CHILD GUIDANCE CLINIC

Child guidance clinic were started in 1922, as part of programme sponsored by a

private organization Common Wealth Funds Programme for the prevention of
juvenile delinquency.
The first CGCwas started in india in 1939 at the TATA institute Mumbai. The
CGC IN DELHI was started in 1955 at RAK con, simultaneously with Madras.

DEFINITION:-
Child guidance clinic are specialised clinic that deal with children of normal &
abnormal intelligence, exhibiting a range of behaviour & 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 childs physical & physiological functioning
& the environment to which is exposed at home & school should be taken care off.
All this is possible through interaction with & counselling of the child & his family by a
health care team.


OBJECTIVE:-
Providing help for children with behavioural problem like pica, bed wetting, sleep
walking , speech defects etc.
Providing care & guidance for children with mental retardation.
Providing care for children with learning difficulties.
Providing counselling & guidance & information to parents regarding care &
upbringing of children.


SERVICE PROVIDED BY CHILD GUIDANCE CLINIC:-
Managing behavioural problems.
Managing learning difficulties.
Managing emotional problems.
Managing adjustment problems.
Managing developmental problems.
Managing intellectual deficit.
Managing socio legal issue.

PRINCIPLES OF CHILD GUIDANCE TREATEMENT:-
o 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
paediatricians, a PHN, & educational psychiatric social worker, & play room
worker.
o 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 CGC:-
TREATMENT OF THE CHILD HIMSELF.
FAMILY ATTITUDE AS A FOCUS OF TREATMENT.


TREATMENT OF CHID HIMSELF:-
Treatment of any physical illness if it is present .
Psychotherapy which includes:-
o Suggestion & persuasion.
o Hypnosis.
o Re education.
o Psychoanalysis.
Play therapy & other form of expressive therapies.


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.
FAILURE TO THRIVE
INTRODUCTION:-
Failure to thrive (FTT), more recently known as faltering weight or weight faltering, is a
term used in pediatric, adult as well as veterinary medicine, (where it is also referred to as ill
thrift) to indicate insufficient weight gain or inappropriate weight loss.
When not more precisely defined, the term refers to pediatric patients. In MeSH, the term is
assumed to refer to an infant or child. In children, it is usually defined in terms of weight, and
can be evaluated either by a low weight for the child's age, or by a low rate of increase in the
Children.
DEFINE FTT:-
The term usually is defined as weight for age below the third to fifth percentiles of the
standard Centers for Disease Control and Prevention (CDC) growth charts (for boys
and girls from birth to 24 months) on two or more occasions; weight crossing two
major percentile lines over 6 months; or weight less than 80% of ideal body weight
for age
Children with failure to thrive are unable to maintain expected growth rate over time
The majority of cases are due to psychosocial problems rather than organic disease
Problems in the immediate care of the child, the interaction between the infant and
caregiver, and the social and psychological health of the caregiver are often involved
Affected children need to increase their calorie intake for 'catch-up' growth
Some families require continued careful long-term monitoring and assistance from a
multidisciplinary team
The role of the primary care physician is often paramount in detecting and
addressing this condition, and referrals to pediatric specialists are sometimes
needed.
Epidemiology:-
Incidence and prevalence:
Incidence and prevalence are difficult to ascertain due to multiple etiologies
Demographics:
The condition primarily is diagnosed in children under age 2; 80% of cases are
diagnosed in infants by the age of 18 months
Many genetic diseases can contribute to failure to thrive, including disorders that
contribute to anatomical defects, inborn errors in metabolism, and use and storage of
calories.
Poverty is a primary contributory factor.
Causes of FTT:-
A variety of causes, often in combination, may be responsible, including the following
common causes:
Insufficient calorie intake, which may be due to the following:
o Psychosocial problems, including the following:
Poor or inappropriate diet for age (eg, excessive intake of fruit juice)
Poverty or financial stressors leading to food shortage
Parental neglect
Improper formula preparation (diluted or over concentrated)
Food fads and special diets, including applying diets appropriate for adults at risk of
cardiovascular disease to children
Behavior problems in the child (eg, misbehavior at meal times, which can lead to power
conflicts and tension resulting in inadequate feeding)
Oral aversion, which may result from texture issues or occur after an illness during which
the child was not fed orally
Food phobia, perhaps following a choking episode
Parental mental health problems (eg, postpartum depression)
Parental eating disorders, such as anorexia nervosa
Anatomic problems causing mechanical feeding difficulties, including the following:
Congenital anomalies, such as cleft palate, retrognathia, or macroglossia
Oromotor dysfunction from a neurologic problem, such as hypotonia, cranial nerve palsy,
Arnold-Chiari malformation, or neuromuscular weakness
Oral or esophageal trauma, infection, or neoplasm
Pain from dental caries
Severe gastroesophageal reflux
Gastrointestinal obstruction, such as pyloric stenosis
Abdominal pain and anorexia from lead poisoning
Inability to utilize calories ingested, which may be a result of malabsorption due to cow's
milk protein allergy, cystic fibrosis, other causes of pancreatic insufficiency, celiac
disease, biliary atresia, necrotizing enterocolitis or short-gut syndrome, inflammatory
bowel disease, liver disease, chronic diarrhea, or disaccharidase deficiency, or improper
utilization due to inborn errors in metabolism (eg, amino acidopathies), storage
disorders, or growth hormone deficiency (leading to failure to grow at the correct rate)
Increased metabolic needs as a result of the following:
o Prematurity
o Recurrent infections
o Chronic infections, such as human immunodeficiency virus (HIV) disease or
tuberculosis
o Endocrine disorders, such as hyperthyroidism or growth hormone deficiency
o Cardiac disorders, such as congenital heart defects or congestive heart failure
o Pulmonary disorders, such as chronic lung disease, bronchopulmonary
dysplasia, or poorly controlled asthma
o Malignancy
o Renal disease, such as chronic renal failure or renal tubular acidosis
o Chronic liver disease
Rare causes include child abuse, diabetes insipidus, and rickets.
Risk factors:-
Poverty, homelessness, and neglect, which may also result in infrequency of clinical
visits
Genetic or physical abnormality
Depression in the parent, linked to stress or environment
Depression in the child
Inexperience in the parent, which may result in the failure to recognize hunger
signals from the infant, or inability to breast-feed coupled with inadequate medical
and social support
Overprotection by the parent, who may respond to a perceived reduction in feeding
by using coercive feeding practices
Underfeeding by the parent in the case of a child that frequently vomits, to prevent
emesis
Inattention from the parent, perhaps distracted by other children or events
Infants with special needs
Prematurity, which may result in difficulties in sucking and in keeping feeds down,
and in secondary illness such as bronchopulmonary dysplasia or sepsis
Autism leading to tactile sensitivity or sensory defensiveness with oral aversion
Intrauterine growth retardation may result in infants who grow normally but never
exhibit catch-up growth, thus remaining small for age
Infants with difficult temperaments
Irregular lifestyle in parents
Mothers with eating disorders, such as anorexia nervosa, or body image issues.

Screening
Summary approach
Screening for failure to thrive begins with a careful assessment of the child's height
and weight, as well as nutritional status, during well visits
Plotting height and weight on standard growth charts can help identify children at risk
Population at risk
Children whose weight falls below the 2.3rd percentile on a standard growth chart or
crosses two major percentile lines on the World Health Organization (WHO) growth
chart
Children whose parents are in low socioeconomic status situations, especially
homelessness and poverty
Children with chronic and/or genetic conditions, such as cystic fibrosis
Screening modalities
Standard growth charts, graphs showing height and weight measurements on a
curve based on age and percentile ranges, should be used; in the U.S., the
recommendation is to use the WHO growth charts for children under age 2 and the
CDC growth charts for older children.
Exams and Tests
The doctor will perform a physical exam and check the child's height, weight, and
body shape. Parents will be asked about the child's medical and family history.
A special test called the Denver Developmental Screening Test will be used to show
any delays in development. A growth chart outlining all types of growth since birth is
created.
The following tests may be done:
Complete blood count (CBC)
Electrolyte balance
Hemoglobin electrophoresis to check for conditions such as sickle cell disease
Hormone studies, including thyroid function tests
X-rays to determine bone age
Urinalysis
Treatment
Treatment depends on the cause of the delayed growth and development. Delayed
growth due to nutritional problems can be helped by showing the parents how to
provide a well-balanced diet.
Do not give your child dietary supplements such as Boost or Ensure without talking
to your health care provider first.
Other treatment depends on how severe the condition is. The following may be
recommended:
Increase the number of calories and amount of fluid the infant receives
Correct any vitamin or mineral deficiencies
Identify and treat any other medical conditions
The child may need to stay in the hospital for a little while.
Treatment may also involve improving the family relationships and living conditions.
Prognosis:-
Normal growth and development may be affected if a child fails to thrive for a
long time.
Normal growth and development may continue if the child has failed to thrive
for a short time, and the cause is determined and treated.
Complications:-
Permanent mental,
emotional
physical delays .
Primary prevention:-
Summary approach
The best means of prevention is by early detection at routine examinations and
periodic follow-up with all pediatric patients.
Population at risk
Children whose weight falls below the 2.3rd percentile on a standard growth chart or
crosses two major percentile lines on the WHO growth chart
Children whose parents are in low socioeconomic status situations, especially
homelessness and poverty
Children with chronic and/or genetic conditions, such as cystic fibrosis
Preventive measures
A nutritional evaluation should be conducted to ensure adequate caloric intake
Social services should be contacted to assess for needs, such as nutritional
assistance
In patients with chronic diseases, treatment of the condition and prevention of
complications are essential.

BIBLIOGRAPHY:-
Basvanthapa Text book of child health nursing 1
st
edition, New Delhi.
jaypee brothers medical publisher (p) LTD,

Beevi Assuma the text book of pediatric nursing
1st
edition, ELSEVIR A division of
reed, Elsevier India private limited.

Dutta parul pediatric nursing 2
nd
edition. New dhlhi. Jaypee brothers medical
publishers (p) LTD, 2009

Sharma Rample, Essenntial of pediatric Nursing, 1
st
edition, New Delhi, Jaypee
brothers medical publisher (p) LTD, 2013

Marlow R. Dorothy, Redding A. Barbara, text book of pediatric nursing, 6
th
edition,
New Delhi, published by Elsevier, a division of reed Elsevier India private limited,
2006.

Ghai,op,Ghai essential pediatrics, cbs publisher, New Delhi,6
th
eddition,2004,

Wongs,essential of pediatric nursing,elsvier publication,New Delhi,8
th
eddition,2009.

GOOGLE WEKIPEDIA.











SUBMITTED TO
MADAM GEETARANI NAYAK
SENIOR LECTURER.
SUM NURSING COLLEGE.







SUBMITTED BY
PURNASHA MITRA.
Msc. 1
st
year student.
SUM NURSING COLLEGE