Interpersonal violence, aggression, and antisocial behaviours in the adolescents.

Violence is a growing problem among adolescents all over the world. Exposure to violence can have lasting and pervasive effects on an adolescent's mental and physical health, general well-being, and ability to become a productive adult. Research on adolescent violence in India and Southeast Asia is limited; very little is written in clinical journals. Addressing adolescent violence is currently a low priority for medical practitioners because disease, poverty, and infant maternal health pose more immediate threats to morbidity and mortality in Asia. Physicians, especially in India, have a unique opportunity to take preventative actions now, to stem the tide of morbidity and mortality from gun violence that plagues the United States. Adolescents in Asia are at greatest risk for violence exposure in their homes. Pediatricians who are proactive and educate their patients, families, and the community can help reduce or prevent morbidity and mortality resulting from violence in adolescents.

Disorders of cognition, attention and learning.

The inability to successfully navigate the educational system can cause serious problems for children, their parents, the Indian society, and the world at large. When children are required to engage in academic exercises which require attention, specific cognitive abilities and processes, and demonstrations of learning, a subset of these children are unable to perform due to some type of intellectual, emotional, behavioural, physical, or environmental deficit. Any combination of these factors can result in school failure. Although, resources for remedial or special education services in Southeast Asia and India are particularly meager, efforts must be directed towards the retention and achievement of those children who do enroll in primary and secondary schools. Learning disability represents a major form of impairment in society, and much more needs to be done to bring about a general awareness of its consequences. An urgent priority is the education of physicians and teachers about disorders of cognition, learning, and attention.

Encopresis.

Encopresis is fecal soiling associated with functional constipation in a child. Constipation and encopresis are common problems in children. Encopresis is most common between ages 3 and 7 years. Infants and pre-school children present with a history of constipation and withholding maneuvers. The school-age child may have constipation and fecal soiling for some time prior to detection. In some children encopresis is associated with enuresis and urinary tract infection. Family education is the essential first step in management, followed by disimpaction of stool and complete evacuation of the rectum. Reaccumulation of stool should be prevented by appropriate use of laxatives and stool softeners. This is followed by a gradual weaning of the laxative regimen and instituting toilet training. Relapses may occur. Up to 50-60% of children achieve acceptable bowel control, free of soiling, within a year.

Eating disorders.

Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behaviour. Anorexia nervosa has been well documented in pre-pubertal children. Eating disorders are most prevalent in the Western cultures where food is in abundance and for females attractiveness is equated with thinness. Eating disorders are rare in countries like India. As Western sociocultural ideals become more widespread one may expect to see an increase in number of cases of eating disorders in non-Western societies. Etiological theories suggest a complex interaction among psychological, sociocultural, and biological factors. Patients with anorexia nervosa manifest weight loss, fear of becoming fat, and disturbances in how they experience their body weight and shape. Patients with bulimia nervosa present with recurrent episodes of binge eating and inappropriate methods of weight control such as self-induced vomiting, and abuse of diuretics and laxatives. Major complications of eating disorders include severe fluid and electrolyte disturbances and cardiac arrhythmias. The most common cause of death in anorexia nervosa is suicide. Management requires a team approach in which different professionals work together. Individual and family psychotherapy are effective in patients with anorexia nervosa and cognitive-behavioral therapy is effective in bulimia nervosa. Pharmacotherapy is not universally effective by itself. Patients with eating disorders suffer a chronic course of illness. The pediatrician plays important role in early diagnosis, management of medical complications, and psychological support to the patient and the family.