Anak. ▫Oppositional – Defiant Disorder. ▫Feeding Disorder. ▫Obesity. ▫Enurisis ...
in children vary with age and sex. ... playing video games or watching TV.
Deviasi pada proses sosialisasi dan pemicunya pada Awal Masa Anak Oppositional – Defiant Disorder Feeding Disorder Obesity Enurisis
Feeding disorders in infancy or early childhood are shown by the failure to eat enough food to grow normally usually one month or could be longer. feeding disorders do not have a medical or physiological condition that will be able to explain the very small amount of food they intake or lack of growth. These disorders include a wide array of conditions ranging from problem behaviors during feeding such as poor appetite, food refusal, food selectivity, food avoidance, and pica to rumination and vomiting. Such disorder appears most often during the first year of lif e and before the age of six.
Feeding disorder has been divided into six further sub-types : 1. Feeding disorder of state regulation 2. Feeding disorder of reciprocity (neglect) 3. Infantile anorexia 4. Sensory food aversion 5. Feeding disorder associated with concurrent medical condition 6. Post-traumatic feeding disorder
Childhood obesity is a condition where excess body fat negatively affects a child's health or wellbeing. The diagnosis of obesity is based on BMI. The term overweight rather than obese is often used in children as it is less stigmatizing. DIAGNOSIS: Body mass index (BMI) is acceptable for determining obesity for children two years of age and older. The normal range for BMI in children vary with age and sex. BMI = Weight in kilogrammes (Height in metres)2 -Obese children defined to have a BMI ≥ 95percentile. -Overweight children defined to have a BMI ≥ 85-6months • Onset nocturnal enuresis • Familial nocturnal enuresis • Nocturnal polyuria enuresis : urine production > functional bladder capacity on wet nights, nocturia on dry nights
Epidemiology of Nocturnal Enuresis • 15 – 20% of 5-year-olds, 5% of 10-year-olds, 23 % of all adolescents wet the bed at least 1/month • Enuresis has a 15% per year spontaneous resolution rate • Bed wetting is the cause of significant psychosocial stress, especially in older children
Arousal Dysfunction in PNE
Arousal Defects in Enuretics • Enuretic children are heavier sleepers compared with non-enuretics • Arousal was successful on only 9.3% of attempts in enuretics, compared with 39.7% in the controls
Categories of Enuresis • Type I: detectable EEG response to bladder distension and a stable CMG, 58% • Type IIa: no EEG response to bladder distension, stable CMG, 10% • Type IIb: no EEG response to bladder distension, unstable CMG during sleep, 32% • Type I & II: mild to severe arousal defects
Arousal and Bladder Function in Nocturnal enuresis
Treatment of Nocturnal Enuresis • Primary nocturnal enuresis (PNE or MNE) with or without nocturnal polyuria desmopressin responder or non-responder arousal dysfunction or bladder dysfunction • Secondary nocturnal enuresis dysfunctionalvoiding neurogenic voiding dysfunction psychological distress
Treatment of Primary Nocturnal Enuresis • Conditioning therapy: Alarm system or drybed training,effective in about 30-80% • Medcal therapy: (1) Tricyclic antidepressant (TCA), imipramine, amitriptyline effective in 10-50% (author 24%) (2) anti-cholinergics (3) desmopressin (DDAVP) • Side effect in combination medical therapy
Secondary Nocturnal Enuresis • Psychological factors: stress, anxiety, depression • Neurogenic detrusor underactivity and overflow incontinence • Dysfunctional voiding • Urinary tract infection • Bladder outlet obstruction • Diurnal incontinence
Impact of Psychological Stress • Enuresis occurs in mental retardation, autism, attention deficit disorder, dysfunction in motor control or perception • Enuresis is more common in lower socioeconomic groups, in large overcrowded family, and in children living in institution • Enuresis is associated with short stature, reflecting deficiency of growth hormone secretion and vasopression deficiency
Conclusions • Nocturnal enuresis has a multifactorial etiology • It may be best regarded as groups of conditions • A 15% annual spontaneous cure rate • Treatment should match to etiologies • Balance between bladder functional capacity and nocturnal urine output appear to be the most important
No More Bed Wetting
