Introduction:

The parent-child relationship consists of a combination of behaviours, 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. Of 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 quality

of the parent-child relationship is affected by the parent's age, experience, and

self-confidence; the stability of the parents' marriage; and the unique

characteristics of the child compared with those of the parent. Parent-child

relationship is so important that it shapes and moulds the character and

personality of a child. Parents are a vital source of satisfaction of the child’s

every need. The relation of child with the parents is the most intimate one.

Family is the oldest institution in the world. According to Dewey “the family is

a social agency for the education and protection of the race. It is in the family

that the child acquires such important qualities as sincerity, sympathy, self-

submission and realizing responsibility etc.” It is the first and the most

immediate social environment to which a child is exposed. It is an outstanding

primary group because; it is in the family that the child 208 develops its basic

attitudes, values and virtues of life. The relationship between the family and the

child however is a reciprocal and dynamic one. The socialization of a child

begins in the family. It is influenced by the family’s subculture, its social status,
its economic status, the parents’ occupation, their education, their child-rearing

practices, their religion, their aspirations for the child, their energy, their

motivation, the number of children in the family and their birth order, and other

relatives living at home. As Whiting and Edwards (1988) points out, parents

around the world resemble one another in numerous ways because of the

universal needs children have as they grow and develop. But it is also true that

the specific ecology of each culture, its socialization goals, and the demands it

places on the family unit can dramatically shape parenting practices and the

course of the individual child’s socialization.

Definition: The parent-child relationship consists of a combination of

behaviours, feelings, and expectations that are unique to a particular parent and

a particular child. The relationship involves the full extent of a childs

development.

Marlow

Types of Parent Child Relationship:

There are mainly four categories of parent child relationship.

 Secure relationships.

 Avoidant relationships.

 Ambivalent relationships.
 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

needs support.

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 behaviour 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 learn 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.

Parenting:

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.

• Authoritative.

• Permissive/Indulgent.

• Detached

1. 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.

2. 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.

3. Permissive/Indulgent: -

Permissive (indulgent) parents have little or no control over the behaviour 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.

Characteristics of a Healthy Parent-Child Relationship:

 Flexible/Adaptable

 Connected

 Appropriate boundaries

 Open Communication

 Discipline
1. 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.

2. Connected: -

Parents should have ability to differentiate the child’s worth from his other

behaviour, and create a reward-oriented environment in which consequences are

positive outcome. Respond to a child’s problems or feelings.

3. 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.

4. 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 behaviour.

5. Discipline: -

For healthy parent child relationship discipline also very important aspect. To

finding the solution of conflicts and behavioural problem helps to encourage the

strong relation rather than punishing children in an attempt to teach.

Factors Influencing Parent-Child Relationship:

 Family structure

 Social and community suppor

t Relationship History

 Emotional system

 Temperament

 Parenting Experiences

 Intellectual Capacity

 Education (formal and informal)

 Cultural context and experiences

Methods to Improve Child - Parent Relationships

1. Play games with Child.

2. Casual conversation.
3. Bring the child to new places.

4. Rewarding

Principles of basic behavioural paediatrics:

Principle 1:

Negative consequences sometimes change behaviour, but they do not change

attitude.

In children who consider consequence structures, negative consequences such

as time out, sentence writing, restriction of privileges, verbal correction, and

physical punishment, as well as others, will effect at least temporary behaviour

change. Unless used in combination with equally powerful positive

reinforcement strategies, they will, however, worsen the negative attitudes that

underlie the misbehaviour and increase the likelihood of subsequent

misbehaviour.

Principle 2:

Only positive reinforcement strategies produce long-term attitudinal change.

As children grow older and into adulthood, positive behaviour is not maintained

through the threat of negative consequences; it is maintained because the

individual has an internal attitude or value system, which discriminates between

right and wrong behaviors. In the long term, children behave properly because

they want to, not because they are forced to.

Principle 3:

Negative consequences do not improve the behaviour of impulsive children and

frequently increase the frequency and intensity of misbehaviour.

Impulsive children, by definition, do not consider the consequence structure

prior to initiation of the behavior. No matter how negative the consequence, it

cannot influence behavior unless it is considered prior to the behavior itself. In

impulsive children, the consideration of the consequences comes after the

behavior, meaning that it has been outside conscious cognitive control. When

punished for behaviors that are outside their control, they learn helplessness and

respond emotionally with anger, resignation, and eventually depression.

Principle 4:

Cognitive control of behavior can be learned through the use of appropriate

positive reinforcement systems.

Even very impulsive and behaviorally difficult children can learn greater

behavioral control through cognitive strategies. Time out works very well if

used for brief periods for the purpose of establishing emotional control and

behavioral calm, and if the time-out period is followed by cognitive discussion

of the reasons for misbehavior with appropriate positive alternatives. Where

possible, the alternative positive behaviors should be practiced and positively

reinforced, even if the behavior occurs only with the direct instigation of an

adult. Cognitive cueing strategies, which rely on nonverbal cues for self-control,

are the most effective long term strategy for controlling impulsive behavior, but

their effective use requires much consistency and patience on the part of the

adults involved in the behavior management system.

Principle 5:

Positive reinforcement systems must be incremental in nature such that the child

can directly observe even small improvements in behavior.

Many children with significant behavioral problems are very discouraged

regarding the possibility that they can effect positive changes in their lives.

Positive reinforcement systems which have expectations set too high, such that

it is difficult for the child to earn rewards at the outset are a cause of further

discouragement and have a negative effect on esteem. Systems that have

expectations too low however, where almost all children involved in the

program receive the same reward, devalue the accomplishments of the child

who makes very significant progress, and can be equally esteem defeating.

Well-designed positive reinforcement systems rely on incremental rewards

where the range of reinforcement varies from no reinforcement to mild

reinforcement to moderate reinforcement to intense reinforcement, so that the

child can witness in a visible and tangible way relative levels of progress.
Principle 6:

You must always reinforce the final compliance with adult authority no matter

how long it takes to get there.

Many children in management systems require numerous requests, or even

commands, before their behavior finally complies with adult expectation. The

tendency is to not provide positive reinforcement after many reminders, since

adult patience is limited and the adult expectation is that the child should do

what he is told the first time. Unfortunately, if no positive reinforcement is

provided following the final compliance, all that children learn is that there is no

reason to comply. The imposition of negative consequences following

compliance only increases the likelihood that non-compliant behavior will occur

in the future.

MATERNAL DEPRIVATION:

 The term maternal deprivation dates back to the

early work of psychoanalyst John Bowlby on the

effects of separating infants and young children

from their mother (or mother-substitute).

 Maternal deprivation is when a child is denied

of normal maternal care.

  The effect is marked if the child is deprived in

the first two years of life.

Maternal deprivation is when a child is denied of normal maternal care.

The effect is marked if the child is deprived in the first two years of life.

It is a form of extrinsic handicap

 It is a form of extrinsic handicap

Maternal deprivation- Inadequate mothering, whether delivered by the mother

or another primary care giver, during the first six months of life, leading to a

failure of attachment, OR more generally inadequate mothering during the

first five years of life.

Types of maternal deprivation:

 Mother- Child separation

 Multiple Mothering

 Distortion in Quality of Care

 Institutionalization

Mother Child separation: occurs when a child is separated from his/her

mother or mother substitute for prolonged periods of time or permanently

through death, chronic illness such as insanity.

Multiple Mothering: A child has different people providing the care that a

mother or a mother substitute should provide. There is no particular person that

the child can identify as his/her mother.

Distortion in the quality of care- two extremes

 Overprotection

 Child abuse

 Overprotection

 The child is extremely sheltered, not adequately disciplined and quite

often too spoilt. This often occurs if the child is a precious baby, only

child or a particular sex the parents have been hoping for. It doesn’t allow

the child to develop properly.

 Child abuse

 Also known as child maltreatment. It constitutes all forms of physical and

/or emotional ill treatment, sexual abuse, neglect or negligent treatment or

commercial exploitation resulting in actual or potential harm to the child’

s health, survival, development or dignity in the context of a relationship

of responsibility, trust and power.

Causes of child abuse:

 Most of d time it is not entirely intentional.

 Previous abuse or neglect in parents themselves.

  Very young or inexperienced parents.

 Extraordinary family stress.

 Alcoholism or use of other drugs.

 Socioeconomic class.

Major categories of child abuse:

 Neglect

 Psychological / Emotional Abuse

 Sexual Abuse

 Exploitation

Institutionalization:

 This occurs when a child is kept in an institution such as motherless

babies home or hospital (for congenital malformations, surgery) for a

prolonged period of time.

 Elmer kersey, the first Baptist nurse in Ogbomosho established the 1st

motherless babies home- kerseys children’s home in Nigeria.

Maternal deprivation syndrome(mds):

 Also known as Non-organic Failure to thrive.

 It is a form of failure to thrive that is caused by neglect which can be

intentional or unintentional.
  Failure to thrive (FTT) is defined as failure to gain adequate weight,

failure of linear growth and failure to achieve some or all developmental

 Causes of MDS :

 Poverty

 Child abuse

 Dysfunctional Caregiver interaction

 Parental ignorance about appropriate child care.

 Milestones.

Predisposing factors:

 Young age of parents (teenage parents)

 Unwanted pregnancy

 Lower socioeconomic status

 Lower levels of education

 Absence of the father

 Absence of a support network (family, close friends, or other support)

 Mental illness, including severe postpartum depression.

Features of MDS:

 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.

Diagnosis:

 History taking from the parent(s)

 Physical Examination of the child

 Anthropometric measurements OFC, MUAC.

 Careful examination of the patients growth

chart.

 Extensive lab inv. should be delayed until dietary management has been

attempted for at least 1week and has failed.

Management of MDS:

 It involves a multidisciplinary team approach,

which includes

 Physicians

 Nutritionist

 Social Workers

 Behavioural Specialist

 Visiting Nurses
  Helping extended family members recognize that a problem exists and

recruiting their help will provide increased support for the mother and

child.

 In special cases, the infant may be admitted to the hospital where

adequate feeding, care can be given.

 Emphasis should be given to the psychological aspect of the care giver

and the child.

Prevention of MDS:

 Addressing the causes and risk factors appropriately. e.g.

 Parental classes and support groups for pregnant teenagers and young

adults should be encouraged.

 Early intervention programs specifically designed to bring together the

necessary resources to assist children with FTT.

Failure to thrive:

FTT 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.
Definition:

FTT is inadequate physical growth diagnosed by observation of growth over

time using a standard growth chart, such as the National Centre For health

Statistics (NCHS) growth chart.

Usually it refers to a child whose growth is below the 3rd or 5th percentiles for

their age.

Epidemiology :

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 taken.

Classification of FTT:

Traditionally FTT has been classified as:

1 •Organic

2 •Inorganic

Based on pathophysiology FTT is classified as:

1 •Inadequate caloric intake

2 •Inadequate absorption

3 •Increased caloric requirement

4 •Defective utilization of calories

Organic:

Organic causes include following medical disorder

. Premature birth

, Maternal smoking , alcohol use, or illicit drugs during pregnancy

 Mechanical problems present,

 Unexplained poor appetites that are unrelated to mechanical problems

 Inadequate intake also can result from metabolic abnormalities,

 Poor absorption of food, inability of the body to use absorbed nutrients, or

increased loss of nutrients.

Inorganic:

Inorganic causes:
Inorganic causes are those caused by a caregivers actions.

 Poor feeding skills on the part of the parent

 Dysfunctional family interactions

 Difficult parent-child interactions

 Lack of social support

 Lack of parenting preparation

 Family dysfunction, such as abuse or divorce

 Child neglect

 Emotional deprivation

Inadequate caloric intake

Incorrect formula preparation

Neglect

Food fads,

Excessive juice consumption

Poverty
 Behavioural problem affecting eating Inadequate absorption 

Cystic fibrosis

Celiac disease

Vitamin deficiencies

Hepatic diseases.

Causes of FTT:

 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 Inadequate absorption Increased

caloric requirement Defective utilization of calories.

Symptoms :

 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. Diagnostic evaluation:

History taking Examination and Tests

History taking

 Prenatal

 Labour, delivery, and neonatal events

 Medical history of child

 Social history

 Nutritional history

Examination and Tests

 Physical examination

 Denver Developmental Screening Test

 A growth chart outlining all types of growth

 Complete blood count (CBC)

 Electrolyte balance

 Hemoglobin electrophoresis

 Hormone studies, including thyroid function tests

 X-rays to determine bone age

 Urinalysis
Assessment of degree of FTT:

Degree of Failure to Thrive Growth Mild Moderate Severe parameter Weight

75-90% 60-74% <60%Height 90-95% 85-89% <60%Wt/Ht ratio 81-90% 70-

80% <70%.

1. Management : Children with FTT require 150% of Recommended

Dietary Allowance (RDA) of calories for catch up growth.

2.  Correction of any underlying disease The child’s developmental

stimulation

3.  Improvement in care-giver skills. Regular and effective follow up

Treatment may also involve improving the family relationships and living

conditions. Cont.….

4.  Feeding interval should not be greater than 4 hours & a maximum time

allowed for sucking should be 20 minutes

5.  Eliminating distractive events

6.  Avoiding excessive fruit juices

7.  For older & young children meals should be last for 30 minutes, solid

foods should be offered before liquid, environmental distraction should

be minimized.

Nursing management:  care of child with FTT

 The nursing management to the and their families includes

1 • Optimum nutrition

2 • A consistent, warm, caring environment

3 • Maintenance of daily dietary record

4 • Parental support and education

5 • Discharge planning

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.

Possible complications  Permanent mental Emotional Physical delays can

occur.

Prevention :

 by physical

Initial failure to thrive caused 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.

Child abuse:

The term child abuse has come to mean any intentional act of physical,

emotional, or sexual abuse, including acts of negligence, committed by a

person responsible for the care of the child.

According to UNICEF violence against children can be "physical and mental

abuse and injury, neglect or negligent treatment, exploitation and sexual

abuse. Violence may take place in homes, schools, orphanages, residential

care facilities, on the streets, in the workplace, in prisons and in places of

detention." Such violence can affect the normal development of a child

impairing their mental, physical and social being. In extreme cases abuse of

a child can result in death.

Factors affecting child abuse: parental factors:

• Parent has already abused a child

• Pregnancy was not wanted

• Young, unsupported mother often with low education.

• Parents have unrealistic expectations of the child and lack parenting

knowledge.

• Parent is isolated and has few supports

• Parent has a mental illness or is abusing drugs or alcohol

Environmental factors:

• Overcrowding in the house

• Poverty or lack of opportunity to improve the family’s resources

• Family violence is present

• A non-biological adult living in the house

• Family is experiencing multiple stresses

Child factors:

• Baby is sickly, or unwanted

• Child has a physical or developmental disability

• Child is the product of an abusive relationship

• Lack of attachment between child and parent

Effects the family:

Child abuse has long-term as well as immediate effects. The abused child

may be hyperactive; may exhibit angry, antisocial behaviour; or may be

especially withdrawn. When child abuse is suspected or confirmed, the child

may be removed from the home or separated from the family for protection.

Abusive parents often were abused themselves as children; thus, the problem

of child abuse continues in a cyclical fashion from generation to generation.

Forms of child abuse: Child abuse has many forms:

• Physical,

• Emotional,

• Sexual,

• Neglect

Forms of child abuse any of these that are potentially or actually harmful to a

child's health, survival, dignity and development are abuse. This definition is

derived from the W.H.O.

Physical abuse :

Physical abuse may occur when the caregiver is unfamiliar with normal child

behaviour. Inexperienced caregivers may not know what normal behaviour is

for a child and become frustrated when the child does not respond in the way

they expect. Physical abuse is when a child has been physically harmed due

to some interaction or lack of interaction by another person, which could

have been prevented by any person in a position of responsibility, trust or

power.

Shaken baby syndrome:

Shaken baby syndrome occurs when a small child is shaken by the arms or

shoulders in a repetitive, violent manner. When the child is shaken, a

whiplash type injury occurs to the neck. In addition, the child may have

edema to the brain stem and retinal or brain haemorrhage's. Loss of vision,

mental retardation, or even death may occur in these children.

Clinical manifestations : may include lethargy, irritability, vomiting, and

seizures, but often this form of child abuse does not have easily noted signs

and can be missed on examination of the child. Internal symptoms are

detected by the use of computed tomography (CT) and magnetic resonance

imaging (MRI).

Munchausen syndrome by proxy: In Munchausen syndrome by proxy,

one person either fabricates or induces illness in another to get attention.

When a caregiver has this syndrome, he or she frequently brings the child to

a health care facility and reports symptoms of illness when the child is
actually well. Child’s illness fabricated or induced by the parent (usually the

mother) Mother develops a dependent relationship with her child’s doctor /

medical staff.

Munchausen syndrome by proxy This situation is frustrating for health care

personnel because it is difficult to catch the suspect in the act of endangering

the child. Close observation of the caregiver’s interactions with the child is

necessary. For instance, if episodes of apnea occur only in the presence of

the caregiver, be alert for this syndrome. The caregiver who suffers from this

syndrome must receive psychiatric help.

Emotional abuse:

Injury from emotional abuse can be just as serious and lasting as that from

physical abuse, but it is much more difficult to identify. Injury from

emotional abuse can be just as serious and lasting as that from physical

abuse, but it is much more difficult to identify. Emotional abuse can be seen

as a failure to provide a supportive environment and primary attachment

figure for a child so that they may develop a full and healthy range of

emotional abilities.

Emotional abuse Several types of emotional abuse can occur, including:-

• Verbal abuse, such as humiliation, scapegoating, unrealistic expectations

with belittling, and erratic discipline

• Emotional unavailability when caregivers are absorbed in their own

problems.

• Insufficient or poor nurturing, or threatening to leave the child or otherwise

end the relationship

• Role reversal in which the child must take on the role of parenting the

parent and is blamed for the parent’s problems.

Sexual abuse:

Sexual abuse is engaging a child in any sexual activity that he/she does not

understand or cannot give informed consent for or is not physically, mentally

or emotionally prepared for. Abuse can be conducted by an adult or another

child who is developmentally superior to the victim. This includes using a

child for pornography, sexual materials, prostitution and unlawful sexual

practises.

Sexual abuse of children has existed in all ages and cultures, but it seldom

has been admitted when perpetrated by parents or other relatives in the

home. The Federal Child Abuse Prevention and Treatment Act defines

sexual abuse as “the employment, use, persuasion, inducement, enticement,

or coercion of any child to engage in, or assist any other person to engage in,

any sexually explicit conduct”.

The Indian government backed a survey of 125000 children in Thirteen

states. Of the children interviewed, more than half (53%) said that they had

been subjected to one or more forms of sexual abuse. Over 20% of those

interviewed said they were subjected to severe forms of abuse. Of those who

said they were sexually abused, 57% were boys. (2007)

Neglect: Neglect or negligent treatment is purposeful omission of some or

all developmental needs of the child by a caregiver with the intention of

harming the child. This includes the failure of protecting the child from a

harmful situation or environment when feasible.

Child neglect is failure to provide adequate hygiene, health care, nutrition,

love, nurturing, and supervision needed for growth and development.

Neglect takes many forms and can be classified broadly as physical or

emotional maltreatment.

• Physical neglect involves the deprivation of necessities; such as food,

clothing, shelter, supervision, medical care, and education.

• Emotional neglect generally refers to the failure to meet the child’s needs

for attention, affection, and emotional nurturance.

Diagnosis:

• Anxiety, Fear by child related to history of abuse and fear of abuse from

others.

• Ineffective Coping by the no abusive parent related to fear of violence from

abusive partner or feelings of powerlessness.

• Impaired Parenting related to situational stressors or poor coping skills.

• Disabled Family coping related to unrealistic expectations of the child by

the parent.

Battered child syndrome Battered child syndrome: A disease in which

children are physically abused. The battered child syndrome is a form of

child abuse. Not until the 19th century were children granted the same legal

status as domesticated animals in regard to protection against cruelty and/or

neglect. In 1962 the term "battered child syndrome" entered medicine. By

1976 all states in the United States had adopted laws mandating the reporting

of suspected instances of child abuse.

Child abuse involves a complex and dangerous set of problems that include

child neglect and the physical, emotional, and sexual abuse of children.

Child neglect is the most frequently reported form of child abuse and the

most lethal. This form of abuse is defined as the failure to provide for the
shelter, safety, supervision and nutritional needs of the child. Child neglect

can be physical, educational, or emotional neglect.

Physical neglect includes refusal of or delay in seeking health care,

abandonment, expulsion from the home or refusal to allow a runaway to

return home, and inadequate supervision.

Educational neglect includes the allowance of chronic truancy, failure to

enrol a child of mandatory school age in school, and failure to attend to a

special educational need.

Emotional neglect includes such actions as marked inattention to the child's

needs for affection, refusal of or failure to provide needed psychological

care, spouse abuse in the child's presence, and permission of drug or alcohol

use by the child.

Physical abuse is the second most frequently reported form of child abuse

and is defined as physical injury inflicted upon the child with cruel and/or

malicious intent. Physical abuse can be the result of punching, beating,

kicking, biting, burning, shaking, or otherwise harming a child. The parent or

caretaker may not have intended to hurt the child, rather the injury may have

resulted from over-discipline or physical punishment.

Emotional abuse is the third most frequently reported form of child abuse

and includes acts or omissions by the parents or other caregivers that could
cause serious behavioral, emotional, or mental disorders. For example, the

parents/caregivers may use extreme or bizarre forms of punishment, such as

confinement of a child in a dark closet. Emotional child abuse is also

sometimes termed psychological child abuse, verbal child abuse, or mental

injury of a child.

Fatal injuries from maltreatment can result from many different acts

including severe head trauma (injury), shaken baby syndrome, trauma to the

abdomen or chest, scalding, burns, drowning, suffocation, poisoning, etc.

Factors affecting the likelihood of potential abuse and predisposing to

child abuse include:

• The abuser's childhood: child abusers often were abused as children.

• The abuser's substance abuse: at least half of all child abuse cases involve

some degree of substance abuse (alcohol, drugs, etc) by the child's parents.

• Family stress: the disintegration of the nuclear family and its inherent

support systems has been held to be associated with child abuse.

• Social forces: experts debate whether a postulated reduction in

religious/moral values coupled with an increase in the depiction of violence

by the entertainment and informational media may increase child abuse.

• The child: children at higher risk for child abuse include infants who are

felt to be "overly fussy", handicapped children, and children with chronic

diseases.

• Specific "trigger" events that occur just before many fatal parental assaults

on infants and young children include: an infant's inconsolable crying,

feeding difficulties, a toddler's failed toilet training, and exaggerated parental

perceptions of acts of "disobedience" by the child.

Summary:

In this topic we learned regarding the parent child relationship and its types.

Behavioural paediatric principles and specific behavioural disorders and

maternal deprivation, failure to thrive, child abuse, and battered child.

Conclusion:

Parent child relationship is very important of the healthy growth of child.

behavioural problems should be early identified and child abuse, child neglet

should be avoided.