PHYSICAL PROBLEM
Fever – Fever is described as a temperature greater than 100 F and is a symptom, not a disease. Fever is the
body’s normal response to infection and plays a role in fighting infections. Fever turns on the body’s
immune system. Most fevers are caused by viral illnesses and antibiotics are not used to treat viral
infections. If the doctor determines that your child has a bacterial infection, then most generally an
antibiotic will be prescribed for the infection, not the fever. In general, the height of the fever doesn’t relate
to the severity of the illness. Home care ‐ encourage extra fluids and light clothing (unless the child is
shivering), acetaminophen (generic Tylenol) or ibuprofen (generic Advil) can help lower the fever, and
lukewarm sponge baths. Never give aspirin or aspirin containing medications unless instructed by your
physician. Please read the label before giving any medication. Some may contain aspirin such as Pepto‐
Bismol. Several studies have linked aspirin to Reye’s syndrome. Contact your physician when: the child
complains of a stiff neck (bring chin to chest), difficult to awaken, purple spots on the skin, breathing
difficulty, cannot swallow, burning or pain upon urination, severe pain, tender abdomen, bluish lips, fever
is over 105 F, any fever that lasts 24 hours without an obvious cause or location of the infection, any fever
lasting more than 72 hours, previous history of febrile seizures, or any other concerns or questions.
Chicken Pox – Multiple small red bumps that progress to thin‐walled water blisters, break open and then
scab over within 24 hrs. New sores erupt as older ones scab over. A fever usually accompanies the illness.
The child is contagious until all sores are scabbed over. Home care – cool bath, calamine lotion, nonprescription
antihistamine such as Benadryl, acetaminophen for fever or discomfort (no aspirin containing
products because of the link with Reye’s syndrome), trim fingernails to prevent scratching and infection,
good hand washing with antibacterial soap such as Dial or Safeguard.
Otitis Media (middle ear infection) – A bacterial infection of the middle ear (the space behind the
eardrum). The pain is due to pressure and bulging of the eardrum from trapped, infected fluid. Antibiotics
are the course of treatment. Even if your child feels better in a few days, continue to give the antibiotics as
prescribed. A follow‐up exam is usually indicated in 2 to 3 weeks.
Otitis Externa (swimmer’s ear – external ear infection) – Swimmer’s ear is an infection of the skin lining the
ear canal. The symptoms include: painful ear canals, pain when the earlobe is moved up/down, pain upon
pushing the area just in front of the ear/along the jaw line. The key to prevention is keeping the ear canal
dry when your child is not swimming by turning the head side to side and pulling gently on the ear lobe to
allow the water to run out. Antibiotic eardrops are indicated for treatment. Preventative eardrops for
swimmer’s ear are usually indicated for recurrent problems.
Pinkeye – Redness of the sclera (white part of the eye), yellow drainage (sometimes eyelids are matted
together upon rising in the a.m.), and itching or burning. Prescription antibiotic eye drops are the course of
treatment. Bacterial eye infections are very contagious and spread easily. Your child will be contagious and
not allowed to attend school until after 24 hours of treatment. Good hand washing is important to prevent
the spread of infection to the other eye and other children or family members.
Fifth Disease (Hawaiian Blush) – Bright red or rosy rash on both cheeks that lasts for 1 to 2 days (“slapped
cheek” appearance). There is no fever or a low‐grade fever. The rash on cheeks is followed by pink lacelike
rash on extremities that comes and goes several times over 1 to 3 weeks. The rash may come and go for up
to 5 weeks, especially after warm baths, exercise, and sun exposure. The disease is contagious during the
week before the rash begins; therefore a child who has the rash is no longer contagious and does not need to
stay home from school. Inform any women who are pregnant that may have been exposed. Home care –
no treatment is necessary. The rash is harmless and causes no symptoms that need treatment.
Roseola – Fine pink rash mainly on the trunk of the body lasting 1 to 2 days, high fever preceding 2 to 4
days before the rash appeared, and most often affects children age 6 months to 3 years. Home care ‐ no
particular treatment is necessary, roseola is contagious until the rash is gone, children who have been
exposed may come down with roseola in about 12 days.
Scarlet Fever – A strep throat infection accompanied with a rash. The rash presents with: reddened and
sunburned‐ looking skin, increased redness in skin folds, rough feeling to the skin‐somewhat like sandpaper
and a flushed face. The sore throat and a fever usually precede the rash by 24 hours. Antibiotics are the
course of treatment. The child is no longer contagious after he/she has been on antibiotics for 24 hours.
Vomiting and Diarrhea – Most vomiting is caused by a viral infection and is often associated with diarrhea.
Dietary changes usually speed recovery. Home care ‐ clear fluids for 8 hours then bland foods for the next 8
hours. Usually the child can be back on a normal diet within 24 hours. Watch for signs of dehydration:
decreased urination, crying produces no tears, dry mucous membranes (eyes, mouth).
Athlete’s Foot – A fungal infection that grows best in warm, damp skin that presents with a red, scaly,
cracked rash between the toes that itches and burns and an unpleasant foot odor. Home care – anti‐fungal
cream (over the counter) such as Tinactin. Continue the cream for at least 7 days after the rash has cleared.
Cotton socks, keeping the feet dry, and wearing open toed shoes helps to improve the infection.
Eczema – An inherited type of sensitive skin that can be a chronic condition which comes and goes. It most
commonly affects the creases of elbow, wrists, knees, ankles, feet, and neck. The rash is red and extremely
itchy and can appear raw and weepy if scratched. Home care – children with eczema have dry skin.
Hydrate the skin by applying moisturizer after a bath and using a humidifier in your home. Use a
nondrying soap such as Dove. Cotton clothes can help by allowing the skin to breath. Avoid scratchy
materials such as wool. Triggers that can cause the condition to flare up: excessive heat or cold, sweating,
dry air, chlorine, harsh chemicals and soaps. The use of a steroid cream such as a hydrocortisone cream can
aid the healing process of the affected areas. Consulting your physician is necessary if the condition hasn’t
greatly improved in 7 days or if the rash becomes infected.
Impetigo – An infection of the skin caused by a staph or strep bacteria. Open sores, cuts, scrapes, insect
bites, chicken pox lesions can become infected. The areas do not heal, usually increase in size, and then
become covered with honey‐colored crusted scabs. The scabs may drain pus. Home care ‐ remove the
crusts by soaking in warm soapy water and gently rub (a little bleeding is common when you remove the
entire crust) and then apply an antibiotic ointment such as Neosporin or Bacitracin (over the counter).
Apply for 7 days or longer if necessary. The use of an antibiotic soap such as Dial or Safeguard is necessary.
The bacteria live under the crusts and until these are removed, the antibiotic ointment cannot get through to
the bacteria. Contact your physician if the condition does not improve within 24 hours of home care.
Ringworm – A fungal infection of skin that is often transferred from puppies or kittens that presents with a
mildly itchy ring‐shaped pink patch (about ½ ‐ 1 inch in size) that has a scaly, raised border with a clear
center. Home care ‐ responds well to appropriate treatment with anti‐fungal cream such as Tinactin or
Micatin cream (over the counter). Continue treatment for 1 week after the ring is gone. Ringworm of the
skin is not contagious enough to worry about. After 48 hours of treatment, it is not contagious at all. Your
child does not need to miss any school. You can simply cover the area loosely with a band aid or patch for
the first 48 hours. Contact your physician if the area has not cleared up in 4 weeks, the ringworm continues
to spread, or if the scalp becomes involved (an oral antibiotic is needed).
Pinworms – Infection is caused by swallowing pinworm eggs. Symptoms include anal itching and irritation
especially at night. To check the child, wait a few hours after bedtime and examine the anal area with a
flashlight for very small(1/4 inch long), thin, white worms that move. Call your physician in the a.m. for a
prescription and instructions on treating clothing, bedding, and family members. Prevention: good hand
washing before meals and after use of the bathroom, keep fingernails trimmed, and discourage nail biting
SOCIAL PROBLEM
Lies differ in type, incidence, magnitude and consequence, with many gradations of severity, from harmless exaggeration and embellishment of stories, to intentional and habitual deceit. Behavioral scientist Wendy Gamble identified four basic types of lies for a University of Arizona study in 2000:
• Prosocial: Lying to protect someone, to benefit or help others.
• Self-enhancement: Lying to save face, to avoid embarrassment, disapproval or punishment.
• Selfish: Lying to protect the self at the expense of another, and/or to conceal a misdeed.
• Antisocial: Lying to hurt someone else intentionally.
Lying is considered by most child development specialists to be a natural developmental occurrence in childhood. Though there is no empirical data about how children learn to lie, parental honesty is recognized as a primary influence on the development of truthfulness in children.
Preschool
Making up stories is part of a normal fantasy life for young children. It is a positive sign of developing intelligence and of an active and healthy imagination. Preschool children who are beginning to express themselves through language are not yet able to make a clear distinction between reality and make-believe. Storytelling at this age is seldom an intentional effort to deceive. When preschool children do engage in intentional deceit, it is usually to avoid reprimand. They are concerned with pleasing the parent, and may fear the punishment for admitting a mistake or misdeed.
Many children are socialized by their parents at a very early age to tell "white"; lies to avoid hurting another's feelings. "White lies" or "fibs" are commonplace in many households and social settings and are observed and imitated by children. The incidence of prosocial or "white lies," tends to increase in children as they grow older.
Dr. Kang Lee of the Department of Psychology at Queens University in Kingston, Ontario, Canada, observed young children telling so-called "white lies" to avoid disappointing the researcher. Such prosocial lying behavior occurred in children as young as age three. Dr. Lee's research found that over 60 percent of the 400 boys and girls he studied would pretend to be pleased when asked how they liked a used bar of soap, given as a prize after playing a game with researchers. When parents instructed the children to "be polite" when the researcher asked if they liked the soap, as many as 80 percent of these children, ages three to 11 years of age were dishonest.
Dr. Michael Lewis of Robert Wood Johnson Medical School, has found that as many as 65 percent of the children he studied had learned to lie by age two and one half. This research also reveals a correlation between higher IQ and the incidence of lying in children.
School-age children
Children from age five or six have learned the difference between lies and truth. The motives for lying in this age group are more complex. Prosocial lying may increase, particularly among peers, to avoid hurting another's feelings. In addition, if a parent's expectations for the child's performance are too high, the child may engage in self-enhancing lies out of fear of censure. School-age children also experiment with selfish lies to avoid punishment, or to gain advantage. They are testing the limits as they try to understand how the rules work and what the consequences may be for stepping out of bounds.
By age seven children have developed the ability to convincingly sustain a lie. This capacity has serious implications with regard to children's competency to testify in a court of law. The veracity of child witnesses and their understanding of the concept of an oath are important research issues. Children at this age recognize the difference between what they are thinking and how they can manipulate the thinking of another to serve their own ends.
The type and frequency of lies and the reasons why a child may be dishonest are also related to their stage of moral development .
Children progress sequentially through several stages of moral development, according to psychologist Lawrence Kohlberg:
• avoiding punishment
• doing right for self-serving reasons
• fitting in with and pleasing others
• doing one's duty
• following agreed upon rules
• acting on principles
Adolescents are developmentally involved in becoming independent persons. They are working hard to establish their own identity, one that is separate from that of their parents. Peer approval is more important than parental approval during adolescence . Conflicts during these years between parental control versus personal autonomy may lead to increased lying to preserve a sense of separation and power from parents, teachers, and other authority figures. Adolescents may also lie to cover up serious behavior problems. A discerning parent will attempt to discover the motive behind the lie.
Common problems
Childhood lying has many causes, including the need to maintain parental approval, to gain attention, to avoid disappointing others, to evade the consequences of misbehavior, or to avoid responsibility. Older children may lie as a means of breaking away from parental control. Issues of self-esteem , fear of consequences, the desire to have one's own way, the need to gain attention, or to protect oneself from harm, are also a factor. Difficult circumstances in the home and social environment of the child may increase the likelihood of problem lying.
Early intervention in the case of compulsive lying may reduce the risk of the child developing a life-time habit of deceit. Children who are chronic liars are often found to engage in other antisocial behaviors. If a child's lying is accompanied by fighting, cheating, stealing , cruelty, and other impulse control problems, appropriate intervention is required. Lying that is consistently self-serving with no prosocial motive is a serious issue. Lying with malice and without any sign of remorse may indicate that the child has not yet developed a moral conscience, and may need help to move toward a higher stage of moral development, one that includes a concern for the impact of one's actions upon others.
Children become more adept liars with practice. As they grow older it may become increasingly difficult for a parent, teacher or caregiver to detect dishonesty. Close observation and familiarity with the child, as well as an understanding of their developmental stage, are critical to the diagnosis of problem lying.
Most children with the benefit of a loving family environment, one where honesty is valued and modeled and dishonesty is appropriately challenged, will more often than not come to recognize that lying is not an acceptable behavior. Early and appropriate intervention when problem lying persists will increase the possibility that the child will choose honesty in subsequent interactions.
Children may observe much routine dishonesty in the home, school and surrounding culture. Parental examples of honesty in interpersonal relationships are critical if a child is to develop an ethic of truthfulness. Children commonly experiment with lying in the natural course of development. They need help recognizing and understanding the distinction between prosocial and antisocial lying.
Exaggeration and embellishment when relating incidents or telling stories, and the so-called "white lies," told to avoid disappointing or hurting others feelings, do not have the negative, antisocial consequences of serious lying. Parents should intervene when the lying is of a serious nature and explain the impact of dishonesty on another's feelings. This will help the child to develop a moral sense of right and wrong and to value honesty in interpersonal relationships.
MORAL PROBLEM
Stealing is taking someone's property without permission. Very young children do not understand the concept of personal property. When they see something they want, they simply take it. Young children generally take things for immediate use only, whereas older children will take them "for keeps." Since they have no sense of personal property, young children should not be accused of stealing when they take another person's things without permission. However, the concept of stealing should be explained right from the start, even before the child can understand. If a parent, teacher, or other adult simply tells the child, "Don't take Sally's crayon," the child will believe only that taking Sally's crayon is wrong, while taking a crayon from Juan, or a cookie from Sally, is okay. A child must be told repeatedly that taking other people's things is wrong in order to develop an understanding of the broader concept of stealing.
Most children have a basic sense of "mine" and "not mine" by the age of two and can therefore begin to learn respect for other people's possessions. However, a true understanding of the harmful nature of stealing does not begin to develop until about age five to seven. At this age, children are deterred from stealing mostly by their fear of parental disapproval. Internal motivations of conscience and guilt do not develop until the middle childhood years. Once the recognition of property boundaries develops, stealing becomes an intentional act that must be addressed more deliberately.
Children steal for a number of reasons. Young children, or older children who have not developed sufficient self-control, may steal to achieve instant gratification when an object cannot be obtained immediately by honest means. Older children may steal to gain a sense of power, to acquire status with peers who resist authority, to get attention, to take revenge on someone who has hurt them, to alleviate boredom, or to vent unresolved feelings of anger or fear. Children who steal are often expressing displaced feelings of anxiety , rage, or alienation resulting from a disruption in their life, such as a parent's divorce or remarriage.
People who feel excluded or disconnected from society have fewer qualms about stealing, because they have less sense of respect, trust, or responsibility in relation to the community. They may even purposely steal in retaliation for the pain they feel society has inflicted on them. Studies have shown a direct correlation between stealing and alienation. Community-building programs in U.S. high schools have greatly reduced the incidence of theft by developing a sense of unity among the students and faculty. When a child feels integrated into a community, he or she is more likely to support all members of that community. Stealing becomes less tempting in a mutually supportive environment.
A child who is caught stealing for the first time should be treated compassionately; the focus should be on the reason(s) for the act rather than on the act itself. Parents, teachers, or other adult caregivers need to discern if the child lacks self-control, is angry (and with whom), needs attention, is bored, feels pressured by peers to cross boundaries, feels alienated from the community, has poor self-esteem , or needs to develop more positive moral values. A habitual stealer is expressing a serious internal problem that needs close attention. Children at risk of becoming habitual stealers often times have the following characteristics: low self-esteem; strong desires and weak self-control (impulsiveness); a lack of sensitivity to others; are angry, bored, or feel disconnected; spend a great deal of time alone; have recently experienced a significant disruption in their lives. Stealing is a behavior problem, not a character problem. The behavior can be corrected if the underlying difficulty is resolved.
Preschool
Children under the age of five generally are not sufficiently able to understand the concept of property to realize that they are stealing. Even though they might not understand, parents of children this age should make the child give back whatever was stolen and should explain why stealing is bad and how it hurts other people. The child should not be labeled bad, but the lesson should be made clear that stealing is wrong.
Elementary school
Children in elementary school generally are developed enough to understand that stealing is wrong and why it is wrong. When elementary school children steal, it is generally because they have seen something that they want, and they lack well-developed self-control. Children in this age group who are caught stealing should be made to take the item back or should be made to find ways to make enough money to pay for what they have stolen. Usually if a parent or other adult forces the child to apologize to the person from whom they stole, the embarrassment is enough to deter repeated episodes of stealing.
Middle and high school
Older children steal for different reasons than younger children. They want to feel powerful or want something expensive to try to keep up with their peers, or they may be distressed about a situation at home. Or they may want to fit in with a group. One fourth of all people caught shoplifting are between the ages of 13 and 17. In most cases children outgrow this behavior, but it still needs to be dealt with in a serious manner. Children who steal are not necessarily delinquents; however, children over the age of 15 who steal may have serious underlying troubles that need to be dealt with by a mental health professional.
Common problems
Though children who steal do so for a number of different reasons, stealing should always be treated seriously. If there is an underlying cause, such as unhappiness at home, then resolving the underlying problem usually resolves the stealing behavior, although the stealing itself should never be ignored.
EMOTIONAL PROBLEM
Emotional problems in children have become more widely recognized. A child's emotional problem can become a chronic problem if it's not attended to properly and in a timely manner. Many adult emotional problems can also affect children, but these problems may not be as easily recognized in children. Some emotional problems in children can be treated quite easily, but some require long-term care that can be complicated.
Childhood Bipolar Disorder
1. Childhood bipolar disorder is an emotional problem that can affect children. This childhood emotional problem can be hard to diagnose, because its symptoms are also symptoms of many other childhood emotional problems. Common symptoms include mood swings, irritability, episodes of extreme happiness and episodes of severe depression. Childhood bipolar disorder is a serious condition and should be treated as such. Treatment most often includes a combination of medication (sometimes more than one) and behavior therapy (teaching the child how to handle certain situations better).
Childhood Depression
2. Childhood depression is an emotional problem that can affect children. This childhood emotional problem is considered serious, but it can be difficult to diagnose because its symptoms are not unique. Common symptoms include irritability, fatigue, hopelessness, social withdrawal and poor performance in school. Childhood depression is most often treated with medication and behavior therapy.
Autism
3. Autism is an emotional problem that can affect children. This childhood emotional problem is often serious and consists of three distinctive behaviors. These autism behaviors include trouble interacting socially, obsessive and competitive behavior and difficulty with nonverbal and verbal communication. Medications (often more than one) and behavioral and educational therapies and interventions are used to treat autism. Family counseling is also used to help families learn about autistic children and to help them cope.
Childhood Schizophrenia
4. Childhood schizophrenia is an emotional problem that can affect children. This emotional disorder often affects a child's ability to develop normal social, educational and emotional skills and habits. Children with emotional disorder often have difficulty performing daily tasks, think and act irrationally and have delusions and hallucinations. Childhood schizophrenia is most often treated with a variety of treatments including medications (most often antipsychotics) and psychotherapy (teaches the child to cope with the illness and its challenges).
Tourette Syndrome
5. Tourette syndrome is an emotional problem that can affect children. This emotional problem is also considered a neurological disorder. Tourette syndrome is characterized by stereotyped and repetitive vocalizations and involuntary movements referred to as tics. Tourette syndrome is most often treated with a combination of medication and psychotherapy.
