Pediatric Annals

EDITORIAL 

A Pediatrician's View

Milton I Levine, MD

Abstract

Pediatrics is the only area of medicine devoted to the growth and development of a human being. It is a thrilling profession. Much of what an individual is as an adult, physically and emotionally, depends largely on the care he or she received during childhood and adolescence. The pediatrician cares for children as they constantly progress toward adulthood. Thus, he or she is largely responsible for directing the growing child physically and often joins with the parents in molding the child emotionally, educationally, socially, and even morally.

On the surface it may appear that the pediatrician's role in the emotional development of the child is minimal. However, within recent years parents have been turning more and more to their child's physician for aid in understanding and correcting numerous problems relating to their development and behavior. And if pediatricians with a fairly active practice review their patients, they will immediately realize that the parents have numerous questions involving many areas of child development and behavior.

Most of these questions are the same that have been asked for generations. The only new and fairly frequent question asked is "Is my child taking drugs?" This is most usually asked when a previously good student starts doing poorly in school or when a child starts sleeping much more than has been his or her habit. The child almost always denies it, so it is the pediatrician's province to make the decision. And if a urine specimen returns positive, it is best for the child's physician to be the first to notify the patient of the findings and give advice before the worried parents express their upset, resentment, and anger.

But the more frequent problems met by all pediatricians are those of aggressive behavior, shyness, sibling rivalry, and poor scholarship. There are others also, including hyperactivity and inattention at school, rejection by classmates, stealing, lying, truancy, and depression. Some of these are due to physical defects such as auditory and visual problems which can usually be easily detected and corrected.

But in most behavior problems of childhood the etiology is often complex. Vífe must know the mental ability of the child, the home environment, the relation of the parents to each other and to the child, the adjustment to siblings, the degree of assurance and praise given to the child, the methods and type of punishment used, the relation to friends and classmates, the interest in schoolwork, and the attitude of the child's teacher.

Detecting the cause of emotional problems is often difficult but usually fascinating. Solving the problem is much more difficult but can be successfully handled by caretaking pediatricians without the need of trained psychotherapeutic help. I have had many interesting experiences in efforts to comprehend and solve behavior problems and every situation differs.

To bring us up to date on this most interesting subject we have selected as Guest Editor Dr. Melvin D. Levine, one of the best known and respected contributors in this field. Dr. Levine is Professor of Pediatrics and Director of the Clinical Center for the Study of Development and Learning at the University of North Carolina School of Medicine.

He has chosen as the first contribution to this symposium the general subject of "Behavior During Middle Childhood" written by Dr. Paul H. Dworkin, Professor of Pediatrics at the University of Connecticut Health Center. Dr. Dworkin describes the activities and problems of children during the middle years - those important years when they are developing physically and emotionally on their way to adolescence. He notes their early sexual interests and their desire to be liked by their peers. For…

Pediatrics is the only area of medicine devoted to the growth and development of a human being. It is a thrilling profession. Much of what an individual is as an adult, physically and emotionally, depends largely on the care he or she received during childhood and adolescence. The pediatrician cares for children as they constantly progress toward adulthood. Thus, he or she is largely responsible for directing the growing child physically and often joins with the parents in molding the child emotionally, educationally, socially, and even morally.

On the surface it may appear that the pediatrician's role in the emotional development of the child is minimal. However, within recent years parents have been turning more and more to their child's physician for aid in understanding and correcting numerous problems relating to their development and behavior. And if pediatricians with a fairly active practice review their patients, they will immediately realize that the parents have numerous questions involving many areas of child development and behavior.

Most of these questions are the same that have been asked for generations. The only new and fairly frequent question asked is "Is my child taking drugs?" This is most usually asked when a previously good student starts doing poorly in school or when a child starts sleeping much more than has been his or her habit. The child almost always denies it, so it is the pediatrician's province to make the decision. And if a urine specimen returns positive, it is best for the child's physician to be the first to notify the patient of the findings and give advice before the worried parents express their upset, resentment, and anger.

But the more frequent problems met by all pediatricians are those of aggressive behavior, shyness, sibling rivalry, and poor scholarship. There are others also, including hyperactivity and inattention at school, rejection by classmates, stealing, lying, truancy, and depression. Some of these are due to physical defects such as auditory and visual problems which can usually be easily detected and corrected.

But in most behavior problems of childhood the etiology is often complex. Vífe must know the mental ability of the child, the home environment, the relation of the parents to each other and to the child, the adjustment to siblings, the degree of assurance and praise given to the child, the methods and type of punishment used, the relation to friends and classmates, the interest in schoolwork, and the attitude of the child's teacher.

Detecting the cause of emotional problems is often difficult but usually fascinating. Solving the problem is much more difficult but can be successfully handled by caretaking pediatricians without the need of trained psychotherapeutic help. I have had many interesting experiences in efforts to comprehend and solve behavior problems and every situation differs.

To bring us up to date on this most interesting subject we have selected as Guest Editor Dr. Melvin D. Levine, one of the best known and respected contributors in this field. Dr. Levine is Professor of Pediatrics and Director of the Clinical Center for the Study of Development and Learning at the University of North Carolina School of Medicine.

He has chosen as the first contribution to this symposium the general subject of "Behavior During Middle Childhood" written by Dr. Paul H. Dworkin, Professor of Pediatrics at the University of Connecticut Health Center. Dr. Dworkin describes the activities and problems of children during the middle years - those important years when they are developing physically and emotionally on their way to adolescence. He notes their early sexual interests and their desire to be liked by their peers. For some years I was the pediatrician to a well known grade school in New York City. I had the opportunity at that time of noting first hand so many of the middle childhood attitudes expressed in this article. I remember especially one girl who was looked on as the female leader in the class - and how each morning most of the "in" girls in the class would telephone this girl to learn how she would dress so they could dress in similar fashion.

These middle years described by Dr. Dworkin as years of development of competence and selfconfidence are the road to autonomy. However, he also describes the mental disorders which may occur, such as conduct disorders and depression.

The second article discusses "The Development of Thinking Skills in School Age Children." It is contributed by Dr. Heidi Feldman, Assistant Professor of Pediatrics of the University of Pittsburgh School of Medicine, and of the Child Development Unit of the Children's Hospital of Pittsburgh.

Dr. Feldman emphasizes at the outset that processing and using information depends on many basic psychological skills such as perception, memory, attention, language, problem solving, and motor implementation. She proceeds to study the changes in these basic skills during the school age years. These include memory capacity, attention span, and the ability to select important aspects of a subject. Furthermore, the academic skills such as reading and mathematics are learned and applied. The article further discusses children with learning problems and suggests ways by which parents can aid in their education and build up their self-esteem.

The following paper considers "Attention and Memory" of the school age child and is written by Dr. Melvin D. Levine, Guest Editor of this issue of Pediatric Anncds.

This is a most interesting subject, and especially interesting and important during the school years. These years, Dr. Levine states, are years of expanding capacity for mental effort. There are so many stimuli confronting a child that he or she must learn, and usually does learn, to select those that are most important. One leams to control the attention so as to focus on a specific task. It is during this school age period that there is considerable improvement in memory. The child gradually leams which important facts must be memorized and which can be figured out. The ability to summarize also develops.

The subjects of attention deficits and memory disorders are also covered in this article. These are behavior difficulties often brought to the attention of the child's pediatrician.

The next contribution deals with "Language Development from Six to Twelve." It is presented by Dr. Gary B. Landman, Assistant Director of the Child Development Center of Northern California, and Clinical Assistant Professor of Pediatrics, University of California Medical School, San Francisco.

These are years when children progress from a rudimentary understanding of syntax and grammar to a much greater understanding of the complexities of language. The child progresses from writing simple sentences in early school years to writing ideas and long term papers on entering high school.

Dr. Landman takes us through these developmental stages and also discusses the role of the pediatrician in identifying children with language problems. He advises on helpful approaches to aiding or resolving such problems.

The final paper covers a most important subject, the "Social Development in Middle Childhood. " It has been written by Dr. Adrian Sandler, Fellow of Developmental-Behavioral Pediatrics at the Clinical Center for the Study of Development and Learning at the University of North Carolina. This is an important subject covering the child's relationship with peers and especially with the peer group. The importance of acceptance by peers is stressed. Firm friendships are established and popularity is assured. Children of school age who are lacking in socialization are often depressed, feel rejected, and lack stimulation in their schoolwork.

Dr. Sandler notes that popular children tend to be more attractive physically, and in addition they actually have better social skills. The various critical popularity subskills are mentioned, all of which tend to increase popularity. The importance of the pediatrician in guiding parents and children in encouraging friendships and peer interaction is stressed.

10.3928/0090-4481-19890601-04

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