Childhood
Content:
Objectives:
- To be aware of the physical cognitive social and emotional developmental milestones in early and middle childhood
- Be able to identify any red flags in development
- Show an understanding of what other questions to ask or things to observe if a developmental delay is identified
- Identify if bullying if present and offer help when needed
Developmental tasks vs Developmental milestones
Developmental tasks are overarching goals or themes that should be completed upon departure of a age period
Developmental milestones are specific things that often emerge upon arriving at an age or age period eg flipping from back to belly in childhood
Developmental tasks
In middle childhood the child should have achieved:
- School adjustment and academic relationships
- Peer relationships
- Rule governed behaviour
Physical development:
- Physical growth (balanced diet is important!!!)
- Primary tooth loss between 6-12 years
- Puberty onset girls 10-14 boys 12-16
- Sleep is extremely highly important for good growth and development
Motor development:
Ages 6-7:
- Gross motor skills: hop jump climb bike (if a kid doesnt have a bike they wont learn to bike)
- Fine motor skills: tie shoelaces, brush teeth, wash selves, and use eating implements. Ages 8-12:
- Develop balance coordination and strength
Cognitive development:
Key achievements:
- Theory of mind (4 YEARS (AND BEYOND))
- the understanding that others have different mental states from you, EG understanding that people can be scared of something you arent. Marble experiment
- While simple applications of theory of mind can be present from a young age more complex applications are difficult and can be unachieved even in adulthood
- Inhibition
- Ability to stop a learned or preferred behaviour for one that is more appropriate response. Example of this is shouting in here in hide and seek when wondering where the child is
- Deception
- Just be able to present false information
- Categorisation
- overgeneral or overspecific, if they only see big brown dogs they might struggle to name black poodles
- Conservation 6-11 yrs (this can be altered/ unrelianable)
- the ability to understand that an amount of something changes even when it can look bigger (taller glass)
- also if there are 2 rows of coins and one is more spread out a child may say the spread out one has more
- A study showed if a naughty teddy altered the rows or items the child reported no difference upon alteration
- Episodic memory (2.5yrs and beyond)
- 3-4 yrs is often the earliest memories
- Called infantile amnesia
Emotional Development
- Extending emotional literacy
- Recognise broader range of emotions
- Understand bittersweet emotions
- Emotion regulation
- Calming and soothing self
- Empathy
- Socially sanctioned deception
- saying thank you for this present when the child might not like it
- Self reflection and insight (may need help to achieve)
- understand that what they do may not be perceived as good for example when they did it to be good
Social development
- Formation of coherent self concept (see below)
- Major developments in peer relations
- Separation of family in exchange for peers
- Morality
- Shades of grey and moral development
- Increased independence
- Learning to cooperate
- Social justice
- what is fair and what is not
Social development: Language
- In middle childhood, children can use long and complex sentences
- Understand other points of view and show that they agree or disagree
- Keep a conversation going by giving reasons and explaining choices
- Start a converation with adults and children they dont know
- Understand and use passive sentences
- Clarity of speech improves
- Sentence length and complexity increases
- Ability to elaborate on responses improves
Self concept
- Self concept - description and understanding of self using internal and external characteristics
- Influenced by cognitive development, exposure to experiences and feedback from parents, teachers, and peers
- Cultural influences an seld concept
- Western vs eastern
- “I am a wonderful and very smart person” (personal reference)
- I’m my mom and dad’s child, my grandma and grandpa’s grandson” (social reference)
- Self esteem - evaluative judgements of self
- This is influenced by system that one grows up in
| 4-8 Years | 8-11 Years |
|---|---|
| Singular and concrete attributes and comparisons | - percieved personality characteristics and psychological qualities rather than physical appearance - self descriptions more abstract (yellow hair vs smart) - more complex and differentiated (able to recognise stregths and weaknesses) |
| “i’m a boy”, “I have yellow hair”, “I’m bigger than my baby sister" | "I’m funny”, “I like to help people”, “I’m good at reading”, : Im better at him in reading but he is better at maths |
Self concept: Low self esteem
Children and young people with high self-esteem often:
- Have a positive image of themselves
- Are confident
- Can make friends easily and are not anxious with new people
- Can play in groups or on their own
- Will try and solve problems on their own, but if not able to will ask for help
- Can be proud of their achievements
- Can admit mistakes and learn from them
- Will try new things and adapt to change. Children and young people with low self-esteem often:
- Have a negative image of themselves, they might feel bad, ugly, unlikeable or stupid
- Lack confidence
- Find it hard to make and keep friendships, and may feel victimised by others
- Feel lonely and isolated
- Tend to avoid new things and find change hard
- Can’t deal well with failure.
- Tend to put themselves down and might say things like “I’m stupid” or “I can’t do that”
- Are not proud of what they achieve and always think they could have done better.
- Are constantly comparing themselves to their peers in a negative way.
Peer Relations and Bullying
Healthy peer relations = empathy, helping behaviour, social and emotional growth, sense of belonging
Bullying is a behaviour that includes
- Intentional act of aggression with the objective of causing physical, psychological, or emotional stress to another
- Disproportionate distribution of power, with the stronger individual or group abusing the weaker one
- such behaviour repeating over time
Bullying can be :
- Physical
- verbal
- social
- cyber
Characteristics of childhood bullying
Physicians role in bullying
The physicians role is to assess bullying
- Normalise and check in
- Validate and encourage elaboration
- Explore additional support or resources
- additionally:
- Physician should encourage parents to share any concerns about child’s development or behavior
- Ask for examples, or a description of a recent occurrence (to validate if it is an actual example of the reported behaviour)
- Assess broadly and consider system child functioning within
- Refer for specialist ax & tx
- Effective early identification of developmental delays and timely early intervention can positively alter a child’s long-term trajectory
- Physician should encourage parents to share any concerns about child’s development or behavior
some children are at a higher risk of being a victim and should be screened carefully. A child is more at risk if they are/have: disabled, depressed, moved recently, learning or behavioural issues, headaches, abdominal pain, sleep difficulties, or bedwetting.
Ax possibility of bullying?????????
Consider possibility of bullying when children with chronic conditions that were stable begin deteriorating for unexplained reasons or when children become non-adherent to medication regimens.
Clinical reccomendations: