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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Early Childhood,Behaviour,Problems(continued),Child Assessment&Therapy:512-924,October 2007,Gaining control of bladder&bowel,Normal development,Infants:urinate often,small amounts,reflex,1-2 years:child notices full bladder,void less often,larger amounts,Age 3:child holds for longer periods,can get to toilet,Preschooler often cannot empty bladder unless it is full(,eg,cant go before a car trip on request),20 24 months a good age to begin in normally developing child.Older age,easier to learn,Signs of readiness:,Being able to sit on potty or toilet seat(coordination),Able to understand simple instructions,cooperative,Able to hold urine for 1-2 hours without leakage,Regular bowel movements,no soiling during sleep,Summer easier in cold climates,Avoid times of stress(,eg,birth of sibling),Toilet training,Every Parent(Sanders):active teaching,using doll as model,Toilet training,Bedwetting and Soiling(Herbert,PACTS series):more gradual,Managing Problem,Behaviours,(Dodd),Ways of toilet training,All,approaches emphasize importance of:,No undue pressure,calm,matter of fact approach,Minimal attention and no negativity about mistakes,Positive attention for success(praise,maybe stickers),(Remember age of child:tends to be oppositional!),Principles of toilet training,Useful suggestions,Increase fluid to increase rate of learning,Once not in nappy at home,remove nappy altogether,Plastic sheet covered with towel for car seat,Take potty everywhere initially,Keep child in uncarpeted areas,Boys to sit down initially,learn to stand later,Intellectual,physical disabilities:,Similar issues of readiness(likely to be older),More specific training,based on careful observation and monitoring of childs current routine of eating/drinking;elimination,routines;,behaviours,prior to elimination,Role of occupational therapists where physical difficulties,Toilet training children with disabilities,Autism Spectrum Disorder issues of:,Communication,Sensory issues,Preference for routine,difficulty adjusting to new,behaviours,Motor planning difficulties,Difficulty imitating,Sequential learning:(identify how the child learns best),Anxiety levels,Toilet training children with disabilities,Nocturnal enuresis,:bedwetting in a child over 5 years(or equiv.developmentally),Diurnal enuresis,:wetting during the day in children 5 years and over,Primary enuresis,:where a child has never been dry longer than 6/12 months,Secondary enuresis,:children who have been dry longer than 6/12 months&begin wetting again,Enuresis:,termin,o,logy,%bed-wetting at different ages,(variable figures depending on definition of bed-wetting),Age in years,3,4,5,6,7,8,9,14,%who wet the bed,20,15,12 (15-20),12,8 (7),6,5,4 (15 yr 1-2%),More boys wet beds than girls,Seek help at ages 5 7 years,Often a family history of bed-wetting:genetic,Developmental delay,Emotional stresses may lead to secondary enuresis(but rarely,severe,emotional problems),Medical reasons occasionally(,eg,urinary tract infection,epileptic seizures,central nervous system or bladder),Causes of enuresis,High production of urine at night,associated with insufficient,arginine,vasopressin(,avp,)release at night,(Wetting soon after going to bed,large wet patches),Small functional bladder capacity(,fbc,)associated with bladder,overactivity,.(Nighttime:multiple bedtime wettings,small wet patches),Possibly a difficulty with arousal from sleep when bladder reaches its maximum capacity,(Butler&Holland 2000),Causes of enuresis(continued):The Three-Systems Model,Educational,simple strategies,Refer to specialist or clinic,Role of Psychologist,Need medical review to exclude bladder infections,constipation,renal problems,Monitor nighttime wetting(frequency,timing,amount,etc),Measure functional bladder capacity if seems indicated,Assessment(and clinical interview),Encouragement and reinforcement,Keep a record of wet and dry beds,Reward(small and as soon as possible after the dry bed),Not suitable for a child who invariably wets:too difficult and,demoralising,Toilet routine,:practice getting out of bed and going to toilet a number of times,make sure easy access,Lifting,fluid restriction before bedtime:not effective,Caffeine,Some studies suggest eliminating caffeine from diet helpful,Forms of treatment,Bladder stretching exercises,(if child is passing urine often and in small amounts),Control training,:helps children gain more control over their muscles by stop and start flow of urine when using toilet,Forms of treatment(where bladder,overactivity,frequency of urination),Scheduled waking,if wets at same time each night,Bell and Pad,(bedwetting alarm;pad&buzzer),Cochrane review of 52 trials:,About 2/3 became dry during alarm use,50%remained dry after treatment,Relapse rates reduced when over-learning(giving extra fluids at bedtime once successfully dry)occurred,More effective than medications,NB Higher rates of succe
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