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On Raising Children - "It Is Never What The Books Say"

Learnings from a conversation with a physician specializing in pediatric development and behavior - about her work and this challenge.

Photo of Bettina Fliegel
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I had a conversation with Dr. Seijo, a developmental pediatrician working at the Kennedy Center for Child Development, Bronx, NY.  Her patients hail from the surrounding communities.  Most live in culturally diverse, low income neighborhoods.  Children are referred to this center for evaluation of their development by pre school teachers, primary care doctors, or the parents themselves.  
The approach is multidisciplinary.  Child and family are seen by a team of practitioners.  An assessment is made.  If needed therapy is prescribed - speech, occupational, physical and play therapy are available interventions.  There are also infant/parent support programs with a focus on attachment issues.

In the USA children are seen by their general doctor 7 times within the first year of life, and 3 times in the second year.  They receive general care, developmental surveillance, preventive care including vaccinations.  A formal developmental screening tool is utilized at the 9 and 18 month visits for all healthy children.  This is a good opportunity to educate parents about normal development and to encourage them to pay attention to specific milestones and to follow up for any concerns.  If there is a concern the child is referred to a free government sponsored program, Early Intervention, for a full developmental assessment.  EI is a home based program for children aged newborn to three years old.  If intervention is needed the therapists visit the home to provide care.  There have been many studies done that show that Early Intervention Programs are successful.  They create impact by improving outcomes for children diagnosed with delays and treated early in life.
 

Questions, Answers and Learnings

What skills are crucial for children to develop in the first five years of their lives?
1) Cognitive - Verbal and Non Verbal Language
Mental processes, decision making, problem solving, receptive and expressive language, academic skills
2) Social/Emotional/Behavioral
3) Physical - Gross and Fine Motor Skills
4) Adaptive - Learning how to adapt to one's environment.  Understanding danger, toilet training, learning to cross a street
5) Learning How To Play - Very important
This includes 1 - 4 above.  In modern times early introduction to technology will enhance later success if used to enhance development.

What are some challenges facing parents in low income parents communities around the world?
I. Basic needs
Poverty
Access to food
Housing
Access to clean water
Sanitation
     For children to grow, develop, and thrive the above need to be in place first.

II. Psychosocial Stressors - exposure to violence, domestic violence, sex abuse, maternal depression, alcohol and drug abuse, relationship issues.

III. Accurate Knowledge About Development
"Most parents do not know anything about early childhood development until they have a child themselves.  Due to the above life stressors, basic needs unattended to, low literacy and time constraints parents in low income communities are at an even greater disadvantage regarding access to information about normal child development.
They also might misinterpret written information.
Videos and visual information are a better source of information for parents to learn about development particularly in the areas of language and cognition.  Prior to spoken language there is non verbal language development such as gesturing by 15 months - reaching, clapping, waving bye.  This can be visualized and understood.  Physical development is easier for parents to understand as it is more obvious."


What is an example of a solution that supports children well?
1) Early Intervention - developmental surveillance, referral for concerns, evaluation, diagnosis and therapeutic treatment.  This program in the US for children under the age of 3 has been show to have impact.  Children catch up!
2) Visiting Nurse Program for first time parents.  
3) Parent Education Programs - Infant/Baby Support Groups for at risk families.

What are some of the biggest misconceptions that first-time parents have about raising children?
1) NO MATTER HOW MUCH YOU PREPARE IT IS VERY DIFFERENT
2) IT IS NEVER EXACTLY WHAT THE BOOKS SAY
3) That you will have "the village" to help you. We are losing community because we "don't have the village." 

In developed countries some families live far apart, there is loss of extended family.  Grandparents are not close by.
In the developing world having the village can be an asset.  The problem here is lack of knowledge about normal child development.

What solutions in the area of early childhood excite you?
Integrating Services - There is a push now to integrate physical, mental health and developmental/behavioral services so that they are all present in one clinical site.  The increases access and buy in.  Providing services together saves money as intervention happens early and outcomes improve.  This integration also facilitates communication between providers improving coordination and overall care.

Reach Out and Read - A program that gives books to young children at each doctor's appointment.  While children wait in the waiting room there is a reader who reads stories to the children.  The program promotes early literacy and gives books to children who would not otherwise have them.

Final Notes-
Parents of children who who receive services at The Kennedy Center for developmental delays feel supported and have a sense of community.  They do not feel marginalized, as they do in the greater community, when others express negative reactions to their child who might be different from other children.  They feel that they can access care without judgment.  It is a social place for them.  They meet other parents with similar circumstances.  When they receive the therapeutic interventions - speech, OT and PT they enjoy the sessions.  They learn from these sessions.  Of note parents who go through the process of evaluation also find this educational and enjoyable.

Parents need access to clear and visual information on early childhood development.  The process of evaluation for developmental delay and the process of therapy are experienced by parents as opportunities to learn about normal development.  What types of initiatives can we design that take this into consideration?  One on one support and learning is important.

First time parents need support and community.  Parenting is a learning process.  Children are constantly growing and changing.  Systems of support need to be flexible to accomodate for these factors.


 

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Photo of Meena Kadri

Amongst so many great highlights here – I'm really digging the prompt that information needs to be visual. Especially relevant in low-income communities in the developing world, due to the diversity of languages / dialects and to varying levels of literacy. We're amped to see what this will inspire for the Ideas phase and hope to see team collaborations form to include folks who have visualisation skills.

A big thanks from all of us, Bettina, for all your insights and inspiration during our Research phase!

Photo of Bettina Fliegel

I agree Meena. That was probably the biggest take home message. Interesting because for practitioners working with kids it is always visual learning as well.
One needs to see things and be hands on to get the full picture.