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31.10 Elimination Disorders

intervals, and offer only water between meals. The parents are trained to deliver praise to the infant for any self-feeding efforts, regardless of the amount of food ingested. Furthermore, par- ents are guided to limit any distracting stimulation during meals and give attention and praise to positive eating behaviors rather than intense negative attention to inappropriate behavior during meals. This training process for parents is done in an intense manner within a short period of time. Many parents are able to facilitate improved eating patterns in the infant as a result. If the mother or caregiver is unable to participate in the intervention, it may be necessary to include additional caregivers to contribute to feeding the infant. In rare cases, an infant may require hos- pitalization until adequate nutrition on a daily basis is accom- plished. If an infant tires before ingesting an adequate amount of nutrition, it may be necessary to begin treatment with the placement of a nasogastric tube for supplemental oral feedings. For older children with failure-to-thrive syndromes, hos- pitalization and nutritional supplementation may be necessary. Medication is not a standard component of treatment for feeding disorders; however, there are anecdotal reports of preadolescents with failure-to-thrive and feeding disorders who were comor- bid for anxiety and mood symptoms and who received enteral nutritional interventions in addition to risperidone (Risperdal), and who were observed to have an increase in oral intake and accelerated weight gain. R eferences Araujo CL, Victora CG, Hallal PC, Gigante DP. Breastfeeding and overweight in childhood: Evidence from the Pelotas 1993 birth cohort study. Int J Obes. 2005;30(3):500. Berger-Gross P, Colettoi DJ, Hirschkorn K, Terranova E, Simpser EF. The effec- tiveness of risperidone in the treatment of three children with feeding disorders. J Child Adolesc Psychopharmacol. 2004;14:621. Bryant-Waugh R. Feeding and eating disorders in children. Curr Opin Psychiatry. 2013;26:537–542. Bryant-Waugh R. Avoidant restrictive food intake disorder: An illustrative case example. Int J Eat Disord. 2013;46:420–423. Call C, Walsh BT, Attia E. From DSM-IV to DSM-5: Changes to eating disorder diagnoses. Curr Opin Psychiatry. 2013;26:532–536. Chatoor I. Feeding and eating disorders of infancy or early childhood. In: Sadock BJ, Sadock VA, eds. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 9 th ed. Vol. II. Philadelphia: Lippincott Williams & Wilkins; 2009:3597. Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J. Rumination syn- drome in children and adolescents: Diagnosis, treatment, and prognosis. Pedi- atrics. 2003;111:158–162. Cohen E, RosenY,Yehuda B, Iancu I. Successful multidisciplinary treatment in an adolescent case of rumination. Isr J Psychiatry Relat Sci. 2004;41:222. DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoro- scopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol. 2005;47:149. Esparo G, Canals J, Ballespi S, Vinas F, Domenech E. Feeding problems in nursery children: Prevalence and psychosocial factors. Acta Pediatr 2004;93:663. Equit M, Palmke M, Beckner N. Problems in young children: a population based study. Acta Paediatr. 2013:10. Feldaman R, Keren M, Gross-Rozval O, Tyano S. Mother-child touch patterns in infant feeding disorders: Relation to maternal, child, and environmental factors. J Am Acad Child Adolesc Psychiatry. 2004;43:1089. Hughes SO, Anderson CB, Power TG, Micheli N, Jaramillo S, Nicklas TA. Mea- suring feeding in low-income African-American and Hispanic parents. Appe- tite. 2006;46(2):215. Jacobi C, Agras WS, Bryson S, Hammer LD. Behavioral validation, precursors, and concomitants of picky eating in childhood. J Am Acad Child Adolesc Psy- chiatry. 2003;42:76. Lewinsohn PM, Holm-Denoma JM, Gau JM, Joiner TE Jr, Striegel-Moore R, Bear P, Lamoureux B. Problematic eating and feeding behaviors of 36-month-old children. Int J Eat Disord. 2005;38(3):208–219. Linscheid TN. Behavioral treatments for pediatric feeding disorders. Behav Modif. 2006;30:6–23. Liu YL, Malik N, Sanger GJ, Friedman MI, Andrews PL. Pica—A model of nausea? Species differences in response to cisplatin. Physiol Behav. 2005; 85(3):271–277.

Ornstein RM, Rosen DS, Mammel K, Callahan ST, Forman S. Distribution of eat- ing disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders. J Adolesc Health. 2013;53:303–305. Rajindrajith S., Devanarayana NM, Perera BJC. Rumination syndrome in children and adolescents: a school survey assessing prevalence and symptomatology. BMC Gastroenterol. 2012;12:163–169. Rastam M, Taljemark J, Tajnia A. Eating problems and overlap with ADHD and autism spectrum disorders in a nationwide twin study of 9- and 12-year-old children Sci World J. 2013;15:315429. Tack J, Blondeau K, Boecxstaens V, Rommel N. Review article: The pathophysiol- ogy, differential diagnosis and management of rumination syndrome. Ailment Pharmacol Ther. 2011;33:782–788. Uher R, Rutter M. Classification of feeding and eating disorders: Review of evi- dence and proposals for ICD-11. World Psychiatry. 2012;11:80–92. Williams DE, McAdam D. Assessment, behavioral treatment, and prevention of pica: Clinical guidelines and recommendations for practitioners. Res Develop Disab. 2012;33:2050–2057. Disorders The developmental milestones of mastering control over bowel and bladder function are complex processes that involve motor and sensory functions, coordinated through frontal lobe activi- ties, and regulated by neurons in the pons and midbrain area. Mastery of bowel and bladder function is achieved over a period of months for the typical toddler. Infants generally void small volumes of urine approximately every hour, commonly stim- ulated by feeding, and may have incomplete emptying of the bladder. As the infant matures to be a toddler, bladder capacity increases, and between 1 and 3 years of age, cortical inhibitory pathways develop that allow the child to have voluntary con- trol over reflexes that control the bladder muscles. The ability to have muscular control over the bowel occurs even before blad- der control for most toddlers, and the assessment of fecal soiling includes determining whether the clinical presentation occurs with or without chronic constipation and overflow soiling. The normal sequence of developing control over bowel and blad- der functions is the development of nocturnal fecal continence, diurnal fecal continence, diurnal bladder control, and nocturnal bladder control. Bowel and bladder control develops gradually over time. Toilet training is affected by many factors, such as a child’s intellectual capacity and social maturity, cultural deter- minants, and the psychological interactions between child and parents. The ability to control bowel and bladder functions depends on the maturation of neurobiological systems, so that children with developmental delays may also display delayed continence of bowel and bladder. When children exhibit incon- tinence of urine or feces on a regular basis, it is troubling to the child and families, and often misunderstood as voluntary misbehavior. Encopresis (repeated passage of feces into inappropriate places) and enuresis (repeated urination into bed or clothes) are the two elimination disorders described in the Fifth Edition of the American Psychiatric Association’s Diagnostic and Statis- tical Manual of Mental Disorders (DSM-5). These diagnoses are not made until after age 4 years, for encopresis, and after age 5 years for enuresis, the ages at which a typically develop- ing child is expected to master these skills. Normal develop- ment encompasses a range of time in which a given child is able to devote the attention, motivation, and physiological skills ▲▲ 31.10 Elimination