Working papers : The care of the child from 1-6

WORLD HEALTH ORGANIZA TI:ON REGIONAL COMMIT'lEE Seventh Session Manila, Philippines 1-13 September 1956

REGIONAL OFFICE FOR '.lHE WES'lERN PACIFIC TECHNICAL DISCUSSIONS WP/RC1/'IDl 4 June 1956 ORIGINAL: ENGLISH

WORKING PAPERS

'lhe following seven technical papers are presented as background information for the representatives attending the Technical Discussions to be held during the seventh session of the Western Pacific Regional Committee. These papers were prepared at the invitation of the Regional

Director by health people who have worked or are working in this region. Topics far these papers were selected by a conunittee in the Regional Office in order to focus attention on what were considered important aspects of the main technical discussions subject: CHILD FROM 1-6. The ideas expressed in these papers are those of the authors themselves and are not to be considered as official statements of the Organiz a tion. It is hoped that th(se working papers will be useful to the representatives in preparing for the Technical Discussions. Comments regard'!HE CARE OF '.lHE

ing these doc tlnEnts are invited am should be directed to the Regional Director.

\VP/Rc7/IDl - 1 30 April ORIGINAL:

19.56

ENGLISH

THE IMPOR'D\.NCE· OF TrIE PROBLEM OF THE CARE OF 00 CHILD FROM 1-6 IN THE WESTERN PACIFIC REGION

by F .W. Clements*

1.

INTRODUCTION

A section of a great religious order is reputed to have stated that if given the control of a chlld until the age of six years it would in that time shape the nature of the whole of t.b:l childts fut'l.re behaviour. Whether this claim was ever made, it is nevertheless true not only in respect to ethical and moral behaviour, but also in respect to piwsical, mental and social well-being. The type of care and handling an infant receives in its first year is important for its current existence and for its future welfa-re, however the years 1-6 are probably more important becaU3e of the wide variety of development·~_l features which can be influenced in these years. It was a wise decision by the conmi twe responsible for planning these discussions to exclude consideration of the first year of life. We now recognize that much of what happens in the first year is detennined by the pre-natal and reri-natal experiences of the infant. In countries with low infantile death rates a high percentage of these deaths is directly due to, or closely associated with, conditions occurring through pregnancy, more particularly noxious influences and nutrition. In countries with a high infantile mortality there are good reasons for believing that malnutrition both of the mother in the prenatal phase, and so of too foetus, is a strongly contributing factor, even in deaths due to infections, including upper respiratory infection> and gastro-enteritis. 2.

PHYSICAL WEU.-BEIW1

2.1

Mortallli:r

There is little doli::Jt that mortality rates in the period 1 to 6 years of age reveal more acc1U"ately conditions of infant and child care than do the infantile r.lo!"tality rates. The infantile mortality rates of the countries with the highest rates (around 120 per 1000 live births) are about

* Institute

of Child Health University of Sydney Australia

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five times treater than the rates for countries with the lowest figures (around 25 per 1000 live births). By comparison the mortality rates in the age group 1 to 4 years in the countries with the highest figures (100 - 150 per 1000 living) are from 10 to 15 times greater than the rates for countries with the lowest figures (10 ± 1 per 1000 living).l Another way to look at this siliject is the ratio of deaths in the pre-school period to total deaths. In some countries, e.g. Ceylon, they constitute about 20 per cent of total deaths, whereas in a country like the Netherlands they are only 2.1% of to tal deaths. 2 2.2 Morbidity

Few facts are available about the morbidity patterns in the preschool period, and it is difficult to draw comparisons between different countries. However, in general terms it can be accepted that where frank cases of certain diseases, particular deficiency diseases occur, terminating in death, am so appearing in the mortality lists, there will be considerably more frank cases of disease which do not terminate fatally and an even greater number of the sub-clinical forms of th:; disease. '!hus it is a reasonable assumption, borne out by surveys and hospital statistiCS, that where there is high mortality rates in childhood there is a high incidence of the non-fatal forms of the diseases. 2.3 Nutrition

We now know that the newly born infant can bring from its foetal existenoe relatively large quantities of most nutrients, and that during the first three or four months of post-natal life it draws upon these reserves, whioh undoubtedly supplement the food it receives from its mother or other souroes. The last third of the first year and the second and third years of life are critical ones in oountries where supplies of safe milk are not freely available at costs within the purchasing power of the mass of the population. It is during this time that a number of deficiency diseases have their highest incidence. This is particularly true of kwashiorkor, scurvy and rickets. Undernutrition due to unsatisfactory diets is a oommon feature, revealed by flattened weight curves. Low food consumption during this time often sets a pattern of food consumption which affects the amounts eaten in later years. '!here is some evidence to support the idea that low food intakes during these vital years are largely respons:ible for the failure of the great majority of too people in these countries to reach their potential height. 2.4 Disabilities and skeletal physical handicaps

Certain diseases of infancy and childhoo<;), particularly poliomyelitis am non-respiratory tilierculosis, are likely to be associated with a relatively large amount of residual orippling. Many of too gross deformities oan be prevented by early diagnosis and adequate medical care.

1 United Nations (1952) Foetal, infant and early childhood mortality. Volume If The Statistics. New York (ST/SOAjSeries A; Population Studies No. 13) 2 World Health Organization (1953) Annual Epidemiological and Vital Statistios, 1950, Genev'a

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2.5

Blindness

1his is a most crippling handicap and unfortunately relatively large numbers of children in many of the countries and terri tories in the Region are blind. Some of this blindness is of congenital origin; mOst, however, is the outcome of disease or gross malnutrition during infancy and early childhood. Early diagnosis and adequate treatment of the diseases responsible woUld greatly reduce this national burden.

3.

MENTAL HEALTH

Mental health is tiE counterpart of pqysical health and is a condition within the individual. Just as the standard of ptwsical health can be expressed in terms which relate to the degree of pqysical fitness, vitality or vigour, so the level of mental health can be expressed in terms of certain aspects of behaviour. Mentally healthy people have the ability to love and to work; to feel comfortable with thanselves and with other people; to be able to meet lifels demands, such as holding a job, successfully rearing a family, accepting the real limitations of their environment and getting a reasonable amount of joy, satisfaction and pleasure out of life. The foundations of sound mental health are laid in infamy and early childhood. These are provided by the elementary family, father, mother and child. It is during this period that the child learns to form a close and satisfactory relationship with one person, usually its mother, and thus achieves the capacity to form satisfYing relationships with other people throughout its life. Certain cond! tions must exist for a close mother-child relationship to develop. These include an emotionally mature mother (or mother substitute) who finds satisfaction in her relationships with the immediate members of her fa"llily, especially the child J s fa ther (or kinsman who is the father figure), and who enjoys adequate financial security (or its material equivalent) and ptwsical security (usually shelter) in her community. Where these do not exist, or are of a weak character or broken for long periods, the mother may develop deep anxieties. Numerous studies have shown that it is extremely difficult for the mother (or mother substitute) to keep these feelings away fran her child. Maternal feelings both pleasant and unpleasant are conveyed to the child in many ways. Escallona believes that one way is by contagion, that is through the Ptwsical contact of mother and childo In other families it not infrequen~ happens that, fer a variety of reasons, the mother and other members of the family reject the child. In some families this is overt and sustained, in others it is overlaid with deep feelings of guilt, ··1eading to over-protection of the child and other tL~ealttw emotional relationships. Histories of individual children and the results of group studies clearly show that if a poor mother-child relationship exists for any length of time during the first six years of life, the mental mal th of the child, both then and later, is usually seriously affected. This is manifested in a variety of ways; in behaviour disorders extending :trom minor departures £rom the normal to gross antisocial acts (juvenile delinquency); in psychosomatio d1sturbames, such as ileo-colitis, asthma, migranous headaches, abdominal pain, eneuresis and in interference with pnysical growth.

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'!be outstanding example of the significance of the period from 1 to 6 years of age for the development of sound mental health is seen in those unfortunate children who suffer deprivation of a mother (or mother substitute). These are the orphans and others who for a variety of reasons live in institutions from infancy onwards and who fail to develop a capaci'tu to make satisfactory relationships with people. Some of these later become tre autistic children of the psychiatric clinics. Many of the girls later exhibit the unemotional promiscuity of the prostitute, who is forever seeking something she cannot find - a firm liaison with one person - but seldom finding it because the deficiency lies within herself.

Less seriously deprived children grow to adult life, apparently unaffected, marry and have children of their own, but because of this defect in their own infancy and childhood are unable to fom a satisfactory relationship with their own children and thus the pattern is perpetuated.

4.

SOCIAL WELL-BEING

The period from about 2 or ~ to 6 years of age is the time of intense socialization of the child. Prior to this it is closely tied to its mother and the intimate family circle. From 2 to ~ years of age onwards it should be ever widening tre scope and nature of its contacts with other people and previously unexperienced situations. In the first part of this period, that is from 2 to 3, it is content to play beside or be in the company of other children; from about 3 years onwards it wants to join in the activities of its peers. In addition it sees, often perceiving for the first time, an increasing array of items, events and adults that native curiosity' demands it should know zoore about. This is the period of interu;e explora tion. However, making new personal contacts and exploring new situations or things is not something the average child can do alone; it needs support, encouragement and someone to talk to about these new experiences. Normally 'this help comes from within its family, for in each new adventure the child must be supported with the assurame that there are loved ones on whom he can lean i f necessary, but who will encourage him to go as far as he can. Of equal importance in each new excursion is the record of past experiences. If these have been pleasant and satisfactory the child undertak es new experience with confidence and enthusiasm. If past experiences have been unpleasant or frightening he is loa the to face the salOO experience again, or any new ones. The child's own inner sense of security is an important element in determining his attitude towards new experiemes. If his relationships with his mother have been good and he has developed a good level of mental health he will have that inner sense of security which will support him in his process of exploring the people and things of his world. If his relationships have been unsatisfactory, he will be timid and afraid. In this process of socialization of the child much depends upon the a tti tude of the community towards children. This ranges from high regard with an emphasis of adequate services, to an almost complete disregard of their existence and the absenoe of special services for them.

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During this period of life curiosity and exploration are at peaks, but judgment and experience are still at low levels. This combination is undoubtedly the basis of the high death rates from accidents in these years of life. In some countries accidental deaths now constitute one-third of all deaths in these ages, and even though the percentage of deaths due to accidents in other countries (and this applies to many of the countries of the Western Pacific Region) is low, the death rates for accidents is almost identical with those for the countries where they constitute one-third of the total. deaths. This shows that accidental deaths are an important item in all countries. Many of the accidents in which children are involved can be prevented either by parental care and action or by education of the child of the potential hazard in a particular situation. The onus for this education rests wi th the parents within the home. Some parents have a kind of seventh sense which enables them to foresee accident sit 00. tions and to offer the necessary guidance. Helping parents in this phase of child care and management is one of the big tasks confronting public--health authorities in many countries.

5.

CUL'IURAL CHANGES AND '!HE CARE OF CHILDREN

In societies which have remained stable for long periods of time, for example, many rural conununities in most of the countrjes of the Western Pacific Region, tradition has determined the way in which children shall be handled. The continued existence of the extended family (i.e. gt'ardparents, parents, uncles am aunts and children all living in olose proximity, even in the Sam3 compound or house) ensures that the traditional attitudes to children, inter-relationships between the generations am accepted methods of handling children will be maintained. 111e grandparents are the guardians of these traditional beliefs and practices. In these circumstances mothers know what to do in various child management situations, or are direoted to action by their parents. In societies which are undergoing change under the pressure of industrialization, the faroi1¥ is often a small one of parents and chll cren. These parents often feel the need of guidance, or to be able to appl¥' traditionally aocepted methods of management, but find that such procedures are impossible in their pattern of life. Unable to app1¥ traditional methDds they have little to fall back upon. Often they have no one to guide them in selecting and adapting those features of the traditional procedures which are applicable to the new conditions. Guidance in '!he broad questions of child care and management is often a greater need for the families in transition from one oulture to another than detailed instrm tions about a par tic ular facet of behaviour, such as infant feeding. The latter certainly helps to remove ourrent anxieties, but it is essential that these should be seen as part of the total problem of aoculturation.

WP/Rc7 /ml - 2 30 April 1956 ORIGINALa ENGLISH

HOW CAN COUN'IRIiS • ND 'JERRI TORIES IDENTIFY AND DE '!ERMINE: THE EXTENT OF THEIR paOBLEMS IN THE CARE OF THE CHILD FROM 1-6 by Amansia S. Mangay, M.D., Dr.P.H.

*

1.

IN'lRODUCTION

The scope of the problems of the child from 1-6 is very broad and the nature very vi tal. '!he ob jec uves implici t in the broadening concepts of the "total child" include the physical, the mental and the social aspects of the care of the child. '!he "whole child" is the product of the family, the parents, the school, and the community. MaI\V' persons are therefore concerned with his health and welfare. His problems are shared by his parents, his nursery school teacher, by the pl'\Ysician or nurse, by the health educator, by the psychologist, the nutritionist or by the social worker. His problems may be seen differently, depending upon the interest of the one who assesses them. His problem will also be viewed according to the economic and cultural levels of development of the country where he belongs and to the customs, traditions am mor3S of his people.

The spectacular decline and virtual disappearance of ma~ communicable diseases which afflict children in many countries have channelled the emphasis of programmes and activities to other interests in child care such as physical growth and development and understanding the behaviour of children. Like any other public health activity, the dynamic character of child care is clearly manifested, for no sooner is a problem of the child brought near to solution than another em emerges to make even greater demands for knowledge am new practices. But while there is much more to know about the child 1-6, there is also much more to do about what we already know of him. The avenues of approach to the identification of the extent of the problems of the child will vary according to the degree of development of the organizational structure of the country or territory. '!hey may vary from tb3 obvious and gross counts of illnesses and deaths to the refinements of research methodology-. Some avenues of approach in the identification of the problems of the child from 1 ... 6 include the followingt

* Rural

Health Demonstration and Training Center Quezon City, Philippines

WP/RC7/'JDl - 2 Page 2 2. THE CElf3US AND '!HE BIRTH REGIS'IRATION

'!be adequacy and completeness of census reports and birth registration are often very important in the definition of the problems in childhood because they provide the base in determining the extent of the problem of any particular disease or condition. When the census of population is not taken or is done at very long intervals of time or when birth registration is far from being canplete, information on the numerator for some rates and ratios beoome meaningless when attempts are made to determine the prevalenoe of a disease or condition among the childhood population.

3.

MORTALI'lY AND MORBIDI'lY REPORTS

In some countries deaths provide the only reliable data in measuring the impact of a disease on the childhood population. The evaluation of a disease by counting the deaths it causes has generally been a measure of expediency. Unfortunately, however, the ~1.tration of deaths is far from complete or adequate in sane countries. While counts of deaths may be acourate, certification of the oause of death is sometimes unreliable. For many diseases, deaths no longer provide a good index of total health significance. Morbidity reports may give a better picture of the impact of diseases on the ohildhood population" but reports of sicknesses are very difficult to obtain especially among children. Measles and chickenpox are often considered a necessary part of the growing of ohildren and very few mothers bother to report them. Moreover, the epidemiology of a disease is often invalidated by the lack of knowledge of the subclinical cases" the very early cases or the undiagnosed cases. While death certificates am morbidity reports serve as a history of the impact of medioine on the lives of children, many problElllS transcend mortality reports and elude statistics. '!be psychological needs of g:rowing children and the evaluation of diseases in terms of effects other than death sooh as defects or disability are examp]e s.

4.

RECORnS OF HOOPITAIS,1 ORPHANAGES AND OrnER INS TITU'lIOlf3

Data obtained from tm records of hospitals, orphanages and other child caring institutions often give valuable information in determining the magnitude f the problem of a particular disease or condition. They should, however" be used with caution because a disease is like an iceberg and hospital statistics at best reveal only the overly manifest or only that portion of the iceberg which fioats on the surface.

5.

NURSER'{ SCHOOLS AND KINDERGAR'lEN SCHOCl..S

In urban communities where there are nursery schools and kindergarten sohools the anecdotal records of children with their historiDal and observational data provide a valuable source of information on the problems of the pre-school child. Unfortunately, however, in malV' countries the government

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does not have as good administrative control or supervision of pre-school education as it has on elementary or secondary school education. And the worst cut of all, many teachers of nursery and kindergarten schools are the very ones who do not qualify for the elementary or secondary school teacher's requirements and generally do not possess the professional background in dealing with and teaching children in their formative years of life.

6.

PRE-SCHOOL ROUND-UPS

Pre-school round-ups and the physical and medical examinations of children before or soon after entering school often reveal the laok or the inadequacy of child health supervision during the pre-school age. These pre-school examinations are often nullified by the lack of school health personnel and the consequ,mtly poor quality of the routine health insIE ctions.

7.

IN'lERACTIONS AMONG MOTHERS AND CHILDREN AND PHYSICIANS, NURSES, 'lEACHERS AND SOCIAL WORKERS

The day-by-day exchanges of mothers and children on the one hand and of physicians, nurses, teachers and social workers on the other may not constitute an organized body of knowledge on the problems of the child, but invariably they reveal many of his un-met needs. Consultations in a pediatrician's office, attendame at child health conferences and prenatal clinics, home visits by a nurse or by a social worker, parent-teacher association meetings or teacher-parent conferences cut across so many phases arrl facets of a child ' s life and his health supervision tha. t no one group of profession or circle of interests can long remain indifferent to the emerging needs of the "total child ". 'lhese approaches however are encumbered by a lack of continuity of services. There is often a dearth of inter-cooperation among agencies and professional groups dealing with pre-school children.

8.

THE GRADE SCHOOL, THE HIGH SCHOOL ~ND THE ARI1Y SELECTION BOARD

It is increasingly recognized that many problems in later years have their onset in the early years of life. The nincubation period" of psychological disorders in most cases is a long one. The vexing problems of the teen-agers and of the juvenile delinquents have often been traced to their early years of life. Roundtree, McGill and Edwards cite that the United states induction boards rejected 12% of the 18 and 19 year old registrants from 1943-1945 on neuropsychiatric grounds. Hypothesis has been advanced that the fundamental factor in all cases of psychoneurosis, in a great deal of psychosis and in cases of social maladjustment is faulty personali~ structure which has its beginnings in the early years of life. There has been an increasing awareness of the long-range influences of child nutrition on health problems of la ter maturity. Deviations from normal expec t.ancy in sta ture and physique of adults have often been traced to faulty dietary intakes during early childhood.

wp/Rc7/ml - 2 Page 4 9. SURVEYS AND CANVASS REPORTS

Surveys and canva$reports are often the results of a focus of interest on one specific diagnosis or condi lion arbitrarily picked out of community context. Some examples of these are a survey of handicapped children, a survey of intestinal parasitism in schools or other institutions or a survey of the nutritional status of a certain group of children. By and large such surveys are d.me in connection with the justification or evaluation of some special programmes or projects. 10. RESEARCH AND SPECIAL STUDIES

While a great mass of formulated knowledge is already known about the normal growth and development of pre-school children or of their behavioural patterns, more local research studies must be encouraged. It is often a mistake to appraise the growth and development of children of one race in terms of norms of children of another or to expect the sane behavioural patterns from children of people of oriental and western cultures. In the field of growth and development, cross-sectional studies of a great number of children at a given period of time or longitudinal studies of a few representative groups of children followed up for a long period of t~ yield valuable infonnation, but more research is needed to know what problEmS can best be approached by cross-sectional studies and which one can best be answered by longitudinal studies. Research methodology is more within the province of universities and teaching institutions than in service agencies like the health departments. A wealth of infonnation often buried in the theses of graduate students is untapped arxi finds little opportunitu for practical application. b development of skills in utilizing the approaches, the measuring of the magnitude of the needs and the assess:ing of adequacy of existing resources to meet tmse needs are of paramount :i.mportame to everyone concerned with the health and welfare of tb:l Ire-school child.

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Jure

1956

ORIGINAL a ENGLISH

HOW CAN COUN'IRIES AND 'IERRI'IDRIES IDENTIFY AND DE'IERMINE 'mE EX'1ENT OF THEIR PROBLEMS IN THE CARE OF THE CHILD FROM

1-6

by G.D. Pirrie, M.D., D.P.H ..~!IN'lRODUC'ITON

While it is very nice to be able to look at this as though it were a problem that can be tied up into a neat package, that by careful definition can be thought of a separate entity, yet it is as well to remember that different countries and different cultures will regard in different ways what appear to be the same problem. Even in the same country problems will be regarded differently from year to year. Moreover different countries will have varying service available so that they are likely to uncover slightly different problems and to attribute these problems to different causes. A doctor and a social worker, a nutritionist and a psychologist will look with different eyes at the same group of children. In all countries this age of 1-6 forms a group that tends to be neglected in favour of the school-child and the infant, and there are several quite sound reasons for this, the most important being that children of this age present fewer problems that involve a risk of death, that the problems they do present tend to grow less urgent and, in any case, mothers often feel that few doctors are able to help them. These reasons are sound because they are largel¥ true, and all who work in this field will find that this is so, though the third grows less with experience. The following is largely a list of possible avenues of approach to these problems in the hope that they will stimulate the interest and criticism of those who read it. S m 'ITS TICAL

Mortality statistics by age, of limited value, is of some use to compare the mortality rates at each year 0 f age between different parts of the country concerned. An absence of the fall that you would expect after the age of 12 months indicates an area that should be explored. Comparisons between the rates of different countries are of less use.

* ~lE:;

J\.C:7iae;~'

~6ternal

and Child Health Project Taichung, Taiwan

WP/Rn7/TDl - 3 Page 2 Causes of Death Where these are available they should be studied, but it is necessary to know a good deal about local conditions or inaccurate certification may lead you astray. Morbidity Notifications of conunl.ll1icable disease is rarely of any help, but the registers of an up-to-date paediatric department should be studied carefully. Similar~, records of general practitioners or even conversation wi th general practitioners will show what doctors are called upon to treat. SCHOOL ENTRAN'IS Routine School Medical Inspections Many countries arrange for medical inspections to be routinely carried out before or soon after entrance to school. The results of these examinations should indicate the results of lack of care in the treatment and prevention of disease during previous years. In fact these results are often invalidated by the quality of the work, made ineffective by insufficient time or inadequate equipment or space. 'ilie inspection of entrants must allow for the taking of a history from the mother in addition to screening procedures am medical examination. '!he results obtained from such inspections must be checked agains t the information obtained from other sources. Special Surveys 'lhese may be either ad hoc surveys designed to reveal defects developing during the immediate pre-school years or may have been plarmed for some .other reason. For example a recent nutritional survey in a country in this region revealed an incidence of vitamin A deficiency rising steadily during school years, but with a disquietingly high incidence in entrants, dU3 to inadequate feeding in the pre-school years. '!he special. survey of school entrants is easy to organise and is well worth doing. It is necessary to gain the co-opera tion of the parents for, though a dental history can be read in the child's mouth, history-taking for the 5 or 6 years old child is as important as for any patient.

'IHE ffiE-SCHOOL CHILD Great care mmt be taken in the selection of representative groups if you wish to examine children of this age. Usually the groups tMt are available, nursery schools and attendants at child health clinics are already highly selected and represent families in which the level of child care is above the average. Conclusions drawn from such examinations can not be applied to the Whole community. '!hi s is not to say tha t such examina t i.e ns are only of value to the individual child, but that we must remember the limitations.

WP/RC1/'IDI - 3 Page 3 Special "horizontal lf surveys of children at a certain age are not easy to arrange and conclusions have to be drawn from few observations. "Longtitudinal lf surveys, the following up of groups of children from birth to school age is a most important study and one that should be done in each country really interested in this problem. Th3 leading investigation of this kind has been the follow-up of all children born in the first week of March 1946 in England. These children have been followed up at a chosen interv~ls during the past ten years. The following up of these children scattered over the whole country has presented many difficul ties but the information yielded has been invaluable. For details the publications of the Institute of Child Health of the University of London should be oonsulted and a repor t cailed "The Pre-School Child" is shortly to be published. While a nation-wide scheme is difficult however desirable, every good health station or centre is capable of carrying out a limited survey for its own information. If they carmot follow-up all Children, it would be as well if time were allocated for the follow-up of a group selected only by the time of birth or in sone such random manner. 'ilie protocols used by the Institute of Child Health might be helpful. CONCLUSION Briefly, certain returns and records are available and limited conclusions may be legitimately drawn from them only where the local circumstances are well known. Special surveys reveal the inaccuracy of conclusions drawn from other rna terial. Before large-scale planning is undertaken accurate informa tion is required and this may take some years to obtain. At the same time certain procedur'es are sufficiently well established and widaly used to allow work to be begun if it is appreCiated that it may be necessary to alter the plans in the light of what is learnt from surveys.

WP/RJJ7/'IDI - 1\ 30 May 1956 ORIGINAL, SOME IMPLICATIOlS OF THE 'lRADITIONAL SYS1EMS OF CHILD CARE IN THE WE5TEalN Picn IC hEGIOtJ wi th particular reference to tre child of 1 to 6 years by A. Burgess, ENGLIS H

M.B.,

Ch.B., L.D.S.*

flIt was time then the Old Man thought, for me to start learning about native customs. He told me to take lessons first of all from the Kamure of Tabiang village •••• "A little golden girl of seven, naked save for a wreath of white flowers on her glossy head, invited me to mount upon the raised floor of the l1JW'enga. As she spread a fine guest mat for me to sit upon, she told me her name was Tebutinnang - Moverrent-of-Clouds. Sea ted cross -legged on another mat, she explained with gravity that her grandfather had charged her to entertain me with conversation, should I arrive before his return from fishing. He would not be very long now; would I like to drink. a coconut while she went on entertaining'? When I said yes, please, she climbed down from the floor, brought in a nut which she had opened under the trees outside with a cut-lass knife almost as long as herself, sat down again and offered it to me cupped in both hands, at arms length, with her head a little bowed. "You shall be blessed," she murmured as I took it. I did say "'!hank you" in reply, but even that was wrong; I should have re turned her blessing word for word, and, after that, I should have returned the nut also, for her to take too first sip of courtesy; and at last, when I had received it back, I should have said "Blessings am peace" before beginni~ to drink the milk. All I did - woe is mel - was to take it, swig it off, and hand it back onehanded, empty, with another oareless "Thank you". "She did not rise and run off with it as I had eJq)soted, but sat on instead with both arms clasping the nut to her little chest, examining me over the top of it. "Alas", she said at last in a shocked whisper J "Alas J " Is that the manners of a young chief of Matang'l" "She told me one by one of too sins I have confessed, and I hung my head in shame, but that was not yet the full tale. My final discourtesy had been the crudest c,f all. In handing back the empty nut, I had omitted to belch aloud. "How could I knOW' when you did not belch, /I she said, "how could I kneM' that my food was sweet to you? See, this is how you should have done itJ"

* Fonnerly of th

Malayan Medical S rv1ce, and later C ntral Council for Health Education. London.

WP/RC 7/ml - 4 Page 2 "She held the nut towards me with both hands, her earnest eyes fixed on mine, and gave vent to a belch so resonant that it seemed to shake her elfin form from stem to stern. "That", she finished, "is our idea of good manners" and wept for the pity of "it." (Grimble) For the health worker to IIstart learning about native customs ll in the field of child care, and particularq with regard to the child of 1 to 6 years, is difficult. Present day avidit,y for action has replaced the years of apprenticeship, formerly considered necessary for any would-be administrator, by a scant,y period of briefing or orientation, often carried out by others who have no personal experience of the local conditions. Once in the field, however mmh one waniiS" to do' ~o, there is little time to "stand and stare", and to ponder long enough to develop the insight needed for the correct interpretation of one's observations. And the coniJination of action and observation is self-defeating, for the om influences and distorts the other. (Freedman) Nor is consultation of the literature always easy. Medical libraries are just beginning to house the anthropological records to which one instinctively turns for help, and not all anthropological records contain the details of child rearing practices which we need, though there has been some brilliant leadership in this field in recent years. In the search for knowledge about the child of 1 to 6 years in this region, the first problem might be the definition of the kind of "years" ... Mohammedan, Christian or Chinese, for'all systems of reckoning are to be fO'lIDd in different parts of this area. But this is unimportant compared wi th the main difficulty... the fac t tha. t the child of this par ticula.r age is apparently an unknown entity, unrecognised and undescribed, except in some of the medical or educational literature of those cO'lIDtries where the native customs include that of beginning the child's formal education at six years of age. In many of the other cultures chI'onological age is 'lIDimportant and its reckoning apt to be haphazard. Where life is monotonous and the birth of a child an unremarkable am frequent occurrence "'!be actual age in months and years is no concern. In fact it is very difficult for the average mother to count back through the nunber of gardens she has planted, in order to tell you whether her child was born even three or four years ago." (Du Bois) In such oircunstances it is not surprJ.sJ.ng to find that the stages of a child's growth are recognised by changes in its behaviour - for example, the unborn Child; "infancy - from birth to walking; early Childhood - from walk~ to wearing a loin cloth; late Childhood ... from loin cloth to thoughts of marriage". (Du Bois) It seems fairly general that the ohild of five or six begins to take on some of the tasks of the communal life, and that walking and weaning oocur about the same time ... though the latter may not be oomplete (unless hastened by a further pregnancy) till the end of the second year or later. The divisions recognised are social rather

WP/RC7/TDl - 4 Page 3 than physiological and do not correspond to any fixed chronological pattern. liThe case of adolescence is particularly interesting ...•..• The most casual survey of the ways in which different societies have handled adolescence makes one fact inescapable: even in those cultures which have made most of the trait, the age upon which they focus their attention varies over a great range of years. At the outset, therefore, it is clear tha t the s o-c alled puberty ins ti tu tions are a misnomer i f we continue to think in terms of biological puberty. The puberty they recognise is social, and the ceremonies are a recognition in some fashion or other of the child's new status of adulthood." (Benedict) This same lack of correspondence between cultural institutions and the physiological stages of child development is found also where western customs have spread. The culturally determined division 1 to 6 years is not in accord with the recognised growth periods - the first great spurt of intra-uterine development, or the second slower one from birth to seven years. Nor is the third milestone - the change from primary to secondary schooling - any more happily placed, except for those fortunate children who begin their "Upper school" at 13+ instead of the more usual 11 +. I t is diffic ul t to find an a de qua te reason for such arbitrary arrangements in a culture which has developed the means of recognising the physiological stages, "without the clue that in our civilisation at large, man's paramount aim is to amass private possessions and multiply occasions for display. • ••• Our attitudes towards our children are (e qually) evidences of this cultural goal. Our children are not individuals whose rights and tastes are casually respected from infancy, as they are in some primitive SOCieties, but special responsibilities, like our possessions, to which we succunb or in which we glory as the case may be. They are fundamentally extensions of our own egos and give a special opportunity for tl'E display of authority. '!he pattern is not inherent in the parent-child situation, as we so glibly assume. It is impressed upon the situation by the major drives of our culture, and it is only one of the occasions in which we follow our traditional obsessions." (Benedic t) It is impossible here to describe and discuss all the varying "traditional obsessions" found in the nunerous cultures in this region, and their effeet on the parent-child situation and the health and welfare of the child. Margaret Mead and others have pointed out how every detail of the childts experience frem the earliest moment influences and moulds his charaeter and his attitude to the world around him, and equips or fails to equip him to survive in his adult world. A few examples* must suffice. liThe Arapesh (New Guinea) treat a baby as a soft vulnerable precious little object to be protected, fed and cherished. Not only the mother but the father also must play this over-all protective role. After birth the father abstains from work and sleeps beside the mother, and he must abstain from intercourse while the child is young, even with his other wife •••••• 1hrough tl'E long protected infancy, during which children are carried slung in bags from their mothers' foreheads or high on their fatrers'shoulders, up and down the steep mountain trails and are never asked to perform tasks which are difficult or exacting, their whole interest is focussed on the mouth. • ••• The Arapesh child, male and female,

* Taken from -

Mead, M., "Male and Female ll New York, William Morrow & Co., Inc. 1949.

WP/RC7/'IDl - 4 Page 4 continues to take in receptively, passive~, what is offered it - and to fly into tempers if food is ever refused, as it sometimes may be from necessi V. . .. When the usual pattern of marriage is followed, in which the husband as a boy of twelve or fourteen begins to feed his betrothed wife, himself playing a role that his mother - and his father - have played to him - and the marriage is not interrupted, the woman is in a psychological position that is the perfect development of her childhood experience - passive, dependent, cherished. But what happes to the Arapesh male? ••• They engage very little in warfare, they permit themselves to be blackmailed and bullied and intimidated and bribed by their more aggressive neighbours;· they admire so deeply the artistic prodrets of others that they have developed practically no art of their own. When they hunt they set traps and wait until the animal falls in, or else they "walk about in the· bush looking for game" and quarrels between the hunting partners come over who first caught sight of the animals •••• It is a society that makes it much more difficult to be a male, especially in all thOse assertive, creative, productive aspects of life on which the super-struc ture of a civilisation depems." In contrast, "'!he Mundugunor (New Guinea) women actively dislike child-bearing and they dislike children. Children are carried in harsh opaque baskets that scratch the skin, later high on the mother's shoulders well away from the breast. Mothers nurse their children standing up, pU9hing them away as soon as they becOme the least bit satisfied. '!he occasional adopted child is kept sharply hungry, so as to suck vigorously on· a woman's breast until the milk comes in. Here we find a charac ter developing that stresses angry eager avidity. In later life, love-making is condooted like the first round of a prize fight, and biting and scratching are important parts of fore-play. When the Mundugunor captured an enemy they ate him, and laughed as they told about it afterwards. II And finally, II '!he charac ter type in which the most anphasised communication between parent and child has been an emphasis on eliminatJ.on is one that occurs frequently in our own society. We find it writ large among the Manus tribe of the Admiralty Islands, a group of efficient puritans, where women never swing their grass skirts - grass Skirts, after all, are items in tb3 endless exchange of goods that goes on - girls are never allowed to flirt, and all love, even the affection between brother and sister, is measured in goods. Here among these small Stone Age villages there was prostitution, and the owner of a war-captured prostitute made money. Here a woman never loosens her grass skirt even in the extremes of child birth. Between husbands and wives sex is a hasty, covert shameful rna tter; and otherwise 1 t is adultery heavily punished by vigilant puritanical ghost~ guardians. Women's roles am men's roles are very slightly differentiated; both participate importantly in the religious system, both conduct economic affairs. If a man is stupid, his relatives seek for him a bright wife to compensate for his deficiencies. "

wp/RC7/TDI - 4 Page> It becomes obvious that the child cannot be viewed apart from the community in which he is growing up, and in which he has to succeed as an adult, and that therefore all efforts to improve his health and welfare must, if they are to be acoepted willingly, be in accord with his communi tyt s values and expec ta tions • For example, where a fair skin is a sign of beauty, and good breeding or rank it is often difficult to persuade mothers to expose their little girls to the sunshine. Again, where boys are roore highly valued than girls, the young wife may be forbidden to breast feed her baby daughter, in cas e the chance of the birth of a son is thus delayed. Perhaps the most startling example of the diffic ul ty of changing stamards of "health" in its widest sense cctlles from the island of Dobu, where the "social forms which obtain (in Dobu) put a premiun upon ill-will and treachery and make them the recognised virtms of the society. Here the abnormal simpleton "was the man who was natUl:'ally friendly and found activiw an end in itself. He was a pleasant fellow who did not seek to overthrow his fellows or to punish them. He worked for anyone who asked him, and he was tireless in carrying out their commands. He was not filled with a terror of the dark like his fellows, am he did not, as they did, utterly inhibit simple pmlic responses of friendliness towards women closely related, like a wife or a sister. In any other Dobuan this was scandalous behaviour, but in him it was regarded as merely silly." (Benedict) '!he inter-dependence of the young child's health and the behaviour not only of its immediate parents but of the whole group to which it belongs has been made tragically clear in reoent years. Protein malnutrition is ore of the chief causes of ill-health in this age-group in many parts of the world today. The contributing causes are many, but it appears that in some areas an important ore has been the cUI:'tailment of the breastfeeding period due to the breakdown of the traditional custans of separation of the husband am wife during tlE suckling period. Writing of Fiji, Thoms on (1908) says, "As soon as his wife was confine d he (the husband) was banished to the "MbUl:'e-ni-sa ll (bachelor house) for the entire suckling period, which lasted from two to three years •••• Natives, when asked to account for the decrease in their numbers, have for years mentioned th3 breaking down of this cus tom of abstinence as the prinCipal cause, asserting that cohabitation injures the quali t.v of the mother's milk. Not understanding tlE true cause tba t lay behind this belief, EUI:'opean medical men, as well as missionaries, have treated this opinion with contempt, wi thout, however, shaking the native's fixed belief. • •• '!he fear of impoverishing her milk was a superstition which hid behind it a most important truth, namely that a second conception taking place during the suckling period m1.l3t cause the child to be prematUl:'ely weaned. Thus, with the breaking down of Fijian custom and more frequent pregnancies, the children are weaned earlier, and as no substitute is available in the form of COWlS milk, a sudden deprivation of protein occurs. The infant is left at the end of the queue at the comm'lmal eating mat and has no chance of obtaining any of the choice protein foods which are consumed by the older men. II

WP IRe 7/ 'lDI- 4 Page 6 '!he last sentence illustrates well another hazard 1P the health of the child in this age group - one which is particularly prevalent today _ the unevenness of change. Here one aspect of the traditional methods of child rearing has changed, but others have remained. '!he child of three, with a relatively mature digestive system, could probably "make do" with the bulky taro, tapioca, or yam which formed the rna jar part of the family fare, having had a good "protein start" from the c us 1x>mary prolonged breast feeding. But for the child weaned at nine months or a year, the unchanged custom of reserving the protein delicacies for the elders becomes Similarly, the belief held by sO[OO peoples in this a major tragedy. region tha t the yOlll'€ child cannot be given fish ar eggs may mve much more importance than formerly, as it may deprive the new early weaned child of the only suitabl.e protein locally available. It is sometimes diffic ul t for the child health worker to urxierstand the force of various beliefs and taboos in the lives of the more unsophisticated peoples, but, in fact, the situation does not differ grea:.ly in the more developed areas of the Region. 'nle child from 1 to 6 years in, for example, Australia is, or can be, protec~ed from the major hazards to its health by various ac tions carried out at family, communi'tor or State level. 'lhe problem of dental caries, practically universal among the child population, remains, however, still unsolved - not so much because of lack of knowledge, but because of the strength of the traditional customs and values pertaining to certain foodstuffs. It would take a courageous mother to brea.k with tradition am the expectations of her gt"oup, and provide a birthday feast for her five year old tha t was not highly cariogenic. It would be equally diffic ul t for her to allow her child to go barefoot, or shod in the non-deforming wooden clogs, and so avoid the other practically universal affliction of the "civilised" adult - the hallux valgus deformity of the foot. How mooh roore difficult it must be for others, whose traditional beliefs include witchcraft and sorcery performed perhaps over carelessly deposited excreta, to exchange the seoret place in the bush for the latrine which anyone with evil intentions can get at easily. The following extract is applicable to some peoples in the Pacific region. "Because from early childhood Africans are habituated to a culture different from ours, they may be expected - in our generation, at least - to employ their talents and interests in directions different from those in which we employ oU['s. Development and other policies will be misdirected if we ignore this, and particularly if we ignore or under-estimate the hold of witchcraft beliefs. So long as the Afrioan explains illness, crop failure and industrial accidents in terms of the machinationS of witches, and not, as we do, in terms of microbes and misadventure, and so long as his economic and social advances are accompanied by crippling fears of retaliation from those he has left behind, he will partiCipate in development schemes with hesitancy and reservation - if he participates at all. II (Marwick) Even without the problem of witchcraft to complicate matters, how can a people whose whole way of life depends on preserving the idea of masculine prestige (which entitles the man to reoeive the meat distributed

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at the feasts) be persuaded that it is tffi small growing child who should have this priority? Or little girls be taught a pride in personal hygiene and well combed hair when such interest is frowned upon socially as evidero e of flightiness in a future wife whose chief virtue is her capacity to work hard and long in the gardens? It would appear that to encourage even minor improvements in the health and welfare of the child, each health worker must try to become his own social anthropologist. II There was a time when a social anthropologist was content to make an inventory of the elements, both material and non-material of the way of life, or culture of a people. Now he concerns himself primarily with the social significance of these elements. He assumes that each culture-element has a reason for existing, and that this is to be found in the contribution it makes to the effective organisation, and ultimately the sUr\?ival, of tha groq:> concerned. " (Marwick) Nevertheless, in spite of the wide variation in different unsophisticated societies in this region, there appear to be certain common elements in the treatment of children in the family situation. (Firth) These include the recognition of the social importance of the child as illustrated by the pregnancy taboos on the mother and sometimes also on the fat her; the sensitive attitroe of the adults to the child as a person with needs and opinions of his own; the influence of the wide kinship groups and the "publiCity" of private life on the child's acceptance of care and services from a variety of people other than its own mother - and also of the discipline "less rigid and more diffuse" than in a wes tern family, and varying also in its emphasis. Edmation seems directed, generally, ~ social ends than to the acquisition of individual skills, though mothers may deliberately teach their daughters crafts, such as weaving or basket-making, am time and attention may be given to the learning of complicated kinship relationships and geneologies. The children, by the time they have reached their fifth or sixth year, will have been weaned - either gently or abruptly - and experienced hunger, frustration, and the vagaries of their guardians and of an unstable or settled life. They will have learned to walk, to play, to imitate or to take part in some of the adult activities; to eat certain foods, and avoid others; have learned some of the traditional taboos; and heard of some of the spirits tha t menace or protect them; have gained some impression of their status as males or females in the community; and often assumed responsibilities and acquired knowledge not usually shared by their contemporaries in western cultures. The child may still be with its own parents, or have been lent - for various reasons - to another relative, or adopted by a different family, sometimes of a different culture altogether. It may have been deprived of both its parents and its home - as where custom decrees that, on the death of one parent the children must remain in the village of the dead parent while the other returns to his or her hostile village, never to be seen by the children again. During these years, the health and welfare of the child will thus have been affected by its own experiences and by those of its parents and the community of which he is a part.. Behind the practic al and visible influences are the values held by those within his social sphere, by whioh

WP /RC7 /'lDl- 4 Page 8 the norms of behaviour and rohievement are set, the abnormal defined and revered, tolerated or punished as the case may be, and smcess or failure as a community member recognised. And behind these are the constant pressures of change - some lIimpersonal" - floods, crop failure, political or economic changes - and some deliberateq applied by individuals who mayor may not belong to the same culture. 'ilie health worker, whether he belongs to the same culture or not, and no matter how sympathetically he considers the IIfelt needs" of the people, is inevitably an instrunent of change, making judgments based on an entirely different set of values and encouraging action and change based on these judgments. It is essential to remember that "no social order can separate its virtues fran the defects of its virtues" (Benedict) am to try to see the possible future defects of the virtues which seem so obviousq desirable now. To do so, it will be necessary to learn the difficult art of scrutinising our own customs and values as objectively as we scrutinise those of other people. It may not be completely possible, but we can try, and the past is full of warnings to guide us. Child health, like charity, begins at home. It is just possible that lasting improvement in the standards of health and welfare of the children in the remote mounta:ins am islands of the . West Pacific region will only be achieved wren we have put our own house in order and changed some of our own standards and valoos.

WP/RC7/'ID1-4 Page 9 REFERENCES AND BACKGROUND READING Bates, M. Ifalik - LonelY'Paradise of the South Seas Nat. Geogr. Mag., 1956, 109, 547-571 Benedict, R. (1935) Patterns of Culture, London Cole, F.C. (1945) The Peoples of Malaysia, New York and London Du Bois,

c. (1944) The People of Alor, Minneapolis

Firth, R. (1953) The child and his relationship to the community; family patterns and child care. Seminar on Mental Health in Childhood, Sydney See also: Int. Child Welf. Rev., 1953, 2, 163-171 Freedman, M. (1954) A report on some aspects of food, health and society in Indonesia (WHO mimeographed report) Gilliard, E. T• To the land of the Head Hunters Nat. Geogr. Mag., 1955, 108, 437-486 Grimble, A. (1952) A Pattern of Islands, London Hayden, H. (1954) Moturiki - A Pilot Project in Community Development, London Jelliffe, D.B. Infant nutrition in the sub-tropics and tropics (World Health Organization: MOnograph Series, No. 29) Marwick, M. The continuance of witchcraft beliefs The Listener, 1956, ~ 490-492 Mead, M. (1930) Growing Up in New Guinea, New York Mead, M. (1949) Male and Female, New York

WP/RC7/TDl-4 Page 10 Mead, M. and Calas, N. (1953) Primitive Heritage, New York Mead, M. (Editor) (1953) Cultural Patterns and Technical Change, Paris Morrison, H. Jungle journeys in Sarawak Nat. Geogr. Mag., 1956, 109, 710-736 Thomson, B. (1908) The Fijians; A Study of the Decay of Custom, London quoted by: Manson-Bahr, P.E.C. Fijian Kwashiorkor Docum. Med. Geogr. Trop. (Amst), 1952, ~, 97-106 Young, K. (1946) A Handbook of Social Psychology, London

WP/RC7/TDl 3:'" May 1956 O:qIGlNAL~

5

ENGLISH

SOME POSSIB::r.-S APPROACHES TO THE CARE OF 'IRE CHILD FR~~'I;l 1-6 YEA:-'S by

E.M. Alexander, M.r.C.S., D.F .H.

1.

IN'lRODUC TION

This consideration of possible approaches to the probl<Jms of children must of necessity be in gereral rather than explicit terms. An attempt will be made to outline the guiding principles which have been found effective by other workers, and to present SOITB of the questions wh:!.ch have to be answered when possible solutions to problems are being discussed by the individuals responsible for dealing with them in their differer.t sett.ings. A recent conferenoe(l) on the ways and means of improving standards of parental care concluded that: "all efforts to improve child health and welfare must be bas ed on the known needs 0 f the child at all stages of his development" The family is universally the natural environment for the child am every effort to strengthen and maintain the family should be founded on experience, should involve the active coopera tion of the parents themselves, and should be adapted to mee·t the different problems which different cultural millieux: present". The emphasis on the approach to the child through the parGnts has developed out of some unforeseen and disturbing aspects of the prcblem of child care tcday in North America and Europe. During this century, numerous agencies have developed approaches (partly by intention, partly as war-time expedients) all ai:ned. a t :L~"provi:1g the health of tl;'8 child by the provision of scrvj.c es mostly cen:jrcd dj.1"3C tly 0:1 t1:1e child hil:1:Jet!. i'ay-nurseries, nursory schoc:'s, i'::~ ~~::~~:-; cc~:~!'es, t~e provision of r.:.: :::J<;: C:1 d :)'~he:,:, foods especially fa:;." infar:::Ls and tho child of pre -se 1',001 a 6 e becam widely acc epted by the parents, whose only responsibility was to see t::.at the child received all the benefits provided~ At the same time, the cQnbined impact of rather did3.ctic and often critical "educa tionll of mothers in MCH or other centres, an:I of the new, am sQnetimes not well understood concepts of child psychology, tended to produce feelings of inadequacy in the parents themselves. An ironic situation has now arisen where parents bemused by a multitude of advisers *Regional Adviser on Maternal and Child Health Western Pacific Regional Office Manila, Philippines

WP/RC7/'lD1 - 5 Page 2 and services, have acknowledged their incompetence and accepted the fact that others know best, and IlOW' find themselves being blamed by the same advisers for their lack of responsibility for their own children! Most parents, (except the gravely disturbed) have some sense of responsibility towards their children, though it may take different forms in different cultures. 2.

'!HE TASK

In trying to improve the health and welfare of the child our task is to discover how parents view their responsibilities towards their children, to foster these feelings by encouragement am timely aid, and to provide the knowledge directed towards stimulating the parents to achieve by their own efforts as far as poss:'ble, the health and welfare of their children. 'Ihis parental "paralysis of incerti tude" is probably more widespread in the highly industrialised countries than it is where tradition, habit and religion still provide strong guide-lims for child rearing. But industrialisation is invading and disrupting the familiar boundaries of rural life, and it is therefore necessary for us to think in terms of how best to prepare and enable parents to meet the problems thus created. Wherever the child is growing up his developing needs are met more or less adequately according to the customs, resources and the attitudes of the parents and the community. The hazards to which his growing personality is exposed also vary wi th the environment - physical, social and emotioml. There is little reliable statistical ma tarial available at the moment on the different kinds of haz~rds to child life and health in this age group in different countr:ies,(2) and little on the normal gl'owth and developnent of children other than those in the USA and sane European countries.

3.

PRELIMINARY S'IUDY

The first step, therefore, in any undertaking to deal lems of young children is a study of the actual situation, aspects, and a thoughtful interpretation of the results of in terms of the obvious and probable effects on the health of the growing child.

with the probin all its such a study and welfare

The study in any aspect of child or community health may be done by experts working sing~ or in gt"olPs or it may be dom by the members of the community itself, with a leader of special competence. It may be a gemral study of community health problems, or it may be a study of some particular aspect of child health.

4.

"SELF-SURVEY"

TIE "self-survey" by the community of its own health meds is popular today, but where it has been carried out with some critical detachment c3rtain limitations have been recognised. It has been found that people's perception of and interest in health matters vary widely. "Primarily it

WP/RC 1/ml Page :3

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appears that a perception of the community's needs stems from a sum of the perceptions the individual has regarding health and illness, the means of treaiment, and the worth of that treatment. Only when the individual or family has a high level of such perceptions is a similar level of concern shown for the community as a wholeO)". One critical assessment of this method(4) found that of the local people participating, onl¥ 4% did so out of interest in improving health standards. It was felt tha t more effective results would probably be obtained if the survey plan was limited to more specific subject matter and preceded by a complete compilation of existir.g informa tion included in the initial design, fair4r defini te plans for following up on the findings, with w C oromuni tv involved in the follow-up action,

5.

SPECIFIC STUDY

Where the study has been limited to one aspect of child health(5) it has been found that, in order to result in effective action, tm community, leaders and others, must want to improve this aspect of child health, they must understand the purpos e of the propos ed measures and rec ognise them as a means to the desired end.

6.

IN'1ERPRE'D\ nON AND FINDINGS

Another published study ( 6) demonstrates clearly th3.t considerable thought must be given to the interpretation of the findings before any action is planned. Especially if the improvement in child health is part of a general c omrounity development plan, partie ular care must be exercised to enwisage the effects of the impact of other aspects of the total programme on the health of the children. On the occasion described, a pilot experiment in communit,y development was carried out on a small island by an enthusiastic and hard-working team. '!he preliminary survey showed tha t only ore· child under five years of age had died in the two years preceding the survey. Notwithstanding this unusually heal thy record the mothers were eXhorted to change their childrearing practices, to wean their babies at the "proper" time of nine months am to cultivate more regular sleeping and toilet habits in their children. Moreover, another part of the general plan was to introdme the growing of rice as an additional crop. What the u1. timate effect of these two innovations - early weaning and the addition of rice to the diet would have been on the health of the children is not hard to imagine, but the inherent reI 00 tan:: e of motter s to change their ways is sometime s a blessing J In the same project a mid-day meal for the rohool children was started, and skim milk provided. As long as the milk was distributed free tte children obligingly drank this unaccustomed food. When a snail sum was charged daily, however, the true val1E of the acceptability of tm milk was revealed. It was replaced by an excellent soup made from the abundant fish and some local ,vegetables, and prepared by the "Committee" of women who delighted in praf'ttising their newly acquired cooking skills and continued to do so with considerable tenacity after the team had left the island.

TIP /RC7 ITDI Page 4

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Trere is a growing tendency to scrutinise the findings of aqr swh preliminary survey and to distirguish those customs which can, with benefit be retained or modifie d, and to accord some measure of respect to the traditional ways which people have worked out for themselves over the centuries. It is also becoming recognised that improvements in the health practices of the children can only be lasting if they are part of a general change in the outlook, kmwledge and values qf the community in which the children are growing.

7.

MULTI-PURPCBE APiROACH

'D1e present temency, a t least in rural areas, is to organis e childcare facilities as part of a multi-purpose development plan. But in spite of the obvious association between health am tM whole way of lite of the people, this approach has been found to have definite disadvantages. It :is apt to be confusing to the people themselves who have to adjust to many new ideas all at the same time. And it is sometimes contusing to the personnel involved. An anthropologist(7) working with a health project was asked to seek the reason for the non-attendance of the villagers at the heal th centre. He found th9. t the difficulty lay with the menbers of the project staff themselves. The real th nurse and the social workers were . not on speaking tems, so messages about times of atterxiame at the centre were rot reaching the villagers concerned.

B.

GRADlAL APPROAC H

Experience seems to suggest that where facilities for the improvement of child health do not alreactr exist it is better to start from small beginnings - helping the people to deal with some problem that worries them, and gradmlly expaming the services as the need arises and is recognised. Even so, ttere are decisions and choices which have to be made.

9.

ADAPTATIONS '10 LOCAL CClIDTIIONS

'D1ere is no doubt that the quali tu of the health of tre child aver om year old dep:mds to some extent on tre quality of his health dU'ing tre first year, and that this in turn depends on the mother's health, and on her lmowledge of child care. Is the cornerstone of child health good prenatal edooation and care and good obstetric practice, or is it unwise to introduoe innovations first of all into a field so closely bound up with tre roots of traditional life? Some guidance as to the best approach in this respect may be gaine d from a study of tte social position of the tradi tional midwife. \fuere sha is a highly respected powerful influence in the community, changes in pre-natal and obstetrio practices are likely to be only slowly accepted, and a more direct approach to the chU,d after its birth am during its early years may produce less resistame(B). Can we expect to convince by "education" without demonstration of our competence to adVise which a successfully cured complaint provides? If we are to follow the ideal of helping parents to provide adequately for their children's reeds, we may have to think along lines very different from the traditional p1blic-health approach. Our concern may have to be with

WP/RC7/TDl Page 5

5

fitting our work, (and our working hours) to the daily pattern of the parents I occupations, to their meeting places, their hours and places of social congregation, with much less concentration of staff am services in a centre, and much more time arrl energy spent on visiting the families in th ei.r homes. In one "Family Service,,(9) it was found that child health (as measured by the infant mortali ty rate) improved more rapidly after two educators - especially trained in the 10081 socio-anthropological aspects of health - were added to the doctor - nurse - midwife team am carried out intensive edooation in too homes. Particularly with the child of the toddler age we may find that disciplines, other than the medical, may be able to contribute more directly to improving the child's total health. Recent research(lO) into the psychomotor development of some African children has shown that the young A.frican chlld was precocious in development as compared with ihe European or Atoorican child, not only in psychomotor skills but als 0 in adaptivity, sociabilit.Y and language, but that this precocity was usually lost about the third year. A mtable exception was a small number of children of theologic al students who were looked after in their pre-school years' in a "nursery school ll under the supervision of a teacher. ~se children did not shON the same loss of their early advance. The possible reasons for this difference were difficult to isolate and the author suggests too t further research is necessary and iha t more a tten tion should be given to the possib lity of encouragirg s110h local nursery SChools in African community.

10.

INDIREC T APPROACH

'!he role of the medic al child-health worker in promoting the health and welfare of this age-group may be to encourage and facilitate the work of the nutritionist, the sanitarian, the home economist, the educator, and the agriculturalist in the rural community. 11. UREA N AREAS

It will gernrally be found in urban areas today that the pressing need is for the integratioo rather than the establishment of child-health services. The usual pic ture is that of a number of organisations, governmental arrl voluntary, all operating in isolation and in comparative ignorance of each other's ac ti vi tie s, excep t where over lapping occurs and is somewhat acrimoniously discussed. In such circumstances, it is one of the prime responsibilities of the national child-health administrators to organise the IlJ3 ans of integration and co-opera ticn of the different agenc i.es, and to ensure that tre mechanism for such co-operation exists at all levels of practi.c e. Decisions as to the amount of time to be spent by the local childhealth administrators in direct 'work with the child or his parents, or in the organisation of co-operation mU3t be based on a comprehensive

wp/Rc11IDI Page 6

5

understanding of the local potentialities, and a sympathetic understanding of the other person1 s points of view. Where rapid industrialisation is producing new problems for the pre-school child, new services may have to be created. It may not be possible for the parents to undertake these entirely on their own, but every effort should be made to inv9lv~ the parents in their functioning from the outset. In one country~ll) where the nutrition of the weaned child is a major problem, child-feeding rehabilitation centres which act as a "half-way house ll between hospital and the MCR centre have been established, on the understanding that the mothers give several hours service in the care of the children at regular intervals, thereby learning by doing, and also accepting some responsibility for the maintenance of the service. 12. CONSTANT REVIEW" OF WORK

Even in areas with long established child-health centres it is usually necessary to review the existing procedures from time to time to ensure that they are meeting most adequately and economically tre needs of the community. Discussir;g the educational aspect of the work of a child-health centre, Jelliffe\I2) writes, IIBut if the most valuable educational methods - such as discussions in the clinic and demonstrations in the home - are to be encouraged, a good deal of thought will have to be given to tre values accorded to different aspects of the centre's work, and to the time-priorities of the daily routine. Which is more valuable - many people seen and trea ted, under the pressure of time and numbers, or a more leisurely contact wi th a few; time spent in distributing milk or IlEdicine s at the centre, or tiIlE spent in visiting the families in their homes; time spent in keeping records and making returns to various authorities, or tiIlE spent in making a flannelgraph; time spent on curative measures or time spent in the form of educati on - on the prevention of ill health? How much time should be allowed for intra-office discussions of the work - its past mistakes and future improvements - or for staff education; how much for discussions with other MCH workers and with the agricultural officer, the sanitary inspectors, the local practitioners, the village leaders, the fathers of the MCH clientele, the school-children, so that everyone understands and can co-operate in wha t the MCH centre is trying to do? Some of these decisions cannot be made by tre MCH staff alone; the people will have their ideas of what they want, arXI others may have to be persuaded of the relative value of foms returned to "head-office" and children returned to health. It may be that the appointment of one efficient clerk, or - where milk distribution forms part of the centre's work the addition to the staff of a competent assistant-dispenser will have to be considered, in order to release the highly trained medical staff to carry out more long-tem nutrition education in the homes.

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7

Like th3 edu:::ation, the administrative details have to be fitted to lac al. conditions, and no hard and fast rules can be laid down." Every thoughtful student of the prcblem of child health - par ticularly of the hitherto neglected age group, the 1-6 year olds - knows the grateful experience of finding some care fully and honestly recorded account of methods that have been tried with seme assessment of their virtues and their disadvantages, or some reliable data on the normal ani abnormal aspects of the health of these children and the particular hazards that beset these years. Child-health workers are in a uniqre position for observing and recording such details in too different environmen ts, and for evalua tirg the different maas ur'es adopted. Only through too gradual compilation of smh records, their regular publication and careful study can one hope to hasten the solution of the special problems associated with these years of the child's life, and to preserve the adaptable approach which "alters when it alteration finds".

WP/RC7/TDl-5 Page 8 REFERENCES 1. International Union for Child Welfare, Geneva. Report of Conference on Raising the Standards of Parental Care, Paris 1955 (mimeographed) See also: Child health and parent education. Int. Child Welf. Rev., 1955, 2, 163-171 Clements, F.W. Accident prevention in childhood J. troPe Ped., 1956, !, 227-231 Koos, E.L. (1954) The health of Regionville, New York Sower, C. and Freeman, W. Symposium on community self-surveys in health No.3; The role of social relationships in achieving community health goals. Amer. J. pub. Hlth, 1955, ~, 280-284 Meltzer, N.S. A psychological approach to developing principles of community organization Amer. J. pub. Hl th, 1955, .12., 198-203 ~den,

2.

3. 4.

5.

6. 7.

H. (1954) MOturiki. A pilot project in community develOpment, London Notes on the application of anthropology Hum. Org o , 1955, 12, 10-14

Adams, R.

8,

Wellin, E. A cultural approach to rural health work (unpublished working document: WP/RC6/TD3-1) Kark, S.

9.

The Pholela Health Centre - a progress report. S. Afr. med. J., 1952, 26, 101-4, 131-6 See also: Slome, C, The problem of the PholelaHealth Centre in Natal, London School of Economics Service Report (mimeographed) 10. Geber, M. Developpement psycho-moteur de l'enfant africain I.C,C. Courrier, 1956, ~, 17-27 Bengoa, J.M. (1955) Venezuela. Personal communication Jelliffe, D.B., Infant nutrition in the sub-tropics and tropics, p. 183 (World Health Organization: Monograph Series, No. 29)

11. 12.

WP/RC1/'IDl - 6 23 Maroh 1956 ORIGINAL. THE EFFECTS OF INDUSTRIALIZATION AND URBANIZA'l'ION ON THE CHILD AND HOtl THEY MAY BE DEALT ~VITH* ENGLISH

l.

IN'IRODUCTION

Although it is assumed that Japan is most advanced in industrialization and urbanization among the countries in the ~vestern Pacific Region, very little study has been carried out on the effects of such processes on the child, particular4r on the developnent of personality. The limitation of time has precluded exhaustive examination of all relevant factors. It has, therefore, been necessary when preparing this important report to rely on limited material. Generally speaking, urbanization develops concurrently with industrialization with a few exceptions such as, for example, the mining districts, or rural areas wOOre factories have been set up; such areas are called industrialized and yet they are not necessarily urbanized. In these areas, the employees live in houses buil t by the company, and make up a special type of conununity where the pattern of living is different to that in a city. The discussion will be developed on the assumption that the same considerations prevail when treating either industrialization or urbanization. A comparison will, therefore, be made of urban a1.d rural areas in terms of the different conditions which exist and the influence of these conditions on the child will be discussed. These conditions include: (a) nutrition, (b) role of the family in personality development and (c) social environmental factors. 2. NU'lRITION

According to the Annual Report of too "National Nutrition Survey, 1954", people in urban districts consume an average of approxjmately 2010.4 calories per day, in comparison to 2121 • .5 in rural districts. People in rural distriots, therefore, consume about 110 calories more per day than those in urban districts. 1his is due to the differenoe between the quantity of carbotwdrates consumed by the people in both areas. Although there is little differenoe in the quantity of protein intake, people in urban distriots consume more aniJnal protein and fat. This being the case, profound differenoes in height, weight and girth of chest beiNleen children in urban and rural distriots, have not been observed. Little is known for certain about the effeo ts of specific

*

From too National Institute of Mental Health

Tokyo, Japan

WP/RC7/IDl - 6 Page 2

nutritional deficiencies on the infant but it seems like~ that the state of malnutrition is responsible for the disturbances of the gastro-intestinal system and the absenc e of tendon-reflex and so on. It is obvious that the children of ages ranging from 12 to 16 at the time of the 1954 survey seem to have poor physical development beoause of the shortage of food during war time. 'lhis suggests that nutrition in infancy may be a decisive factor in the inferior phirsical structure in later years. Yamagata and his associates, who have carried out a study on weaning, oomparing two gr"oups, one urban and the other rural, report that weaning begins much faster in ·the urban district than the rural. One of the factors in fast or slow weaning is the father I s (parents') occupation. 'lhose infants whose parents belong to the salaried class are weaned faster than those whose parents are dealers, then the children of parents without a regular occupation, those of factory workers and farm lct>ourers follow. While the infants in the urban district largely depend upon prescribed formulas for weaning food, those in the rural district large~ req on carbonydrate and starch furnished with rice. Consequently, the effects of malnutrition caused by the poor weaning food given to the children in the rural district was reported to be responsible for the :Jlferior weight and the imperfect nourishment in the children after weaning.

3.

ROLE OF THE FAMILY IN PERSONALI1Y DEVELOPMENT

The family is the most important factor in terms of its effects on personality development of the child. A difference in conditions of the family in the city and rut'al area has been observed. Dis or ganization 0 f the lar ge family sys tem pr ogresses faster when the area becomes urbanized and industrialized. It is not infrequent in the rural district for several near relatives to live together. However, urban middleclass families differ from those that are rural and tend to be made up on the basis of one pair of spouses and tre direct children" Because of the fact tm t the YOtmg adult s are usually bread win119rs, the children that are rural are more often taken care of by the grand-parents. As far as the rural district is concerned, whether the main occupation is farming or fishing, it is assumed that the working conditions are compatible with the family life. Apart from the families connected with small commercial enterprises or industries, parents in tl'.a3 urban district b?ve their working places outside the family life. It is nr)t yet common fer both father and mother to work for their living in urban districts. Therefore, in comparison to the close father-child relationships in the rural areas, the urban child has not necessarily a strong attachment to the father as he is working outside the home situation. On the other hand, tm mother-child relationship may be considered comparatively closer than that in the rural areas.

4.

SOCIAL ENVIRONMENTAL FACTORS

Generally speaking, the daily life of the ut'ban district is more complicated than that in the rut'al area. Children in the urban district have more opportunities for making friends than toose in the rural district and receive all kinds of stimulation in comparison to the rut'al child whose s~here of personal contac ts is ratoor limited c

wp/RC7/IDI - 6 Page 3 It is not yet clear whether these conditiions have different effects on the personality development or mental health of tiE child. ~ve have experienced, in dealing with the child with personality or behaviour disorders that the child of the rural area tends to be rather withdrawn and s~ and that the city child shows a tendency to nervousness. We also have observed from the result of a study on social maturity among the child of the city, farming, fishing and coal mining districts, by app1¥'ing a modified scale of Doll's Social Maturity Scale, that the child of the city area has shown superior indications in every aspect of social maturi tu, although less mature in self-dirac tion. Children of farming areas have indicated superiority in occupa tion but less maturity in communication or social relationships. It is clear that the difference in ph;rsical development of the child in the urban and the rural district depends large1¥' on the differe:oo in the nutrition of tre infant and the method of baby and child care. A plan, therefore, to decrease nutritional deficiency and improve the education aoo guidance should be necessary-, and further study to yield factors related to personality and mental development of the child is indicated.

WP/R1J7/'lDl - 7

31

May

1956

ORI GINALa

EN CiJB H

THE CON'lRIBUTION OF '!HE EDUCA TOR IN MEETING THE NEEDS OF CHILDREN 1-6 YEARS by

G.E. Pendred.

•

1.

IN!RODUC~

Edooation is a creative process which begins at birth am continues all through life. Many contr:ibute, for good or ill, to the process - the family, neighbours, teachers, doctors, etc. Every society edu::ates its children in accordance with its religious arrl rrDral beliefs and its economic re quire roonts , so th:lt they will conform to a partioular sec ial pattern" However, this century has seen an unprecedented Slrge of interest in stooying the developmental needs of children, particularly tre 1-6 years. Research in medicine, nutri tion, psychology .. edmation, social anthropology has been directed to this end, each discipline approaching the subject by its own specialised path.

2.

AIM OF EllJCA TION

As a result of this research, a new concept bases educational theory and practice on meeting the developing needs of children, believing that if, at each stage, a ohild can live a f~rich life, integrating his experienoe in accordance wi th his part:ic ular stage of development, his unique potentialities will be more fully realised, and he will better be able to adjust am contribute to a rapidly changing society.

3.

:mE IMPLICA TIO N

(a)

To help each ohild to develop his own potentials means that education must be com erned wit h 1he "whole" child - e.g. physical, emotional, social, spiritual and moral, intellectual growth, and not merely wi th the acquisition of skills am knowl edge. To help each child to accept responsibility as a contributing memb er tp too soci ety to whic h he belongs, will depend on the growth of self-awareness, leading to the ability tp form hannonious relationships with others, based on a satisfying identifica tion with his parents and those whom he loves, during the early years of his life.

(b)

*

Au~ftralian

Federal Pre-school Officer Pre-school Associa tion

Canberra, A.C.T.

WP/RC 7/ 'lDl Page 2

"I

'1HE ROLE OF THE EDUCA'lOR is to use the knowledge made available by the specialists to provide the envirorunelll:i (people and material things) whioh stimulates and satisfies the child's needs at each level of development, and to allow the self-active process of learning to take plaoewith a minimun of frustration and maximum of sucoess,

4.

5.

'!'HE IMPORlll£E OF THE YEARS

1-6

During these years, foundations for fut'lre physioal and mental health are being laid, based on genetic constitution but influenced by environmental conditions, as many reoent stu::lies lEve shown (Bowlby and others). Growth and development follow the same broad pattern in all children, therefore the eduoa tor (mother and teacher) requires knowls dge of these processes in order to meet developing needs. But within the range of the normal, children show marked individual differemes. '!hese the edooator must recognise and aooept, and adjust experienoes and expectations of behaviour accordingly.

6.

'lWO BROAD AREAS OF LEARNING OF PAR 'J!CULA.R SIGNIFICANCE IN '!'HE EARLY YEARS (a) (b) '!he growth of self-awareness; Adaptation to the world of people and ma terial things. Both are inter-related.

6.1

The Growth of Self-awareness

'!he basis for this lies in the unconscious learning by "contagion" in the early life of the infant. The good mother-edu:::ator provides the "olimate" which, it is believed, develops in the baby a basic social trust. Where a basic mis-trust has been engendered, the task of the educa tor later, is made mooh more difficul. t. '!he mother, by her care, awakens a response from the baby ~ Parallel with the gradual growth of self-oonsciousness, is the need by the ohild to establish a satisfYing identification with his parents. On this will depend his emotional security, the values he develops, his ability to form relationships and will lead to a release of intellectual qUllities speech, thinking, etc. Mu:::h of a young child's inability to learn, in the pre-school and infant-school years, can be traced to an unsatisf,ying child-parent relationship, resulting in social and emotional immaturity.

The contribution of the educator With this emergence of personality, the child needs from his parents and teachers, a loving objectivity which recognises his own individual temperament, rate of maturation, etc., so that he is not forced to

WP/RC7/'IDl- 7 Page 3

conform to a pattern pre-determined by the adults to fulfil their own desires. If this happens, tension is created in the developing personality, which seeks am needs approval from thos e he loves, but whioh oan be gained then only by a negation of his unique needs. This may result in exaggerated aggression, anxiety, withdrawing, or by symptoms such as night.terrors, bedwetting, eating problems, etc. '!he same conflict arises over conditioning the child to fit family praotices and social custans, for the child's need is for self-assertion with 11 ttle or no ability to UIXierstand adult requi..reroonts. Sane feelings of frustration and deprivation are inevitable resul ti.ng in ambivalent emotions of love and hate.

The child needs a reasonable, consistent, supporting authority, who relates demams to his stage of development, treating his mistakes as part of a learning process, not as moral Lssues, and giving him constant reassuraroe that his behaviour does not affect then- love or their confidence in him. Chlldren need authority for their protection, security, and to give them olear direction as to what is considered acceptable behaviour. They need also, degrees of freedan related to then- stage of development, for the growth of self-discipline. The educator needs to preserve a balance between requiring obedience and allowing the freedan neoessary for a child to be able to learn to make decisi ons within the range of hLs ability an d experience. 6.2 Adaptation to the World of People and Material '!hings

']he crystallising of the "self", developing gradmlly during the preschool years, is influenced by tre degree of basic emotional security achieved, . the development of the intellect and experiences of social relationships. It comes ab out through a gradual inte gra tion of a child's "inner world", with that of external reality, through the learning process.

Play is a young child's principal way of learning am must rot be confused with the adult conoeption of playas amuser:ne nt or recreation. Apart from his relationship with his family, it is the most important way he learns to crystallise his emerging "self" and learns to know and adapt to his environment. Play materials are a young child's tools of leaming, hence their importaroe at horre and in a pre-school centre, in the education of children. Play material may be defined as anythir:g which attracts a child and can be manipulated by him, with safety and adult sanction - e.g. earth, water, household utensils, etc., as well as tre toys of childhOod. Recognising the importance of plB¥, the pre-school movement has developed a wide varie1u of play material to sti.mulate arrl satisfy tre varying growth needs of children.*

* Booklet on

"Play Material· for Young Children", A.P.A. p1i>lication. Parents' News Sheets, A.P.A. publication. Report of papers given at the 7th Biennial Conference, A.P.A. on "Childhood and Mental Health".

WP/RC7/'IDl - 7 Page 4

7.

PIA Y AS A MEANS

(Ii'

DEVELOPMENT

7.1 'Ib discuss play under separate headings is to impose an artificial division, for a child's pla;r is continous and mvolves all aspects of development, 'though at a partic.ular moment of tire, one phase may predominate. Havever as it is helpful in understanding its signific~e arrl relating it to the basic aim of education, four aspects are presented briefly2(a) (b) (c) (d) 7.2 play and physical development; playas a means of aChieving emotional equilibrium; playas a means of intellectual development; play in rela ti on to soc ial development.

PICV and Physic al Development

A healthy, young child develops increasing skill in the control of his body through maturation and by being given opportunities to exercise his gra-Ting powers. Once he is mobUe, he usual1;v delights in perfecting skills but even here, although tre anphasis is on physical development, his competence or inadequacy may profoundly affect his erotional and social attitudes. Success and failure reverberate through a child's whole personality so that it is important that success should outweigh failure. '!he Role of the Edu::ator (mother and teacher) is to provide an environment which offers stimUlus, to define and maintam limits of safety, to give support and enco'lZ'agement when needed and to introdroe fresh challenge to meet developing needs.

7.3

Playas an Emotional Outlet .Helping a Child gain Emotional Equilibrium

As a child matures, one sees him using playas a means of outlet, to channel specific emotions. In this way he externalises and deals with many of his personal problems, instead of drivillg than inward, unresolved. 'Iba reason behind the behaviour may be difficult for an adult to 1.Ulderstand. A child may show tenderness to a toy, expressing wmt he himself receives and transferring it to a lO\Ted possession with which he is identified, or he may be compensating for the love he needs and feels, rightly or wrongly, he is not receivi~.

Aggression in a play situation often appears to be a projection of feelings of aggression towards adults, which can be expressed without a feeling of guilt. A si tU3.tion provoking fear or anxiety may be "played out" in various zoodia - by reconstructing the experieree in dramatic form, by painting or draWing, in conversation or story-teiling, by modelling in clay J etc. It may be alone or in tlE company or others. It may be a single expression or a recurring theme but it enables a child to come to tems with his problem and to integrate it.

WP/RC7/'JDl - ? Page 5 The Role of the Educator is that of a sympathetic friend, gaining insight where sm can, accepting each child's need to meet his problem in his own way, helping him to clarify it if she feels she understands the cause of the underlying tension. She must supply a variety of play material to meet varying needs. She must also allow him time, so that the child has not to mee t the additional .£rustra tion of adult authority breaking in on an t~gent, personal need to find a satisfYing solution for his inrer c onflic t. If the play is a threat to othe r children, she must channel it into a more acceptable outlet.

7.4

Playas a l1eans of Developing Intellectual Understanding of the World of Reality

Gradually, during the pre-school years, one sees the abill ty developby the child to "accommdate himself to realityll. If not pressed by inner tensions, his mind is freed and one finds him examining the world aroum him with eager interest, reconstrooting it in his play. From the confusion between imaginative and realistic play, the realistic features emerge more and more. i~

'1he Role of the Educator here, is that of an active participant in the learning sitm tion, answering questions, stimulating further tho~hts, helping children to acquire infonnation for themselves by observing and experimenting, enriching their play material aal providing experiences which will lead on to the formal reading and nwber later, in the Infant School. Illustrated books for infonnation, nature collections, gardening, elementary science equipment (magnifying glass, scales, magnets, pulleys, etc. ), excursions to places of interest in the community, waste material for constroo tion are all needed to be added to the basic play material always available, e.g. building blocks, miniature life toys, outdoor equipment, painting, clay, sand, water, dolls, picture books, dressing-up clothes, etc.

7.5

Playas a Means of Developing Sooial Relati.onships

The development of genuine sooial rela tionships is a slow process though there is marked difference between children, some showing sympathy more readily than others, at an early age. Trends towards introversion or extraversion are observable in t h3 pre ..school years but all children pass through a "monologous" stage, wrere they play alone, even in the compaI\Y of other Children. Gradual1¥" contacts are made, helped considerab4r by the growth of language. By 6 years, one finds elementary co-operaticn in play am the forming of friendships.

']he Contribution of the Educator. ']his S ooialising process is due partly to maturation but also to the "climatell set by too educator. Her role is to try to exemplify in her own life, the qualities thct promote good relationships - sensitivity to the needs of others and personal trustworthiness. Her values are accepted

WP /RC7 Iml Page 6

- 7

unconsciously by children but permeate their relationship with her and influence attitudes, long before they are examined intellectually and consciously accepted, or rejected. 'Ihe mother or teacher must protect children from undw interference by others by establishing and maintaining simple rules of behaviour, at the same time, giv ing help with techniques that enable children to work together. She will need to be ready to interpret the behaviour of ore child to anot her, to avoid friction through misunderstanding of motives. She will be aware of the play materials that pranote co-operation end me them to draw in the srv or withdrawn child to play with those who are gentle arrl friendly. She needs to be ready, when play deteriorates, with suggestions that offer a fresh challenge and, if that fails, to take charge of the situs tion, to relieve social tensions. She needs also to be perceptive enoug...'1 to know when to leave children to find their own solutions to their connicti~ wishes.

8.

'!HE IDLE OF THE PRE-SCHOOL TEACHER

All through this paper I have thought of the educator as either mother or teacher, but I would like to define briefly too two-fold function of the trained pre-school teacher. (a) (b) 'lhe guida:r:c e of children during the hours they are under her care;

The guidance of parents by interpreting the needs of Children to those who need help in understanding behaviour.

This should be done, not by didactic teach~g methods, but rather by seeking to establish a relationship of mutual trust and then to share their knowledge, so that bo~h may adjust their attitudes and practices according to their ability t.o see and meet the problem. If the problem is too deep-sea ted fo r a teacher to handle, then she should me her in.f1 uence to try to get the parents to seek more highly specialised help.

9.

SOO PRESENT-DAY PROBLEI'1S

1. In our society, although the knowledge gained by research on the developing needs of children forms the basis of pre-school education, and even though the same principls have been accepted by our' thoughtful edu::ators at all levels of edu::ati on, they have not yet been :incorporated in practice into our statutor,r school system, to any extent. At an age when children, 5-6 years, are beginning to show independence, a growth in self-discipline and to develop relationships with their peers, far too often they begin formal school, where large classes, a teacher-directed programme and nass instruction are the accepted methods of teachin g.

WP/fUJ7/TDl - 7 Page

7

2. At the beginn:ing of this paper I said that ever;r society educates its children ••.• to train trem to conform to a partie ular social pattern. Wrere societies are isolated, whatever fom educa tion takes, it c an be organised to fulfil its fum t:iDn. But i f a socieiv canes into close contact with another with different religious, political am economic values, as is happening in the Territories of Papua and New Guinea, the educator faces a grave proolem. Are the children to be trained in the traditions and customs of their If so, how are they going to ad/ipt later, i f the trend is toward following a different way of life'1

own SOCiety?

If the education is planned to fit the children to a mar:-kedly different type of society, how can thi s be done without creating conflict between them am their parents, underm:ining the security we believe every child needs, and which he gets orily through a satisfying identification with hiE pare nts arrl family 7 To think of educa tion orily in tems of intellectual development based on teac l1i.ng children skill s and fac ts in seho 01 which have no roo ts in the traditions of the family would lead, one would think, inevitably, to smh frustration of basic emotional and social needs as to result in serious instability. '!here is urgent need for careful stlrly of this dilemma by those qualified to undertake it.