Supporting Children with Challenging Behaviors — Children with Challenging Behaviors that May Impact Medical Care — Clinical Pathway: Primary Care

Supporting Children with Challenging Behaviors Clinical Pathway — Primary Care

Children with Challenging Behaviors that May Impact Medical Care

This pathway is for children through 18 yrs of age with challenging behaviors that may impact medical care at Primary Care offices.

Common reactions to anxiety, fear, or loss of control may include aggression, anger, poor cooperation, withdrawal, or regression1. Lagging skills, developmental delay, level of cognitive development, psychopathology, situational demands, parent/caregiver response, and other factors may negatively impact how children respond to stressors in the medical environment2.

Early recognition is imperative for successful management.

Recognition of Challenging Behaviors

Possible Early Signs
of Agitation
  • Verbal
    • Increased voice volume, use of expletives, threatening statements, refusal to cooperate
  • Physical
    • Pacing, fidgeting, picking, crying, rocking, withdrawing
Possible Risk Factors for Agitation
  • Recent traumatic experience (child/family perceived; provider reported)
  • Autism Spectrum Disorder
  • ADHD/ADD
  • Anxiety
  • Cognitive/learning disabilities
  • Sensory disorders
  • Communication impairment
  • History of, reported or current difficulty participating in medical treatment
  • Current reported behaviors of aggression or violence
  • Trauma (abuse, neglect, divorce, car accident, house fire, etc.)

References

  1. Minimizing Pediatric Healthcare-induced Anxiety and Trauma  
  2. Multimethod Assessment of Children's Distress During Noninvasive Outpatient Medical Procedures: Child and Parent Attitudes and Factors