Behavioural patterns in infancy and toddlers
There are certain behavioural patterns which are common in infancy and toddlers. They are a part and parsel of normal development but when occurs excessively/abnormally can disrupt the trajectory of normal growth and development. Whether these behavioural patterns are considered disorders that requires intervention beyond reassurance depends on the degree to which they interfere with the child’s physical, emotional, or social functioning.
1. Temper tantrums : Terrible 2’s is the age when typical expression of frustration and anger comes forth. It may reflect toddlers typical struggles for autonomy and independence. During this age the child may show enormous temper tantrums. Managing toddlers sometimes could be challenging for the parents. Once a child has begun a tantrum, turning away briefly is the only effective course of action. The parents should not be angry at the time, as it further aggravates the tantrum. They should calmly give different options/ choices as it will help the child to feel more in control and to develop a sense of autonomy. Parents who respond to toddlers defiance with punitive anger run the risk of reinforcing the defiance. It is a normal phenomenon in toddlers but it can turn into oppositional defiant nature if not addressed to on time. Also, temper tantrums are difficult to manage if associated with autism spectrum disorder or other developmental or intellectual deficits and requires the help of a specialist.
2. Teeth grinding/Bruxism : It is a common habit and can begin in first 5 years of life. It is generally associated with daytime anxiety and has no co-relation with intestinal worms. Helping the child relieve the anxiety reduces the intensity of teeth grinding. Also bed time should be made more enjoyable and relaxing, by reading books or talking to the child. Persistent bruxism should be referred to a specialist dentist for pain in muscles or temporomandibular joint. It is resistant in certain neurodevelopmental disorders of children like autism spectrum disorder or in intellectual disability .
3. Thumb sucking : It is normal in infancy and toddlerhood, but in older children it occasionally disrupts the alignment of teeth. Thumb sucking is considered self soothing for the child. Interventions to reduce it should not be considered before 4-5 years of age. Ignoring thumb sucking and simple reinforcers like giving the child a sticker should be encouraged. Use of noxious agent to prevent thumb sucking is rarely necessary and should be considered as 2nd line approach.
4. Head banging : Self injurious behaviour like self biting or head banging can occur in 25% of normally developing toddlers but are almost invariably associated with developmental disorders in children older than 5 years of age. Such injurious behaviours meet the child sensory needs and sometimes may be associated with frustration. If the child is safe it is better to avoid emotional response to the behaviour and consider alternative ways to give the child attention for prosocial behaviour. If it is resistant and associated with autism spectrum disorder or other neurodevelopmental disorders then the child should be referred to a specialist.
5. Breath Holding : Holding of one’s breath for brief period leading to loss of consciousness and sometimes a seizure like activity is called breath holding spell. These occurs when the child is angry, frustrated, in pain or is afraid. The spell is a reflex and is not under the control of the child. It can be managed by simply ignoring and making sure that the child is safe and the surroundings are clear. Iron supplements are given if the child has iron deficiency anemia to alleviate the symptoms.
