Chapter 28: Nursing Care of the Child With an Alteration in Behavior, Cognition, or Development

Nursing Care of the Child With an Alteration in Behavior, Cognition, or Development pediatric nursing chapter provides a comprehensive overview of alterations in behavior, cognition, and development, which collectively constitute a significant portion of the "new morbidity" affecting children and adolescents, with up to 20% suffering from mental health problems that often go untreated. The text details various specific conditions, including developmental and behavioral disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD), Intellectual Disability, and Learning Disabilities (like dyslexia and dysgraphia). It addresses the complexities of Autism Spectrum Disorder (ASD), emphasizing the need for early intensive behavioral intervention, highly structured environments, and recognition of hallmark behaviors such as impaired social interaction and repetitive behaviors. Coverage also extends to mood disorders like depression and bipolar disorder, anxiety disorders (including Generalized Anxiety Disorder, OCD, and PTSD), and eating disorders such as anorexia nervosa and bulimia. Nursing care centers on comprehensive assessment, gathering detailed health histories, utilizing standardized screening tools, and performing physical examinations to rule out physical causes or identify signs of abuse. Therapeutic management is individualized and often multidisciplinary, combining pharmacologic treatments (like psychostimulants or selective serotonin reuptake inhibitors) with various psychological therapies including cognitive behavioral therapy, family therapy, and milieu therapy. Essential nursing interventions involve behavioral management techniques such as limit setting and consistent routines, promoting coping skills, and preventing high-risk behaviors like suicide, necessitating careful monitoring and assessment. The chapter stresses the nurse’s mandatory role in recognizing and reporting suspected cases of abuse and violence (including child maltreatment and medical child abuse), and supporting families in obtaining necessary resources and accommodations like Individualized Education Plans (IEPs) for conditions like ADHD and learning disabilities.