Positive environments for early child and family support. Part 7: An ideal approach to early child and family support and including the role of paediatricians

Introduction to the series

In the first part of this serialised essay I suggested hospital and clinics are not favourable environments to promote education/learning in babies and young children who have conditions that affect their development and learning in the long term. I characterised these medical environments as busy, neurotic and morbid and in the second part set them in contrast to places where, typically, babies and children can be relaxed, inquisitive, respected, secure and ready for learning. In the third part I suggested some moves from the health atmosphere and mind-set towards the education mind-set and in the fourth part offered a very personal perspective in joint working between health and education workers. In the fifth part I explored how and why early child and family support has been wrongly medicalised since the middle of the last century. In the sixth part I compared and contrasted two approaches to helping a child learn to roll – the educational approach and the health approach. In this final seventh part, I explain my ideal and include the role of paediatricians and others in it.

Positive environments for early child and family support. Part 7: An ideal approach to early child and family support and including the role of paediatricians.

At the end of Part 6 of this serialised essay I said I would use Part 7 to outline my ideal for early child and family support and include the role paediatricians would have in it. This ideal will focus only on reducing hospital visits to an absolute minimum and moving away from the medical model towards an educational model for babies and infants who need continuing support for their development and learning.

As an educationalist, anything I say about another profession, in this case paediatricians, is bound to be ill-informed to some extent. My first observation is that paediatricians are powerful people. They probably have more years of training than their colleagues in early child and family support, probably carry more authority and probably have higher pay. They might be instrumental in planning local hospital services and community services and in planning how hospital and community interact with each other in early child and family support. I have met very many paediatricians (and neonatologists) whom I admire and respect greatly.

Paediatricians might be closely involved with the life of a child and family from the start. Their concern for the child will include all aspects of the child’s health and development. They will have concern for how well the family is coping and might be able to tell them about other sources of support and information. Because they know the child so well they are in a good position to know what the child needs to keep coming back to hospital for and what needs will be better served in early education settings.

While I might wish I had paediatricians’ expertise I would not like to have their responsibilities. Many parents will be over-awed when talking to their paediatrician and very few will meet them as equals with the same social status. Paediatricians who want to enhance early child and family support will be powerful players – as will paediatricians who resist change and want to preserve an inappropriate medical model for these children and families.

In these essays I have described general hospitals as neurotic and morbid environments that we should keep children and parents out of as much as possible unless they need health investigations and treatments. Within the hospital environment there is likely to be a traditional attitude that the children we are concerned for are patients who have something wrong with them. All of this reinforces the idea that disability and developmental delay can be put right (must be put right), after which the children can take their place in society as normal children. In my view, children, families and society are impoverished by these attitudes.

In a children’s centre, nursery or school children can be seen as ‘just children’, all needing different sorts of help for their development and learning. Here they are already integrated into normal life and its everyday social structures. Parents can see how their child is treated as a ‘learner’ and this will surely help them avoid treating their child as a patient with an illness at home.

In my ideal, the paediatrician’s role can include:

Being clear with new parents about which of their child’s needs are health needs requiring on-going treatment and which are education needs.
Working to the principle, ‘We should not plan for this child to return to hospital, paediatric department or therapy unit unless it is essential for health needs.’
With each family at an appropriate time, giving information about the local educational organisations that could support their child’s development and learning.
Helping build and maintain effective links and co-operation with the local education settings that will share children with the hospital.

In this de-medicalized early child and family support all staff members in hospital units will work to reduce the number of visits the child and parents have to make to the hospital. This can be by doing home visits and/or meeting children in their education settings. When hospital appointments have to be made, it must be for a specific health need. This relies on therapists seeing some of their traditional role as more to do with education than health. This includes skilled support for children’s understanding and skills in moving, playing, communicating, etc. In my terms this is education and should best happen in the young child’s home or in an education setting.

There can be a pro-active effort to talk to parents about when their child does and does not need to be perceived as a patient. There can be a discussion about not viewing disability or developmental delay as an illness and not treating the child as a patient at home. The conversation can move on to every child’s needs for play, songs, love and bonds of attachment – even if there is a medical condition that requires treatment on hospital ward or outpatient clinic.

Very many paediatricians, therapists and others in hospital will already work in this way. There is much good practice to build on. Part of the point of this essay series is to have these principles of reducing hospital visits and de-medicalizing early child and family support acknowledged and embedded in professional protocols, in the information given to new parents and in all discussions with them.

This is the last essay of the series. The essay has evolved rather than being pre-planned so I will write a paper to summarise the seven parts.

Peter Limbrick, November 2020