PE5.1-4 | Behavioural Problems — Glossary

Infant formula composed entirely of free amino acids, used when eHF is not tolerated; recommended for CMPA with severe manifestations or anaphylaxis.

Brief tonic or tonic-clonic movements occurring at the end of a prolonged breath-holding spell as a direct consequence of cerebral hypoxia; not epileptic, not associated with EEG abnormality, and not treated with anti-epileptic drugs.

The level of sensory stimulation (e.g., from a full bladder) required to wake a sleeping child; a high arousal threshold (deep sleep) is one of the three functional mechanisms of MNE; the target of enuresis alarm conditioning.

An anticholinergic drug that blocks muscarinic receptors, thereby inhibiting vagal tone on the heart; used in selected cases of severe pallid BHS to reduce vagally-mediated bradycardia.

Aggregates of ribosomal RNA visible as blue dots in red blood cells on a peripheral smear; seen in lead poisoning (as well as thalassaemia and other conditions); results from inhibition of pyrimidine 5'-nucleotidase by lead.

A 2–3 day record of all voids, volumes, incontinent episodes, and fluid intake; identifies nocturnal polyuria (nocturnal urine >20% of 24-hour total) or reduced bladder capacity; essential for mechanistic diagnosis in MNE.

The concentration of lead in whole blood, measured in µg/dL; the CDC 2012 reference value is ≥5 µg/dL; chelation therapy is indicated at BLL ≥45 µg/dL.

An involuntary paroxysmal episode in children aged 6 months to 5 years in which a stimulus (emotional or painful) triggers apnoea, leading to cyanosis or pallor and transient loss of consciousness; not a form of epilepsy.

A blue-black line at the gum margin caused by deposition of lead sulphide; a classical sign of chronic lead poisoning, visible only in the context of poor oral hygiene.

An immune-mediated adverse reaction to cow's milk protein, occurring in ~2–3% of infants; may be IgE-mediated (immediate) or non-IgE-mediated (delayed), with presentations including FPIES, proctocolitis, and enteropathy.

The commonest type (~85%) of breath-holding spell, triggered by emotional upset; involves forced expiratory apnoea and a Valsalva mechanism leading to cyanosis and, if prolonged, loss of consciousness.

A synthetic analogue of antidiuretic hormone (vasopressin) that reduces nocturnal urine production; used for MNE with nocturnal polyuria; requires fluid restriction to prevent hyponatraemia; high relapse rate (~70%) after stopping.

An evidence-based framework for feeding children: the parent is responsible for what, when, and where food is offered; the child is responsible for whether and how much they eat.

An oral chelating agent used for lead poisoning with BLL ≥45 µg/dL; administered at 10 mg/kg/dose three times daily for 5 days, then twice daily for 14 days.

An intestinal transporter that absorbs divalent metals including Fe²⁺ and Pb²⁺; upregulated in iron deficiency, leading to increased intestinal absorption of both iron and lead in iron-deficient children.

Involuntary voiding of urine beyond the age at which bladder control is expected (diagnosed from age 5 years); classified as nocturnal (during sleep) or diurnal (daytime), and primary (never dry >6 months) or secondary (dry ≥6 months then relapsed).

A conditioning device for enuresis: a moisture sensor triggers an alarm on wetting, waking the child to complete voiding; through classical conditioning, the arousal response to a full bladder is reinforced; the most effective long-term treatment for MNE (~65–75% success, ~10–15% relapse).

Infant formula in which cow's milk proteins are broken down into small peptides, rendering them non-antigenic for most infants with CMPA; first-line substitute for formula-fed infants with CMPA.

Inadequate weight gain or a downward crossing of two or more major centile lines on a growth chart, indicating insufficient nutritional intake relative to needs.

Any difficulty in the acceptance, intake, or tolerance of food that causes parental concern, inadequate nutritional intake, or impaired growth, categorised as organic, behavioural, or developmental.

A severe non-IgE-mediated food allergy causing profuse vomiting 1–4 hours after ingestion of the trigger food (most commonly cow's milk or soy), sometimes with lethargy and pallor.

The maximum volume of urine a child can comfortably hold before urgency; reduced capacity is one of the three functional mechanisms of MNE; increases with age and bladder training.

A surgical procedure that wraps the gastric fundus around the lower oesophageal sphincter to prevent reflux; reserved for refractory GORD with severe complications in children.

A left-to-right wave of gastric contractions visible through the abdominal wall in thin infants with pyloric stenosis, best seen during a test feed.

A form of pica involving the ingestion of soil, clay, or sand; the most common form of pica in Indian and African children; associated with iron and zinc deficiency and potential lead exposure.

Gastro-oesophageal reflux causing complications such as oesophagitis, faltering growth, or respiratory symptoms, as distinct from the normal physiological reflux (GOR) common in infancy.

Continuous 24–48 hour ambulatory ECG recording used to capture cardiac arrhythmias; may document asystolic pauses during pallid breath-holding spells in selected cases.

A serious adverse effect of desmopressin, occurring when the child drinks excessive fluid after the dose; excess free water is retained, diluting serum sodium; prevented by restricting fluids for 1 hour before and 8 hours after the dose.

A tricyclic antidepressant with mild anticholinergic and ADH-like effects; historically used for enuresis but now third-line due to risk of cardiac arrhythmia and potentially fatal accidental overdose in children.

A recognised feeding disorder in infants and toddlers characterised by persistent refusal to eat adequate amounts beginning in the first 3 years of life, in the absence of an organic cause, associated with temperament and parent–child interaction.

A reinforcement schedule in which a behaviour is rewarded only some of the time; produces the most resistant and persistent learned behaviour — the reason that occasionally giving in to tantrums makes them worse.

Oral elemental iron at 3–6 mg/kg/day for 3 months, prescribed in children with BHS and documented iron deficiency; evidence from RCTs supports a reduction in spell frequency.

In children under 5 years, defined as haemoglobin <11 g/dL; iron deficiency (low ferritin) may increase BHS frequency by affecting autonomic dopaminergic tone, independent of haemoglobin level.

Waking the child at a fixed time before the parent goes to bed to void; prevents a wet episode but does not treat the underlying condition and does not achieve long-term dryness independently.

The commonest clinical form of enuresis: bedwetting only, no daytime urinary symptoms, and no identifiable organic cause; associated with one or more of three functional mechanisms.

A positive reinforcement strategy using a reward calendar for dry nights; effective as an initial intervention in younger children with MNE; does not address the underlying mechanism but reduces stigma and improves adherence to other treatments.

A simple anthropometric measure used to screen for acute malnutrition; in children 6–59 months, <11.5 cm indicates SAM and 11.5–12.5 cm indicates MAM.

Excessive urine production during sleep, defined as nocturnal urine volume >20% of 24-hour total; caused by reduced nocturnal ADH secretion; the most common mechanism in MNE and the target of desmopressin therapy.

Slowing of the heart rate in response to ocular pressure, mediated by the trigemino-vagal reflex; used diagnostically to demonstrate enhanced vagal tone in children with pallid BHS.

Impaired coordination of the muscles used for sucking, chewing, and swallowing, seen in children with cerebral palsy, neuromuscular disease, or developmental delay, leading to inefficient feeding and aspiration risk.

A form of pica characterised by compulsive ingestion of ice; strongly and specifically associated with iron-deficiency anaemia; resolves with iron supplementation.

A less common type (~15%) of breath-holding spell triggered by sudden pain or fright; caused by intense vagal stimulation producing bradycardia or asystole, resulting in pallor and syncope.

The persistent ingestion of non-food, non-nutritive substances for ≥1 month in a child developmentally older than 18–24 months; considered pathological above this age threshold and associated with iron deficiency, lead poisoning, intellectual disability, and ASD.

A behavioural management strategy for temper tantrums in which the parent provides no attention (positive or negative) during the tantrum; based on extinction of operant behaviour reinforced by parental attention.

Chronic lead poisoning resulting from ingestion of lead-containing substances; manifests as hypochromic microcytic anaemia, basophilic stippling on blood smear, cognitive impairment, and (in severe cases) encephalopathy.

The addition of a rewarding stimulus following a desired behaviour, increasing the probability of that behaviour recurring; the cornerstone of toddler behaviour management.

Food refusal or aversion triggered by a frightening or painful oral event (choking, prolonged nasogastric intubation, painful procedures), resulting in conditioned aversion to eating.

A period of confusion, drowsiness, or lethargy following an epileptic seizure; its absence after a spell strongly favours BHS over epilepsy.

Enuresis in a child who has never been continuously dry at night for more than 6 months; accounts for 80–85% of nocturnal enuresis; more likely to be functional/developmental.

Hypertrophy and hyperplasia of the pyloric muscle causing progressive gastric outlet obstruction; presents at 3–6 weeks with projectile non-bilious vomiting, metabolic alkalosis, and an olive-shaped palpable mass.

Surgical division of the hypertrophied pyloric muscle, the definitive treatment for pyloric stenosis; performed after metabolic correction of the hypochloraemic hypokalaemic alkalosis.

Another term for pallid breath-holding spell, emphasising the reflexly triggered cardiac inhibition that produces cerebral anoxia and the seizure-like movements; used interchangeably with 'pallid BHS'.

Defined as weight-for-height z-score < −3 SD, or MUAC <11.5 cm in children 6–59 months, or bilateral pitting oedema; requires urgent therapeutic feeding.

Paroxysmal dystonic posturing of the neck and trunk associated with GORD in infants, which may be mistaken for seizures; resolves with effective GORD treatment.

Enuresis in a child who was previously dry for ≥6 months and then relapsed; accounts for 15–20% of cases; almost always has a precipitant (psychological stress, UTI, diabetes mellitus) and must be investigated.

A pattern of accepting only a limited range of foods, often based on texture, colour, or taste; extremely common in toddlerhood and usually does not compromise growth.

A group of congenital anomalies of neural tube closure affecting the spine (including spina bifida occulta and meningomyelocele); may cause neurogenic bladder and secondary enuresis; detected by sacral skin stigmata (tuft of hair, dimple) and lower limb neurological signs.

An episode of emotional dysregulation in a toddler characterised by crying, screaming, and physical protest behaviours, arising when a wish is denied or frustration is experienced; developmentally normal from 18 months to 3 years.

A mass of ingested hair that accumulates in the stomach or intestine; a complication of trichophagia (hair-eating pica); may cause abdominal pain, vomiting, and gastric outlet obstruction; requires surgical or endoscopic removal.

A form of pica involving ingestion of hair; may lead to trichobezoar formation; associated with obsessive-compulsive spectrum disorders in older children.

Stimulation of the vagus nerve (cranial nerve X) causing slowing of the sinoatrial node, producing bradycardia or transient asystole; the mechanism underlying pallid breath-holding spells.

The physiological consequence of forced expiration against a closed glottis or increased intrathoracic pressure, which reduces venous return to the heart and decreases cardiac output; the key mechanism in cyanotic BHS.