Children of the 21st century: Slipping through the net

My latest research publication briefly explores the literature focusing on early childhood development, parenting and the provision of health services to young families. It is particularly focuses towards child health nurses, but parents may also find it interesting.
The paper highlights a number of reasons why some children with subtle developmental difficulties are not identified until school age.

1. Changing health problems in children: children of the late 20th and 21st century are no longer threatened by exposure to potentially fatal illnesses that were cause for concern in earlier times. Good public health measures ensure clean water, adequate housing and the availability of nutritious foods for most Australian children. Concerns for children now focus on long-term conditions and disabilities such as developmental, learning and behavioural problems. Infant and child health centres are now particularly focusing on children who are identified as ‘at risk’ within the first four months of age. ‘The risk’ assessment is based on a number issues, including the social, mental and functional factors of the family, mother or baby. For example, a child health nurse will regularly visit a premature baby born to a single mother with limited resources, or a mother who has experienced post-natal depression. Other parents and babies can attend clinics as part of a group. While the focus on ‘at risk’ infants and mothers is appropriate, not all children display developmental problems within the first four months of life, including children with Autism, delayed speech development and children with integration problems that will effect later school learning.

2. Attendance at child health clinics: There is a very low repeat attendance at child health clinics. After the initial home visit that occurs after birth, many parents do not visit their local child health centre again. Parents visit their local doctor when their child is unwell or requires immunisation. Advice on their infant or child’s development is often from books or family members. Today, the Internet is also a very popular source of information for parents. Some research studies have found that parents are unwilling to submit to surveillance by the child health nurse visits. Fear of being identified as ‘an inadequate mother’ keeps mothers away from child health centres.

3. The use of screening tools: When a parent, child health nurse or doctor is concerned about a child’s development, a screening tool, that measures a child’s development against a ‘norm’, may be used. There are many different screening tools available for use, and it is up to the health professional to choose the correct tool. Unfortunately these tools are only about 75% accurate, so a child with subtle developmental problems may not be identified with a problem. Some of these tools are also complex and time consuming and are not always implemented properly, increasing the likelihood of incorrect diagnosis.

4. The lack of involvement of parents in decision-making: Sometimes when parents raise concerns with health professionals about their child’s development, no action is taken. This problem seemingly arises because of a lack of consensus between health professionals and parents as to the level ofseverity at which evaluation and intervention become appropriate.  Sometimes it is the parents who do not acknowledge that their child has a problem, at other times it is the parents who are concerned, but the health professional does not agree. Unfortunately, parents of children who show signs of mild delays commonly complain that health professionals insist they ‘will grow out of it’ or that the problems relate to inadequate or inappropriate parenting skills. Health providers may adopt a ‘will grow out of it’ attitude, because some children with mild delays do sometimes ‘catch up’ as part of their natural development. This attitude is reinforced when screening tests return results indicating that the child does not have a major developmental problem. Blaming the parents may stem from the health care provider’s belief, based on research undertaken in the 1950’s, 60’s and 70’s, that focused on the parenting style as the cause of a child’s developmental problem.

What parents can do 

Actively engage in your child’s development: Parents who are well informed about their child’s development will confidently be able to raise concerns with their health professional. While children do develop at different paces, if you are concerned that your child’s development is not where you think it should be, then raise your concerns. Parents are able to detect subtle developmental variations much more effectively than health professionals, because they are with their children every day. Actively search out a health professional that will listen to you as a parent.

There are now excellent parent-based screening tools available for health professionals to give parents. They are simple tick-sheets that ask parents a number of questions about their child’s development. Most take less than 10 minutes to fill in, so mums and dads can complete them while waiting to see a doctor or nurse. These simple tools are important ways of raising both a parent’s awareness of their child’s development and draw attention to any concerns they have to their local health provider. Children whose developmental problems are picked up early are able to access early intervention programs. Early intervention may mean the difference between failing and achieving, either socially or academically, at school.

From: Williams, J., & Holmes, C. A. (2004). Children of the 21st century: Slipping through the net. Contemporary Nurse, 18(1), 57-66.
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Jane Williams is a children’s nurse currently undertaking doctoral studies in the School of Nursing at James Cook University. Jane has been
involved in the field of early childhood development for the past 15
years. Her current research focuses on the experience of mothers whose
children were not diagnosed with developmental problems until school
age. In particular, Jane is focusing on the relationship between mothers
and health professionals, and the influence of societal and cultural
beliefs on what mothers do when they are concerned about their child’s

Brain Power – How Does Your Child’s Brain Develop? By Tessa Grigg 

When you look into the eyes of your newborn baby, and wonder “What is going on in that little head of yours?”, wouldn’t it be interesting if you could also see the “code” that was responsible for firing it all up!!

The days of believing that genetics were the major key to how well a brain would function are long gone and the importance of the environment to which the child is exposed has risen in importance – ‘Nurture’ is gaining on ‘Nature’!.

With the volume of recent research findings into how the brain develops, parents could feel overwhelmed by what seems a huge responsibility, but do not fear: there are some key elements to focus on, many of which are things you are probably doing anyway. An understanding of the significance of what you are doing is useful.

What the research says

Fifteen years ago scientists believed that a baby was born with the brain essentially complete and as the child grew so did the brain (similar to the way organs grow in the body as part of the maturing process). The complex wiring of the brain had yet to be discovered at that time.

Scientists now generally accept that genes play a vital role in the formation of the brain, especially in the womb, as during those first nine months in-vitro connections are created between brain cells (neurons) to enable basic life-sustaining functions to be carried out, e.g. heartbeat and basic breathing. But the majority of the neurons are still waiting to be wired. The complex interaction between what the genes (nature) and the environment (nurture) each provide will determine how well the brain will develop through the first 12 years of life.

Eric Jensen, one of America’s leading researchers into brain development reminds participants on his courses that the biggest time for connections to be made is in the first six weeks of life. The brain is beginning the process of making sense of the world it has entered. The first six months still have a rapid rate of connections being made and by the time the child is three years old each neuron will link up with as many as 15,000 others forming approximately 1,000 trillion connections (Partridge). Jensen believes that “new” connections continue to be made until the child is approximately 12 years old and from then on it is all about developing the connections further through a wonderful thing called “experience”.

There is also a culling process that is used by the brain to eliminate connections that are not used. This does not happen in the first three years but after that the pruning of connections can be as many as 33 per second. The elements that influence the creation and pruning of neuron connections are genetic selection, sex hormones and, of course, the environment. And the environment is where parents play their vital role.

While attending one of Eric Jensen’s courses, I couldn’t stop myself finding out what he thought about the GymbaROO programme that we operate. He was thrilled about the opportunity that young minds were being offered. Jensen likes to use movement to teach, he likes to teach in small snippets, he insists on creating stimulating challenges, he likes children to get feedback (not always teacher/parent directed), he says that the brain likes water and protein for food, and he believes that “brain breaks” are essential (brain breaks are times when the brain is resting, e.g. sleep time, day-dreaming time). He believes that the brain breaks are when the brain has time to make sense of all the recent experiences.


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