Understanding Childhood Depression

Childhood Depression

• Depression can be hard to spot in children, as they may struggle to express feelings and instead act out.
• Some depressive states are temporary, like acute depression following a traumatic event.

Causes of Childhood Depression

• Physical health issues like obesity, diabetes, cancer or CRF can make children more prone to depression.
• Stressful life events, such as changes at home/school/ with friends, increases depressive symptoms
• A stressful home environment increases mood disorder risk
• Children with a family history of mood disorders/depression face an elevated risk.
• Imbalanced hormone and chemical levels in the brain can heighten depression risk.

Characteristics of Child Depression

• Behavioral signs include a consistently sad face with limited emotional range.
• Behavioral signs include solitary play and a preference for being alone.
• Behavioral signs include disinterest in play and previously enjoyed activities/relationships.
• Behavioral signs include reduced school grades, diminished motor activity and lack of homework interest.
• Behavioral signs include tearfulness, crying, dependency and aggression.
• Internal signs include low self-esteem, hopelessness, guilt and suicidal thoughts.
• Physiological signs include constipation and appetite changes leading to weight loss or gain.
• Physiological signs include sleep pattern changes like sleepiness or hypersomnia/ not feeding well.

Nursing Considerations for Child Depression

• Identifying a depressed child involves gathering a detailed history via interviews with the child and family, and observing the child with nurse, parents and teachers.
• Healthy growth, development and social/family health are key considerations.
• Early treatment is important.
• Depressed children require a health team specialized in pediatric mental health.
• Suicidal children need hospital admission for protection if family monitoring is inadequate.
• Pharmacological intervention involves antidepressant drugs and the child's age is considered for medication treatment.
• Parents/caregivers should keenly observe children taking medication and promptly seek medical help when worried.
• Children must not stop medication without a doctor's approval to avoid side effects.

Enuresis

• Defined as intentional/involuntary urination into bed (usually at night) or clothes during the day, in children beyond bladder control age.
• Inappropriate urination should occure twice weekly, for at least 3 months to be considered enuresis.

Signs and Symptoms of Enuresis

• The primary sign is urgency, which is immediate with acute discomfort, restlessness and urinary frequency.

Incidence of Enuresis

• Enuresis is more common in boys.
• Nocturnal bedwetting usually stops between ages 6-8.

Causes of Enuresis

• Organic causes include structural problems in the urinary tract.
• Organic causes include urinary tract infections and neurological defects.
• Organic causes include disorders increasing urine output like diabetes mellitus.
• Organic causes include conditions impairing kidney's concentrating ability, like chronic renal failure and sickle cell anemia.
• Emotional factors like fear, anxiety, and stress can lead to enuresis.
• Parents report that children with enuresis sleep more than other children.

Therapeutic Techniques for Enuresis:

• Medications used are tricyclic antidepressants.
• Medications used are anti-diuretics and anti-spasmodics.
• Bladder techniques include scheduled bathroom visits.
• Restriction and elimination of fluids after the evening meal.
• Interruption of sleep to void.

Nursing Considerations for Enuresis

• Nurses ensures children and parents understand enuresis and the need for a treatment plan.
• Provide constant support and encouragement through treatment.
• Punishment is contraindicated due to its negative impact and limited effectiveness.
• Efforts should be made to make child feel confident.

School Phobia

• School phobia marks an overwhelming fear of school, acting as a symptom of underlying anxiety, rather than being a clinical diagnosis.
• School phobia tends to surface during major transitions, such as the start of middle or high school.
• Children experience physical illness symptoms when thinking about going to school.
• Children with school phobia often feel insecure/anxious and might miss many days of school for vague reasons.
• School phobia/refusal often occurs alongside other anxiety disorders.

Children at Risk for School Phobia:

• Has a caregiver who is overprotective.
• A child who is naturally more anxious.
• An only child
• The youngest child
• A chronically ill child

Incidence of School Phobia

• Approximately 2% to 5% of children are affected by school phobia.
• Most common in younger children aged 5-6 or middle schoolers ages 10-.11.
• Symptoms are more common during transitional times, like entering high school.

Causes of School Phobia:

• Home causes include violence, financial and food instability.
• Home causes include inadequate housing/homelessness and lack of parental attention.
• Home causes include significant family changes like moving, divorce, or death.
• School causes include bullying, fear of criticism or punishment, learning difficulties like dyslexia.
• School causes include intense worry over terrible events like school shootings.

Symptoms of School Phobia:

• Physical symptoms include diarrhea, headaches and nausea.
• Physical symptoms include vomiting, stomachaches and tremors.
• Psychological symptoms include fear of leaving caregivers, fear of the dark and nightmares.
• Psychological symptoms include safety concerns for themselves/others and tantrums.

Management of School Phobia.

• Talk therapy, specifically cognitive behavioral therapy, helps children challenge unhelpful thinking patterns.
• Exposure therapy gradually introduces fears into daily life, starting with visualizing interactions before facing real life scenarios.
• Medication, such as antidepressants like SSRIs, can address underlying anxiety, especially with a mental health condition.