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Parents are usually the first people a child learns to trust. Parents and families are
the most important people in children's lives. The many different relationships people form
over the course of the life span, the relationship between parent and child is among the
most important.
The parent-child relationship consists of a combination of behaviors, feelings, and
expectations that are unique to a particular parent and a particular child. The relationship
involves the full extent of a child's development.
There are mainly four categories of parent child relationship.
1) Secure relationships
2) Avoidant relationships
3) Ambivalent relationships
4) Disorganized relationships.
1. Secure relationships: - This is the strongest type of attachment. A child in this category
feels he can depend on his parent or provider. He knows that person will be there when he
2. Avoidant relationships: - This is one category of attachment that is not secure. Avoidant
children have learned that depending on parents won't get them that secure feeling they
want, so child learn to take care of themselves. Avoidant children may seem too
independent and usually do not build strong relationships.
3. Ambivalent relationships: -Ambivalence is another way a child may be insecurely
attached to his parents. Child notice what behavior got their parents' attention in the past
and use it over and over. Children are always looking for that feeling of security.
4. Disorganized relationships: -Disorganized children don't know what to expect from
their parents. Children with relationships learns to predict how his parent will react,
whether it is positive or negative. Child also learns that doing certain things will make their
parents do certain things.

It is the process of promoting and supporting the physical, emotional, social, and
intellectual development of a child from infancy to adulthood.
Parenting styles-
It means a psychological construct representing standard strategies that parents use in
their child rearing.
Parenting styles:-
 Authoritarian Parents: - The parent is demanding but not responsive. Authoritarian
parents are rigid in their rules; they expect absolute obedience from the child without
any questioning. Authoritarian parents are strict disciplinarians.
 Authoritative: - Authoritative parents show respect for the opinions of their children.
Authoritative parents are both responsive and demanding; they are firm, but they
discipline with love and affection, rather than power.
 Permissive/Indulgent: - Permissive (indulgent) parents have little or no control over
the behavior of their children. Indulgent parents are responsive but not especially
demanding. They have few expectations of their children and impose little or
inconsistent discipline. There are empty threats of punishment without setting
limits. Role reversal occurs.
 Detached: - Detached parents are neither responsive nor demanding. They may be
careless or unaware of the child's needs for affection and discipline.
i. Flexible/Adaptable
ii. Connected
iii. Appropriate boundaries
iv. Open Communication Discipline
 Flexible/Adaptable: - Good parents must be flexible and adaptable. They have ability
to recognize and accommodate the child's need. Help the child by giving clear
directions, offering opportunities to choose and negotiate.

 Connected: - Parents should have ability to differentiate the child's worth from his
or her behavior, and create a reward-oriented environment in which consequences
are positive outcome. Respond to a child's problems or feelings with
 Appropriate boundaries: - The parent-child relationship includes various
boundaries. Healthy boundaries consider that what the parent and the child want in
a positive way to find a mutually agreeable solution or limit.
 Open Communication: -- The way the parent and child communicate sets the tone
for the relationship. The healthy parent-child relationships use positive
communication that separates the child's worth from behavior.
 Discipline: - For healthy parent child relationship discipline also very important
aspect. To finding the solution of conflicts and behavioral problem helps to
encourage the strong relation rather than punishing children in an attempt to teach.
a) Family structure
Family structure is an important factor in the parent child relationship, It depends
up on the type of family, whether a nuclear family or joint family.in the nuclear
family the parent child interaction is more when compared with joint family
b) Social and community support
Social and community support is another factor in the parent child relationship.
For example if a child in the family is mentally retarded or any other serious illness,
the community or social support is essential for the parents to survive, otherwise it
will affect in the parent child interaction.
c) Relationship History
Good relationship increases the parent child relation.eg: parent relationship
towards family members and to the community is good,it directly influence the child
d) Emotional system
It is also another factor. If the parent’s emotional status is good, it will directly
influence the child
e) Temperament
Parental warmth and controlling, in a positive way are the two most important
parental attributes that help to create positive effects. Positive emotional reactivity
and self-regulation are important parental factors in developing healthy children’s
f) Parenting Experiences
It is also a factor if the parent got enough care or they saw the interaction with the
parent and child of close relative, it will affect their parent child interaction
g) Intellectual Capacity

The intellectual capacity is the cognitive intelligence of the person, to learn, adapt,
change, create, innovate, built, think, reason, rationalize, synthesize, analyze,
deduce, make right connections, and powder quickly the knowledge, information or
data from their basic, needed, important and absolute importance, saving in the same
time the focusing details with logic, good sense and wisdom. It is as well the fast
ability of the brain to make right decisions or reasoning and to project future good
ideas, plans, designs or strategies
h) Education (formal and informal)
Formal education is classroom-based, provided by trained teachers. Informal
education happens outside the classroom, in after-school programs, community-
based organizations, museums, libraries, or at home.
i) Cultural context and experience
Parenting across cultures can sometimes be challenging, especially when the
values and expectations of one culture are different to those from another. This can
make it difficult for families to feel a sense of belonging to any community.
However, when parents and careers find a way of parenting that feels right for them,
it helps the whole family to develop a cultural identity and a sense of belonging.
This is particularly important for children, because a sense of belonging and a strong
cultural identity supports their mental health and wellbeing.
1. Play games with Child.
Play can be the long-sought bridge back to that deep emotional bond between parent
and child. Play, with all its exuberance and delighted togetherness, can ease the stress of
parenting. Playful Parenting is a way to enter a child's world, on the child's terms, in order
to foster closeness, confidence, and connection.

The normal challenges of every day for a growing child of any age stimulate all kinds
of feelings. Children release these emotions through play. Laughter, specifically,
transforms our body chemistry by reducing stress hormones and increasing bonding

Kids are more physical than adults. When they get wound up emotionally, their bodies
need to discharge all that energy. That's one of the reasons they have so much more energy
than we do, so they wear us out. But we can use this to our advantage, because when we
play physical games with children, they giggle and sweat and scream -- and they release
the same pent-up stress hormones that they'd otherwise have to tantrum to discharge.
Playing is also how kids learn, so when you "teach" an emotional lesson by playing, your
child really gets it. Best of all, playing helps parents and kids feel closer.

2. Casual conversation
Casual conversation improves the parent child relationship. Even small talk about a
particular topic can keep your relationship strong and comfortable. For example: Mention
that cute thing the dog did or talk about how well your little sister is doing in mathematics.
3. Bring the child to new places.
It will help the child prepare for a move, place as much emphasis as possible on the
positive aspects of what awaits her. This is an opportunity for her to live in and learn about
a new city, perhaps even a new country, and its people. She may be exposed to new cultural
traditions and interesting and different ways of life. It also gives a chance to meet new
people and make new friends.it also helps to gain self-confidence. This will improve the
parent child relationship.
4. Rewarding
Rewards can be used as positive reinforcement for modifying negative
behaviors. Rewards that are selected by the child are usually the most powerful. Also, a
variety of reward possibilities helps to keep a child motivated over a long period of
time. Rewards can be privileges, things or activities with parents. These activities will
improve the parent child relationship.
A large body of literature and theory converges on the notion that it is the relationship
between the parent and child that is critical for the positive development of children.
Specifically, a common theme during childhood is that the way in which parents are able
to sensitively regulate their parenting behavior based on the developmental needs of their
children is a critical determinant of positive outcome. Additionally, the context in which
the parent-child relationship occurs is important in affecting the qualities of that
relationship. From the above topic we learned about introduction, definition, types,
parenting styles, characteristics of a healthy parent child relationship, factors influencing
and also methods to improve parent child relationship.
The parent-child relationship consists of a combination of behaviors, feelings, and
expectations that are unique to a particular parent and a particular child. Whereas Parenting
is the process of promoting and supporting the physical, emotional, social, and intellectual
development of a child which is having different styles child rearing. There are many
factors which influence the relationship but parent child relationship can be maintained by
various ways as appreciating the child, taking him to new places and casual conversation
between parents and children.

 The influence of parent-child relationship on young adolescents' use of safety
equipment. The Norwegian Longitudinal Health Behavior Study, published by
Frode Thuen and Jostein Rise in Scandinavian journal of psychology on December
The purpose of this longitudinal study was to examine the extent to which the parent-child
relationship, as perceived by young adolescents at age 13, may account for the use of
various types of safety equipment at age 13 and 14 in terms of seat belts, bicycle helmets,
motorcycle helmets when passenger, reflectors on the clothing when outside in the dark,
and lifejackets when on board small boats. Parental influence was assessed in terms of
three scales: Parental support, parental monitoring of the youngsters, and opposition
towards the parents, with satisfactory internal consistencies (alphas >0.78). The results
showed that each of the three constructs significantly accounted for an independent portion
of the variance in the use of safety equipment measures. In sum they accounted for 20% of
the variance in the use of safety equipment at age 13, and about 10% at age 14. The findings
are discussed with regard to the implications for accident prevention measures aimed at
young people

The term maternal deprivation is a catch-phrase summarizing the early work
of psychiatrist and psychoanalyst, John Bowlby. The term maternal deprivation is used for
emotional abuse and neglect to denote circumstances during which an infant is deprived of
the opportunity of forming an initial tie with a mother figure
The maternal deprivation thesis of Bowlby (1965) suggested that it is essential for the
mental health of an infant and young child to experience a warm, intimate and continuous
relationship with the mother (or permanent mother substitute. As it is commonly used, the
term maternal deprivation is ambiguous as it is unclear whether the deprivation is that of
the biological mother, of an adoptive or foster mother, a consistent care giving adult of any
gender or relationship to the child, of an emotional relationship
Maternal deprivation is when a child is deprived of the normal maternal care. Extrinsic/
Social Handicap – a person whose opportunities at healthy development are hampered by
certain elements in his/ her environment, example:
 Loss of parents
 Maternal deprivation
 Poverty
 Discrimination – Racial, ethnic and gender


•Based on Bowlby’s ideas:
Attachment is important for survival

Prototypes for later relationships

•Predicts developmental difficulty

If the attachment relationship goes wrong:
–General developmental problems

–Specific issues with social development

Core Theory – Bowlby’s Theory

 In the 1950’s John Bowlby developed a theory of Attachment

 From birth infants are biologically programmed to cry, cling, make eye contact,
smile and recognize human faces and sounds.

 The mother is also programmed to respond to these behaviors – mutual attachment

 Both mother and infant feel anxiety when separated.

 He believed that by six to eight months infants shows separation anxiety and
stranger fear demonstrating its attachment to its mother.
 Instinctively bond with one key figure - MONOTROPY

 He believed the attachment between a caregiver and infant had to happen at least in
the first 3 years of the infant’s life.
 He called this the CRITICAL PERIOD for attachment.
 The mother provides security and a safe base from which the child can explore the
 This relationship acts as a role model for all future relationships - essential for
child’s psychological well being.

 If a child did not form an attachment in the first 5 years of life, they would suffer
negative psychological effects, especially in adulthood
 If a child never experiences the opportunity to form any sort of bond it causes

How do early attachments affect relationships?

 Children that form no attachments (privation) can grow up having significant
problems with relationships due to poor social and language skills.
 Children who experience deprivation (because they are separated from an
attachment figure) can grow up to suffer from problems such as depression (where
they withdraw from others) or emotionless psychopathy (where they show a lack
of consideration of others).
 Children who develop and maintain attachments are more likely to grow up to
have productive relationships.

Long term consequences of maternal deprivation

• Delinquency,
• Reduced intelligence,
• increased aggression,
• Depression,

• Affectionless psychopathy
•Maternal Deprivation Syndrome
Factors that contribute to maternal deprivation syndrome
 Young age of parent (teenage parents)
 Unplanned or unwanted pregnancy
 Lower levels of education (especially failure to complete high school)
 Lower socioeconomic status
 Absence of the father
 Absence of a support network (family, close friends, or other support)
 Mental illness, including severe postpartum depression
 Decreased or absent linear growth ("falling off" the growth chart)
 Lack of appropriate hygiene
 Interaction problems between mother and child
 Weight less than the 5th percentile, or an inadequate rate of weight gain

Failure to thrive describes a condition rather than a specific disease. Children are
considered as failing to thrive when their rate of growth does not meet the expected growth
rate for a child their age. If the condition progresses, the undernourished child may become
irritable and/or apathetic and may not reach typical developmental markers such as sitting
up, walking, and talking at the usual ages.
 FTT is inadequate physical growth diagnosed by observation of growth over time
using a standard growth chart, such as the National Center For health Statistics
(NCHS) growth chart ,usually it refers to a child whose growth is below the 3rd or
5th percentiles for their age.
 Failure to thrive(FTT) can be defined as a chronic potentially1ife threatening
disorder of infants and children who fail to gain and may even lose weight, more
specifically, the term characteristics those whose weight is below the third
percentile on a appropriate growth chart.
 FTT affects 5-10% of young children and approximately 3-5% of children
admitted in teaching hospitals
 Under feeding is the single commonest cause of FTT that results from parental
poverty and ignorance
 95% of cases of FTT inadequate food offered or take
Traditionally FTT has been classified as
a. Organic
b. Inorganic
c. Mixed
Organic FTT -It is usually associated with all serious pediatric illnesses like
congenital heart diseases, malabsorption syndrome, intestinal parasitosis, tuberculosis,
juvenile diabetes mellitus, cystic fibrosis, liver abscess, congenital pyloric stenosis,
gastro-esophageal reflux, etc.
Non-organic FTT- It is a psychosocial problem due to disturbed parent child
relationship leading to emotional deprivation, poverty, illiteracy, ignorance, faulty food

habit and conflict in the family resulting social deprivation. All these lead to poor
nutritional intake, feeding problems and failure of growth.
Mixed FTT- It is combined effect of both organic and non-organic causes.
The most common cause of failure to thrive is malnutrition
 Prenatal
 Prematurity
 Exposure in utero to toxic agents
 Intrauterine growth restriction from any cause
 Postnatal
 Inadequate caloric intake(Incorrect formula preparation,Neglect,food fads,
excessive juice consumption,poverty,behavioural problem affecting eating)
 Inadequate absorption
 Increased caloric requirement (hyperthyroidism, congenital heart disease,
chronic immunodeficiency)
 Defective utilization of calories(genetic anomaly, congenital infection,
metabolic storage disease)
 Height, weight, and head circumference do not match standard growth charts
 Weight is lower than 3rd percentile
 Growth may have slowed or stopped after a previously established growth curve
 Physical skills such as rolling over, sitting, standing and walking decreased
 Mental and social skills decreased
 Secondary sexual characteristics delayed in adolescents.
 Constipation
 Excessive crying
 Excessive sleepiness (lethargy)
 Irritability
 Minimal smiling
 Avoidance of eye contact
 Unresponsive
1) History taking
o Prenatal
o Labor, delivery, and neonatal events

o Medical history of child
o Social history
o Nutritional history
2) Physical examination
3) Denver Developmental Screening Test
4) A growth chart outlining all types of growth
5) Complete blood count (CBC)
6) Electrolyte balance
7) Hemoglobin electrophoresis
8) Hormone studies, including thyroid function tests
9) X-rays to determine bone age
10) Urinalysis
Medical management
 Children with FTT require 150% of Recommended Dietary Allowance (RDA) of
calories for catch up growth.
 Correction of any underlying disease
 The child's developmental stimulation
 Improvement in care-giver skills.
 Regular and effective follow up
 Treatment may also involve improving the family relationships and living
Nursing management
The nursing management to the care of child with FTT and their families includes
 Provision of optimum nutrition
 Assess the nutritional intake of infant on the basis of reported type and
amount of feeding, also assess the nutritional value of each feeding
 Provide the nutritional plan according to the age group
 Advice the mother about food preparation and feeding schedule
 Advice the mother to develop a daily routine for the infant for
feeding,sleeping,activities and daily care that can be realistically achieved
in the home
 Advice the mother to provide a calm environment for feeding to minimize
distraction especially for infants
 Advice the mother that the infant is held during each feeding, which should
not last more than half an hour.

 Advice the mother for older children is placed at the same place at the table
for all meals
 Advice the mother to be calm and un hurried during meal times, encourage
the child to eat and also maintain eye to eye contact with the infant or child
during meal
 If the child is hospitalized, the primary nurse assumes the responsibility for
feeding and infant or child is weighed daily at the same time to determine
the rate of gain
 Provision of consistent, warm, caring environment
 The nurse should plan daily schedule according to the child developmental
 The nurse should spend adequate time with the child or infant also
maintain eye to eye contact
 Encourage the infant can be gently rocked, cuddled and carried around the
room to convey warmth and caring to the child.
 Maintenance of daily dietary record
 Parental support and education
 Discharge planning
Permanent mental
Physical delays can occur
Initial failure to thrive caused by physical defects cannot be prevented but can
often be corrected before they become a danger to the child. Maternal education
and emotional and economic support systems all help to prevent failure to thrive
in those cases where there is no physical deformity.
Failure to thrive is a descriptive term, not a specific diagnosis. FTT is result of
inadequate usable calories necessary for a child's metabolic and growth demands.
Simplified approach to FTT is detailed history, thorough Physical Examination
with primary care giver, initial investigation includes CBC, ESR, urinalysis, urine
culture, stool for ova and cyst of parasites. Trail of nutritional therapy with
calorie-dense diet.

 Selection of growth parameters to define failure to thrive,
Published byDeborah K. Steward, PhD, RN Nancy A. Ryan-Wenger, PhD, RN Linda
J. Boyne, MS, RD Colleges of Nursing and Medicine, The Ohio State University,
Columbus, OH in journal of pediatric nursing on February 2003, voliume.18,issue
1,page no25-29.
Failure to thrive (FTT) is a syndrome of growth failure due to under nutrition.
Determining whether an infant has FTT is based on the use of an anthropometric
indicator and a selected cutoff value for that indicator. These anthropometric indicators
include weight for age, weight for length, and length for age, and the cutoff values
include the 10th, 5th, and 3rd percentiles. Each indicator and selected cutoff value
provide unique information about an infant's growth. However, these parameters are
often used interchangeably to explain the same growth phenomenon. The sensitivity
and specificity of each anthropometric indicator are a function of the cutoff value
selected and dictate which infants will be classified as having FTT and which infants
will be classified as healthy. Depending on the sensitivity and specificity of the
indicator, some infants with FTT will be classified as healthy, and some healthy infants
will be classified as having FTT. A clear rationale for the selection of an anthropometric
indicator and a cutoff value for defining FTT are important for increasing the
generalizability of research findings and thereby expanding the current knowledge base
related to FTT. .

Battered child syndrome is a form of child abuse, it is a physical abuse. Internal
injuries, cuts, burns, bruises, and broken or fractured bones are all possible results of
battered child syndrome. Because adults are so much larger and stronger than children are,
an abused can suffer severe injury or death without the abuser intentionally causing such
an injury. Shaking an infant can cause bleeding in the brain (subdural hematoma), resulting
in permanent brain damage or death. Emotional damage to a child is also often the
byproduct of child abuse, which can result in the child exhibiting serious behavioral
problems such as substance abuse or the physical abuse of others.
Battered child syndrome refers to injuries sustained by a child as a result of physical
abuse usually inflicted by an adult
Battered child syndrome (BCS) is found at every level of society, although the incidence
may be higher in lower-income households, where adult caregivers may suffer greater
stress and social difficulties and have a greater lack of control over stressful situations.

 Stress of the parents
 Lack of education
 Single parent hood
 Alcoholism
 Financial stress of parents
 Cultural tradition
sometimes cultural traditions may lead to abuse, including beliefs that a child is
property, that parents (especially males) have the right to control their children any
way they wish, and that children need to be toughened up to face the hardships of

Clinical manifestation
Symptoms may include a delayed visit to the emergency room with an injured child; an
implausible explanation of the cause of a child's injury; bruises that match the shape of a
hand, fist or belt; cigarette burns; scald marks; bite marks; black eyes; unconsciousness;
lash marks; bruises or choke marks around the neck; circle marks around wrists or ankles
(indicating twisting); separated sutures; unexplained unconsciousness; and a bulging
fontanel in small infants.
Emotional trauma may remain after physical injuries have healed. Early recognition and
treatment of these emotional "bruises" is important to minimize the long-term effects of
physical abuse. Abused children may exhibit:

 a poor self-image
 sexual acting out
 an inability to love or trust others
 aggressive, disruptive, or illegal behavior
 anger, rage, anxiety , or fear
 self-destructive or self-abusive behavior
 suicidal thoughts
 passive or withdrawn behavior
 fear of entering into new relationships or activities
 school problems or failure
 sadness or other symptoms of depression
 flashbacks or nightmares
 drug or alcohol abuse

Sometimes emotional damage of abused children does not appear until adolescence or
even later, when abused children become abusing parents who may have trouble with
physical closeness, intimacy, and trust. They are also at risk for anxiety, depression,
substance abuse, medical illnesses, and problems at school or work. Without proper
treatment, abused children can be adversely affected throughout their life.
Diagnostic evaluation
 history collection
 physical examination detects bruises, burns, swelling, or retinal hemorrhage
 X rays, MRI, CT, or other imagingtechniques may confirm bone fractures or inter-
nal soft tissue injuries. The presence of injuries at different stages of healing
(i.e., having occurred at different times) is nearly always indicative of BCS.
 Medical treatment for battered child syndrome varies according to the type of injur
-y incurred.

 Counseling and theimplementation of an intervention plan for the child's parent(s)
or guardian(s) is necessary.
 The child abuser may beincarcerated, and/or the abused child removed from the ho
me to prevent further harm.
 Reporting child abuse to authorities’ ismandatory for doctors, teachers, and childc
are workers in most states as a way to prevent continued abuse.
 Both physicaland psychological therapy are often recommended as treatment for t
he abused child
The prognosis for battered child syndrome depends on the severity of injury, actions t-
aken by the authorities to ensure thefuture safety of the injured child, and the willingn
ess of parents or guardians to seek counseling for themselves as well as for the child.
 Recognizing the potential for child abuse in a situation, and the seeking or offering
of intervention and counseling beforebattered child syndrome occurs is the best
way to prevent it.
 Signs that the child may at risk for physical abuse include parental alcoholism
or substance abuse previous abuse of the child or the child siblings, history of
mental or psychological problems in parents, parents abused as children
absence of visible parental love or concern for the child and the child hygiene
Battered child syndrome is defined as a collection of injuries sustained by a
child as a result of repeated mistreatment or beatings and the psychological and
physiological effects. From the above topic we discussed about the introduction, definition,
causes, clinical manifestation, diagnostic evaluation, management, and prevention and
prognosis of the case.
Battered-Child Syndrome,” and identified it as a clinical condition in children who
have suffered serious physical abuse. Having knowledge of and being able to
identify battered child syndrome may prevent fatal injuries. It is important to equip
healthcare staff on first-contact care units with the knowledge to establish a
presumptive diagnosis of child/adolescent abuse. Only through proper investigation
of social events may just solutions be sought and implement

Child guidance clinic were started in 1922, as part of programme sponsored by a private
organization ‘Common Wealth Fund’s Programme’ for the prevention of juvenile
delinquency. The first CGC was started in India in 1939 at the TATA institute Mumbai.
The CGC IN DELHI was started in 1955 at RAK con, simultaneously with Madras. In 2012
child guidance clinics functioned as part of child and family mental health services.
 Child guidance clinic are specialized clinic that deal with children of normal &
abnormal intelligence, exhibiting a range of behavior & psychological problems which
are summed up as maladjustments.
 A child guidance clinic is one of the medico – social amenities for the organized &
scientific study & treatment of maladjustment in children.
Concept of child guidance clinic:
- For all round development of a child, the child’s physical and physiological functioning
and the environment to which is exposed at home and school should be taken care off. All
this is possible through interaction with and counselling of the child and his family by a
health care team.
a) Providing help for children with behavioral problem like pica, bed –wetting, sleep
walking, speech defects etc.
b) Providing care and guidance for children with mental retardation.
c) Providing care for children with learning difficulties.
d) Providing counselling and guidance and information to parents regarding care and
upbringing of children.
Service provided by child guidance clinic:-
1) Managing behavioral problems.
By behavior therapy the behavioral problems of the child can treat
2) Managing learning difficulties.
Learning disability, which should be managed through intensive individualized
one on one remedial training in a very supportive environment. Good therapist child
relationship is essential.
3) Managing emotional problems.

Through behavior therapy and psychotherapy the child emotional problems can
manage. Family counseling and parental guidance are also necessary.
4) Managing adjustment problems.
Adjustment problems mainly include school related problems and grief
5) Managing developmental problems.
It mainly includes bed wetting, autism and soiling. Through multi-disciplinary
team involvement, there by managing developmental problems through child
guidance clinic
6) Managing intellectual deficit.
Psychiatric therapy is the choice for child with intellectual deficit. This service is
provided through child guidance clinic.
7) Managing socio legal issue
Socio legal issues include child custody evaluation, sexual offences, child abuse
and head injuries
Principles of child guidance treatment:-
 The treatment of the child is carried out not by one person but by a team of workers.
The team of staff members is constituted of a psychiatrist, a pediatricians, a PHN,
& educational psychiatric social worker, & play room worker.
 The child is treated as a whole & the personality has many aspect, viz.., physical,
intellectual, educational, emotional, social & economic etc. Each of these aspects is
studied by the respective staff member who had specialized at the particular field.
The treatment of Child Guidance Clinic
i. Treatment of child himself
a) Treatment of any physical illness if it is present.
b) Psychotherapy which includes:-
 Suggestion & persuasion.
 Hypnosis.
 Reeducation.
 Psychoanalysis.
c) Play therapy & other form of expressive therapies.
ii. Family attitudes as a focus of treatment:

 Attitude therapy to the parents.

 Treatment of psychoneurosis or psychosis in parent, if & when necessary.
Role of nurse:-
 The nurse can help prevent by identifying risk cases in the community.
 Educating the public.
 Not only encouraging but also undertaking research studies herself.
 Provide holistic nursing care.
 Lobby for child rights.
 Nurse plays a important role in the child guidance clinic.
 Help to established good child parent bond as well as good teacher parent child
bond by guiding them.
 Be an exemplary role model.
Child guidance clinics were established in the 1930s and formalized by the 1935
Child Welfare Act. An important motive in the development of child guidance clinics
was to counteract 'juvenile delinquency', but the clinics did try to take a holistic approach
to the child's condition and tried to avoid placing children in care. Child guidance clinics
used psychology and medicine to deal with difficult behavior and help children adjust
to challenging issues in their lives. Family members were frequently involved.
The Child Guidance Clinic is a community service for children and families and is part
of the County Health Department. The services provide early detection, diagnosis and
treatment for children and families who have developed behavioral, emotional, social,
speech, language, hearing, and intellectual and communication problems; and provides
intervention services, which enhance the development of children. Adults or children
identified as needing services not available in the Child Guidance Clinic are provided with
appropriate referrals. Services will be provided based on the needs of the client and
availability of specific staff. Individual cases are reviewed by a team of staff members for
Research abstract
 The real world of the child guidance clinic

Utilizing yearly clinic census data and a larger sample of children served over a three-
year period by three child guidance clinics in Duchess Country, New York, this study
describes the types of children seen in outpatient clinics, the actual services the children
received, and the outcome of these services. The majority of clients received a
combination of treatments, with each receiving a unique sequence of modalities.


 Suraj Gupte(2016),the short text book of pediatrics.12 edition pubished by health

sciences publisher 112-113
 Dorothy R.Marlow,Barbara A.Redding(2007).Text book of pediatric nursing.sixth
edition.saunders publication,677-684,47-51
 Assumma beevi T.M(2009).Textbook of pediatric nursing.Elsesvier
 Parul data(2009) pediatric nursing.second edition.jaypee brothers medical