Physical Development, Nutritional Needs, Health and Illness in Early Childhood

Physical Development in Early Childhood (Ages 2-6)

• Children experience physical changes, including:
  • External changes like height and weight increase.
  • Internal changes in the brain, skeleton, and muscles.

Variations in Physical Development

• Physical growth is slower during preschool years compared to infancy.
• Height:
  • Average 3-year-old: approximately 95 cm tall.
  • Average 5-year-old: approximately 109 cm tall.
• Weight:
  • Around 14 kg on the 3rd birthday.
  • Over 18 kg by the 6th birthday.
• Body Proportions:
  • Change due to cephalocaudal and proximodistal development.
  • Become more adult-like with lengthening arms and legs.
  • Body fat decreases relative to total body tissue, leading to a slender physique.
• Head circumference increases by about 2.5 cm, reflecting brain development.
  • Brain reaches 70% of its adult size by age two.
  • Brain reaches 90% of its adult size by age six.
• The skeleto-muscular system becomes sturdier.
  • Cartilage hardens into bone.
  • Muscle mass increases.
• Children start losing primary teeth and grow permanent teeth towards the end of early childhood.
• Table 6.1 displays average height and weight during early childhood:
  • Age 2: Height = $85.71$ cm, Weight = $12.37$ kg
  • Age 3: Height = $94.74$ cm, Weight = $14.17$ kg
  • Age 4: Height = $101.77$ cm, Weight = $16.1$ kg
  • Age 5: Height = $108.57$ cm, Weight = $18.26$ kg
• Improvements in nutrition and healthcare have led to taller children in industrialized nations.
• Individual variations in height and weight are influenced by genetics and environment.

Individual Variations

• Significant variations exist in height and weight among children of the same age.
  • Example: 10% of 6-year-olds weigh 25 kg (5-6 kg more than average).
  • Another 10% weigh only 16 kg (5 kg less than average).
• Physical discrepancies impact development.
  • Taller, heavier children are generally stronger and may be more skilled in physical activities.
  • Smaller children are at greater risk of play-related injuries and may struggle with physical activities requiring strength and endurance.
  • Example: Shorter children may need to climb stairs one step at a time.
• Body size affects social, emotional, and cognitive development.
  • Larger children may be treated as older, leading to mismatched expectations.
  • Smaller children may be babied, hindering their social-emotional and cognitive growth.
  • Smaller-sized children may lack self-confidence and peer acceptance.

Group-Based Differences

• Sex Differences:
  • Boys are slightly larger than girls on average.
  • Example: 4-year-old girls: Height = $101.03$ cm, Weight = $15.88$ kg; 4-year-old boys: Height = $102.51$ cm, Weight = $16.32$ kg.
  • Girls tend to have more body fat, while boys are more muscular.
• Racial and Ethnic Differences:
  • Asian children tend to be shorter than European and Australian children.
  • European/Australian children tend to be shorter than some African tribal groups (e.g., Maasai).
  • Asian children have shorter legs and arms relative to their torsos and broader hips.
  • Aboriginal-Australian and Maasai children have longer limbs and narrower hips.
• Individual differences outweigh group-based differences.
• Variations are determined by genetic and environmental factors.
• Heredity influences physical size and growth rate.
• Human growth hormone (HGH) plays a critical role in regulating growth.
• Environmental factors, including nutrition, also impact growth rates and body size.

Nutritional Needs in Early Childhood

• Preschool children require a balanced diet with sufficient kilojoules, protein, vitamins, and minerals.
• Food intake lessens compared to infancy due to slower physical growth.
• Appetite can vary significantly from meal to meal; children tend to balance their kilojoule requirements over time.
• Parental anxiety and pressuring children to ‘eat up’ may promote inappropriate food intake and obesity.
• Early childhood is a critical developmental window for later obesity.
• Rate of weight increase from age two is associated with adolescent obesity.
• Weight gain in pregnancy and birth weight are related to weight in early childhood.
• Children become more selective in their food choices.
• Restriction in the range of foods eaten is weakly associated with poor growth.
• Exposure to different foods is important for balanced food intake.
• Parents should introduce variety positively, avoiding coercive comments.
• Offering incentives like dessert can devalue nutritious foods and overvalue empty calories.
• Novel foods should be offered repeatedly without insistence; parental modeling can be helpful.
• Introducing new food as ‘special’ for parents can increase curiosity.

Malnourishment

• Malnourishment affects a large proportion of the world’s preschoolers.
• These children lack kilojoules, vitamins, minerals, and protein.
• Protein-energy malnutrition (PEM) is prevalent in developing nations and low socioeconomic sectors of developed nations.
  • Marasmus: severe form of PEM characterized by emaciation and wrinkled skin.
  • Kwashiorkor: occurs when a child is weaned onto an inadequate diet after a new baby's arrival, characterized by oedema (swelling) due to fluid retention.
• Both can result in premature death, increased risk of infectious disease, cognitive deficits, and poor academic achievement.
• Malnutrition affects all areas of development, leading to diminished exploratory behavior, fewer social interactions, apathy, negative affect, anxiousness, and memory impairments.
• Malnourished children show poorer academic performance, limited attention span, and distractibility.
• Long-term effects include reduced ability to deal with frustration and difficulty with impulse control, and greater fearfulness and social withdrawal.
• Early childhood stunting affects 151 million children worldwide and is associated with poor psychosocial outcomes in late adolescence.
• Stunted individuals experience greater anxiety, depressive symptoms, hyperactivity, and lower self-esteem.
• Coercive comments regarding food can have detrimental effects, associating undesired foods with unpleasant experiences.
• Adequate food supply does not guarantee good nutrition; understanding and skills are needed for appropriate food choices.
• The UN Decade of Action on Nutrition (2016-2025) aims to reduce hunger and improve nutrition globally.
• Less nutritious Western crops have replaced beneficial indigenous foods in many developing nations.
• Cultural practices and beliefs play a role in malnutrition.
• Parent education can modify detrimental food-related beliefs and practices.
• Educational strategies should build on pre-existing knowledge and consider the family's culture and economic situation.
• Alternative foods should supplement rather than replace cultural food items in the diet, such as adding oil or fat to sweet potato diets in Papua New Guinea.

Health and Illness in Early Childhood

• Preschoolers experience frequent acute infectious illnesses (respiratory, ear infections, stomach upsets).

• Young children's immune systems are not fully developed; they come into contact with more individuals.

• The frequency of these infections has led to the term ‘daycare syndrome’.

• Hygiene practices like hand washing can reduce infection rates.

• Major infectious diseases like polio and diphtheria are now rare in industrialized countries due to immunisation.

• Infectious diseases account for 70% of the 8.1 million child deaths before age five, with pneumonia, diarrhoea, malaria, and HIV/AIDS being major causes.

• Unsafe water and contaminated food lead to diarrhoea, a cause of millions of deaths.

• Oral rehydration therapy has saved millions of lives since 1990.

• UNICEF’s Millennium Developmental Goal (MDG4) aimed to reduce child mortality by two-thirds between 1990 and 2015.

• MDG4 was not fully attained, although significant progress has been made.

• Health interventions address mother-child HIV transmission, malaria prevention, and rehydration therapy.

• Child mortality rates differ markedly between developed and developing regions.

• For every million children born, at least 6000 die before their fifth birthday.

• Minor illnesses, combined with malnourishment, increase health risks for preschoolers.

• Poverty disproportionately affects Aboriginal-Australian preschoolers, who have increased rates of ear and respiratory infections.

• Repeated ear infections can cause temporary hearing loss and cognitive delays. Strategies to alleviate health issues include:

  • Educating children and families about health and illness.
  • Systemic reorganization of health care delivery.

Injury

• Increased size, strength, and motor competence, coupled with greater independence, increase injury risk.
• Accidents are the main cause of childhood mortality in the first four years of life.
• Common causes of death: traffic-related injuries, domestic accidents, burns, and drowning.
• Injuries can cause physical, cognitive, and social-emotional disabilities.
• Injuries are more accurately termed ‘unintentional’ rather than ‘accidental’ because most are preventable.
• Child Factors:
  • Boys are 1.5 times more likely to sustain unintentional injuries due to risk-taking behavior.
  • ‘Difficult’ temperament (inattentive, irritable) is associated with greater risk.
• Parental Factors:
  • Poverty and maternal employment increase the risk due to parental stress and less vigilance.
  • Parents’ beliefs about the preventability of injury are a key risk factor.
• Parental vigilance is critical to prevent injuries.
• Physical, cognitive, and motor developments lead to preschool children outgrowing constant supervision.
• Parents must rely on negotiation, rule-setting, and warning children of dangers.
• Prevention can occur at family, community, state, and national levels.
• Families have primary responsibility for child safety.
• Teaching safety rules and creating a safe home environment are vital.
• A safety inventory of the home is a proactive way of preventing injuries.
• Community organizations should minimize environmental hazards in playgrounds and childcare facilities.
• Safety legislation at the state or national level (car restraints, pool fencing) plays a preventive role.

Child Abuse

• Not all injuries are unintentional; intentional injury is termed physical abuse.

• During early childhood, children are particularly susceptible to physical abuse.

• Boys are more likely to be victims of physical abuse than girls.

• Warning signs of physical abuse:

  • Suspicious injuries (burns, fractures, extensive bruising).
  • Injuries to protected body parts (thighs, abdomen, buttocks).
  • Shape of injuries (circular burns, bite marks, loop-mark bruising).
  • Inappropriate clothing to conceal injuries.

• Suspicious child behaviors:

  • Persistent complaints of pain.
  • Fear responses to physical contact and adults.
  • Extreme reactions like aggression, passiveness, and withdrawal.

• Professionals (doctors, nurses, teachers, social workers) are required to report suspected child abuse.

• Any member of the public can provide a voluntary notification to child protection authorities.

Table 6.3: Common Sources, Remedies and Prevention of Unintentional Injuries in Preschoolers

• Drowning
  • Remedy:
    • Extend a stick or other device if not trained in water safety.
    • Use heart massage and mouth-to-mouth breathing.
  • Preventive Action:
    • Teach children to swim early.
    • Supervise swim sessions closely.
    • Stay in shallow water.
• Choking on small objects
  • Remedy:
    • If still breathing, do not attempt to remove object; seek a doctor.
    • If breathing stops, strike child twice on the back. If that doesn't work, grab from behind with fist under ribs, pull upward.
  • Preventive Action:
    • Do not allow children to put small objects in mouth
    • Teach them to eat slowly, taking small bites
    • Forbid vigorous play with objects or food in mouth.
• Cuts with serious bleeding
  • Remedy:
    • Raise cut above the heart
    • Apply pressure with cloth or bandage
    • If necessary, apply pressure to main arteries of limbs.
  • Preventive Action:
    • Remove sharp objects from play areas
    • Insist on shoes wherever the ground or floor may contain sharp objects
    • Supervise children’s use of knives.
• Fractures
  • Remedy:
    • Keep the injured limb immobile; see a doctor.
  • Preventive Action:
    • Discourage climbing and exploring in dangerous places, such as trees and construction sites
    • Allow bicycles only in safe areas.
• Burns
  • Remedy:
    • Pour cold water over the burnt area
    • Keep it clean, then cover with sterile bandage.
    • See a doctor if burn is extensive.
  • Preventive Action:
    • Keep matches out of reach of children
    • Keep children well away from fires and hot stoves.
• Poisons
  • Remedy:
    • On skin or eye, flush with plenty of water; if in stomach, phone poison control centre doctor for instructions
    • Induce vomiting only for selected substances.
  • Preventive Action:
    • Keep dangerous substances out of reach of children
    • Throw away poisons when no longer needed
    • Keep syrup of ipecac in home to induce vomiting, but use only if advised by doctor.
• Animal Bites
  • Remedy: Clean and cover with bandage; see a doctor.
  • Preventive Action: Train children when and how to approach family pets; teach children caution in approaching unfamiliar animals.
• Insect Bites
  • Remedy: Remove stinger, if possible; cover with a paste of bicarbonate of soda (for bees) or a few drops of vinegar (for wasps and hornets).
  • Preventive Action: Encourage children to recognise and avoid insects that sting, as well as their nests; encourage children to keep calm in the presence of stinging insects.
• Poisonous Plants
  • Remedy: Remove affected clothing; wash affected skin with strong alkali soap as soon as possible.
  • Preventive Action: Teach children to recognise toxic plants; avoid areas where poisonous plants grow. Remove poisonous plants from the backyard.
• The Australian Institute of Health and Welfare (AIHW, 2017) reported:
  • 162,175 (or one in 33) children had an investigation, care and protection order and/or were placed in out-of-home care (OOHC) (with 73% being repeat clients).
  • Of these, more than 60,000 became substantiated cases of child abuse and neglect in 2015–16.
  • This figure underestimates the true prevalence of child maltreatment in Australia, as abuse often goes undetected.