Who you are:
You are FY2 in the GP clinic.Who the patient is:
A 35-year-old lady made an appointment because her 3-year-old child Jack is acting strangely.What you should do:
Talk to her and address her concerns.
Temper tantrums:
Usually start at around 18 months and are very common in toddlers. Hitting and biting are common, too. One reason for this is that toddlers want to express themselves but find it difficult to know how to do that appropriately. They feel frustrated, and the frustration comes out as a tantrum.
Exclude:
Autism
ADHD (unable to sit still, unable to concentrate on one task, excessive talking)
Other developmental aspects.
P1 (odipara)
First confirm identity, name of child, relationship to child and child’s D.O.B.
Doctor: How can I help you today?
Patient: My son is acting weird whenever I give him food he throws it away, and whenever I put him to sleep, he just runs out of bed and plays around.
D: When did he start acting like this?
P: He has been like that the last 2 months.
D: Has anything happened in the last 2 months that may be causing him to act like this?
P: Nothing specific no.
D: Is there anything that makes this better or worse?
P: No, he is just like this all the time.
D: Apart from this, is there anything else concerning you?
P: No.
DDs:
D: When you call him does he respond to you?
P: Yes, but sometimes he ignores me.
D: Can he maintain eye contact?
p: Yes.
D: Does he interact and socialise with other kids?
P: Yes.
D: Is he active and playful?
P: Yes.
D: Any repetitive movements?
P: No.
D: You said he threw his food away, does that mean his appetite is not good?
P: No, I am satisfied with his appetite.
D: Does he sleep enough?
P: Yes, he sleeps very well.
D: Any stress or new change in his life?
P: No.
D: Does he do this with you or with other people?
P: Most of the time with me.
D: And what do you do in response to him?
P: I try to ignore him but sometimes I shout at him.
P2
D: Has he had this problem before?
P: No.
D: Has he been diagnosed with any medical condition?
P: No.
BIRD DDD
Development is important
D: Are you satisfied with his development?
P: Yes
D: Is he able to walk?
P: Yes.
D: Are you happy with his speech so far?
P: He can talk very well.
Birth
D: Was he born preterm or full term?
P: Full term.
D: Any problem during pregnancy or labour?
P: No.
Dehydration
D: Is he normally active and playful?
P: Yes.
DIET:
D: Are you satisfied with his appetite?
P: Yes.
NAI
D: Who do you live with other than Jack?
P: My husband.
D: Is that his dad?
P: Yes
D: No other children?
P: No.
D: Is everything OK at home?
P: Yes, we are a happy, little family.
MAF
D: Any medication including OTC medicines?
P: No.
D: Any allergies?
P: No.
D: Any family history of similar behaviour?
P: No.
Examination
Observation
Head to toe
Provisional diagnosis
From the chat that we had it seems to me that Jack is just having some temper tantrums. It’s perfectly normal behavior for many children. Sometimes the reason for this is that toddlers want to express themselves and their feelings but find it difficult to know how to do that appropriately.
They have not yet learnt how to manage their emotions, so they feel frustrated, and the frustration comes out as a tantrum.
Management:
Find out why the tantrum is happening
Your child may be tired or hungry, in which case the solution is simple. They could be feeling frustrated or jealous, maybe of another child. They may want more of your time, attention and love, even though they’re not being very loveable.
Understand and manage your child’s anger by diffusing the situation.
Find a distraction.
Don’t change your mind about things: Giving in to his demands won’t help you in the long term. If you’ve said no, don’t change your mind and say yes just to end the tantrum.
Talk to them: Children often go through phases of being upset or insecure and express their feelings by being aggressive. Finding out what’s worrying them is the first step to being able to help.
Show them you love them, but not their behaviour Don’t beat them.
Encourage them to let their feelings out in healthier ways: Find a big space, such as a park, and encourage your child to run and shout.
Involve him/her in tasks that could be done easily.
Spend more time with him to show him your love.
Read stories to him before he/she sleeps.
Letting your child know that you recognise their feelings will make it easier for them to express themselves without hurting anyone else.
Safety net.
