King Solomon and the baby: Children’s health in early childhood education

King Solomon and the baby

Children’s health in early childhood education

Susan Bates

In the Hebrew story, King Solomon was asked to decide which of two “harlots” was the mother of an infant. His proposal to divide the baby between them revealed who could recognise the child’s best interests. This ancient story has resonance for early childhood education (ECE), for although our curriculum (Ministry of Education, 1996) holds the wellbeing of children at its core, the wisdom of Solomon is needed to navigate the inconvenient truth that early childhood education can be detrimental to the health of young children.

International literature points to multiple underlying causes: poor environmental conditions and overcrowding (Bailey, 2013; Chen, 2013), lack of consistent emotional connections to a primary caregiver (Biringen et al., 2012), as well as the spread of infectious diseases (Fairchok et al., 2010; Lyman et al., 2009), and increased stress in unattended infants (Bedford & Sutherland, 2008; Vermeer & Ijzendoorn, 2006). In Aotearoa New Zealand these concerns are reflected in the 2012 report of the Office of the Children’s Commissioner (OCC), Through Their Lens, which proposed that the regulations in ECE needed to be urgently revised, particularly with the rapid increase in children under two attending long-day child care services.

This article explores some of the recent research regarding the OCC’s recommendations and their implications for good governance of the lives of children aged 0–3 years. It is the contention of this article that interdisciplinary dialogue, research, and training should be undertaken at government, academic, community, teacher, and parent level, to promote health and wellbeing of children. In addition, those who qualify as early childhood teachers need to have more than basic knowledge of health conditions that affect children in their care.

However, even with this wide focus, it is impossible to proceed without acknowledging, as did King Solomon, that the child’s family, especially the mother, is the source of the child’s wellbeing. So while this literature review starts with the importance of “attachment”, it is acknowledged here that maternal mental and physical health is key to infant and toddler wellbeing. As King Solomon was willing to engage with the feuding women of the biblical story, so too can early childhood teachers accept the challenge of engaging with the parents whose wellbeing is so important to their children’s wellbeing.

While the foregrounding of sociocultural context is considered basic to the New Zealand early childhood curriculum, this article draws primarily on international health literature. This reflects another aspect of King Solomon’s wisdom—the value of looking through somewhat detached eyes at a familiar situation that does not have an easy solution. If the child is positioned as a learner/student within an educational setting, “health” can be secondary. While context matters and culture will shape our responses to health challenges, considering children’s wellbeing through international health literature can trouble “situation normal” narratives in early childhood settings in Aotearoa New Zealand.

Health research

Attachment

The foundation of infant and child mental health is successful attachment to primary caregivers. Depression in infants and toddlers is estimated to be as high as one in five (Bayer, Hiscock, Ukoumunne, Price, & Wake, 2008), while addiction, risky behaviours, lack of empathy, self-efficacy, and poorer physical and mental health throughout life have been linked to insecure or indifferent attachment in a person’s early years (Connors, 2011; Laranjo, Bernier, Meins, & Carlson, 2010; Puig, Englund, Simpson, & Collins, 2013).

Secure attachment is at risk when mothers are not sensitive to their baby’s cues (Nenide & Sontoski, 2014). Emotional availability, or positive, engaged, adult response to children, is essential for the reciprocal nature of developing an attached relationship and yet carers and trained teachers of infants in long-day care have been found to display a lowered emotional availability to very young children over time, rather than higher (Biringen et al., 2012).

In the context of early childhood settings in Aotearoa New Zealand, one adult can be responsible for up to five children aged less than 2 years old. There is effectively no maximum limit on group size which becomes a variable that is determined within the resources and politics of a centre’s management priorities.

Infant stress and mental health

It is accepted in fields of psychology, heart disease, treatment of addiction and depression that infant mental health is a primary cause of these conditions in adulthood. Both deprivation and deluge of infant senses through neglect, stress, and noise can cause infants to experience raised cortisol levels, which affects brain development. Sustained exposure to cortisol is toxic for a developing brain, and prolonged stress is so detrimental, that the effects can be irreversible (Bedford & Sutherland, 2008; Marshall, 2011; Vermeer & Ijzendoorn, 2006).

Child obesity

Obesity is a major factor in the onset of non-communicative diseases (NCDs). According to Ministry of Health reports (2013), 33 percent of New Zealand’s children are overweight or obese. It is difficult for adults to reduce weight, whereas interventions for children are more successful. Early childhood centres are a natural environment for improving diet, encouraging taste preferences, and increasing physical activity (Dehghan, Akhtar-Danesh, & Merchant, 2005).

While some guidelines for healthy eating are offered through the Ministry of Health and health organisations such as the Heart Foundation, and centres are required to keep records of what children have eaten, there is evidence that quality nutrition is not always a priority in day-to-day practice, and this can go unnoticed by inspectors and by parents who rarely visit during the day. Although it is difficult to imagine centralised control on children’s diets, there are also problems with centres’ self-monitoring of this issue.

Respiratory disease

Babies are at particular risk of contracting infections. Immature infant immunity can be permanently damaged by overexposure to pathogens. Immature infant immune systems are at risk of being overwhelmed by serial infections (Thibodeau & Patton, 2007). During the first year of life, the developing immune system requires gradual exposure to other children, and therefore to pathogens circulating in a community, to function for life (see, for instance, Immunisation Advisory Centre, 2012).

Both homes and childcare centres are risk areas for contracting respiratory illnesses. Centres can be over- or under-ventilated, and overcrowded; they can harbour infectious children, and have insufficient hygiene practices in place. Children in long-day childcare are often incubating, in the throes of, or recovering from more than one infection at any time (Chen, 2013).

Lung disease and asthma are of serious concern to New Zealand health practitioners. Acute lower respiratory infection in New Zealand’s pre-schoolers is two to four times higher than other developed countries (Cameron et al., 2011). Poor housing and second-hand cigarette smoke are causes of respiratory disease in children, and poor nutrition, eczema, and viruses are all linked to lung disease in children (Ministry of Health, 2012). In addition, age and attendance of an early childhood setting affect the experience of severe respiratory infection, particularly in infants (Tregoning & Schwarze, 2010).

Physical exercise

Exercise is a key factor in general health and wellbeing, and in particular in mitigating obesity (World Health Organisation, 2012). Exercise requirements for preschool children are little understood or researched, particularly for children up to 2 years old. However there is some suggestion that infants and toddlers benefit in motor and cognitive development and reduced body fat when they can move freely and test their bodies through physical challenge (Timmons et al., 2012), and there are concerns that many infants and toddlers are too sedentary (Cardon, van Cauwenberghe, & De Bourdeauhuij, 2011). Centre practices are contributing to this when space, equipment, weather, safety, and routines are barriers to children engaging in physical activity (Vanderloo, Tucker, Johnson, van Zandvoort, & Burke, 2014). Centre practices and teacher awareness of nutrition and exercise are vital at this early stage of children’s developing habits and physiologies.

Infections and viruses

A United States study found that children in full-day centre-based ECE are up to 18 times more likely to suffer from ear, eye, skin, and gastrointestinal infections than those in home-based care, or at home with a parent (Bailey, 2013). The risk of contracting infections increases with the number of children in a group (Bailey, 2013; Chen, 2013; Bedford & Sutherland, 2008). In New Zealand, childcare facilities account for more outbreaks of notifiable and other diseases than acute care hospitals, schools, prisons, and other institutions combined. Person to person is the most common mode of transmission (91 percent) (Institute of Environmental Science and Research, 2013). Improved hygiene practices mitigate disease spread. There are many anecdotal examples of infectious children being sent to childcare dosed with Pamol to mask symptoms. Improved sick leave for parents would no doubt mitigate this.

Children in multiple facilities have even greater exposure to pathogens, poor practices, and unhealthy environments. Childcare facilities bring children from different health environments and habits together and the risk to children’s health is significantly increased where there are six or more children present (Chen, 2013). In ECE, groups of children under 2 years of age are commonly in groups of up to 20 children.

Dental caries

“Early childhood dental caries” refers to tooth decay or missing teeth, or teeth that have had fillings, in children aged up to 6 years (Gomez, 2013). Dental caries have significant effects on development and learning for young children. Children suffer pain, loss of sleep, sepsis, have difficulty eating, and poor nutrition, all of which lead to other illnesses (Bach & Manton, 2014; Gomez, 2013; Kagihara, Niederhauser, & Stark, 2009). Parent and carer knowledge of diet, and of infant feeding and dental hygiene practices are the key factors in prevention (Gomez, 2013).

While the rate of dental caries has decreased in other populations in New Zealand, there has been no decrease in the last decade for preschoolers. It is the single most chronic disease in early childhood (Gomez, 2013).

In New Zealand, children as young as 2 years old are having all of their teeth removed and hospital oral surgery departments can have waiting lists of up to 100 children (Hill, 2013).

Equity and wellbeing

Significant health inequities exist globally and New Zealand is no exception. Māori and Pacific Island peoples are over-represented in statistics of cardiac conditions, skin complaints, and respiratory diseases, while rheumatic fever is almost exclusively found in these populations. Asthma and measles particularly affects Māori children—one in five in both cases (Ministry of Health, 2012).

According to the 2012/13 New Zealand Health Survey, 19 percent of Māori and 27 percent of Pasifika children were obese. Children living in the most deprived areas were three times as likely to be obese as children living in the least deprived areas. The average decayed, missing, or filled teeth in Māori 5-year-olds is double that of other ethnicities, while for Pacific children, it is three times.

Western society has developed from an emphasis on the Cartesian divide between mind and body, while capitalism has created an almost pathological individualistic, competitive attitude. This is reflected in carefully demarcated, non-communicative departments within and between services and sciences, academic and government, affecting both research and policy.

Māori philosophies of the indivisible connection between tinana, wairua, whanaungatanga, and manaakitanga (body, spirit, family, and community connections) would serve better in promoting healthy individuals who are members of healthy communities.

There are genetic, cultural, and education factors to be considered, but all of these problems and the over-representation of Māori and Pasifika children can be attributed to diseases of poverty. For instance, there is no correlation between genetics and the high rate of asthma in Māori children (Ministry of Health, 2012). Household income is the correlating factor.

Health initiatives

The World Health Organization (WHO), United Nations, Pacific forums and partnerships, the ministries of Health, Māori Affairs, and Social Development, along with dental health, public health, maternity, Plunket, and community groups, have stated aims for children’s health, and provide health initiatives through, for example, millennium development goals, child action plans, primary care plans, parenting courses, education, and home visits. Integrated care strategies within the health system exist (Cumming, 2011). However nowhere in any of these initiatives—including those that are cross-departmental (such as Whānau Ora which involves Te Puni Kōkiri, the Ministry of Health, and the Ministry of Social Development)—is early childhood education included in the planning or execution of the strategies.

Teacher training and registration has no requirement for knowledge and practice in health and wellbeing beyond the regulations. These regulatory standards have been described as too low, and teacher training for infant and toddlers is acknowledged as being too meagre (Carroll-Lind & Angus, 2011).

Discussion and conclusion

For the early childhood sector, this article raises a number of challenges. While there are obvious starting points for improved outcomes for children—such as reduced group size, and adult:child ratios that enable responsive caregiving especially for infants—these are political decisions which need to be addressed at the level of the Ministry of Education. But for the ECE sector, more confronting is to acknowledge that ECE brings with it health challenges that its professional teachers are ill-equipped to deal with.

Caregiving and health knowledge are lacking both in the Graduating Teachers Standards and the Professional Teacher Criteria set by Education Council of Aotearoa New Zealand. In a well-run school, there is a health department and a school nurse (or equivalent). In a well-run early childhood service, who is the on-hand health professional?

There are no easy answers to the health challenges that arise within ECE and indications are that ECE is as much a problem as a solution. While there are baselines for care and education of children, issues surrounding health and education need to be addressed in ways that reflect the local context. There are no “one size fits all” solutions.

Early childhood education is positioned to address some of the inequities in education and wellbeing of children, particularly vulnerable children, but teachers must have tools to notice, recognise, and respond to health issues.

As an early childhood sector we might take from King Solomon’s story the necessity of good governance for families when making decisions about their children. King Solomon in this instance is not an individual but rather a collective for whom making good decisions is possible through opening channels of communication and breaking down systemic political and economic limitations to the sharing of knowledge. Where multiple agencies are failing to work together, the baby appears “cut in parts”.

Good governance, then, starts with the bringing together of the community. This includes a willingness to incorporate health capability into the key competencies for early childhood teachers.

Solomon’s wisdom is required to consider the question “Is ECE good for children’s health?” and to re-engage in the debate about quality ECE without undermining the professionalism of those working day after day for the good of children and their families.

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