Chapter 11: Infant mental wellbeing and health or ‘how to grow a healthy adult’

ANSWERS TO SCENARIO 11.1: BERNEICE AND ZARA

Berneice was pregnant at 17 and her boyfriend did not stay with her. Berneice felt abandoned and afraid. She knew she could not rely on her mother, also a single parent, as Berneice’s own upbringing had been chaotic and complicated with several episodes of social work involvement due to concerns about Berneice’s growth and development. Her boyfriend had been her only constant companion for the previous year, and now he had abandoned her, Berneice lived at home with her mother. Initially she was not at all sure about the FNP nurse and was reluctant to engage but with time and patience she grew in confidence over her pregnancy, had a successful birth of Zara, supported by her mother. Over the first months and years Berneice developed her communication skills, insight and awareness of her own strengths and limitations. She worked hard with her FNP nurse to maximise her strengths and practical parenting skills, and her mother seemed to benefit from the support also. Gradually as time progressed Berneice was able to start to think about her future with Zara and started a part time Animal Welfare course at the local College. The college had a crèche which helped with childcare thus enabling Berneice to concentrate on her studies.

  • Make notes on Berneice’s story and critically reflect on the main negative and positive issues throughout her story.
  • Critically reflect upon whether it is a children’s nurse’s role to facilitate successful attachment bonding and development of parenting skills.
  • Cross-reference your notes with:
  • UN Convention on the Rights of the Child
  • NMC Code (use the most current edition)
  • Your own country's current Children's Welfare policy

Answers: Berneice had a history of a chaotic upbringing and much experience of loss and abandonment which adversely affected both her self-belief and actual ability to effectively and safely parent her own child. Although her own mum loved her she was unable to provide Berneice with consistent stable parenting over the years and therefore was not equipped to help unassisted when it came to her grandchild. Despite initial misgivings about the FNP programme, Berneice was able over time to build a relationship of trust and permanence with her FNP nurse. Using specialist interpersonal skills and interventions this relationship helped Berneice to bloom as a mother and recognise her strengths and abilities to develop as a caring and responsive mother. Berneice’s mother was able to develop awareness and capability also resulting in her supportive presence at the birth of her grandchild. Thus an intergenerational mutual support system was facilitated and enhanced. Through consistent positive capacity building work the family came to see their strengths and abilities and Berneice grew to believe she could and would have a better life for herself and her child through harnessing her new-found abilities and furthering her educational and employment opportunities. These developments are in line with UNCRC which recognises the right of all children to have health, social welfare, education and opportunity throughout all of their life. This too is enshrined in the UK’s (and most developing countries) Strategy for Children and Young People. Look up your Government website for specific information on your country’s strategy and vision for children and young people. A recent example from Northern Ireland (2016–2026) can be accessed at:

 www.health-ni.gov.uk/publications/strategy-paediatric-healthcare-services-provided-hospitals-and-community-2016-2026

ANSWERS TO ACTIVITY 11.2: CRITICAL THINKING

How good are our children’s lives? What do they say?

Read and reflect upon the information given by children in the following document:

Jacobs Foundation (2015) Children’s Views on their Lives and Well-being in 15 Countries: A Report on the Children’s Worlds Survey, 2013-14.  Available at:

www.isciweb.org/_Uploads/dbsAttachedFiles/ChildrensWorlds2015-FullReport-Final.pdf

Answers

The study

… The study aims to collect solid and representative data on children’s lives and daily activities and on their perceptions and evaluations of their lives. The purpose is to improve children's wellbeing by creating awareness among children, their parents and their communities, opinion leaders, decision makers, professionals and the general public.

Concepts

The thinking behind the project draws together several related strands and areas of interest. 

First, we wished to focus on childhood as an important life stage in its own right, rather than as a preparation for adulthood.  Social research on children is often concerned with the implications of certain experiences in childhood for ‘outcomes’ in later life – for example whether childhood poverty affects educational attainment.  These are very important issues.  However childhood, while it has different meanings and definitions in different contexts, is a significant and substantial period in people’s lives and merits consideration in itself, and not only because of how it may affect later life stages.

Second, we wished to focus on children as social actors.  Many social surveys gather statistics on children primarily as members of families or households.  A drawback of this approach is that children’s status becomes defined by their household or family status and this may not reflect their personal experience.  For example, a household may be defined as ‘not in poverty’ on the basis of household income, but a child in that household may still experience material deprivation depending on the spending choices that adults in the household make. It has been argued for some time that children should be a ‘unit of observation’ in social accounting.  As we will see, this issue has become particularly pertinent in some countries where substantial minorities of children no longer live in a single household. (Jacobs Foundation, 2015: 4–5)

Topics covered in the report include: The context of children’s lives, Life as a whole, Money and possessions, Friends and other relationships, School, Local area, Self view, Other aspects of life, Children’s rights and Time use.

Conclusions

The overall picture presented in relation to children’s evaluations of their lives is a positive one.  Mean satisfaction ratings for life as a whole were higher than is typical in adult populations and, for most aspects of their lives, the proportion of children having low-being was less than one in ten in all or almost all countries. 

Generally, children seem more satisfied with family and friendships than other aspects such as school and local area.

Findings suggest that in most countries children may not perceive their local area as being particularly child-friendly.

Children’s knowledge of their rights, and their views about whether these rights were respected by adults, varied very substantially between countries. In most countries most children felt that they knew what rights children have, but in four countries – the UK, South Korea, Israel and Germany – only a minority did so.

In the Children’s Worlds survey children were asked two questions about the frequency of being hit by other children and of being excluded by other children in the last month.  There were wide variations between countries here also.  Children in South Korea were the least likely to experience either form of bullying; children in Turkey were the most likely to have been hit by their peers; while children in the UK were the most likely to have been left out by their peers.  It remains to be seen whether these varying levels of bullying are associated with levels of school or overall wellbeing within and between countries.

There were also age-related differences in many countries (mostly European apart from Norway) in terms of how much children felt that adults in their country respected children’s rights.

Finally, there were some notable age patterns in time use.  In most countries children in the 12-years-old survey tended to read for fun significantly less frequently than in the 10-years-old survey.  On the other hand, in many of the more industrialised countries the older age group tended more frequently to spend time watching television and/or using a computer.

There was a more mixed picture in terms of gender differences.  In some aspects of life – such as family life, friendships and material possessions – there was little significant variation between girls and boys regarding their evaluations of their lives.  There were some indications that girls tended to be a little more positive about aspects of school life.  However the aspect of life where there were the most notable gender differences related to children’s views of themselves.  In five European countries and South Korea, girls were significantly less satisfied with their appearance and their body than boys.  However, in other countries this was not the case.  This is an illustration of the value of undertaking the survey in such a diverse range of countries and cultural contexts.  Differences that may seem commonplace in one cultural context may be found not to exist in other contexts and this can challenge the notion that these types of differences are inevitable or universal.  The question of why girls feel much less positive about themselves than boys in some countries and not others merits further research.

There were gender differences in relation to time use also.  In many countries there was a fairly typical pattern of boys being more likely than girls to spend time playing sports, exercising and using computers; while girls were more likely than boys to read for fun and help with housework.  However, there was a lack of evidence of a gender difference in frequency of time spent caring for siblings and other family members.  There was no clear pattern here and in only one country (Norway) was there a significant difference, with boys reporting spending more time on this activity than girls.

The first key message is that it has been possible, using cross-national comparisons, to identify positive and negative aspects of children’s lives in all countries involved in the survey.  The combination of different comparative approaches taken in this report has suggested, for example, that school is an aspect of life where there is considerable variation in children’s experiences and the findings on this topic may be of particular concern to national policymakers as this is certainly an aspect of children’s lives which is amenable to policy intervention.  The findings on relatively low levels of satisfaction about body, appearance and self-confidence in some countries provide important messages for policy makers and all those concerned with children’s wellbeing in those countries, as it is apparent that there are countries where these issues are much less pronounced.  The substantial cross-national variations in children’s knowledge of their rights, and in their opinions regarding adults’ respect for these rights, is another area where there are important messages for national and international policy organisations.  Cross-national variations like these also offer the opportunity to identify areas of strength in particular countries, and the learning from these countries may be of value to other countries in developing new initiatives to tackle key issues and improve children’s lives.

A second related message comes from the exploration of age and gender differences.  One of the challenges for research on children’s subjective wellbeing within individual countries is that it is not clear whether observed differences between sub-groups of children, for example on the basis of age or gender, are distinctive to that country’s context or are a more universal feature of childhood.  It is only through cross-national comparative work that answers to this question can be found.  We have observed in this report that some of the age and gender differences previously identified in specific countries are not in fact universal phenomena.  For example, if gender differences in children’s satisfaction with a particular aspect of life are not evident in all countries this presents important information and a challenge for each individual country with regard to the equality of children’s wellbeing.  This is an important initial broad finding which has been made possible by the diversity of countries involved in the research.  

To conclude, this initial report has hopefully begun to demonstrate the potential of the Children’s Worlds survey and, more generally, of international comparative research which gathers children’s own opinions and perspectives, in identifying both positive and negative aspects of children’s lives in different countries and priorities for future action.

Note the NMC Code directs us to protect the public (our children and young people) and by knowing what children and young people experience, like, value and dislike we can start to build societies and communities which offer them the best possible opportunities to thrive. Note also that this approach of ‘listening to’ children is espoused in the principles underpinning the art and science of children and young people’s nursing.

ANSWERS TO ACTIVITY 11.3: CRITICAL THINKING - NOTE TO READER FROM AUTHOR

In every nursery there are ghosts.  They are the visitors from the unremembered pasts of the parents, the uninvited guests at the christening...  These intruders from the past have taken up residence in the nursery, claiming tradition and rights of ownership.  They have been present at the christening for two or more generations.  While no one has issued an invitation, the ghosts take up residence and conduct the rehearsal of the family tragedy from a tattered script...  The baby in these families is burdened by the oppressive past of his parents from the moment he enters the world.  The parent, it seems, is condemned to repeat the tragedy of his own childhood with his own baby in terrible and exacting detail. (Fraiberg, 1980, pp. 164–5)

This is a very personal and complex activity and one which may be upsetting for some of you.

You may choose not to think about this activity at this time for various reasons, and that is a matter of personal judgement and requires no apology or explanation from you. Instead it may be more acceptable for some to simply appreciate that for Fraiberg this is her perception.

Feel free to move on from this activity – you can always return at a later time should you deem it helpful to do so.

Find out what the specific provision is in your local area for enhancing attachment, bonding and parenting skills in the early years of a child’s life. You may find this information by searching the website for your areas of government or reading the relevant Children’s and Young People’s Strategy for your country.