CHILDHOOD TANTRUMS

CHILDHOOD TANTRUMS

What are tantrums?

Tantrums represents a child’s way of communication being upset in the absence of matured language or expressive skills. They can involve sudden bursts of anger, frustration and disorganised behaviour. The child may demonstrate cats of crying, screaming, kicking, falling down, flailing about or running around. Sometimes, they may hold their breath, vomit, break things or get aggressive. It is also a learned behaviour.

Click below to watch a video on how to deal with tantrums

Why do tantrums happen?

Tantrums are very common in children aged between 1-3 years because at this age, the child’s social and emotional skills are only just starting to develop at this age. Children have not learnt enough words to express their emotions yet.

There are some factors which may make a child more likely to throw a tantrum:

  • Stress, hunger, tiredness or being overstimulated. In these situations, a child is more likely to throw a tantrum
  • Situations that children just can’t cope with. A child may not be able to do a puzzle or had a toy taken by another child
  • Each child has different ways of reacting to being upset or frustrated

How to reduce the chance of tantrums

Here are some things you can do to make tantrums less likely to happen:

  • Reduce stress or tiredness. Let your child sleep when he/she is tired.
  • Tune in to your child’s feelings. Help your child manage his/her feelings in a calm manner
  • Identify tantrum triggers so that you can prepare ahead. If your child throw tantrums when you do grocery shopping, it might help to go after your child has had a nap and a snack.
  • Talk about emotions with your child. For example, ‘Did you throw your puzzle because you were upset you could not fix it? What else could you have done?’

How to handle tantrums

Sometimes tantrums will happen, no matter what you do to avoid them. Here are some tips to handle tantrums:

  • Stay calm and do not get angry because it will make the situation worse. Keep your voice calm and avoid showing your emotions of frustration or anger
  • Acknowledge your child’s feelings to prevent the behaviour getting more out of control. It also gives your child a chance to calm down
  • Wait out the tantrum but stay close to your child so that he/she knows you are around
  • Try not to give in to what your child wants but instead reason with him/her
  • Do not give rewards to manage the tantrum as it will send a wrong message to the child
  • Be consistent and calm in your approach

Click below to watch a video on 5 tips to handle your child’s tantrums

Download Teleme’s mobile app and consult Ms Katyana, Psychologist
Ms Katyana

Ms Katyana

Psychologist

AUTISM: HOW TO RECOGNISE THE SYMPTOMS

AUTISM: HOW TO RECOGNISE THE SYMPTOMS

When you suspect that your child may have some behavioural issues, you need to know what symptoms to look out for.

Autism Spectrum Disorder (ASD) is characterised by ‘persistent deficits in social communication and social interaction across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviours used for social interaction and skills in developing, maintaining and understanding relationships’.

More than half the children would have the diagnosis by the age of 6 years and over 90% diagnosed by the age of 12 years.  Boys are affected more often than girls.

Source: canada.ca/en/public-health

Definition (DSM-V Criteria)

  • Persistent deficits in social communication and social interaction across multiple contexts
  • Restricted, repetitive patterns of behaviour, interests or activities
  • Symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capabilities or may be masked by learned strategies in later life
  • Symptoms can cause clinically significant impairment
  • Disturbances are not better explained by intellectual disability and Global Developmental Delay (GDD)
Source: harkla.co

What are these repetitive patterns of behaviour?

  • Stereotypes or repetitive motor movements, use of objects or speech
  • Insistence on sameness, inflexible adherence to routines or ritualised patterns of either verbal or non-verbal behaviour
  • Highly restricted, fixated interests that are abnormal in intensity or focus
  • Hyperactivity to sensory input or unusual interest in sensory aspects on environment

Click below to watch a video on 10 early signs which may suggest ASD

There are 3 levels of severity in ASD

Level 1: Requires support

  • Without support in place, deficits in social communication cause noticeable impairments
  • Difficulty initiating social interactions and clear examples of atypical or unsuccessful responses to social overtures of others
  • May appear to have decreased interest in social interactions
  • Inflexibility of behaviour causes interference with function
  • Difficulty switching between activities
  • Problems of organisation and planning hamper independence

Level 2: Requires substantial support

  • Marked deficits in verbal and nonverbal social communication skills even with support
  • Limited initiation of social interactions (reduced responses to social overtures from others)
  • Inflexibility of behaviour, difficulty coping with change or other repetitive behaviours appear frequently enough t be obvious to the casual observer
  • Difficulty changing focus or action

Level 3: Requires very substantial support

  • Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning resulting in limited initiation of social interactions
  • Minimal response to social overtures from others
  • Inflexibility of behaviour, extreme difficulty coping with change or other repetitive behaviours markedly interfere with functioning in all spheres
  • Great distress when changing focus or action

Take your child to a child psychologist or therapist for assessment if you have any concerns.

Download Teleme’s mobile app and consult Ms Katyana, Psychologist.

Ms Katyana

Ms Katyana

Psychologist

OBSTRUCTIVE SLEEP APNEA (OSA): TREATMENT

OBSTRUCTIVE SLEEP APNEA (OSA): TREATMENT

OSA is the most common type of sleep apnea. Around 15-20% of adults experience OSA and it is associated with being overweight, older age groups, smokers, rhinitis, pharyngeal reflux and in males. During sleep, our muscle tone relaxes and the airway lumen diminishes which requires more respiratory effort. This increase in respiratory effort results in negative airway pressure causing the airway soft tissue to flop back and obstruct the airway.

Source: science based medicine.org

Symptoms of OSA

Most common symptoms include snoring and restless sleep with periods of silence (apnea) followed by sudden gasping and even arousal from sleep. This causes poor quality sleep which results in early morning headache, unexplained daytime sleepiness, trouble concentrating, mood changes such as irritability and poor work performance.

There are also heath implications as they are more likely to get hypertension, heart disease, stroke, diabetes and involved in accidents.

Investigations

Important to have a complete examination by an ENT doctor to check BMI, neck circumference, nose and oral cavity to look for any anatomical obstruction by any polyp, septum deviation, tongue or lymphoid tissue.

Sleep study (PolySomnoGram or PSG) is the ‘gold standard’ to diagnose OSA and can be done at home by sleep coordinators who will do a home visit.  Some other parameters which can be measured include heart rate, oxygen saturation, airflow and sleeping position. The Apnoea:Hyponoea Index (AHI) is used to grade the severity of the sleep apnea depending on the number of ‘events’ detected per hour of sleep.

An ‘apnea event’ is defined as complete cessation of airflow for at least 10 seconds while ‘hyponoea event’ is defined as 50% decrease in airflow for at least 10 seconds or 30% decrease in airflow with associated decrease in oxygen saturation or an arousal from sleep.

Treatment options

  • Lifestyle modification such as losing weight and gentle regular exercise (read “How much exercise should we need daily?”)
  • Avoid stimulants such as caffeine, alcohol or light emitting devices before sleep and observe good sleep habits (read “Sleep Disorders”)
  • Treat any nasal symptoms such as allergic rhinitis
  • Surgery such as Adenotonsillectomy or Cautery Assisted Palatal Stiffening Operation (CAPSO) or mandibular advancement procedure may be helpful
  • Continuous Positive Airway Pressure (CPAP) device

Download Teleme’s mobile app to find an ENT surgeon near you or ask a Sleep Coordinator about Sleep Apnea.

SLEEP APNEA: HOME EXERCISES

SLEEP APNEA: HOME EXERCISES

In addition to wearing a CPAP mask for sleep apnea, you can also strengthen the muscles around the airways by doing mouth exercises. When practiced for around 30 minutes a day, these simple myofunctional therapy exercises (which involve chewing and swallowing motions as well as specific movements of the tongue) have been found to improve symptoms by:

  • reducing the severity of sleep apnea
  • improving sleep
  • easing snoring

Myofunctional therapy is to re-train the movement of the tongue and orofacial muscles to establish adequate postures. These exercises will strengthen the tongue and muscles which may improve breathing problems, speech and facial growth.

Click below to watch a video on Myofunctional Therapy Exercise

Other recommended exercises which you can also do:

  • Push the tip of your tongue against the roof of your mouth and slide the tongue backward. Repeat 20 times
  • Suck your tongue upward so that the entire tongue lies against the roof of your mouth. Repeat 20 times
  • Force the back of your tongue downward against the floor of your mouth while keeping the tip of your tongue in contact with your bottom front teeth

Source: sleepfoundation.org

Download Teleme’s mobile app and find an ENT doctor near you

SLEEP APNEA: TESTS & INVESTIGATIONS

SLEEP APNEA: TESTS & INVESTIGATIONS

If you have trouble sleeping, snore or suspect that you have sleep apnea, you can do the following 2 simple steps to:

i) Take a SLEEP APNEA QUIZ to see if you’re at risk.

ii) Talk to your doctor or sleep clinician about how to get a SLEEP APNEA TEST. This can be either an overnight sleep lab test (known as a polysomnography or PSG which needs to be done at a hospital) or a home sleep test (HST).

1) Sleep Lab Test (Polysomnography)

In a sleep lab or at a hospital, sensors will be placed on your body to monitor your sleep. With your permission, staff may also want to film your sleep study to gain more insight into your sleeping behaviour. This is to assess for unusual movements in your sleep (like sleep talking or walking) and for night-time seizures. You will need to stay overnight at the hospital for this test.

2) Home Sleep Test

A home sleep test (HST) is similar to a sleep lab test but with the convenience of being in your own home. Before a home sleep study night, a sleep clinician will show you how to apply the sensors & monitors and also how to use the recording device during the night. When you wake up in the morning, you can remove the sensors and return the recording device to the sleep clinician.

ResMed’s ApneaLink™ Air home sleep testing device includes a chest belt, nasal cannula, oximeter and recording device, which can detect apneas, hypopneas, flow limitation, snoring, blood oxygen saturation and breathing patterns during your sleep.

Results

The following aspects of sleep evaluation may be measured during your test:

  • Sleep efficiency: These results quantify the total number of minutes a person sleeps during a sleep study divided by the total amount of time they were recorded sleeping. The higher the sleep efficiency, the higher the percentage of sleep time versus awake time
  • Apnea Hypopnea Index (AHI): This looks at how often a person experiences sleep apnea and hypopnea (partial obstruction). More than five episodes of either is considered an abnormal AHI in adults
  • Oxygen Desaturation Index (ODI): This refers to the number of times a person’s oxygen level drops while they’re asleep. Oxygen levels above 90% are considered normal
  • Heart rate: In general, a normal heart rate is between 60 and 100 beats per minute (BPM)

After your sleep study, you can discuss the treatment options with your doctor or sleep clinician.  Treatment of sleep apnea can lead to an improved well-being and help alleviate these symptoms:

  • Loud snoring
  • Lack of energy during the day
  • Daytime sleepiness
  • Morning headaches

Download Teleme’s mobile app to find an ENT surgeon near you or ask a Sleep Coordinator about a Home Sleep Test.

SLEEP: HOW TO GET A GOOD NIGHT’S SLEEP

SLEEP: HOW TO GET A GOOD NIGHT’S SLEEP

Getting a good night’s sleep requires more than just going to bed on time. Try the following sleep tips to give yourself the best chance of getting consistent, quality sleep each night.

  • Allocate enough time for sleep. Sleep is just as important as diet and exercise so it is important to allocate the right amount of time in your day for sleep and plan the rest of your schedule accordingly. Getting a good night’s sleep means 7–8 hours each night for adults (including older adults), 9–10 hours for teenagers, at least 10 hours for school-aged children and 11–12 hours for preschool-aged children.
  • Create a consistent sleep routine. As creatures of habit, we are usually more successful when following a routine. Sleep is no different. From your pre-sleep ritual to going to bed and waking up at the same time, you will find that consistency makes it easier for you to fall asleep.
  • Create a comfortable sleep environment. Make sure your bedroom is quiet and comfortable – especially your bed. It may take some experimenting on your part but finding a comfortable bed and pillow is invaluable. We spend one-third of our lives in bed so don’t compromise on comfort.
  • Turn off all light emitting gadgets at least 30 minutes before bedtime. Whether it’s television, reading, email or texting, give yourself a nice window of time to unwind and relax before sleep. Television and bright lights also suppress melatonin production thereby making it more difficult to fall asleep.

If you feel like you’re doing everything you can to get a good night’s sleep but no longer have the energy to do the things you love, you may have sleep apnea which affects three in 10 men and nearly two in 10 women. Talk to your ENT surgeon or Sleep Coordinator about your sleep issues.

Download Teleme’s mobile app and ask a Sleep Home Medical Appliance Coordinator about Sleep Apnea                        

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