3.1 The child and the family
Introduction
The ecological model of the determinants of children’s health, development and wellbeing places the child at the centre of expanding spheres of influence. Surrounding the child is the family, the family’s community and the wider society. A child’s family exerts direct influences on the growing child and mediates the potential influences, both positive and negative, of the community, society and culture of origin.
The vast majority of the developmental health needs of children are met within the context of their family. A healthy child is one who is physically well, whose emotional needs are met and who is socially adjusted. Each of these needs has several parameters, which are discussed below.
The physical needs of the child
• Care and protection from violence
• An adequate diet to provide for nutritional needs
• Protection against heat and cold in early life, and protection against physical dangers, such as fire, electricity, water, poisons and motor vehicles
• Prevention of illness through good living standards, education, health surveillance, immunization and other public health measures. A home environment that is free of tobacco smoke, lead and other toxins.
Children grow and thrive in the context of close and dependable relationships that provide love and nurture, security, responsive interaction and encouragement of exploration. Without at least one such relationship, development is disrupted and the consequences can be severe and longlasting.
The emotional and social needs of the child
• The opportunity to grow up in a family context with close and dependable relationships with one or more adults (parents)
• Consistent, positive caregiving
• Reasonable limits to be set on the child’s behaviour
• Feelings of being worthwhile and concern for the wellbeing of others
• The development of self-help skills and a sense of achievement
• Opportunities for play, recreation and companionship
• Opportunities to learn and explore
• Sensitive responses to emotional needs during illness, particularly in chronic illness
• Recognition of each child’s individuality
• Recognition of the basic rights of every child, as outlined by the United Nations Declaration of the Rights of the Child.
To meet the physical, social and emotional needs of their children, parents and others in a caring role must fulfil their own needs. Caregiver needs include:
• adequate housing and transport
• freedom from unnecessary economic stress
• freedom from community and domestic violence
• easy access to family support and early childhood services, such as child care, health and education services
• knowledge of how to access community supports and services
• social networks and extended family supports, community and cultural connections
The growth and development of a child in the family and community context are determined by the interplay of genetic, physical, social and emotional factors, and experience. The balance of risk and resilience factors influences a child’s developmental pathway.
Risk factors preventing optimal progress might include:
• family conflict and disintegration
• economic disadvantage (low household income)
• parental mental health disorders
• individual child factors, such as low intellectual ability or difficult temperament
• external factors, such as unsafe neighbourhoods, environmental threats, war, etc.
Balanced against these are resilience factors, which are protective and promote wellbeing:
The building blocks for intellectual development
There are many components of the family and societal environment that are important in the intellectual development of the child. Some of these are:
• a loving and nurturing caregiving/family environment
• child-rearing beliefs and practices that are designed to promote healthy adaptation
• the opportunity to play, learn, explore and communicate
• the growth of self-regulation of physiological systems, emotions, behaviours and social interactions
• positive and consistent human relationships
• access to developmentally appropriate educational settings: children are active participants in their own development and learning
As a child grows from a newborn infant to an independent young adult, his or her social environment expands and diversifies. A young infant has all its needs met within the immediate family. Contact with other young children is important for the social and emotional development of the preschooler. A young teenager may spend more time with peers than with her or his family. The structure of the family, the style of parenting and the capacity to support the growing child’s progressive independence are all important determinants of the health and wellbeing of children.
The family
‘Families are big, small, extended, nuclear, multigenerational, with one parent, two parents, and grandparents. We live under one roof or many. A family can be as temporary as a few weeks, as permanent as forever. We become part of a family by birth, adoption, marriage or from a desire for mutual support. As family members, we nurture, protect, and influence each other. Families are dynamic and are cultures unto themselves, with different values and unique ways of realizing dreams. Together, our families become the source of our rich cultural heritage and spiritual diversity. Each family has strengths and qualities that flow from individual members and from the family as a unit. Our families create neighbourhoods, communities, states and nations.’
(Developed and adopted by the New Mexico Legislative Young Children’s Continuum and New Mexico Coalition for Children, June 1990.)
The Australian family
Australian society is multicultural, with pluralistic values and child-rearing practices. Child- and family- centred health care of children and young people should be carried out within the cultural and values framework relevant to the child.
Leanne was the 4-year-old daughter of professional parents who had migrated from another country in Asia. Her behaviour was demanding, overly active and often aggressive. Her communication skills were delayed. Both parents stated that in their families of origin children were not disciplined until school age and were cared for by the extended family.
Behavioural intervention needed to include these views of parenting.
Traditionally, Australian families have been made up of mother (usually at home), father, and two or more children. However, this picture of the ‘nuclear’ family no longer represents the Australian family. Families may be comprised of:
• couples with or without co-resident children of any age (85% of Australian families in 2006–2007)
• lone parents with co-resident children of any age (14% in 2006–2007)
• other families of related adults, where no couple or parent–child relationship exists (1%).
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