RE: ideas needed

[Dena Casey]

Title: Message

Very interesting!  Wondering what the reason is behind this behavior.  Sometimes easier to tackle the cause than protect the knuckles.  start at square one and do a detailed assessment first. When did behavior start?  since childhood/admission/relocation/other losses what makes it worse, better, Constantly?  or does it stop when sleeping or eating?  Is it a response to oral pain-like babies who are teething? or to arthritis and knuckle pain? Get dental exam. Rule out all the basics like hunger, thirst, needing sleep or toileting, constipation, UTIs. Medical causes (like obsessive compulsive, ADD/ADHD, autism) vitamin or mineral deficiency, pica, anemia, allergies, tumors? Review medications for possible side effects like this, or drug interactions. Is this attention seeking, boredom, self stimulation or is this self-injury used to control anger, anxiety, sexual urges?  Post traumatic stress? Any chance he is being abused? Did he used to smoke? Is the resident verbal?  Does it bother him?  what would he like to do? Does he need counseling? Psychiatric consults? if non-verbal and no identifiable cause, what medications have been tried? antianxiety, antidepressants, etc., positive reinforcement program for every moment not spent chewing knuckles, or ignore the behavior and see if it resolves.  Does he need a private room or space, smaller facility, a job, strict daily routine? To address the knuckle injury, what about casts?  chewing gum, hard candy or suckers, teething ring, beef jerky,   I would be Very interested to know if you find a cause or solution! Dena [EMAIL PROTECTED]     -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Park Lane MDS Sent: Thursday, April 15, 2004 10:36 AM To: [EMAIL PROTECTED] Subject: ideas needed   I have a question for the group.  I am at wits end, and I am looking for any suggestions.  I have a male resident who is in his 60's, he has downs syndrome, I recently inhearited his problem from the other mds coordinator when a room swap was done.  But  I digress.  The problem we are having is he is constantly chewing on both of his thumbs.  He chews on them at the knuckle part, and he has them red, sore, and the doctor would like something done.  We have tried different types of flavors, like tobacco, hot sauce, bitter tastes, putting band aides on them.  He is not fased by the tastes, and he removes the band aides, and throws them in the trash.  We thought about biker gloves, but he would not leave them on.  So I am in need of help.  Any ideas will be greatly appreciated.  You can email me privately if you want. Thank you in advance, Shellie [EMAIL PROTECTED]