HEALTH TRAINING OF THE PRESCHOOL CHILD Sidonie M. Gruenberg, Director, Child Study Association of In the development of our educational ideas we have discovered different stages in the life of the child, but not in their chronological order. Apparently the adolescent was the first object of educational concern; perhaps it has always been true that this period is a period of strain and stress-for the surrounding adults. The younger child became of educational concern on a large scale only in comparatively modern times, partly because attention to the training of adolescents revealed defects in their preparation. In very recent times the infant was discovered, especially with regard to his physical care; it had become obvious that at least the high mortality rates could be reduced by closer attention to the care the infant receives and by applying what is known of physiological science. For years, however, the period between infancy and school, from about two years to five or six, was the neglected period. The child had survived the perils of ignorant or unskilful handling during infancy, but had not become subjected to the organized supervision of kindergarten or school; he belonged nowhere in particular, and was nobody's business. This is the stage that we commonly have in mind when we speak of the nursery or preschool child. It was the kindergartners who really helped to discover this child; they could not but be impressed with the number of bad habits and with real deficiencies in the children that came to them. We all want children to be healthy and happy, but we do not want them to make health or happiness objects of conscious desire. It would be very unfortunate and not at all conducive to happiness to get children launched upon the pursuit of health. And yet we recognize that health is a condition that bears directly upon happiness and effectiveness, and that health is to a large degree subject to educational or training influences. During this preschool period the child acquires very many habits that are of direct and constant relation to his health. On the physical side, it is obvious that what he eats, and how, his elimination, his sleep, his cleanliness, are of the utmost importance. But the period is of equal importance because here are fixed emotional attitudes that affect his well-being and happiness for the rest of his life. Here is where most people get their negativism and obstinacies, their fears and hostilities and jealousies, and their other hampering and injurious fixations of feeling. Whose business is it to guide the child through this period and to see that his habits do fit into healthful living and wholesome relations to others? Obviously this responsibility rests with the mother; but the mother often needs the help of the public health nurse, of the social worker, and increasingly her efforts are being supplemented by those of the nursery school teacher. What must these do for the health of the child? We think first of proper nutrition. And then there are the several kinds and degrees of cleanliness: he needs training in proper habits of elimination, as well as in routinizing sleep and rest. His clothing is being standardized for season and occupation, and no doubt we shall soon have minimum daily exposure to quartz lamp in lieu of sunshine for cloudy days. All of these things and several more are given thought, and all are being taught to those who have to deal with the child, including mothers and prospective mothers. But the greatest difficulties come after the solicitous mother has learned all the rules and tables. Here is a picture of an intelligent and earnest and wellinformed mother stuffing carrots down the throat of a very unhappy, very obstinate, struggling child, held firmly in place for his own good while alphabetical vitamins are forced into service. We know that milk is an excellent food for young children-Nature's own, if you please. Eggs seem also to have been invented especially for the nutrition of young vertebrates. The mother and nurse ought to know what is good for children, including carrots. With many mothers, at least, it often seems to be a choice between making the child eat what is good for him and letting him eat what he likes or go without food. A little more knowledge, however, may relieve us of these cruel alternatives. It is possible, for example, that in the case of a particular child milk is not an ideal food, or even a desirable one. Some children do have idiosyncrasies that present genuine obstacles to a predetermined diet, and that is something to know, in addition to standard diet. Moreover, it is not merely more physiological knowledge that is needed, but knowledge of an entirely different order, namely psychological knowledge. For example, the very solicitude of the parent is in many cases the most serious obstacle of all in the health training of the child. The mother who resorts to forcible feeding of carrots or spinach has the conscientious determination to do what is right by the child. The child, on the other hand, may be unconsciously taking advantage of the mother's panic to get for himself a maximum of attention. Here is a case of malnutrition from Minnesota. We see a large, dominating woman, who knows exactly what the child needs, and a child with the same firm lips and strong determination. The child has her own way. The conflict is dramatic and furnishes the child with the center of the stage and the satisfaction of triumphant outcome. In nothing else is the mother so much concerned about what the child does or does not do, and in no other relationship can the child get so much excitement for so little effort. The panic of the parent, impressed with the importance of calories, proteins, and vitamins, is the opportunity for the child to get a circus every day in the week, and to be herself the chief actor with 100 per cent attention from all present. One of the great needs for the health training of this period is some way of helping parents acquire the technique for establishing health habits without making the child too self-conscious, too much aware of his importance, too much concerned with the significance of each detail of the ritual. This need is em phasized especially in those cases in which the parents have already mastered the essentials of physical care. In a case from Massachusetts, an educated mother, a well-meaning father, and an intelligent child of two and one-half to three years, and one younger child tangle up their feelings with their knowledge and desires until all concerned suffer in health. Every meal is an event-yes, an adventure for there is no telling what the outcome will be. The child refuses to eat alone; with the mother present she will sit tight until the mother places the food in her mouth; then she will hold the food, but not chew it. Finally, the mother is exhausted and at her wits' end. What help does she get from her eager study of diet? There is certainly much more that she needs to know if she is to keep her child well, to say nothing of getting her into habits of health. The father and mother do not agree on the first principles of discipline. When the mother has the child in hand and makes requirements that the child does not meet, the father takes the position, What can you expect of a little child like that? When it is his move, however, and he finds himself equally futile, his reproach reads: Why don't you train her better; you have her all day. Practically every normal child would much rather go hungry than miss a show like that. These conflicts do not make for either health or happiness, but they do give a thrill to life. In another case, this time from New Jersey, the child over two years old is still given to bed wetting, to thumb sucking, to waking at night with frights, and to temper tantrums. The tantrums finally bring her to the attention of the public health nurse; but what does the nurse use out of her technical training? She knows that there are conditions to correct-sound health habits to be established in place of those from which the child suffers. And she knows what good habits would be. But does she know that the child's difficulties arise chiefly from a faulty relationship between the parents? The father suffers from feelings of inferiority, and the mother is indeed in many ways his superior. He has few friends, does not care to go out, does not read. When the child cries out at night, he goes to her, and soothes her by taking her to his bed with him. This gives the child a great deal of satisfaction, but apparently the father also derives satisfaction from being able to comfort the child in this fashion. How is the mother going to train the child away from the enuresis when she is actually jealous of the little girl? She did succeed in breaking her of the thumb sucking, but only by scaring her into the belief that the mitten she used would destroy the use of the hand. One of the things the little girl needed was weaning from the excessive concern and sublimated jealousy of her mother, and from the father's misdirected affections. This she needed at least as much as regular hours for feeding and excretion and sleeping. Many of the habits we seek to establish during these years are acquired easily enough if they are a part of the colorless routine of everyday life. In so many cases that come to the clinics the ignorance of the parents is an obvious factor; but in many cases the trouble comes from the mother's knowing some thing that her mother did not know, and from the mother's having more time to fuss with the one child than her mother had for a whole brood. The adjustment of the parents to changing conditions, to increased leisure, have a direct bearing on the attitudes which they display in connection with the details of everyday life. Their adjustment to each other as mates colors what they do and say to the children and how they say it. We have to learn, then, in addition to diets and rules and tables, to cultivate a certain casual manner in handling everything connected with the routine of the day's living. We must be friendly, to be sure, but we must also affect indifference regarding a thousand important details. In a nursery the teacher in charge has to deal with the activities of the day's living in an impersonal way, without emotion. This fact makes it possible for the children to do here what their mothers have such difficulty in getting them to do, whether it is eating carrots, or going to the toilet before it is too late, or washing their hands, or saying "thank you." The children need affection and they need attention, if they are to be well and happy, but they do not need to have their feelings attached too firmly to those things that must be accepted as matters of coursethe things that make up keeping alive and well. The child should eat, and he should eat in accordance with the best knowledge of the nutrition laboratories; but he should not eat in the presence of a personality charged with emotion, watching every move and counting the calories. The child should empty the bowels, of course, and regularly; but this need not be an occasion for an exciting drama. Health habits should be the unconscious habits of healthful living, acquired as simply and unquestioningly as habits of wearing clothes, or sleeping in bed, or being polite, or using the mother tongue. The child needs to know nothing of the philosophy or of the importance of these habits. He gets them because they are parts of his living environment, the way in which those around him live and act. It is important for the adults in the child's immediate surroundings to understand what kind of living is healthful living; but it is far from necessary for them to raise with the child an issue as to which articles of diet or which details of routine he will or will not accept. This distinction between supplying the conditions for healthful living and attempting to teach what is healthful is well illustrated by what happens to the child in the matter of sex knowledge and attitude. Many children reach the kindergarten with very decided notions and feelings on this subject. Much of what is in their minds does not correspond to the facts, and their feelings are of a morbid kind. On the other hand, it is quite feasible to bring the child through this period without any of these untoward manifestations. In the first place it is possible for the child to acquire a considerable amount of first-hand knowledge about the anatomy of his own body, with a decent vocabulary that does not carry any unwholesome suggestions or connotation. All parts of the body, as he becomes aware of them in turn, are equally interesting, equally important, equally clean; and as fast as he knows them apart he should have names for them. The alternative is the early association of the idea of secrecy, or indecency, or impropriety, or wickedness, with some organs or functions. This prejudice does not stand in the way of learning what he needs later, but it makes difficult and often impossible a wholesome approach; it involves a great deal that has to be unlearned, and tends to fix certain fears or disgusts and inhibitions that impede healthful living and adjustment. During the early years the child can learn not only about his own body, but also about the bodies of other members of the family-and he does, apparently, often in spite of the earnest but foolish efforts of elders to prevent him. He should learn in a casual, normal way that the human race consists of males and females; and when he gets around to the question of the source of babies he should be informed without fear and without embarrassment. Moreover, the parents who have adjusted themselves to life will have no difficulty in explaining to the child, in terms of his own limited knowledge and understanding, the function of the male parent in the creation of a new life. It cannot be claimed that these early lessons about life are of direct value to the child as useful knowledge. To satisfy his curiosity all sorts of stork stories and other zoological fables might serve for the time being. The value of direct, truthful, and casual information lies first in keeping open the confidence and sympathy between parent and child, a relationship of first importance from the health point of view. In the second place, it lies in forestalling degrading and confusing information that will inevitably come from a variety of sources, and that we now recognize to be powerful agents in the development of habits that undermine mental and physical health. It has always been known that physical conditions affect the mental and emotional development of the child, and it has been known that mental states affect the physical health. The tremendous increase in our knowledge of the child's nature and development has come about through the studies of many specialists, each dealing with a minute detail. As fast as each important fact is established we are tempted to make practical application of it. The result very often is that the child comes to be treated as a bundle of sharply defined departments that have nothing to do with one another. However valuable specialization may be in research, the time has surely come for us to deal with the child as a living unity, to coordinate for his welfare the many useful things we have learned. |