Usual Problems in Early Childhood

Early Childhood

Pre-school years (2-5 years)

          This phase brings a rapid increase in intellectual abilities, especially in the complexity of language. Social development occurs as the child learns to live within the family. He begins to identify with the parents and adopt their standards in matters of conscience. Social life develops rapidly as he learns to interact with siblings, other children, and adults. Temper tantrums continue, but diminish and should disappear before the child starts school. At this age, the child has much curiosity about the environment and may ask a great number of questions.

          In children aged 2-5, fantasy life is rich and vivid. It can form a temporary substitute for the real world, enabling desires to be fulfilled regardless of reality. Special objects such as teddy bears or pieces of blanket become important to the child. They appear to comfort and reassure the child, and help sleep. They have been called 'transitional objects'.

Common Problem in Early Childhood

          In children from birth to the beginning of the fifth year, common problems include difficulties in feeding and sleeping, as well as clinging to the parents (separation anxiety), temper tantrums, and reactive attachment disorder.

















Temper Tantrum

          Occasional temper tantrums are normal in toddlers, and only persistent or very severe tantrums are abnormal. The immediate cause is often unwitting reinforcement by excessive attention and inconsistent discipline on the part of the parents. When this arises it is often because the parents have emotional problems

Temper tantrums usually respond to kind but firm and consistent setting of limits. In treatment it is first necessary to discover why the parents have been unable to set limits in this way. They should be helped with any problems of their own and advised how to respond to the tantrums.

Sleep Problem

          The most frequent sleep difficulty is wakefulness at night, which is most frequent between the ages of 1 and 4 years. About a fifth of children of this age take at least an hour to get to sleep or are wakeful for long periods during the night. When wakefulness is an isolated problem and not very distressing to the family, it is enough to reassure parents that it is likely to improve.

When sleep disturbances are severe or persistent, two possible causes should be considered. First, the problems may have been made worse by physical illness or an emotional disorders. Second, they may have been exacerbated by the parents excessive concern and inability to reassure the child. If no medical or psychiatric disorder is detected, the reasons for the parents concerns should be sought and dealt with as far as possible. Some parents overstimulate their child in the evening, or condone crying in the night by taking the child into their own bed. 

A behavioral approach to these problems is generally helpful (Richman et al. 1985). The handbook by Douglas and Richman (1984) is useful for parents.
Hypnotic medication may be used occasionally for special occasions but should not be used in the long term.

Other sleep problems such as nightmares and night terrors are common among healthy toddlers but they seldom persist for long.

Pica- rice eating problem

          Pica is the eating of items generally regarded as inedible, for example soil, paint, and paper. It is often associated with other behavior problems. Cases should be investigated carefully because some are due to brain damage, or autism, or mental retardation. Some are associated with emotional distress, which should be reduced if possible.
Otherwise, treatment consists of common-sense precautions to keep the child away from the abnormal items of diet. Pica usually diminishes as the child grows older.

Reactive attachment disorder of infancy and early childhood

          This term denotes a syndrome starring before the age of 5 years and associated with grossly abnormal care-giving. There are two subtypes: inhibited and disinhibited. Children in the first subgroup may show a combination of behavioral inhibition, vigilance, and fearfulness, which is sometimes called frozen watchfulness. These children are miserable, difficult to console, and sometimes aggressive. Some fail to thrive. Such behavior is seen among children who have been abused. Children with the disinhibited subtype of the disorder relate indiscriminately to people, irrespective of their closeness, and are excessively familiar with strangers. Such behavior has been described most clearly in children raised in institutions. 
          In DSM-IV, the diagnosis is made when the disturbance of relationships appears to be a direct result of abnormal care-giving. ICD-10 does not use this criterion but requires that the behavior is present in several situations.