Positive environments for early child and family support. Part 5: Early child and family support is often wrongly treated as a health issue

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 this fifth part I will explore how and why early child and family support has been wrongly medicalised since the middle of the last century.

Positive environments for early child and family support. Part 5: Early child and family support is often wrongly treated as a health issue

Having started my thinking that hospitals are not fit environments for early child and family support, I have come to question why this essential support is so often treated as a health issue. It seems to have come about during the last seventy years or so without any conscious thought – but with an inarguable intent to help children. In this part of my serialised essay I want to suggest:

An inappropriate situation persists by default in which babies and children remain as hospital patients long after it is necessary. I will list some of the problems this causes.
There is widespread harmful confusion about the therapy the children receive on their visits to hospital clinics and departments. I will question the validity of the word ‘therapy’.

1. The default position

Babies and young children who once needed medical attention remain as patients with regular visits to hospital for months and years when it is not justified. This feels like a default position that occurs because no one asks ‘Does this child really need to keep coming back to the hospital?’ or ‘Should this child move now from health provision to education provision for their on-going early child and family support?’

The problems that can arise from this default position include:

Child and parents are subject on a regular basis to the busy, neurotic and morbid hospital environment. This is likely to create negative mind-sets in child and parents.
The tag ‘patient’ remains attached long after it is appropriate. This has a psychological impact on child and family which might also create negative attitudes at home and even depress expectations.
Quality of life is spoiled with frequent trips to hospital that interrupt normal child and family routines, cost money, require sometimes difficult journeys and sap energy and spirit.
Parents might harbour the idea the child is going for curative treatments.
Regular hospital visits are usually for therapy. Therapists are busy people and will give each child a time slot. There cannot be flexibility here to properly accommodate the child’s sleep/eating/drinking routine, to respond to the child’s mood or to give parents the time they might need to fully understand what they are being told and to absorb the approach the therapist is using.
Busy therapists with too-large caseloads will rely on parents learning procedures they can practice with the child at home. In my experience this is extremely problematic and requires much more careful time and attention than is usually available. (Some parents have found this works best when they do not take the child with them!)
Almost inevitably, the relationship is ‘expert’ to ‘non-expert’ and will undermine some parents no matter how kind the therapists are.
Therapists rarely have whole-child concerns because they have specialist knowledge about a single aspect of child development. When the child is being helped by a number of health workers for posture, movement, communication, hearing, vision...it is left to the parent (and the child) to try to join it all together into a coherent whole.

2. Confusion about the word ‘therapy’.

The three pillars of early child and family support as I have described them (health, education, family support) do not include the word therapy. Yet, I have shown in Part 4 of this essay my high regard for paediatric therapists I have worked with. How can this be?

There is another easy default position here that we have slipped into in recent decades. We have known for a long time that therapists in hospitals can help children and adults with various medical conditions (for instance with muscles, respiration, speech). From this we have made the very wrong assumption that babies and infants who have disabilities, delayed development and other conditions that impact on development and learning need regular and long-term exposure to therapy.

In my experience, paediatric therapists offer the children in our focus two sorts of help:

The first is medical – offering skilled, practical and relevant treatment for a child’s health needs to do with muscles, joints, breathing, swallowing, etc.
The second is educational – helping a child learn to roll, sit, stand, communicate, name objects, make choices, etc.

In this there is no third category called ‘therapy’. Thinking our children need regular therapy is confused and confusing. It keeps children trapped in medical fetters, keeps them labelled as ‘patients’ as though they were ill. By the logic of this serialised essay, the educational part of the therapist’s role is best delivered in an educational setting in collective competence with a teacher or another who is trained in education.

Helping a child develop and learn and supporting parents in how to help their child develop and learn is an educational pursuit. It is best offered, depending on the age of the baby or infant, at home or in a nursery or other educational setting. With this thinking, and being aware of the downsides of hospital environments, it becomes an imperative to keep children away from hospitals – unless they have an illness that requires treatment. Childhood disability or developmental delay is not an illness.

In the next part (Part 6) of this serialised essay, I will contrast a therapy approach with an educational approach to the early skill of moving on the floor. I will describe the two ends of a spectrum knowing that most practitioners will fall somewhere between the extremes. But the account will, I hope, highlight some basic differences in approach and show the need for collaboration. In a future essay in this series I will bring the role of paediatricians into the discussion.

Peter Limbrick, September 2020

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