Consequences of Stress on a Child's Development

I had a child in a class a few years back who was the sweetest boy. He was smart but a bit of a loner, he stood apart from his classmates and never really got too close to anyone. He had model behavior and did his work meticulously. At first glance, he seemed pretty normal-he was a little smaller than his classmates but appeared healthy. However, after getting to know him you would see that there was something a little off with his emotional development. He was emotionally young for his age and could be extremely clingy once he began to reach out. He would flinch if you patted his shoulder without warning and if anyone raised their voice he would cower. He shied away from the more aggressive boys and would sometimes come to school just completely shut-down and blank. Unfortunately, his behavior was most likely from the violence he witnessed at home. Child Protective Services became involved and he was removed from the unhealthy situation. He returned to school after being placed in the home of his grandparents and after a rough, emotionally stressing transition he began to blossom! This is one story about a child who was fortunate to receive support and be removed from a stressful situation

Witnessing violence is just one of the many stressors that impact a child’s development. Other stressors include war, poverty, racism, natural disasters, isolation, noise, chaos, disease and environmental pollution. Stressors like these can impact a child’s physical, cognitive, and psychosocial development. Although some children are lucky to receive supports, many worldwide are not although agencies (such as UNICEF and WHO) work to provide supports.

Nicaragua is one of the poorest nations in Latin America-about 45% of its population lives below poverty level (most of the poverty is found in rural areas). This impacts children and their development in a few ways. Physical development is affected as many of the children living in poverty do not receive adequate nutrition, in Nicaragua 10% of children under 5 are severely underweight and 20% have stunted growth (Kathyei, 2009). Psychosocially and cognitively, development is affected as many poor Nicaraguan children work to help support their families. Some of the reasons that Nicaragua has such high poverty levels are stressors mentioned above: Nicaragua’s civil war from 1980-1990 and natural disasters such as hurricanes, notably Hurricane Mitch in 1998 and Hurricane Felix in 2007 (IFAD) contributed to the country’s poverty levels. In addition to impacting development, many children in Nicaragua do not attend school and if they do they often do not go further than 5^th grade (Kathyei, 2009).

Some of the things that are being done to help reduce these stressors include some programs sponsored by the government. One such program is designed to ‘provide free meals, school supplies and transportation for primary school-age children” (Kathyei, 2009). Other supports include UNICEF, who has sent aide and supplies (aimed to help provide clean water, sanitation and education) to Nicaragua after hurricanes. Hopefully these supports will help minimize the harm from the stressors Nicaragua’s children face!

References:

Kathyei. (2009, May 4). Increasing poverty in Nicaragua and its effect on Education. Empowerment International. Retrieved from: http://empowermentinternational.org/2009/05/04/increasing-poverty-in-nicaragua-and-its-effect-on-education/.

IFAD. (2011). Rural Poverty in Nicaragua. Rural Poverty Portal. Retrieved from: http://www.ruralpovertyportal.org/web/guest/country/home/tags/nicaragua

UNICEF. (2007, September 6). UNICEF emergency supplies target water, sanitation and education in Nicaragua. UNICEF. Retrieved from: http://www.unicef.org/infobycountry/media_40801.html

Child Development and Public Health

Breastfeeding is a mother’s personal choice that is influenced by many factors. I had made the decision to breastfeed my son before his birth-I was encouraged by doctors, literature, and my family. I made this choice primarily because I knew it would benefit his health-breastmilk is the best nutrition for the first 6 months of life, it provides nutrients, vitamins, and the baby receives antibodies from its mother that help promote immune system development. What I did not know was that breastfeeding sounds a lot easier than it sounds! At first it was extremely painful (I considered giving up) and then when I returned to work I met with the challenge of pumping milk-but still I continued on, determined to breastfeed my son for at least one year. I felt that the benefits outweighed any of my personal discomfort and I found breastfeeding is a very rewarding bonding experience (in fact, my son is not yet fully weaned and I am actually saddened by the thought that soon he will be!).

However, not all mothers can breastfeed and not all mothers choose to breastfeed. Whether for personal of medical reasons, the mother’s choice should be respected. Breastfeeding was a personal choice and I am a strong advocate for breastfeeding and its importance early on.

Research shows that it is extremely beneficial for the mother to breastfeed their infant within the first hour after birth, exclusive breastfeeding is recommended for the first 6 months, and then continued breastfeeding is suggested until the age of 2 (UNICEF, November 2009). Breastfeeding can not only foster healthy development but can prevent malnutrition and possibly death. While I was well-informed and encouraged to breastfeed my son, many mothers in other parts of the world are not. I wanted to share what I found because I thought that it was extremely interesting and shows how public health impacts development.

In Cambodia, early initiation of breastfeeding and breastfeeding itself has only been recently encouraged. Cambodia has high levels of child malnutrition and infant mortality-in 2000, 45% of children under the age of 5 were malnourished (PRB 2003). Also in 2000, only 11% of infants 0-5 months old were exclusively breastfed (although others were breastfed, they were also given water and/or other liquids, which is not recommended and can actually be harmful for the baby).

One of the reasons that this occurred was because women were not being informed of the importance of exclusive breastfeeding and the benefits of breastfeeding in general were not known. It is also suggested that mothers may have been under the impression that formula was more beneficial and were not encouraged to breastfeed by their doctors before or after giving birth. It was also a common occurrence that babies were given water during hotter times and that they were introduced to solid foods earlier than recommended (PRB 2003). All of these factors are harmful for an infant’s development-infants need the nutrients provided in breastmilk to grow and weaning them too early may have a negative impact on their health and/or development.

Fortunately, a public health initiative was launched in Cambodia to help increase awareness and knowledge about breastfeeding. This initiative included “support to health systems and community-based programs” as well as the use of media (Conkle, 2007). Training health care workers in the importance and techniques of breastfeeding allowed them to pass the knowledge on to mothers. The Baby-Friendly Hospital Initiative was also launched in Cambodia by WHO and UNICEF. This initiative is designed to make hospitals “baby-friendly,” meaning that the hospital “does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented 10 specific steps to support successful breastfeeding” (UNICEF, August 2009). Community-based programs include mother-support groups and work with NGOs and other community based programs to increase the knowledge and support network, especially in rural areas. Lastly, the media campaign included TV and radio commercials and songs emphasizing the importance and benefits of breastfeeding (Conkle, 2007).

With this public health initiative, the rate of exclusive breastfeeding in Cambodia increased-to 60% in 2005-and infant mortality rates decreased. I found this to be amazing-I love this story of how a public health initiative can bring such a positive change! Public health is related to child development in many ways, this is just one example. This shows although breastfeeding is a mother’s personal choice her choice is influenced by the context in which she lives. As a professional, this serves as a reminder of the power of knowledge-we are resources for the parents and families we work with and can help relay information to help them make informed decisions.  

References:

Conkle, Joel. (2007, August). Exclusive Breastfeeding in Cambodia: An Analysis of Improvement from 2000-2005. Retrieved from: http://www.scribd.com/doc/969796/Exclusive-Breastfeeding-in-Cambodia-An-Analysis-of-Improvement-from-2000-to-2005.

Staff Members from Department of Planning and Health Information, Ministry of Health, the Reproductive Health Association of Cambodia, and Population Reference Bureau.(2003, January). Cambodia Falls Short of Early Childhood Nutrition Goals. Population Reference Bureau. Retrieved from: http://www.prb.org/Articles/2003/CambodiaFallsShortofEarlyChildhoodNutritionGoals.aspx.

UNICEF. (2005). Statistics By Area/Child Nutrition. ChildInfo: Monitoring the Situation of Children and Women. Retrieved from: http://www.childinfo.org/breastfeeding_cambodia.html.

UNICEF. (2008, April 1). Mother Support Group Network promotes exclusive breastfeeding in Cambodia. Cambodia. Retrieved from: http://www.unicef.org/infobycountry/cambodia_43437.html.

UNICEF. (2009, August 12). The Baby-Friendly Hospital Initiative. Nutrition. Retrieved from: http://www.unicef.org/nutrition/index_24806.html.

UNICEF. (2009, November). The Challenge. ChildInfo: Monitoring the Situation of Children and Women. Retrieved from: http://www.childinfo.org/breastfeeding_challenge.html.

Vachon, Michelle and Naren, Kuch. (2002, August 5-6). Mothers Duped by Milk Products, Officials Say. The Cambodia Daily. Retrieved from: http://www.camnet.com.kh/cambodia.daily/selected_features/milk.htm.

Childbirth

“Childbirth is more admirable than conquest, more amazing than self-defense, and as courageous as either one.”-Gloria Steinem 

My son Jack was born one year ago, at 6:45 am, weighing 7 lbs. 4 oz., 20.5 in. long. The experience I had giving birth was one that I will never forget. I had a high-risk pregnancy and so my labor was induced after the due date came and went. I went to the hospital in the afternoon, I really did not know what to expect and so I was very nervous (plus I am terrified of needles!). I was given Pitocin to induce the labor and contractions started but after a while my water had not broken so the doctor broke it. A few hours later, I was given an epidural and the labor really began. Shortly after, the baby went into distress-this was the scariest part. I did not know what was happening and it felt like I was dying. The doctors rushed in and gave me something to slow the labor done. They put a monitor on the baby and luckily he stabilized. Hours later, the epidural wore off and I was told that I was too far in to receive another. Finally, it was time to push! Even without the epidural, the pain was not too unbearable; I was more scared than anything! After pushing for two hours, the baby began to come and I received an episiotomy…and finally, after over 18 hours of labor, baby Jack was born November 5, 2009! He was given to me almost immediately and I nursed him right away…holding him erased everything that I had been through!

In Central America today, more childbirths are probably in a somewhat similar setting to that of my son’s-more and more women are giving birth in medical facilities and with skilled birth attendants present. In Nicaragua, infant mortality rates are dropping and more mothers are seeking prenatal care (WHO 2010). However, this is not always the case-indigenous women are less likely to seek care at a medical facility and are more likely to give birth at home and without seeking prenatal care (Gallagher 2010). Traditionally, Central American women give birth at home, in a “crouching position. The woman supports herself with a rope strung from the rafters or in the arms of her husband. Instead of painkillers, the woman usually puts her braided hair between her teeth and bites down on it. Traditional birthing attendants and other family members are also usually present” (Gallagher 2010). One reason that some women do not give birth in a medical facility is because their traditions and/or language may not be respected.

So two different birthing experiences- hospital or home, medical or traditional; neither is right, and neither is wrong. The question really is what is best for baby and mother? In doing this research, I found that a number of indigenous women die in or after childbirth because they are afraid to seek medical attention-it is not necessarily that they are not giving the “right” kind of birth but because they may need medical help. To me, this is really a difficult situation: if the medical procedure goes against cultural or traditional values and practices then many women may turn it down even if it is life saving-is it possible for cultural values to be respected when it comes to medical practices? There are some attempts to solve this problem: in Guatemala, they are “piloting an alternative method of maternal healthcare, run by the state authorities: Casas Maternas (‘maternal houses’)" (Gallagher 2010). Here, women from rural areas can come to stay with their spouse before giving birth. In these maternal houses, women can receive medical care and the pregnant woman's family can stay with her to make her feel more comfortable. Another option is a traditional birth attendant- a midwife who can, in some cases, help bridge the gap between culture and medicine. 

I found all of this to be very eye-opening and fascinating. Childbirth is something that occurs everywhere in the world although it does not always occur in the same manner. The care a baby receives both before and after birth can affect its development-for example, children with malnourished mothers may developmentally be at a disadvantage before birth and may not have the adequate nutrition to continue healthy growth after birth. I am fortunate that I was able to receive the prenatal care and care during birth that I did, without this my son may not have turned out as healthy as he did.  Hopefully, infant mortality rates worldwide will continue to decrease and births-no matter what form-will continue to grow safer for both mother and baby.

References:

Gallagher, Cheryl. (2010, September 16). Indigenous mothers-to-be: not mothers enough? New Internationalist. Retrieved from: http://www.newint.org/features/web-exclusive/2010/09/16/indigenous-mothers/

Health, Poverty, Action. (2010, May 5). Traditional Birthing Practices. Retrieved from: http://www.healthunlimited.org/Policy/MaternalandChildHealth/TraditionalBirthingPractices

World Health Organization. (2010). Department of Making Pregnancy Safer: Guatemala Country Profile. Retrieved from: http://www.who.int/making_pregnancy_safer/countries/gut.pdf

World Health Organization. (2010). Department of Making Pregnancy Safer: Nicaragua Country Profile. Retrieved from: http://www.who.int/making_pregnancy_safer/countries/nic.pdf