Posts from — February 2011

Children with gestational ages (GA) (see full Glossary) over 38 weeks and up to 40 weeks are born at term.

Pre-term or “premature” infants are those with gestational ages between 24 and to 37 weeks. Children born premature, especially 35 weeks or under, need neonatal medical assistance through specialized clinics called Neonatal Intensive Care Units or “NICUs.”

For your interest:

Children who are Born Small for Gestational Age

Children who are born at term but with low, very low or extremely low birth weight are termed “small for gestational age” or SGA.

These children show signs of slow growth during pregnancy, that is, growth retardation while in utero. Their small size (for example, length of body and small head circumference (Fig. 1) indicates that they may not have absorbed the necessary nutrientsduring pregnancy.

Figure 1. Head Circumference

Figure 2. Prenatal Nutrition Guide Checklist

Premature children, children with low birth weight, and children who are ”small for gestational age” tend to become very ill and require intensive and specialized care during their first days, weeks and sometimes, even months of life.

Some of the conditions related to premature birth and/or low birth weight may affect a child’s breathing and/or bloodflow (Fig 3). In addition to jaundice (Fig. 4), a common condition for many newborns, many pre-term and low- birth weight children end up receiving oxygen or similar intensive medical attention for brain bleeds (also known as hemorrhages).

Figure 3. Bloodflow

Figure 4. Jaundice

Children who have suffered a long period of lack of oxygen or moderate to severe brain bleeds are at high risk for developmental delays and disabilities because their brain tissue (Fig. 5) is damaged.

Figure 5. Damaged Brain Tissue

To learn about the implications of being born premature in the middle childhood years, please visit the six to 12 part of this course.

Immediately after birth, infants are measured using the Apgar scale . This measures an infant on 5 areas:

1. skin color/complexion;
2. pulse rate;
3. reflex;
4. muscle tone;
5. breathing

The test is generally done at one and five minutes after birth. The tests may be repeated later if the score is and remains low. Scores 3 and below are generally regarded as critically low, scores of 4 to 6 fairly low, and 7 to 10 generally normal. The lower the score, the higher the chance that the child will require additional medical intervention, and probably, some level of early intervention. Low Apgar scores are frequently recorded in children who are born pre-term and with low birth weight, or who are small for gestational age. These are children who are more likely to show other medical complications, including respiratory infections , jaundice, and haemorrhages or (brain bleeds).

Intervention Options

There are a number of possible intervention strategies for children who have had medical complications at birth.  They are:

Infant Development /Aboriginal Infant Development Program

Occupational Therapy

Physiotherapy

Speech Language Pathologist

Vision Consultant

Hearing Consultant

Sensory Integration

Supported Child Development/Aboriginal Supported Child Development program

To learn about the implications of having a low apgar scores in the middle childhood years, please visit the six to 12 part of this course.

Risk factors are well documented and include poverty, abuse, neglect, violence and many others.  A child exposed to these environmental risk conditions is impacted on many levels. There is a higher risk for this child to experience trauma and the degree, severity and duration of such traumatic experiences may have lasting implications. The impact of environmental risk conditions on a child’s development is complicated issue. We must look at both the risk (see full Glossary) and the protective factors (see full Glossary) for the child to better understand the impact of environmental risk conditions.

Family Protective Factors¹

These are factors that include family environment and social networks that protect, or buffer, the child from maltreatment. Examples may include:

• Nurturing parenting skills;
• Stable family relationships;
• Household rules and child monitoring;
• Parental employment;
• Adequate housing;
• Access to health care and social services;
• Caring adults outside the family who can serve as role models or mentors.

Community Protective Factors

These are factors within the child and family’s communities that support parents and take responsibility for preventing abuse.

1 Source: Violence prevention / Child maltreatment

Description

Statistics indicate that one in seven children in British Columbia is poor, making this province’s child poverty rate the highest in Canada. The difficulties faced by these children and their families include the following:

• Limited access to adequate housing;
• Frequent moving or, at times, not having a place to live, or homelessness; Limited access to healthy, nutritious meals with foods from all four food groups, and overall low-quality of life in terms of physical and mental health and well-being.

These children frequently witness their parent’s frustration at unemployment or underemployment. Parents may also deal with issues of anxiety and depression, among others.

Children living with environmental risk conditions may experience a wide range of cognitive and overall developmental delays because they do not get enough healthy food to grow and thrive (malnutrition), or because they live in conditions that are not safe or clean (non-hygienic) and that may bring illnesses or bug infestations.

People who live in poverty spend much of their income on basic living needs such as housing, food and clothing. For example, people generally spend about 34% of income on basic living needs, according to an index known as “LICO” or Low Income Cut Offs. However, a family living at or under the poverty line (see full Glossary) spends about 53%, or over half of their income on basic needs. This creates problems as it is difficult to get these needs met and there is little or no extra income for additional expenses for the child, including winter coats, new boots or recreational activities (see full Glossary).

What can be done and where one can go for help?

Unlike other “risk” conditions, poverty is related to complex social and economic factors. This is why children and families living in poverty require the help and support of provincial and federal government programs to assist them.  They have a right to adequate shelter and housing, food, clothing, and medical attention and education. These families are not alone.  Many individuals and also agencies that are non-profit continue to fight for, that is, to advocate, for the rights for children and families in Canada who are living in poverty. These agencies are known as “NGOs” or non-government organizations.

As a result of these efforts, a number of programs¹ have developed to meet the needs of children living in poverty.

To learn about the impact of poverty in the middle childhood years, please visit the six to 12 part of this course.

1 CAPC, Healthiest Baby and others

Abuse and neglect¹ (see full Glossary) may happen in different ways. It is important to consider the following:

• The type of abuse or neglect;
• The person or situation involved;
• The degree and duration of the abuse.

These factors all have an impact on the child’s development in different ways. Sexual abuse (see full Glossary) and physical abuse (see full Glossary) may cause bruises, but all abuse destroys a child’s development of trust in their world, their sense of safety and control, the way they think about themselves, their self-esteem, and their ability to explore and experience the world in a safe way.

Figure 1. Fear and anxiety

Recent brain research reports have revealed the impact of stress related to fear and anxiety (Fig. 1). Anxiety and stress cause stress.  Stress impact the body of the child. The body responds to the stress with a flood of a chemical known as cortisol. Cortisol creates a poison in the brain that shuts down, or “inhibits,”the neural pathways (Fig. 2) from growing and developing. Stress and trauma can in fact poison the brain because their effect destroys brain cells. They also affect the way the brain functions. For example, a child who survives trauma can miss some of their developmental milestones when they experience abuse and/or neglect. They may also “go back” or regress (Fig. 3) in their development.

Figure 2. Neural Pathways

Figure 3. Regress

When a child is physically, emotionally, sexually or verbally abused, they may not trust their primary caregivers and may feel unsafe around them. These children are likely to develop insecure attachment to those close to them. Children who experienced insecure attachment tend to struggle with forming healthy and loving relationships with significant others later on as adults. Children who are abused often grow up to abuse or be in abusive or unhealthy relationships.

How do we respond to child abuse/neglect?

An infant or child is dependent on their family. It is usually very difficult for children who are abused or neglected to report the problem to anyone. This is why it is important to be aware of the signs of child abuse and know what to do about it. Children may not able to express or protect themselves. For all of these reasons, it is the responsibility of society and the community to protect children from harm.

We have laws in Canada that require adults in this country to report abuse  or neglect to local authorities, generally social workers or police (911). This must be done right away, as soon as a child tells someone they are being abused or neglected.  If an adult has any reason to think that a child might be abused or neglected, this also needs to be reported right away.

When a child tells an adult about abuse, it is important to believe them. Listen openly and calmly. Reassure the child and be supportive. Tell the child that what happened is not her or his fault. Write down what the child tells you, using the child’s exact words, and contact your local police or child welfare agency

1 Sources:
Health Canada, Canadian Incidence Study of Reported Child Abuse and Neglect, Final Report, 2003.
Robin Badgley et al., Sexual Offences Against Children: Report of the Committee on Sexual Offences Against Children and Youths, Volume 1. (Ottawa: Supply and Services Canada, 1984.)
Child Abuse Blog (D. Barriere) at  www.child-abuse-effects.com/child-abuse-intervention.html

Description

Physical abuse is the deliberate use of force against a child which results or may result in bodily harm. It includes behaviours such as shaking, choking, biting, kicking, burning, poisoning, holding a child under water, or any harmful or dangerous use of restraint. Physical abuse is usually connected to punishment or confused with discipline¹.

The distinction between child discipline and abuse is often poorly defined. Cultural norms about what constitutes abuse vary widely among professionals as well as the wider public. People do not agree on what behaviors constitute abuse.

Intervention Options

The child must be protected from harm. In some cases, he or she may be removed from the home (or wherever the abuse is occurring) and taken to a temporary home, with a foster family.  The person who has been abusive is asked to leave the home and stop having contact with the child.

Taking a child away from his parents and placed in another home for a period of time is a legal process that requires proof from the courts, and it is often done by government staff (Ministry for Child and Family Development, MCFD) social workers. Social workers need to obtain this proof about the need to take the child away at that time. The court order consists of a “removal” or “restraining” order. This means that the child receives only supervised visits from one of the parents while they are in custody with a foster or “provisional” family.

At a secondary level of intervention (see full Glossary), it is important to make sure the abuse has as little impact as possible on the child’s. For example, children who have been physically abused need to have medical attention to attend to scars and fractures. In addition, they need to heal the emotional scars that this type of abuse will have left for them.

There are ways to help abused children heal; for example:

• Allow them to break the silence on the violence in their lives;
• Increase their ability to protect themselves physically and psychologically;
• Strengthen their self-esteem;
• Provide a safe and fun environment where they can have positive experiences.

Adults who find themselves in an abusive situation need to get help for themselves and for their children: It is never too late to stop family violence.

We also need to ensure that the child does not return to the abusive situation or that it does not reoccur. Treatment and intervention should be sought for the abuser as well as the entire family system as everyone is affected.

Local, provincial and national resources² are available for children and families who experience abuse and neglect.

To learn about the impact of physical abuse in the middle childhood years, please visit the six to 12 part of this course.

1 According to the National Clearinghouse on Family Violence http://www.phac-aspc.gc.ca/ncfv-cnivf/publications/rcmp-grc/fem-vioeffects-eng.php
2 see References

Emotional or psychological abuse¹ is often hidden and is hard for an outsider to detect. This means only the child can talk about this type of abuse. This is a very hard thing for a child to do because the nature of the abuse makes it difficult for the child to trust his or her own feelings. The child senses that the world is not a safe place to be, and their sense of self is a bit fragile.  Just like for children who experience other types of abuse, they have difficulty at school and learning or trying new activities. Their attention span tends to be short; they lack the confidence to try new or challenging things.

Boys and girls may differ in terms of the impact emotional or psychological abuse has on their development. For example, boys may be more physically aggressive, have temper tantrums more often, engage in fights with peers, show their frustration with destructive and impulsive behaviors, and may be either argumentative (see full Glossary) and loud or very silent and withdrawn. Girls may appear very withdrawn, passive, or may need approval for everything they do (approval seeking). Girls may also be extremely compliant, easily frustrated, overly dependent or stubborn, and may cling to adults or have physical complaints such as stomachaches or headaches.

Description

Psychological abuse, also known as emotional abuse, refers to acts that harm a child’s sense of self in a way that causes or could cause behavioral, cognitive and emotional disorders. This includes making verbal threats and put-downs forcing a child into social isolation, intimidating, exploiting, terrorizing or routinely making unreasonable demands of a child.

Intervention Options

• Protect the child and protect other children who may be involved;
• Respect the rights of the person alleged to have committed the abuse; keep information confidential and seek help for the adult;
• Cooperate with child protection agencies and possibly police.
• Children who are emotionally abused can access programs in local child and youth mental health agencies.

To learn about the impact of emotional abuse in the middle childhood years, please visit the six to 12 part of this course.

1 Reference: Child Abuse Effects Blog at http://www.child-abuse-effects.com/types-of-emotional-abuse.html

Child sexual abuse or sexual molestation (see full Glossary) may be very confusing, conflicting and painful for a child.

Children are sexual beings and some sexual exploration is normal for typical development. When a child is sexually abused or molested, the child is also exposed to sexually inappropriate information or experiences. These inappropriate experiences will have a negative effect on the child developing typical understanding of sexual behavior.

The development of a child who was experienced sexual abuse is impacted in many ways, including loss of self-esteem and self-worth.  This is why sexual abuse has an impact on trust, self-esteem, and may also result in physical injury.

Loss of trust also means the loss of normal loving and nurturing. Without these, the safety and security that make the childhood years unique are no longer there. This, in turn, results in missed opportunities to play and learn, in having fewer chances for normal growth and development and losing a sense of intimacy (see full Glossary) and control over one’s own body.

Children and people with disabilities are at higher risk for sexual abuse and exploitation. This is because both are totally dependent on the care of adults. Social myths about the value of people with disabilities and a lack of protection of children and people with disabilities make it easier for situations of abuse to go unnoticed and unreported.

Description

Sexual abuse ranges from sexual harassment (see full Glossary) to sexual activity. It includes attempted or completed sexual relations, touching or fondling genitals, exposing adult genitals, sexual exploitation, sexual harassment, and voyeurism (see full Glossary).

Though there are few or no outward symptoms, child and youth victims do suffer emotionally. These emotional effects come in varying degrees, depending on the following six factors:

o   The nature of the relationship between the victim and the offender;

o   The age of the child when the abuse began and the duration of the sexual relationship;

o   The type of sexual activity the victim is exposed to;

o   The degree of physical aggression directed at the victim;

o   The response the victim receives when she or he discloses the abuse;

o   The availability of a supportive person in the victim’s life.

Intervention Options

The first step is to contact the local child protection agency. In British Columbia, Canada, this is the Ministry of Children and Family Development.

In a situation of emergency when witnessing abuse, contact 9-1-1 and ask for police assistance.

Specific counseling and therapy services are available for children who have experienced or witnessed abuse through local organizations, including Family Services of Greater Vancouver and other agencies.

Services and therapies vary depending on what the child has experienced (e.g., different types of abuse and neglect, from sexual molestation, to issues of incest (see full Glossary), rape and other abuse/harassments situations).

To learn about the impact of sexual abuse in the middle childhood years, please visit the six to 12 part of this course.

The development of children who are neglected is impacted in a very negative way. If a child is not given proper nutrition he or she will not grow to his or her full potential. The child  may lack important nutrients to develop the brain, bones and muscles and he or she will be hungry and prone to sickness and infections. Neglect also may mean the child is not given the proper medical attention when needed, such a dental care or health care. These children may be sick more often, for longer periods of time, or do not have the regular care of a doctor. Children’s emotional needs are also neglected when they feel that they are not valued or wanted, or not loved.

A child who is neglected may spend a lot of his or her time and energy just wondering what will happen next. He or she is focused on just surviving and is not able to put energy into exploring and learning about the world. This will affect his or her cognitive and communication development.

Description

Neglect occurs when the child’s basic needs aren’t being met. Physical neglect may involve inadequate food, clothing, shelter, cleanliness, medical care and protection from harm. Emotional neglect occurs when a child’s need to feel loved, wanted, safe and worthy is not met.

Intervention Options

As the child is raised within the context of a family, it is important take the entire family system into consideration.

First remove the child from harm and get the unmet needs met. If the child is without adequate shelter find shelter the following may be of help:

• Food banks
• Clothing exchanges
• Free medical and dental care

It is important to determine if the adults in the child’s life are both willing and able to protect the child from harm and to determine if the harm from within the family or external. There may be barriers for the adults in the child’s life that may need to be addressed. Different interventions are required depending on the issues.

To learn about the impact of neglect in the middle childhood years, please visit the six to 12 part of this course.

Children who witness domestic violence or who are involved or living with family violence are just as traumatized as children who experience other forms of abuse. They experience short and long term social, emotional and behavioral problems such as post-traumatic stress disorder (PTSD), inappropriate peer interactions, developmental delay, aggression, depression and anxiety.

Description

Children living with domestic violence live with psychological maltreatment. This is defined as “the repeated pattern of behavior that conveys to the child that they are worthless, unloved, unwanted, only of value in meeting another’s needs or seriously threatened with physical or psychological violence¹.”

These children are also “terrorized.” Terrorized points at the behavior of a caregiver that threatens or is likely to physically hurt, kill, abandon or place the child or child’s loved ones or objects in  “recognizably dangerous situations.”

When children are subject to this level of violence, they experience physical and emotional impact that may end up in “trauma” (see full Glossary). This impact relates to repeated exposure to this violence is physiologically arousing, emotionally distressing and often includes trauma.

The child is often intimidated by the person who abuses and fears for his or her own safety. The child may also have feelings of fear and helplessness at watching their parent get beaten.

Violence is never a way to resolve conflicts and that the adult who abuses (man or woman) has the power in the house. Children who grow up in home environments that are violent may end up believing that violence is acceptable. These children are is often denied the opportunity to express their feelings in appropriate and supported ways.

Maltreatment also happens when the adults keep the child isolated. Adults who abuse often limit social opportunities for the spouse or children so the child is not able to develop a supportive social network.

Children in violent homes often have their health, medical and educational needs neglected.

Intervention Options

As stated with all areas of abuse, there are many variables for the child. The impact on social and emotional development is profound.

In BC there is a program specifically designed for children who witness abuse. This type of programs are community-based and provide individual and group counselling services for children who witness the abuse of a parent, most often a mother. Designed to help break the intergenerational cycle of violence against women, these programs help children cope with, and heal from, the trauma of living in an abusive situation. Support is also provided to the parent (usually the mother) who has been abused by her partner.

1 Source: Holden, 2003