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Pacifiers, head-banging, bed-wetting, breath holding spells, and masturbation in children

Pacifiers. You have a three-year-old girl who continues to suck on a pacifier, particularly when she becomes distressed. When her pacifier is not available, she sucks her thumb. Her parents feel she is too old to do either and might be made fun of when she begins preschool. So pacifier, thumb sucking, used to self soothe. Most will discontinue when they are ready. You see a lot of parents who get into battles and sometimes it has a tendency to prolong. Major harm to the teeth doesn’t occur until about four or five-years-of-age and some parents are worried about this when they see their little infant still … they are constantly snatching the thumb out of the mouth. Sometimes a transition object is helpful. Some kids will take a transition object like a teddy bear, or blanket, but some kids just persist with that thumb.

Head-banging. A two-year-old boy’s parents are concerned about his tendency to bang his head while in his crib at bedtime. His grandparents have heightened their concern by telling them that they have heard that this is a tendency in retarded children. Happens a lot. A lot of relatives are on your backs about all these kinds of things. This occurs in about 5-50% of normal children, 3:1 male to female, often accompanied by thumb-sucking and blanket holding. So you have a two-year-old who is like sucking his thumb and banging his head while going to sleep. It usually stops by four-years-of-age. If it persists then you have to look for developmental delay, any mental retardation or autism.

Bed-wetting. A four-and-a-half-year-old has been toilet trained since he was three. Although he remains dry during the day, his parents are concerned because he wets the bed most nights. His father feels that he should be scolded for doing so. Common, happens a lot. The child is dry during the day, but rarely during the night. May occur until five to six-years-of-age. It may continue until adolescence in predisposed children and there are some males who continue to engage in bed-wetting at 15 to 16-years-of-age. As you know, dad did the same thing. And it happens with the girls sometimes too. You have probably seen some girls who are eight and nine and ten-years-of-age who still have enuresis. If the secondary occurs after the child has been toilet trained, has been dry day and night, you have to look for medical causes; urinary tract infection, diabetes, then look for psychosocial causes. Birth of a new sibling, family discord, divorce, or sexual abuse.

Breath-holding spells. A two-and-a-half-year-old, bright, verbal, girl sometimes faints when she becomes upset after not getting her way. The parents are so terrified by the events that they usually concede and allow her to have her way. I’ve seen this. The child is in control of the house. Breath-holding spells occur between six months to six-years-of- age. The crying may be intense or minimal. The child may be momentarily unconscious after holding their breath. Take a careful history to make sure the child is not having any seizures. The antecedent event is usually that the child doesn’t get what they want and then they start the whole attack, but if it just occurs and there is no antecedent event then that’s something I would be more worried about. Then you have to look for a developmental disability if you are worried about seizures, and a history of previous seizures in the child or in the family. So even if you have something that sounds like a breath- holding spell, you want to take a good history and make sure the child didn’t have any, or doesn’t have any, developmental disability and there is no history of seizures in the family. You know, like maybe they were a preemie and they had a bleed.

Masturbation. A three-year-old boy’s parents have noticed that he has begun to masturbate. They are concerned about being embarrassed if he does so when he begins preschool next month. Masturbation begins to occur in infancy when infants engage in body exploration. It’s common in both boys and girls. Intentional stimulation by the hands might be seen by two-years-of-age and then later on after that. Determine if there is a physical cause at the time, if they have a diaper rash, if they may need to void. It usually not persistent in public after four to five-years-of-age. You can always assure the parents that preschool teachers have seen this. They see it all the time so they really don’t have to worry about it. Later on, the other children will set limits in terms of probably not doing it themselves, and this child, since they will want to socially fit in.