Pediatrics
Behavioural Problems in Children
Childhood behavioural problems for MBBS: thumb sucking, breath-holding spells, temper tantrums, pica, enuresis and encopresis, mapped to NMC codes PE5.1 to PE5.11.
MedNext Academy | 3 min read
Behavioural Problems in Children
Childhood behavioural problems for MBBS: thumb sucking, breath-holding spells, temper tantrums, pica, enuresis and encopresis, mapped to NMC codes PE5.1 to PE5.11.
This chapter covers common childhood behavioural problems including thumb sucking, nail biting, breath-holding spells, temper tantrums, pica, enuresis and encopresis. It emphasises distinguishing normal developmental behaviours from those needing intervention and the role of the child guidance clinic.
High-yield: Behavioural Problems in Children
- Thumb sucking is normal in infancy and toddlerhood, usually disappears by about 4 years, and needs active intervention mainly when it persists beyond 4 years or causes dental deformity.
- Persistent thumb sucking can cause anterior open bite, increased overjet, posterior crossbite and speech articulation problems.
- Punishment, chilli application, tying hands or public shaming worsen oral habits; positive reinforcement and dental review are the core of management.
- Breath-holding spells are benign, provoked by anger, frustration or pain, and are of two types: cyanotic (blue) and pallid (pale).
- Breath-holding spells resolve spontaneously with age, and iron deficiency screening is worthwhile because iron therapy can reduce spell frequency.
- Temper tantrums are a normal part of toddler autonomy, peaking between 1 and 3 years, and are managed by calm consistency and ignoring the behaviour rather than giving in.
- Pica is the persistent eating of non-food substances and warrants screening for iron deficiency, lead exposure and developmental disorders.
- Nocturnal enuresis is involuntary bedwetting at or beyond an age when bladder control is expected, generally taken as 5 years or older.
- Primary monosymptomatic nocturnal enuresis is managed first with reassurance, fluid timing and an enuresis alarm, with desmopressin as a pharmacologic option.
- Encopresis is the repeated passage of stool in inappropriate places, usually secondary to chronic constipation with overflow soiling, and is managed by disimpaction and maintenance laxatives.
- Nail biting is a common self-soothing habit, usually benign, and is managed with behavioural techniques rather than punishment.
- Pica, enuresis and encopresis are diagnosed only above the developmental age at which the behaviour is expected to have resolved.
- New onset of a habit after trauma, bereavement, bullying, parental conflict or suspected abuse is a red flag warranting psychosocial assessment.
- Persistent behavioural problems with developmental delay, regression or safeguarding concern should be linked to a child guidance clinic or paediatric referral.
Behavioural problems and thresholds
- **Thumb sucking:** Normal to ~4 years; treat if persistent with dental change; no punishment.
- **Breath-holding spells:** Cyanotic or pallid; benign; screen for and treat iron deficiency.
- **Enuresis:** Bedwetting at or beyond 5 years; alarm therapy first, desmopressin an option.
- **Encopresis:** Usually overflow soiling from chronic constipation; disimpact then maintain.
NMC competencies in this chapter
- **PE5.1:** Thumb sucking: clinical features, diagnosis and management
- **PE5.2:** Feeding problems: clinical features, diagnosis and management
- **PE5.3:** Nail biting: clinical features, diagnosis and management
- **PE5.4:** Breath-holding spells: clinical features, diagnosis and management
- **PE5.5:** Temper tantrums: clinical features, diagnosis and management
- **PE5.6:** Pica: clinical features, diagnosis and management
- **PE5.7:** Fussy infant: clinical features, diagnosis and management
- **PE5.8:** Enuresis: etiology, clinical features and management
- **PE5.9:** Encopresis: etiology, clinical features and management
- **PE5.10:** Role of child guidance clinic and referral criteria
- **PE5.11:** Visit to child guidance clinic and observe functioning
Frequently Asked Questions
When does thumb sucking need treatment?
Thumb sucking is normal in infancy and toddlerhood and usually fades by about 4 years. It needs active, non-punitive intervention mainly when it persists beyond 4 years or causes dental deformity, skin injury or social distress, using positive reinforcement and dental review.
How are breath-holding spells managed?
Breath-holding spells are benign and provoked by anger, frustration or pain, occurring as cyanotic or pallid types. They resolve with age, need reassurance, and iron deficiency should be screened and treated because iron therapy can reduce their frequency.
How is nocturnal enuresis treated?
Primary monosymptomatic nocturnal enuresis, meaning bedwetting at or beyond about 5 years, is managed first with reassurance, fluid timing and an enuresis alarm, with desmopressin as a pharmacologic option when needed.
What causes encopresis?
Encopresis is repeated passage of stool in inappropriate places and is usually secondary to chronic constipation with overflow soiling. Management is disimpaction followed by maintenance laxatives, toilet routine and behavioural support.
Continue reading
MBBSAll Pediatrics chapters
Continue through the Pediatrics chapter map.
Continue studying Pediatrics
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans