Download Free Medical Introduction to Behavioral Pediatrics PowerPoint Presentation

Introduction to Behavioral Pediatrics PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Pediatrics, which is titled "Introduction to Behavioral Pediatrics", to know about Behavioral Pediatrics and issues like Encopresis and Enuresis.

Tags : Pediatrics, Introduction, Behavioral Pediatrics, Encopresis, Enuresis

Published on : Aug 03, 2021 | Views : 1505 | Downloads : 0

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Introduction to Behavioral Pediatrics Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center
Slide 2-

Overview Encopresis Enuresis An empirically-supported approach to day time toilet training An empirically-supported approach to night time toilet training
Slide 3-

Encopresis Repeated passage of feces into inappropriate places whether involuntary or intentional At least one such event a month for 3 months At least 4 years old Not due to direct effects of substance or medical condition except constipation With constipation and overflow incontinence Without constipation and overflow incontinence
Slide 4-

Encopresis Medical Workup/Management Bowel habits assessment Education Diet assessment/Changes Compliance/Behavioral protocol
Slide 5-

Encopresis Medical Workup/Management Assessment of etiology Slow moving bowels vs. Spina Bifida or Hirschsprung’s disease If constipation – “clean out” Laxatives, stool softeners, or fiber for maintenance
Slide 6-

Encopresis Medical Workup/Management Bowel habits assessment
Slide 7-

ppt slide no 7 content not found
Slide 8-

Encopresis Medical Workup/Management Education Symptoms of constipation Functioning of bowel Behavioral “causes” Diet
Slide 9-

ppt slide no 9 content not found
Slide 10-

Encopresis Medical Workup/Management Education Diet assessment/Changes Diet diary Behavioral protocol to increase fiber Premack principle
Slide 11-

ppt slide no 11 content not found
Slide 12-

Encopresis Medical Workup/Management Education Diet assessment/Changes Behavioral Protocol (to be discussed)
Slide 13-

Enuresis Repeated voiding of urine into bed or clothes (whether involuntary or intentional) Behavior is clinically significant (at least 2x/wk for 3 mos or causes impairment) At least 5 years old (developmentally) Not due to substance/medical condition
Slide 14-

Enuresis Primary vs. secondary Nocturnal vs. diurnal
Slide 15-

Enuresis Medical evaluation Assessment of compliance Behavioral protocol
Slide 16-

First time toilet training Among top concerns expressed by mothers on internet, call-in services Most frustrating Lots of “lore”
Slide 17-

First-time toilet training Passive “child-oriented” Brazelton, 1962 Physical maturity, interest, and “psychological readiness” “relax, be patient” Intensive “toilet-training in a day” Azrin & Foxx, 1974 Physiological readiness and compliance Principles of operant conditioning
Slide 18-

Empirically supported toilet training Thinking time question #1a: How could you provide a child with lots of practice in toileting?
Slide 19-

Empirically supported toilet training Thinking time question #1a, b: How could you provide a child with lots of practice in toileting? How could you provide predictabilty in structuring programming?
Slide 20-

Empirically supported toilet training Thinking time question #1a, b, c: How could you provide a child with lots of practice in toileting? How could you provide predictabilty in structuring programming? How could you provide a high contrast to help skill acquisition?
Slide 21-

Empirically supported toilet training Toilet Training in a Day (Azrin & Foxx) Repetition Fluid load Frequent toilet sits Pants checks
Slide 22-

Empirically supported toilet training Toilet Training in a Day (Azrin & Foxx) Repetition Fluid load Frequent toilet sits Pants checks High Contrast Rewards for compliance with sits, successful voiding in toilet, and dry pants Clean-up and overcorrection for wetting
Slide 23-

Empirically supported toilet training Toilet Training in a Day (Azrin & Foxx) Repetition Fluid load Frequent toilet sits Pants checks High Contrast Rewards for compliance with sits, successful voiding in toilet, and dry pants Clean-up and overcorrection for wetting Predictability Consistent schedule for toilet sits/pants checks Star chart with grab bag Use of attention
Slide 24-

Empirically supported toilet training Institutionalized incontinent adults Typically developing children with toileting resistance Mass audience of first-time learners
Slide 25-

ppt slide no 25 content not found
Slide 26-

Empirically supported toilet training Thinking time question #2: What if the child refuses to sit on the toilet?
Slide 27-

Encopresis Thinking time question #3: What would be a good behavioral protocol for a child who is soiling daily after school?
Slide 28-

Enuresis Thinking time question #4: What would be a good behavioral protocol for a child who is wetting daily at daycare?
Slide 29-

Empirically supported treatment for nocturnal enuresis Assessment Education Urine alarm Support to maintain integrity
Slide 30-

Empirically supported treatment for nocturnal enuresis Assessment Education Prevalence Medication vs. Urine alarm
Slide 31-

Empirically supported treatment for nocturnal enuresis Assessment Education Urine alarm Overlearning Dry-bed training Arousal Training Reward for waking to moisture alarm
Slide 32-

ppt slide no 32 content not found
Slide 33-

Empirically supported treatment for nocturnal enuresis Assessment Education Urine alarm Support to maintain integrity
Slide 34-

Nocturnal enuresis Thinking time question #5: What if the child won’t wake to the alarm?
Slide 35-

Nocturnal enuresis: Trouble shooting “Darren” 13 year-old Caucasian male No medical, psychiatric, academic history or concerns Life-long history of bedwetting Two, one-year trials with moisture alarm. Currently treated with DDAVP
Slide 36-

DarrenNumber of Wet Beds Per Week
Slide 37-

DarrenNumber of Times Mom Intervened At Night
Slide 38-

Darren: Treatment Plan Sleep assessment: Rule out apnea Operant training: Wake to alarm Maintenance: Medication, no alarm
Slide 39-

Darren: Treatment Plan Arousal Training Familiar, loud, clock-radio. Contingency for success. Two alarms per night.
Slide 40-

Darren: Treatment Plan Alarms Week 1: 5:00 a.m. and 7:00 a.m. Week 2: 5:15 a.m. and 6:45 a.m. Week 3: 5:30 a.m. and 6:30 a.m. Week 4: 6:00 a.m. Week 5: 6:00 a.m. Week 6: 6:30 a.m.
Slide 41-

DarrenNumber of Wet Beds Per Week
Slide 42-

DarrenNumber of Times Mom Intervened At Night
Slide 43-

DarrenFrequency of Self-Waking to Toilet
Slide 44-

DarrenNumber of Wet Beds Per Week
Slide 45-

DarrenFrequency of Self-Waking to Toilet
Slide 46-

DarrenNumber of Wet Beds Per Week
Slide 47-

Darren: Conclusions Practice with waking to scheduled alarms: improved independence. increased frequency of self-waking to toilet. increased frequency of sleeping through night dry. supplemented medication therapy.
Slide 48-

Trouble Shooting Arousal Problems Evaluation for sleep disorder, particularly apnea. Programmed alarms for “easy” times and phase to time when urinating likely. Programmed alarms for times when urinating likely and phase toward morning. Supplement behavioral intervention with medication. Use of familiar “alarm clock” gives volume control/replaces moisture alarm.