Oppositional Defiant Disorder

It's not unusual for children -- especially those in their "terrible twos" and early teens -- to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their parents, teachers, or other adults. When this behavior lasts longer than six months and is excessive compared to what is usual for the child's age, it may mean that the child has a type of behavior disorder called oppositional defiant disorder (ODD).

ODD is a condition in which a child displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The child's behavior often disrupts the child's normal daily activities, including activities within the family and at school.

Many children and teens with ODD also have other behavioral problems, such as attention-deficit/hyperactivity disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some children with ODD go on to develop a more serious behavior disorder called conduct disorder.

What Are the Symptoms of Oppositional Defiant Disorder?

Symptoms of ODD may include:

• Throwing repeated temper tantrums
• Excessively arguing with adults
• Actively refusing to comply with requests and rules
• Deliberately trying to annoy or upset others, or being easily annoyed by others
• Blaming others for your mistakes
• Having frequent outbursts of anger and resentment
• Being spiteful and seeking revenge
• Swearing or using obscene language
• Saying mean and hateful things when upset

In addition, many children with ODD are moody, easily frustrated, and have a low self-esteem. They also sometimes may abuse drugs and alcohol.

What Causes Oppositional Defiant Disorder?

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition.

• Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal amounts of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.
• Genetics: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.
• Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.                                                                                                 
  

  How Common Is Oppositional Defiant Disorder?

  Estimates suggest that 2%-16% of children and teens have ODD. In younger children, ODD is more common in boys. In older children, it occurs about equally in boys and in girls. It typically begins by age 8.

  How Is Oppositional Defiant Disorder Diagnosed?

  As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular illness like ODD. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose ODD, the doctor may sometimes use tests such as neuroimaging studies or blood tests if they suspect that there may be a medical explanation for the behavior problems that occur. The doctor also will look for signs of other conditions that often occur along with ODD, such as ADHD and depression.
  If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental illness. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behavior. The doctor often must rely on reports from the child's parents, teachers, and other adults because children often have trouble explaining their problems or understanding their symptoms.

  How Is Oppositional Defiant Disorder Treated?

  Treatment for ODD is determined based on many factors, including the child's age, the severity of symptoms, and the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:
• Psychotherapy : Psychotherapy (a type of counseling) is aimed at helping the child develop more effective coping and problem-solving skills, and ways to express and control anger. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve behavior. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior.  Behavior management plans also often involve developing contracts between parent and child that identify rewards for positive behaviors and consequences (punishments) for negative behaviors.  
• Medication : While there is no medication formally approved to treat ODD, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or depression.

What Is the Outlook for Children With Oppositional Defiant Disorder?

If your child is showing signs of ODD, it is very important that you seek care from a qualified mental health professional immediately. Without treatment, children with ODD may experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior. In addition, a child with ODD has a greater chance of developing a more serious behavioral disorder called conduct disorder. When started early, treatment is usually very effective.

Can Oppositional Defiant Disorder Be Prevented?

Although it may not be possible to prevent ODD, recognizing and acting on symptoms when they first appear can minimize distress to the child and family, and prevent many of the problems associated with the illness. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of defiant behavior.

Source: http://www.webmd.com/mental-health/

Healthy Eating Habits for Your Child

By teaching your children healthy eating habits, and modeling these behaviors in yourself, you can help your children maintain a healthy weight and normal growth. Also, the eating habits your children pick up when they are young will help them maintain a healthy lifestyle when they are adults. 

Your child's health care provider can evaluate your child's weight and growth and let you know if your child needs to lose or gain weight or if any dietary changes need to be made.

Some of the most important aspects of healthy eating are portion control and cutting down on how much fat your child eats. Simple ways to reduce fat intake in your child's diet and promote a healthy weight include serving:

• low-fat or nonfat dairy products
• poultry without skin
• lean cuts of meats
• whole grain breads and cereals

Also, reduce the amount of sugar sweetened drinks and salt in your child's diet.

If you are unsure about how to select and prepare a variety of foods for your family, consult a registered dietitian for nutrition counseling. 

It is important that you do not place your overweight child(ren) on a restrictive diet. Children should never be placed on a restrictive diet to lose weight unless a doctor supervises one for medical reasons.

Other approaches parents can take to develop healthy eating habits in their children include:

• Guide your family's choices rather than dictate foods. Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices. Leave the unhealthy choices like soda and juice at the grocery store. Serve water with meals.
• Encourage your children to eat slowly. A child can detect hunger and fullness better when they eat slowly. Before offering a second helping or serving, ask your child to wait a few minutes to see if they are truly still hungry. This will give the brain time to register fullness.
• Eat meals together as a family as often as possible. Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.
• Involve your children in food shopping and preparing meals. These activities will give you hints about your children's food preferences, an opportunity to teach your children about nutrition, and provide your kids with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.
• Plan for snacks. Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child's appetite at meal times. You should make snacks as nutritious as possible, without depriving your children of occasional chips or cookies, especially at parties or other social events.
• Discourage eating meals or snacks while watching TV. Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.
• Encourage your children to drink more water. Over consumption of sweetened drinks and sodas has been linked to increased rates of obesity in children.
• Try not to use food to punish or reward your children. Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.
• Make sure your children's meals outside the home are balanced. Find out more about their school lunch program, or pack their lunch to include a variety of foods. Also, select healthier items when dining at restaurants.
• Pay attention to portion size and ingredients. Read food labels and limit foods with trans fat. Also, make sure you serve the appropriate portion as indicated on the label.                                                                                                                                                                                           Source: http://children.webmd.com/

How to Treat Cold and Flu Symptoms

Every fall, millions of U.S. children get flu vaccinations at their pediatricians' offices. The CDC recommends an annual flu vaccine for all Americans who are at least 6 months old.
You may have questions about the vaccination. Why can't last year's flu shot protect your child this year? Do you need to get her a separate vaccine for protection against the H1N1 strain? Should you request the vaccination in nasal spray rather than injection form?
For guidance, WebMD spoke with internist Lisa Grohskopf, MD, a medical officer in the CDC's Influenza Division.

Q: Why is it important for all children aged 6 months and up to get vaccinated?

A: Children, particularly those under age 5, are subject to potentially very severe complications from influenza disease; some of those children are hospitalized. Within that group, children under 2 are especially prone to complications. For everyone aged 6 months and up, the annual flu vaccine is the best way that we have available to protect against complications.

Q: Is it really necessary to vaccinate my child this year if she received a flu shot last year?

A: The flu vaccine has four different vaccine virus ... strains in it. In a typical season, at least one of those strains will change.
Also, we know from a number of studies that the antibody response to the vaccine tends to decline over time, so that’s why it’s important to get a flu vaccine every year.

Q: How effective is the vaccine at preventing flu?

A: It depends on how well the vaccine matches the flu strains that are circulating. The vaccine strains have to be chosen well in advance of the flu season starting, and in years when there's a good match, it's likely to work better.
It also depends upon a person’s age and health status.

Q: Are there any reasons why a child who's old enough should not get the flu vaccine?

A: The main contraindication for the flu vaccine is a severe allergic reaction to anything that is in the flu vaccine. One possibility is egg [allergy], because all of the flu vaccines that are available in this country are manufactured through a process that uses chicken eggs, the vaccine is most likely going to have a very, very trace quantity of egg protein left in it.
The CDC has recommended that if a child's egg allergy is a mild one -- meaning the child only experiences hives as a reaction -- they may be given the flu vaccine with precautions: Things like being watched in the doctor’s office for 30 minutes after receiving the vaccine administration to make sure they don't have a severe reaction. We recommend that they get the (injectable or killed) shot rather than the nasal spray because there's more published data about children with egg allergy for the shot.
For those who have a more severe egg allergy -- shortness of breath or any other symptom that may indicate something more serious -- we recommend that they consult with a specialist who's familiar with allergies before they receive the vaccine.
There are other things in the flu vaccine that people can potentially be allergic to, so a history of having had a severe allergic reaction to the vaccine itself or any of its components would be a contraindication.

Q: How can parents protect babies younger than 6 months from the flu?

A: Since babies under 6 months can’t get a flu shot, it’s important to do everything you can to protect your child. The best way to protect those children is getting the flu vaccine yourself. The people who are in close contact with babies and take care of them should do their best not to get sick themselves, so they don’t spread the flu to the baby.

Q: Does a flu shot given to a pregnant woman protect the newborn baby later on?

A: There have been studies showing that newborns do have some protection from mothers' vaccinations.

Q: How many doses of the flu vaccine does my child need, and how long should we wait between doses?

A: Children from 6 months to 8 years getting the flu vaccine for the first time need to get two doses in order to maximize having a good immune response. This year, because the composition of flu vaccine is the same as last year's, we are recommending that children who received one dose last year (instead of the recommended two) need only one this year, rather than the previously recommended two.
If it's your child's first time, she still needs two doses. Or if you don't know what your child got before --- if it's not documented anywhere -- [get] two doses.
This year, we also recommend that children who did not get at least one dose of the 2012-2013 vaccine receive two doses, even if they received two doses in some season prior to 2010-2011.
The doses should be at least four weeks apart.

Q: Is H1N1 (swine flu) still a concern?

A: Yes. We need to consider whether children get an adequate number of doses of the H1N1 pandemic strain to be protected from the 2009 H1N1 pandemic virus. It was in last year's vaccine and is also in this year's vaccine.
Your child will need two doses of this year's flu vaccine if she did not get at least one dose of the 2010-2011 flu vaccine, even if he or she received two doses in an earlier season.

Q: Which children are eligible for the nasal spray flu vaccine?

A: The nasal spray is an option for healthy children over age 2 who don't have asthma, chronic medical conditions, or other medical problems that might place them at increased risk for influenza complications.
Sometimes doctors' practices run out of it, or they're not able to stock it every year. But you can ask for it.

Q: How can a parent prepare a child for the flu shot, particularly if the child is afraid of injections?

A: For children who are fearful of an injection, the nasal spray flu vaccine is an option. Otherwise, it's just like any other vaccination, and it may help if the pediatrician has good distraction techniques.

Q: What are the typical reactions to the flu shot?

A: Generally, the most common side effects from the flu shot are local symptoms around the site where the shot was given -- things like soreness, redness, or swelling. Children who get the nasal spray vaccine may have a runny nose, congestion, or cough.
After either vaccine, some children may have other symptoms, such as fever or aches. These effects are usually mild and last only one to two days.
Severe reactions are rare, but parents could look for a high fever, behavior changes, or signs of a severe allergic reaction, like trouble breathing or hives.

Q: Will the flu shot be painful for my child?

A: There is some pain but it usually goes away fast. And it’s one of the best things you can do to help prevent the flu. There are a lot of things that can impact what your experience is, so it's hard to say. For example, there can be a lot of variability depending on the technique of the person giving the shot.

Q: When is it too late in the season to get a flu vaccine?

A: The season generally begins in September or October and can run as late as May, but some seasons behave differently. Throughout the season, we recommend that people get their vaccines if they haven't already. You can never be sure, because flu is unpredictable. ... We recommend getting it as early as possible in the season, so you can establish your immune protection as early as possible.

Source: http://www.webmd.com/