Five propositions for de-medicalizing early child and family support in a radical redesign
These five propositions aim to adjust the balance between health supports and education supports in what has commonly been called early childhood intervention (ECI)
Five Propositions by Peter Limbrick, Interconnections 2021. Your comments are very welcome.
These five propositions aim to adjust the balance between health supports and education supports in what has commonly been called early childhood intervention (ECI) for babies and young children with conditions that do or might compromise their development and learning. They result from a series of seven quickly-written essays by the author published on Interconnections website during the latter part of 2020. Those essays were in response to an international discussion hosted by the ECDtf network. These five propositions are intended to encapsulate the themes of those impromptu essays.
My phrase above, ‘children with conditions that do or might compromise their development and learning’ is intended as a broad description of babies and infants commonly helped by early child and family support systems. Within this group of children we will find genetic syndromes, diagnoses of physical or mental conditions, delayed development and conditions with no diagnostic label. It is a mixed bag in which the common factor is atypical development and learning that causes significant concern to parents and/or practitioners. A more common description is ‘children with disabilities or developmental delay’, but I am trying to avoid ‘disability’ as a negative term and suspect that the word ‘delay’ might lead some parents to assume, often wrongly, the child will eventually catch up. In this paper for the sake of brevity I shall refer to ‘these children’ or ‘our children’.
The crux of my argument is that in many countries, the conditions I have described are thought of as a health issue requiring treatment in such places as hospital outpatients, paediatric clinics, therapy centres and child development centres. While medical interventions might be needed for wellbeing, pain management and even survival, I think of a baby or infant’s development and learning as equally or primarily an education issue. This education, as I am going to use the term, is a natural element in how parents around the world bring up their young child and, sooner or later, becomes also the province of nurseries and first schools. While support is allowed to remain primarily in the domain of health services, we have the problem of flavouring a child’s condition with illness, disability and dysfunction. These terms are unnecessary, unfair and inappropriate and work against young children taking the rightful place with dignity in society.
Early child and family support has three pillars; health, education and family support. My five propositions deal only with the first two of these. The text with the first proposition explains in brief why a redesign is necessary. I am hoping my five propositions have some relevance in regions and countries with low, medium and high economies.
My first proposition is that our children’s visits to hospitals and other health centres should be reduced to the absolute minimum.
- These medical environments create and perpetuate negative attitudes in our children, families, practitioners and communities.
- Hospitals are busy, neurotic and morbid places that can impact on short and long-term mental wellbeing of children and parents.
- Visits to hospital can be expensive, time consuming and disruptive of normal child and family routines.
1. Negative attitudes
Hospitals and health centres are instituted to offer treatment for illness with some expectation of cure. This is not relevant to our children. Children become patients in the eyes of parents and others and take on a dependent and powerless self-image. Children are separated from their peers with such medical terms as ‘disability’ ( ̶ a label that will never wash off) and ‘developmental delay’ (that holds the promise of catching up). I see no good reason for labelling a baby or infant as disabled. It does not help anyone. Perhaps the word is more useful for older children and adults. I see ‘intervention’ as another medical word with a flavour of authority. I would replace it with ‘help’ or ‘support’. When my family has a problem, I would much rather an outsider comes to support than intervene.
2. Neurotic and morbid environments
These are described in the first of the seven essays. Does a child going to hospital feel like I do sitting in a dentist’s chair? Parents might have similar fearful feelings. The kindness of staff members might help but some deep-seated apprehensions will persist. Our children should be kept away from hospitals as much as possible.
Regular trips to hospital can be expensive and stressful, especially with young siblings and any necessary equipment for nutrition and respiration. Appointment times almost never consider the child’s routines for sleep, food, drinks, changing and play. Everything has to be put aside to meet the hospital’s needs for time and place.
All children might need to visit a hospital for health reasons and so should our children. Also, there might be a need for some occasional visits to specialists, for example neurology and genetics. The principle is to avoid a regime of regular visits for needs other than genuine health needs.
My second proposition is that in early child and family support we think of each child as a learning child and move our mind-sets away from disability, dysfunction, etc.
We can then consider how we can support their education at home and then in their locally available education settings. I am defining ‘education’ as the acquisition from birth of new and relevant understanding and skills, whether or not there has been adult support for it. The term ‘learning child’ displaces such medical terms as ‘invalid’, ‘sick child’, ‘patient’, ‘disabled child’, ‘atypical child’ and ‘abnormal child’. Our children join all the world’s other children as learning children. Then as parents and teachers we only have to consider what support they might need for their learning ̶ whether the task is holding a spoon or managing a first musical instrument.
My third proposition is that the primary task of specialist early child and family support practitioners is to educate parents and other practitioners.
This means helping parents acquire the understanding and skills they need to bring up their child and then to similarly support staff members in the education settings into which they follow the child in an advisory capacity. This can happen while working with the child and in TAC (Team Around the Child) meetings.
My fourth proposition is that we recognise that much of what we call paediatric therapy is actually education.
In this education our babies and young children learn, as far as possible, to bond, look, listen, sit, stand, roll, creep, manipulate with hands, make choices, communicate ‘yes’ and ‘no’, recognise pictures/symbols/words, manage emotions, develop self-esteem, relate to others, empathise, make plans, etc. All these new understandings and skills build on what the child has already acquired and will endure if they are relevant to the child’s daily routines at home and/or at school. There is an invitation here for the world of education and education psychology to embrace our babies and infants to a greater extent than at present.
My fifth proposition is that all specialist practitioners in early child and family support should be considered as a coherent group in each locality’s workforce.
This group would then include teachers, paediatric therapists, psychologists, play workers, etc. A working title for this group could be ‘specialist early childhood practitioners’. While valuing the training, work and wisdom of paediatric therapists, I would drop the confusing and ill-defined word ‘therapy’. A major task of these practitioners must be to support parents and nursery/school staff members. Because these specialists are expensive to employ, there should be an intermediate workforce of home support workers, nursery assistants, etc. all working with children on a more regular basis than specialists can, but working under their guidance. Training for this workforce must cover, at appropriate levels, the science of how babies and young children learn. This training is an essential part of the redesign.
While recognising the good work that happens in hospitals and health centres around the world, and acknowledging the high levels of practitioners’ caring and competence, I believe placing early child and family support in these institutions has happened by default with no conscious decision making. I also believe that the work is unhelpfully flavoured now with negative medical terms about deficiencies while education terms tend to be about growth. I see a great need and great opportunities now for a radical redesign.
The Seven Essays
Positive environments for early child and family support. Part 1: Hospitals are often neurotic environments and are therefore to be avoided
Positive environments for early child and family support. Part 2: Favourable environments for education and learning
Positive environments for early child and family support. Part 3: Implications for early child and family support that is hospital-based
Positive environments for early child and family support. Part 4: A personal perspective on collaboration between health and education workers
Positive environments for early child and family support. Part 5: Early child and family support is often wrongly treated as a health issue
Positive environments for early child and family support. Part 6: contrasting a therapy approach with an educational approach to the early skill of moving on the floor
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
Two books have anticipated these five propositions to an extent:
Bringing up babies and young children who have very special needs: A 21st century guide for parents, students and new practitioners. (Peter Limbrick, 2019)
Early Childhood Intervention without Tears: Improved support for infants with disabilities and their families. (Peter Limbrick, 2016)