The Child Conversation

 

 

 

THE CHILD CONVERSATION SERIES

The following will comprise a series of articles (to follow shortly) on child development.
There will be an article on Piaget's stages of cognitive development, nl pre-operational, concrete operational and the formal operational stages. In this series of articles there will be many more on the milestones of child development, including pysical and moral development, helping kids to heal from stress and trauma and many more interesting topics on child psychology.

Parents, teachers and caregivers who seek to learn more about child development or want to understand all children with difficulties or special needs, might benefit from this series.
 

THE CHILD CONVERSATION:

VOLUNTEERING AT A CHILDREN'S HOSPITAL

I go into the children’s ward , after having gone on a journey of epic proportions through the maze of corridors in the Hospital. While looking dazed and flustered, I ask a robust and efficient-looking nurse where I can find Dawn September (pseudonym), the patient who has been assigned to me as a volunteer.  She points into a general direction down the corridor and I continue the last stretch of my pilgrim’s progress, feeling a bit more confident. I enter the ward tentatively, obliquely glancing around the ward. I look at names that appear above the beds and see her surname written above a bed tucked away in the corner. Apart from the middle of her face, a little girl of about eight is camouflaged by layers of bandages. They cover her from top to toe.  The exposed part of her face, reveals the expression of an impressionable and innocent child, accentuated by hazelnut eyes, tearful and bright.  I was told that she was burnt, but as a volunteer, I am not allowed to have more information. I start introducing myself, all the time smiling and trying to find out a bit more about her background while taking care not to interrogate. She proves to be an Afrikaans girl from Eerste Rivier near Stellenbosch. Slight and fey, she seems to be strengthened by the cards and toys brought by family and friends, surrounding her bed.  A piece of paper with a bible verse on it, is pasted above her bed. It simply reads: “The Lord is my shepherd”.

The film, Patch Adams, begins with Patch traveling in a passenger bus through a scenic valley. His thoughts are expressed to the viewer: “All of life is a home coming. All the restless hearts of the world are trying to find a way back home”. The hospital tries its utmost to be a home for the broken souls of children: the walls are brightened by  colourful  paintings and the staff seem to be friendly and supportive. They appear to really connect with the patients, offering treatment, emotional care and hope.  I hope that this girl will one day find a sanctuary in a world that might very well have little sympathy for the scars that she will have to carry with her through life.

 The hospital appears to have been influenced by the philosophies of Patch Adams, a medical student at Virginia Medical hospital, whose revolutionary and controversial perspectives were met with hostility by the medical authorities during the sixties and seventies.  He emphasized the importance of the medicinal value of laughter and compassion and stressed the benefits of creating a happy, funny, cooperative and creative hospital environment where joy is the way of life and the ultimate goal is love. During that time, the medical students were not allowed to have contact with the patients until their third year and they were taught to be cautious of transference while remembering to keep an emotional distance between themselves and the patients. Patch blatantly and overtly disregarded these rules, doing his utmost to bring lightness, humour and compassion to the patients. In the film that was made on him, one of the scenes focus on the time during his first week as a student when he joins a group of students on a tour through the hospital. The doctor in charge introduces the first patient in a super-impersonal way as: “Here we have a juvenile onset of diabetes with poor circulation and evidence of gangrene. Treatment? To stabilize the blood sugar, antibiotics, possible amputation…” Patch interrupts him and asks: “What’s her name?” An overwhelming silence follows and the doctor in charge looks impatient, irritated and slightly perplexed. Patch repeats his question: “I was just wondering what the patient’s name is.” Someone in the group says that her name is Marion. Subsequently, Marion croaks a soft and feeble “hi”. As the group moves past her, Patch spares a moment to squeeze her hand.  Patch is accused of destroying objectivity as a way of working through his own feelings of inadequacy. Patch is determined to prove his point and refuses to relinquish his perspective. In the end, his passion and academic brilliance prove to be a potent combination and he manages to win everyone’s approval and trust.

Next to Dawn September’s bed, I find myself thinking of the movie of Patch Adams and the scene in which he does a hilariously entertaining performance in the Children’s Oncology Ward of the Virginia Medical Hospital. The reasoning behind his actions are as follows: the old programmed response of a patient can be replaced by new ones if the existing conditions or normal parameters are altered.   He places a red enema ball on his nose, covers a little boy with “bee kisses” and does a funny dance while using two bed pans as clown shoes and placing another bed pan on his head. All the children excitedly jump up and down on their beds and shriek with laughter. I don’t trust myself to have the confidence and flair to pull off such a class act and instead help Dawn to decorate a book with stickers of fairies and flowers. She does seem to be encapsulated in this enchanting world of sugar plum nymphs, honeysuckle and dewdrops during the brief time that I spend with her and I decide to stick with the fairy theme for a while.   After a few visits, our theme reaches saturation point and I decide to read her a humorous book about farm animals. I remind myself of the words of the American Journal of Medicine that emphasizes the benefits of laughter: it increases the secretion of endorphins that in turn increases circulation of blood. It helps to relax the arteries of the heart and to decrease blood pressure while it has a positive effect on cardiovascular and respiratory ailments. It also increases immune system responses. Luckily, the animal-book elicits a few chuckles and giggles from Dawn and, to my astonishment, I find out that she had never seen a real sheep, cow or pig in her life before.

If Dawn had been in a first-world country, such as in the University of Chicago’s Burn Center in the USA, she would have received state-of-the-art care for burns, complex wounds, treatment for burn scars and deformities as well as expert Child Protective Service, Child Life and Social Service. At this particular burn center, child life specialists are dedicated to each child's psychological and developmental needs in order to help them to get used to the new hospital environment.

Children who suffer burn injuries, have very specific emotional and psychological needs. The pain involved in acute burn care can be excruciating and traumatic in itself. Pharmacological pain control methods often fail to control pain effectively. Non-pharmacological interventions that effectively reduce pain in both adults and children have been established. Research had been done into using a simple, easily applicable, and low-cost distraction intervention such as presenting cartoon movies. But it did not seem to be sufficiently powerful to measurably reduce burned children's distress during dressing changes.

At the University of Chicago Burn Center, the child life specialists assist children during hydrotherapy and dressing changes by providing distraction and introducing relaxation methods. Through the use of teaching dolls, medical play, and expressive therapies, child life specialists also help burn patients to come to terms with their injuries and develop a positive body image.

I look at the smooth part of Dawn’ s face and notice how her eyes twinkle as she reaches for a piece of glistening liquorice on her bedside table. My thoughts drift to Patch Adams’ menacing words:  “Looking at all the suffering in the world, I wish that God did not have to rest on the seventh day, but rather spent it on easing the misery all around us…”

THE PHYSICAL MILESTONES:

NEWBORN:

 Marked head lag, suspended – head droops and limbs hang down

6 WEEKS:

Suspended – head in line and hips semi- extended

Places hand in mouth

Moves head to side

3 MONTHS:

Lying on tummy – supports herself on forearms

Little or no head lag

Holds rattle when placed in hand

6 MONTHS:

Lying on tummy - Lifts head and chest

Sits with support

Braces shoulders and pulls up to sit

3 YEARS:

Cuts with scissors

Kicks a ball

Climbs, one foot per step

4 YEARS:

Washes hands

Builds with detail

Eats with knife and fork

Balances for 3 – 5 seconds on one foot

5 YEARS:

Copies symbols

Builds a 6 – cube step

Dresses and undresses

Walks on a narrow line

6 YEARS:

Builds a 10 – cube step

Stands, without help of hands

Walks backward along a line




THE CHILD CONVERSATION

COGNITIVE MILESTONES OF CHILDREN:.

THE PREOPERATIONAL STAGE; 2 – 7 yrs

Huge advances in mental representations. Thoughts are more flexible and efficient due to language. Sensorimotor activity is the primary cognitive structure which children name with words.

PRETEND PLAY: children practice and strengthen newly acquired representational schemes

Direction: Children start EARLY IN THE 3^RD YEAR to become detached participants: a parent doll feeds a baby doll

Realism: YOUNGER THAN 2, toddlers only use realistic objects such as a toy telephone to talk into or a cup to drink from.

AFTER AGE 2, toddlers pretend with less realistic toys – a block for a telephone receiver. They can imagine objects and events.

Complexity: 18 MONTHS: a toddler can pretend to drink from a cup, but cannot combine pouring and drinking.

Sociodramatic play AGE 2: Children combine make-believe play with other children   in SOCIODRAMATIC PLAY

Awareness:  Between 2 and 3, children distinguish make-believe from real-life

Benefits: It has an emotionally integrative function. Young children often revisit anxiety-provoking events

Imaginary play mates: Between 25 and 40 % of pre-schoolers and young children have imaginary companions. Imaginary companions were once viewed as a sign of maladjustment, but now such children are believed to display more complex and imaginative pretend play, are advanced in understanding others’ viewpoints and emotions and are more sociable with peers.

DRAWING:

18 months: children make gestures with their drawings like “rabbit goes HOP HOP”.

3 yrs:  children make their first, very simplistic drawings.

3-4 yrs: children understand the notion of boundaries and can draw their first person.

5 -6: more complex detailed drawing, because memory, perception, language and fine motor-coordination develop.

Middle childhood: for the first time they understand the concept and meaning of depth by drawing diagonal and converging lines.

Older children: organized spatial arrangement.

Cultural:

In Papua New Guinea in the Jimi Valley, older children and adolescents produce the simplest forms: stick figures

In the Western world : Adults encourage children by commenting on their pictures, modelling pictures for them and asking them to label their pics.

SYMBOLS:

Dual representation: until age 3 children have trouble distinguishing an object as an object in its own right and as a symbol.

Books: from as early as 18 mnths, children understand that pictures’ primary purpose in books are to act as symbols.

Diversity of symbols: presenting kids with a whole array of symbols – picture books, photos, drawings, make-believe and maps help them to appreciate the idea of symbols.

LIMITATIONS OF PRE-OPERATIONAL THOUGHTS:

Hierarchical classification: these children have difficulty dividing into classes and sub-classes.

Egocentic thought:  They assume that other people think, feel and perceive the same way that they do. They do not distinguish others’ viewpoint from their own. They believe in animistic thinking or that inanimate objects have thoughts, feelings, wishes and intentions. Magical thinking is also common where human qualities are assigned to physical events.

Conservation:  It refers to the fact that certain physical characteristics of objects remain the same, even when their outward appearance change eg when water is poured from one container into a shorter, wider container, changing the water’s appearance, but not its quantity. Preoperational children still think the quantity has changed.

Irreversibility They have difficulty mentally reversing a sequence, returning to the starting point.

Centration: they concentrate on one feature while neglecting others, Such as only noticing the length of the glass and not the width.

FOLLOW-UP RESEARCH ON LIMITATIONS OF PREOPERATIONAL THOUGHT:

Egocentric thinking: Even two year olds know that what they see sometimes differs from what others see.

Four-year olds adapt their speech  for two-year olds to make it more simple… perhaps these children don’t have as egocentric kind of thinking as Piaget thought..

Animistic thinking: They don’t easily ascribe life-like qualities to objects, only sometimes to animals (they might sometimes think that the head lights of a toy train are eyes).

Magical thinking: Between 4 and 8, people gain familiarity with physical events and principles and magical thinking declines.

Pre-schoolers’ notions of magic are flexible and appropriate.

They entertain the possibility that scary stories or nightmares might materialize.

Depending on the culture, magical beliefs may decline more rapidly ( such as in Jewish culture)

Illogical thinking:

When 3-year olds are given 3 instead of 6 numbers to reverse, they can do it.

Most 3-5 year olds knows what happens to sugar when dissolved in water- that it makes it heavier and continues to exist. They have cause and effect thinking.

Categorization: Piaget assumed that children’s thinking is wholly governed by appearance, but they also categorize according to non-observable traits such as choosing cold-blooded animals when asked to.