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Case
You see a 7-year-old child for a WCCU. The mother is present for the visit and reports that during the past 12 months he has become more clingy . He will separate from his parent as long as he can see them nearby. For example, he will play soccer but will turn around every 3-5 minutes to make eye contact with his mother and becomes agitated if he cannot see her in the crowd. He was excited about going to a Boy Scout overnight camp but then refused to go because his mother could not go with him.
The mother also reports that he has begun to have significant nightmares about 4 times a week. He has moved from his bedroom where he slept with his younger brother to a palette on the floor next to her bed because he is afraid to go to sleep? The child is at 50% in weight and height and his vital signs today are normal. You have done both a vision and hearing screening both were normal. A physical exam is normal except for you to note a soft systolic murmur during his exam.
Treatment Options
Based on the given case, it is possible to suggest that the patient has some symptoms of panic disorder that refer to a strong feeling of fear, which occurs suddenly, sometimes at night, and reaches maximum intensity within a few minutes. For a child, his or her family is the whole world, and the atmosphere in the family, emotional understanding, love, etc. largely identify a childs emotional-mental state. First of all, children can tell their parents about their fears and problems.
Medications are used at the first stages of treatment in the presence of severe symptoms. Only a doctor prescribes medicines and dosage. For example, Tricyclics, Serotonin Reuptake Inhibitors (SRIs), or Benzodiazepines can be prescribed to reduce aggression and prevent attacks (Kossowsky et al., 2013). Psychotherapy is traditionally used as a non-pharmacologic intervention. Cognitive-behavioral therapy, which is aimed at identifying, understanding, and explaining a childs fears, teaches how to monitor panic thoughts, replacing them with positive ones. Emotional-oriented therapy aims at the development of a childs optimistic emotions and positive thinking, while art therapy helps to identify unconscious anxieties.
Parents can use all the mentioned measures of non-pharmacologic intervention to promote adequate self-perception of their child. It is necessary to be patient, attentive, and kind with a child to interact with him or her effectively and address fears. A pediatric provider can study child-parents relationships, provide physical and psychological examinations, or measure a childs self-esteem and self-perception to diagnose maltreatment (Burns et al., 2013). Sometimes child maltreatment can be confused with shyness, or it can be composed by upbringing peculiarities. To identify at-risk children, it is necessary to create open and transparent communication with parents, explaining the significance of their childs self-identification.
Sexuality, sexual orientation, and birth control may cause different views and disputes between people. In case my personal and professional attitudes would vary, I will act according to my professional obligations, providing high-quality care to patients related to their needs. Since I am a representative of health care services, I would perform for the benefit of patients and society in general.
Preschoolers, School-Age Children, and Adolescents
Preschoolers, school-age children, and adolescents have different values, beliefs, and spirituality. For preschoolers, psychological comfort and a sense of security are ensured by the presence of a significant adult in their life (Berk & Meyers, 2015). Good relationships with peers largely define the values of school-age children. Since the period the child enters the childrens collective, the role of recognition by others plays a great role. The vital values of adolescents in most cases are formed based on TV, the Internet, and peers opinion. For them, the values and beliefs focus on the model of the behavior of the average representative of their community, which cannot always be considered a universally recognized model of human virtue (Berk & Meyers, 2015).
A teenager is less dependent on a significant adult and more interested in his or her appearance and state of health than children. At the same time, falling under the influence of peers or the environment, he or she can easily enter the zone of marginal hobbies or begin to lead an antisocial way of life. Often material values and personal ratings in society prevail on the scale of values of a teenager. Thus, adolescents depend on external factors that shape their perception of life, while children are more dependent on their parents. These differences are to be taken into account to initiate preventive care through building trustful relationships.
References
Berk, L. E., & Meyers, A. B. (2015). Infants, children, and adolescents (8th ed.). New York, NY: Pearson.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
Kossowsky, J., Pfaltz, M. C., Schneider, S., Taeymans, J., Locher, C., & Gaab, J. (2013). The separation anxiety hypothesis of panic disorder revisited: A meta-analysis. American Journal of Psychiatry, 170(7), 768-781.
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