-26

What do we do?:

What do we do? Consider their perception of the events Look at their support system Contemplate their coping mechanisms Establish plan of action Respectfully begin treatment Be honest and forth coming

How We Can Help:

2006 IRCA How We Can Help Stay calm and reduce stimuli Avoid touch when possible. May need to leave immediate area. If possible, turn off strobe or flashing lights. If possible, turn off loud noises (siren). Limit crowd intrusion.


ABC’S Awareness Basics Calm and Safe


Awareness Be aware of different behaviors Be aware and change your strategies


Basics Basic Instructions Basic Questions Basic Stuff Basic People Basic Treatment


Calm Be clear and controlled No aggressive actions or behavior Offer empathy and compassion Don’t force your agenda Changes if life-threatening situation


Safe Remove threats Begin care where they feel safe Anticipate possible problem areas Explain procedures before performing Restraints are LAST RESORT Only if immediate danger

Grab and Rescue:

Grab and Rescue Use simple blanket or sheet Place it around person Moves the arms in close to the body Allows movement and direction Protects person and rescuer Provides barrier

Things to Note:

Things to Note They are still kids Perspective is everything Everyone deserves respect A little honest empathy goes far They might be different, but they are NOT less

Slide 35:

"What would happen if the autism gene was eliminated from the gene pool? You would have a bunch of people standing around in a cave, chatting and socializing and not getting anything done." — Temple Grandin (The Way I See It: A Personal Look at Autism and Asperger’s )



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