Saniyah Othman, Your Child Zero to Five (1975)  continued                          p. 2 of 2

Chapter 4.            The Child from First Year to Three Years

          The introductory message is that although the child looks stronger at this age it still needs a lot of care and attention. Many significant events in his development take place here:

-         Weaning

-         Teething

-         Walking

-         Talking

-         Toilet training

          The physical and psychological effects of these landmarks in the child’s development are very important. The child during this period is very pleased with its new abilities. The child wants to discover the “world” and by doing so forms its self-concept. (The traditional concept of the ideal child is the good obedient child, who should be protected by being prevented from moving, doing, or exploring.) The role of the mother is great here because she is still very close to the child and can take the opportunity presented by feeding, bathing and toilet training to teach the child many things: a sense of time (by giving regular meals and baths), a love of learning (by reward and encouragement not fear and punishment) and a feeling of security (by encouraging self expression).

Feeding the Child

          Proper feeding is important for growth. The idea of a balanced diet with a high protein content is introduced. Fish, which is abundant in a lot of Arab countries, is encouraged (there is a traditional belief that fish and milk leads to being crazy and there­fore fish is avoided). The idea of regular meals is encouraged so that the child does not live on snacks such as biscuits, sweets and very sweet drinks.

Training the Child in Self Feeding

          In middle-class families children are spoon-fed some­times till as late as seven years. Therefore mothers are encouraged to let the child feed himself as a form of independence training that is eventually healthier than feeding or force feeding or pampering into feeding, all of which are very common feeding procedures. Pointers that could help the mother in this situation are given.

Toilet Training

What does it mean? It implies sphincter and bowel control as well as teaching the child to use the right place. Toilet training depends on the child’s reaching a level of muscular maturity and mental development (understanding verbal communication). This maturity is only possible beginning around the second year and toilet training should be completed around the fourth year. With the two above factors established, reward becomes a more effective method than punishment. Traditionally, common practices are severe. They often vary from leaving the child on the potty for hours or spanking and, in extreme cases, threats (to boys particularly), to burn their organs with a lighted match. Night cleanliness is discussed and related to the extreme anxiety produced during the day by anger and shouting. Helpful hints for training are included.

Establishing Good Habits:

          The idea of establishing good habits in early childhood is stressed (vs. the traditional concept of “the child will grow up and learn’’). Good habits in cleanliness (bathing, washing hands before and after meals, and taking care of teeth) and in sleep (since traditionally there is no bedtime for children the establishment of a routine bedtime and bedtime problems) are discussed.

Safety

-         Medical - Vaccinations and the idea of booster shots are stressed

-         At home - Since the child will now be more mobile, how to make the home safe. This section pays special attention to the most common accidents in Arab countries, namely gasoline poisoning, bottled gas poisoning, and falls.

Stages of Development

1)     From 12 - 24 months

2)     From 2 - 3 years

i)        physical growth

ii)      abilities and what can be done to develop them. Special stress on:

(a)  Freedom of movement in safe surroundings

(b)  Language development

(c)  Play

1.      Toys for each age level

2.      Importance of individual play

The Importance of Developing Language Ability in Relation to Intellectual Growth

1)     What is language ability: function of physical develop­ment plus learning

2)     How language develops

3)     How to encourage language development

4)     Common ways that usually hinder language development

5)     Some problems of speech

i)        organic causes

ii)      psychological causes

iii)     stuttering

Common Problems of this Period

-         Fear - natural fears; learned fears. The widespread method of using fear to control the child’s behavior is discussed. The harmful effects are pointed out as well as the fact that natural fears should be explained and the child helped out of them. The main idea being that fear hinders learning.

-         Jealousy (sibling rivalry). Discusses causes and how some parents encourage rivalry without meaning to, and sometimes on purpose. For example, the parents who voice and carry out an active preference for the boy child over the girl child.

-         Appetite troubles: Why and what to do. Examines the misconception that obesity is associated with health and excessive feeding with love. Explains that obesity is often an indication of malnutrition.

-         Enuresis: Establishing the fact that before the age of five, it is not abnormal, and explaining how very strict toilet training with threats can lead to it.

-         Playing with sexual organs: clearing misconception that any exploration or even touching organs implies that the habit of masturbation is established.

Chapter 5.            The Child Between Three and Five

          The child after three has all the abilities that allow awareness of himself and others. The child can now explore and communicate, and the process of accumulating knowledge is accelerated.

          Arabs are aware of this change in abilities but often have overly high expectations of what the child should be capable of. This is discussed in this chapter. It is explained that expecting too much from a child all of a sudden may interfere with growth. For instance a three year old child can talk but is not yet able to draw logical conclusions all the time. It can hold a pencil and scribble and perhaps draw but is not yet able to write. The child’s attention span has increased but at three he cannot sit through the long hours of regular school. Expecting more of a child than its physical abilities permit can be psychologically and physically damaging.

          Learning and play are discussed, as well as methods of socialization. Specific methods common in Arab culture, such as verbal threatening and mockery, are discouraged.

Food and Food Habits are very briefly discussed just as a reminder that the child is now feeding himself and has joined family meals.

Play is discussed at length here, since play in Arab countries, as in all other countries in the world, has been traditionally associated with childhood and dismissed as not being important. Traditionally, the ideal child is the inactive obedient child who doesn’t like to play. Therefore, the following benefits of play are examined:

-         the importance of play for both physical and mental growth

-         play as an opportunity for learning

-         play as an opportunity for discovery and creativity

-         play and social learning

-         providing the child with the opportunity to play safely inside and outside the house

          Some examples are given of educational games that can be done at home from simple things in the house, such as classification games, drawing and painting, collecting items, dough and plastic dough, etc.

Learning and School

          The traditional concept is that learning only takes place in formal education. This section discusses what is learning. What does the child learn during the preschool years? How is this related to formal school education? How is it related to the future personality of the child? The importance of making mistakes (something intolerable in Arab countries) is discussed as part of the process of learning.

          What is a nursery school? What are some of the important qualities to look for in a good nursery? What is the difference between regular school and nursery school?

Stages of Development:

1)     Physical growth

2)     The child’s abilities. What can he do?

3)     His needs:

i)        At the age of three

ii)      At the age of four

iii)     At the age of five

Children’s Questions

          This is discussed because of its importance during this age period, where the child has a command of language and is trying to explore and understand the environment, people, and himself. At the age of four a child is questioning because he really is trying to understand. The mother’s attitude is very important to the development of the child at this stage. Traditionally, the child is either scolded for asking because it is a “shame’’ (especially questions about sex differences, birth, etc.), or questions are ignored because parents think the child cannot possibly understand. Many phenomena about which the child asks are given the routine answer, that ‘‘God’’ has determined that this is the way things are (especially in cases of ignorance on the mother’s part).

          The effect of discouraging questions could be to create anxiety as well as to discourage the child from thinking and asking and learning.

          It is recommended that parents answer their children’s questions immediately in short simple language. Parents are encouraged to say “I don’t know, let us find out about it” when they themselves are unsure about the answer. Questions about nature, God, sex and death are discussed according to the common answers we found by interviewing mothers.

Common Problems during this Period

          Training and ‘bringing up” the child is discussed here with specific reference to predominant methods of socialization found in Arab countries. The ideal child has been considered to be the obedient child, burdened with high expectations. After three, the child is expected to be a little adult. His mistakes are a shame to us. His needs and perspectives are ignored. In traditional society this ideal is extreme and is achieved by punishment and disapproval. Some parents, wishing to be modern, think that they should allow the child to do whatever he wants to do and try to satisfy every need and whim to the point of spoiling.

          To bring up a child involves training, and this implies learning good habits and proper behavior. Punishment and reward are necessary for learning, but they are more effective if they are understood by the child. The ultimate aim should be to build the child’s character, not temporarily control his behavior.

          It is good for parents to remember that the child is anxious to grow up and be like adults, and therefore is highly motivated to learn. Children also learn by observation and imitation, therefore the parents’ own behavior is the closest model for their children.

          The harmful effects of severe punishment (especially beating), threats (especially those that are not carried out), and instilling fear, either of imaginary figures (ghouls, etc.) or real people (doctor, injection, etc.), are discussed. Also discouraged are mockery and belittling, two common ways of treating children, handicapped people or any unprivileged person.

Mental Retardation

          Normal individual differences are discussed and parents are exhorted not to expect all children to be the same. An effort is made to clear misconceptions on the following:

-         The difference between mental illness and mental retardation

-         Causes of mental retardation

-         Recognition of mental retardation

-         Individual differences between the mentally retarded

(The following three chapters are included as reference chapters for the mother who wants to know more about specific problems that have sometimes been referred to in the earlier chapters. They are:

-         Nutrition and the states of malnutrition

-         First Aid

-         Children’s Diseases)

Chapter 6.            Nutrition and Different States of Malnutrition

Nutrition and Malnutrition

          In this chapter an effort is made to show the difference between eating to satisfy hunger and enjoy the taste, and proper nutrition to satisfy the different needs and functions of the body. The idea is presented that the kind of food and the quantity of food eaten are both important.

1)     What are the functions of food

2)     Nutrition and the pre-school child (birth - 5)

i)        Importance of Pregnant Mother’s diet; spacing children is discussed in relation to both the health of the mother and the child.

ii)      The importance of nutrition (especially protein) to both physical and mental development.

iii)     The way to determine the normal growth of the child is to compare his height and weight progressively, that is in relation to himself, and not in relation to the neighbor’s child.

Basic Elements of a Good Diet

          All examples are from local foods with special emphasis on cheap, high protein, mixed diets. Suggestions utilize foods already found in traditional cooking such as lentil soup or vegetables stews, served with rice. The function of every element is discussed as well as where each is found:

-         Proteins

-         Carbohydrates and sugars

-         Fats

-         Vitamins (A, B, B Complex, C, D)

-         Minerals (iron, calcium, and iodine

-         Water (necessary, but must be safe)

Pointers to protect against malnutrition of children

-         Breastfeeding

-         Supplementary feeding

-         Gradual weaning

-         Mixed diets for children

-         Avoiding use of sugar. How it can be harmful.

-         Non-foods: colas and teas etc., harmful to health and teeth, also expensive.

Conditions of Malnutrition found in Arab countries

          The selection of nutrition-related diseases was based on WHO Reports for the Arab region.

          Malnutrition is the result of inadequacies in both quantity and quality of the basic elements of food. The most common form of malnutrition is called PCM (protein-caloric malnutrition) and results in retardation of general growth. It is the result of a combination of causes and makes the child even more prone to disease, especially diarrhea. This in turn leads to more severe malnutrition. Some of the common causes are:

-         Not getting enough breast milk (which is a complete reference protein) or very early weaning.

-         Misuse of artificial feeding: the misuse of the bottle and the incorrect choice of milk (especially in quantity. Often the same prescribed combination of milk and water for a two-month-old baby is given until the child is ten months old).

-         Lack of protein in diet

-         Intestinal parasites (most common in Arab countries is Giardia) that lead to continual diarrheas and lack of absorption of nutrients.

-         Recurrent infections of the respiratory tract.

Some Malnutrition Diseases

-         Kwashiorkor

-         Merasmus

-         Anemia

-         Goitre

-         Avitaminoses

-         Rickets

These are discussed as to

-         cause

-         symptoms

-         role of the mother, especially preventive

Chapter 7.            First Aid

          Reports on the most common causes of children’s accidents. In the Arab countries these are burns, gasoline, poisons (used for house cleaning and stored in bottles), and falls. The outline includes:

-        Wounds

-        Burns

-        Falls

-        Foreign Objects in eye, ear, nose, swallowed

-        Poisoning

-        Convulsions

-        Suffocation

-        Insect Bites

-        Animal Bites (dogs especially).

-         What to do or not do at home and when to take the child to the nearest hospital or health unit.

Chapter 8:            Children’s Diseases

          A brief introductory note emphasizing that the following discussion on diseases is to familiarize parents with children’s diseases in Arab countries in order to encourage them to recognize symptoms and seek doctors’ help. The following is underlined: “In no way is it a substitute for the doctor.”

The Sick Child

          Some common symptoms that indicate that the child is not well. These should indicate to the mother that she should take the child’s temperature, not just feel his hand or forehead.

What does a rise in temperature mean?

How do you take a temperature?

          What is a thermometer? How to use it? How do you read it? (Centigrade system is used.) What to do if you find the child has a temperature.

The right ways of using prescribed medicines

-         Stress given to following doctor’s prescriptions on use of drug.

-         Modern drugs may work in seemingly irrational ways. For example, the doctor may prescribe a medicine to be taken in the mouth for an ear infection.

-         For how long.

-         For the patient, not others such as brothers or sisters.

          All children’s diseases are discussed in the same way on a separate page:

1)     Name of disease: (whether it could be avoided by vaccination)

2)     Incubation Period (to instill the idea that diseases are caused by germs and not by envy, evil eye, or superpower)

3)     Symptoms

4)     Role of mother

i)        preventive when possible

ii)      to take the child to visit the doctor or health unit

iii)     to take care of sick child

          Common misconceptions are discussed where possible. For example, infected tonsils are not caused by high pillows and cured by “pushing up.” Hepatitis is never cured by the use of yellow blankets. Convulsions will not be cured by putting scissors or knives over the baby’ s head.

          The diseases are:

Contagious Diseases

1)     Small Pox

2)     Chicken pox

3)     Measles

4)     German Measles

5)     Whooping Cough

6)     Mumps

7)     Diphtheria

8)     Polio

9)     Hepatitis

10) Cholera

11) Enclystoma

12) Tetanus

13) Bilharzia

14) Malaria

15) Tuberculosis

16) Meningitis

17) Scarlet Fever

18) Rheumatic Fever

Respiratory Tract Diseases

1)     Common cold

2)     Tonsillitis

3)     Bronchitis

4)     Pneumonia

5)     Sinusitis

6)     Influenza

Intestinal Diseases

1)     Diarrhea

2)     Constipation

3)     Vomiting

4)     Dysentery

5)     Typhoid and Para-typhoid

6)     Worms

i)        Tapeworm

ii)      Ascaris

iii)     Pinworms

Organ Infection

1)     Eye

i)        Trachoma

ii)      Conjunctivitis

iii)     Styes

2)     Ear Infections - inner ear, outside ear

3)     Mouth (thrush and other diseases)

4)     Urinary Tract Infections

5)     Hernias

Skin Diseases

1)     Heat Rash

2)     Diaper Rash

3)     Scabies

Lice

Allergies

1)     What is an allergy

2)     Most common in pre-school children

i)        Urticaria

ii)      Eczema

iii)     Asthma



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