- PAVITRA A/P INDRAJOTHY
It is the truth to say that children are our future and if that is true, more time and energy should be put into the beginning stages of each child’s life. The early years of a child’s life are the most important in terms of their general well being, their emotional and social development, and their physical, intellectual and emotional growth. Children develop at different paces and a very high proportion of what they learn takes place in the first five to seven years of life. What happens in the home is extremely important to development in early childhood. There are things that can and should be done to help each child live a life that is productive and beneficial to those that they will interact with in their future. There are many aspects in today’s world that make the quality of life of school children better and meaningful. For instance of aspects that can affect quality of life are obesity, bullying, lifestyle, emotional problems, divorce, socio cultural home environment, child abuse, oral health and back pain.
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First and foremost, there are reports saying that obese children demonstrate more negative self-perceptions, decreased self-worth, increased behavioural problems, lower self-esteem and lower body esteem and perceived cognitive ability. However, because of methodological limitations, definitions of obesity that differ with current recommendations and with non-validated measurements of health related quality of life, it is difficult to generalize the conclusions of these studies (Friedlander et al., 2003).
According to research done by Nathan & Woon in year 1981, Peninsular Malaysia is a multi-racial country of 12 million people, 41% of whom are less than 14 years of age (Vital Statistics Peninsular Malaysia 1975-Department of Statistics, Malaysia). The population consists of three main ethnic groups: the Malays (53%), the Chinese (35%) and the Indians (11%) (Vital Statistics, Peninsular Malaysia, 1975). Whilst in recent years, there has been an increasing tendency for the various ethnic groups to intermingle and to respect and understand the various cultures and traditions that coexist within the country, in the specific area of child rearing, as with marriages, deep-rooted traditions and customs continue to remain a crucial factor and probably contribute, to some extent, to the pattern and incidence of child abuse in the various races.
Bullying has been conceptualized globally as acting in any way that threatens or hurts someone less powerful. Furthermore, bullying also can be distinguished among the different way in which aggressive acts are performed. There are different types of bullying which is physical, verbal, or indirect bullying. Furthermore, distinctions among aggressor’s possible aims can also be made. For instance, bullying physically to hurt the victim or for damage the victim’s relationship with others (Rigby, 2003).
Next, parental separation is usually the first major and drastic change in a child’s life. This distressing event drastically alters the family’s future, bringing to a sense of loss due to interference in daily routines as well as absence of daily contact with both parents (Eymann et al., 2009).
Lastly, obesity, dental caries and periodontal diseases are among major public health concerns which may affect children’s growth and development. Sedentary lifestyle and unhealthy eating habits could lead to poor oral hygiene statuses and increase the tendency to develop periodontitis and obesity at young ages (Anand et al., 2014).
Worldwide estimates of childhood obesity are as high as 43 million, and rates continue to increase each year. Childhood obesity is a growing problem in the present era and it causes serious consequences in the later years (Anand et al., 2014). According to Friedlander et al., childhood obesity is a major public health problem with increasing prevalence; approximately 30% of US school-aged children are defined as overweight or at risk for overweight. Anand and Friedlander states that overweight children are more likely to suffer from a range of chronic health problem such as cardiovascular disease, diabetes mellitus, hypertension, sleep apnoea and asthma. They also concluded that children who are overweight are more likely to become overweight adults.
There was a study conducted by Friedlander et al. among 371 students aged 8-10 years old excluding those who had sleep apnoea or who were born prematurely. Based on BMI categories of the study, 17.5% of the children were overweight, 12.4% were at risk for overweight, 8.1% were underweight, and 62.0% were of normal weight. Moreover, children who are overweight have a 2 to 4 times increased odds of having low scores for physiological health, self-esteem, and physical functioning. Similarly, children who are at risk for being overweight have higher odds of having low physical functioning scores. Furthermore, lower self-esteem also was observed in children who are underweight. Children with higher BMIs are more likely than normal weight children to be perceived by their parents as having feelings of anxiety and depression, of exhibiting aggressive or immature behaviour, as having role limitations in their schoolwork and social activities, and as having low self-esteem. And, their parents also report higher levels of emotional distress and little personal time because of their children’s health or behaviour (Friedlander et al., 2003).
As a suggestion, if the child or teenager is overweight, further weight gain can be prevented. Parents can help their children in maintaining their weights in the healthy range. In infancy, breastfeeding and delaying introduction of solid foods may help in preventing obesity. In early childhood, children should be given healthy, low-fat snacks and they should be allowed to take part in moderate-vigorous physical activity every day. Older children can be taught to select healthy, nutritious foods and to develop good exercise habits (Anand et al., 2014).
Bullying invariably involve an imbalance of power in which the aggressor is more powerful than the victim. Moreover, bullying occurs when there is conflict between people of unequally power (Rigby, 2003).
As identified by Rigby in year 2003, four categories of negative health conditions are low psychological well-being, poor social adjustment, psychological distress and physical unwellness. Low psychological well-being includes states of mind that are generally considered unpleasant but not acutely distressing, such as general unhappiness, low self-esteem, and feelings of anger and sadness. Next, poor social adjustment normally includes feeling of loathing toward one’s social environment, evident through expressed dislike for workplace or school, manifest loneliness, segregation and absenteeism. Moreover, psychological distress is considered more serious than the low psychological well-being and poor social adjustment categories and comprises high levels of depression, anxiety and suicidal thinking. Last but not least, physical unwellness can determine by precise signs of physical disorder, evident in medically diagnosed illness. Furthermore, psychosomatic symptoms also can be incorporated in this category.
Various strategies or treatment should be considered and give a thought to reduce the chances of a child’s further severe involvement in bullying that can worsen the child’s condition. The approach include helping victimized children to evolve self-protective assertiveness skills and working therapeutically with bullying children to create a greater awareness of the repercussion of their antisocial behaviour (Rigby, 2003).
Television is still the most widely-viewed screen worldwide. Globally, people are spending more time sitting at work and at home, and there’s mounting evidence that this “sit time” is a major contributor to the obesity epidemic. Sedentary activities not only TV watching, but also working at desk jobs, using computers, playing video games and driving cars. Increasingly, there’s evidence that watching TV and, especially, watching junk food ads on TV promotes obesity by changing mainly as to what and how much people eat (Anand et al., 2014). Too much television viewing among children has been linked with inadequate study patterns. Inappropriate television-viewing has been linked to erratic sleep/wake schedules and poor sleep quality, violent or aggressive behaviour, substance use, sexual activity resulting in decreased school performance or even school drop-out (Karande & Kulkarni, 2005).
- EMOTIONAL PROBLEMS
Conditions which cause emotional problems in children such as chronic neglect, sexual abuse, parents getting divorced or losing a sibling might cause long term distress resulting in academic underachievement. Besides that, children can face severe emotional upheavals during the treatment of chronic health impairments such as asthma, cancer, cerebral palsy, congenital heart disease, diabetes mellitus, epilepsy, hemophilia, rheumatic diseases, or thallasemia, resulting in low self-esteem and loss of motivation to study (Karande & Kulkarni, 2005).
As recommended by Karande & Kulkarni in year 2005, children with emotional problems need counselling sessions with a child psychologist or a child psychiatrist. Depending on the severity, at times, appropriate medications (anxiolytics, antidepressants) may be needed.
As emphasizes by Eymann et al. in year 2009, divorce is becoming increasingly common in our society, seriously affecting all parties involved, especially children. There were studies conducted in USA and in Europe and roughly calculated that 30 to 50% of children will suffer the effect from a divorce, almost same rates have been reported in Argentina.
Eymann et al. conducted a study at the Hospital Italiano, Argentina. A total of 330 families were invited to take part and only 313 completed the questionnaire; 160 from married family and 153 from divorced family. They defined divorced family (DF) as parents who choose to stay at separate residence regardless of legal marital status while married family (MF) as parents who choose to share residence with their children regardless of legal marital status. The aim of this study was to evaluate psychological quality of life among school aged children of divorced parents by using Child Health Questionnaire – Parent Form 50 (CHQ-PF 50). The results showed that CHQ-PF 50 scores were higher in children of MF than in those of DF for various domains, such as self-esteem, time impact on family, mental health, behaviour, social-emotional functioning and behaviour, and lastly the psychosocial summary score joining all these factors.
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As proved in the results, boys had poorer psychosocial quality of life than girls. This was explained perhaps by the effects of less daily father-child connection on gender-specific identity traits. Furthermore, it is well known that separated mothers who have legal child custody usually suffer a greater slope in their standard of living. Norton & Glick and Duncan et al. have clearly proved the unfavourable economic repercussion of divorce on child well-being.
In this study, maternal remarriage didn’t appear to influence quality of life of child. Maternal remarriage could impact children who must readapt to new family basis and dynamics. However, a new partner perhaps could provide additional financial support since parental separation usually involves a fall in family income. Moreover, the new couple may construct an improved marital relationship, hence could minimize the distressing emotional burden on children and making the stepfather as a positive and ideal role model (Eymann et al., 2009).
Lastly, in this study, separation by mutual agreement because of higher maternal education or maternal university education level and longer the length of time passed since separation has inclined psychosocial quality of life scores, while scores declined in boys and for each one-year increment of maternal age. Eymann et al. proves that higher maternal educational level could give positive impact on psychosocial quality of life, which may be explained as a consequence of the skills build through education years, allowing better and organized control of the marital problems and crisis and greater agreement on conflict issues (Eymann et al., 2009).
- CHILD ABUSE
A prospective study was made of all cases of child abuse seen at the University Hospital, between July 1978 and June 1980. A total of 19 cases, 16 of physical and 3 of sexual abuse were diagnosed during this period. The relatively high (32%) incidence of child abuse amongst Malay families was quite surprised, as Malay children are generally much loved and pampered. Nathan and Woon suspect that the increasing incidence of child abuse amongst the Malays is probably related to their urban migration in recent years with the resultant breakdown of the extended family system and the need to cope with the pressures of life in an unfamiliar urban setting (Nathan & Woon, 1981).
The commonest injuries found on admission were bruises and injuries to the face and scalp. The majority of the abusers in our series were parents, the ratio of father to mother being. Both social and personal factors in the life of the abuser seem to contribute to the act of child abuse. Marital disharmony appears to feature prominently amongst the interpersonal problems, while two abusers gave a history of having been abused physically during their early childhood (Nathan & Woon, 1981).
- SOCIOCULTURAL HOME ENVIRONMENT
It has been recognized that children from poor socioeconomic status families have higher chances of poor school performance. Malnutrition due to poverty coupled with low education and status of parents adversely affect their cognitive development. Such children also have higher chances of experiencing, right from their pre-school years, parental attitudes which do not motivate them to study and an unsatisfactory home environment which does not encourage learning (witnessing domestic violence, family stressors, and adverse life events). Alleviation of hunger, by providing one balanced meal in school is one of the mechanisms to improve academic achievement in undernourished low-income elementary school children (Karande & Kulkarni, 2005).
Besides that, many of these disadvantaged children are studying in English medium schools as their parents believe that this would help them progress in life. These children face the added burden of “language barrier”, namely, they are not conversant in English as they came from non-English speaking families, which leads to poor school performance or even school failure. Parents of children with “language barrier” should be counselled to educate their children in their own language medium schools or to attend a facility for “language stimulation” if that is available and affordable (Karande & Kulkarni, 2005).
- ORAL HEALTH
In the research carried out by Anand et al. in year 2014, they noticed that poor oral hygiene statuses in children who spent more time watching television, playing video games, as their consumption of soft drinks and fast foods was more and due to lack of adequate exercise.
- BACK PAIN
Musculoskeletal pain is exceedingly common in young adults. A questionnaire survey was carried out by Brattberg in year 1994 among children 8, 11, 13 and 17 years old. The prevalence of back pain and headaches among 1,245 Swedish school children was studied. 29% of the students reported back pain and 48% headache. In all age groups studied, both back pain and headaches were more common among girls than boys. Girls also reported more frequent symptoms than boys (Brattberg, 1994).
Children who are at risk for or who are overweight having odds 2 to 4 times greater for lower health related quality of life scores for physiological health, self esteem and physical functioning. Parents of children who are overweight also were more likely to evidence higher levels of emotional distress because of their children’s health. Being relatively underweight also was associated with lower self-esteem (Friedlander et al., 2003).
Ken Rigby in year 2003 concluded that being victimized by peers is notably related to relatively low levels of psychological well-being and social adjustment and lastly to high levels of psychological distress and unfavourable physical health symptoms.
Eymann et al. in year 2009 concluded that children’s psychosocial quality of life was affected by divorce. Psychosocial quality of life improved when parents had divorced by mutual agreement, the mother had a university education, when more time had elapsed since separation and was poorer in boys and in children of older mothers. And, quality of life can be improved as more time elapses after the divorce, this is because may be it can be interpreted as a process of accepting the family modification.
And lastly, poor oral hygiene was observed in children who spent more time in leisure activities and that lifestyle factors could make an impact on oral hygiene and periodontal health. A need exists for addressing obesity, oral health and nutrition, jointly in health promotion strategies, to improve well-being of children and also to empower good life-style factors (Anand et al., 2014).
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