Community social pediatrics aims at identifying the needs of children in vulnerable situations, their rights that are not respected, and at reducing or eliminating the sources of toxic stress that affect their development and well-being.
Stress is not necessarily bad. Endocrinologist Hans Selye defines it as “(…) a response of the body to demands placed upon it.” But this response can become toxic when children live with intense, frequent and prolonged adversity. Extended activation of stress response systems can disturb the brain’s development and architecture, as well as other biological systems. It can delay children’s development, harm their ability to learn and increase the risk of developing diseases and cognitive disorders when they grow up. This is why community social pediatrics aims to detect, reduce or eliminate the sources of toxic stress or risk factors that affect the development and well-being of children from disadvantaged backgrounds. Identifying these sources is key to understanding the reasons behind a child’s difficulties. Three elements are essential to determining the presence and impact of sources of toxic stress on the development of the brain’s architecture.
- Children’s heredity can make them more susceptible to certain health problems. Children inherit roughly 23,000 genes from their parents when they are born. Research has shown that a person’s genetic makeup can be influenced in the first years of life by his or her environment or early experiences.
- Social and environmental factors which surround a child all have an impact on his or her health and development. These include physical environment, family income, education level, social support network, cultural background, as well as access to and use of health and social services. In addition to these, we see new problems associated with a 21st-century hectic and high-tech lifestyle such as chronic illness, weight gain, obesity, increased anxiety levels, along with cases of burnout and suicidal behaviours affecting children and adolescents.
- Children who go through negative experiences, occasional or chronic tragic events, can possibly suffer long term consequences when these experiences are intense, frequent or prolonged.
To learn more
- Boivin M., Hertzman C. (eds.) (2012). Early Childhood Development: Adverse Experiences and Developmental Health. Royal Society of Canada – Canadian Academy of Health Sciences Expert Panel (with Ronald Barr, Thomas Boyce, Alison Fleming, Harriet MacMillan, Candice Odgers, Marla Sokolowski, Nico Trocmé). Ottawa: Royal Society of Canada.
- Center on the Developing Child (2012). Toxic Stress: The Facts. Boston: University of Harvard. Retrieved July 23, 2012.
- Diamond A. (2006). The Early Development of Executive Functions. In E. Bialystock, F. Craik (eds.), Lifespan Cognition: Mechanisms of Change. New York: Oxford University Press: 70-95.
- Lanius R. (2010). The Aftermath of Adverse Childhood Experiences: Posttraumatic Stress Disorder and Beyond. In Early Brain & Biological Development: A Science in Society Symposium. Summary Report.Calgary: 26.
- Marmot M., Wilkinson R.G. (eds.)(2003). Social Determinants of Health- The Solid Facts, 2nd Copenhagen: World Health Organization.
- National Scientific Council on the Developing Child (2010). Early Experiences Can Alter Gene Expression and Affect Long-Term Development, Working Paper No. 10).
- National Scientific Council on the Developing Child (2004). Children’s Emotional Development Is Built into the Architecture of Their Brains: Working Paper No. 2.
- Perry B.D., Pollard D. (1997). Altered Brain Development Following Global Neglect in Early Childhood. Society for Neuroscience, Proceedings From Annual Meeting, New Orleans.
- Palfrey J.S. et al. (2005). Introduction: Addressing the Millennial Morbidity – The Context of Community Pediatrics, Pediatrics, 115 (4): 1121.
- World Health Organization (2013). Health Impact Assessment: The Determinants of Health. Retrieved April 22, 2013.
The community social pediatrics approach is also designed to identify the child’s needs. “Les besoins des enfants sont faits d’un ensemble d’éléments de nature physique, sociale, intellectuelle, émotionnelle et spirituelle, liés à l’enfant et à son environnement, dont la somme représente sa santé et son bien-être” (Julien,2004). Meeting these needs is an ongoing and complex process aiming to ensure that the child follows his life course trajectory. It is only possible to identify needs when children’s rights are fully understood, because these two elements are closely connected. Needs and rights are seen as a whole in the practice of community social pediatrics, even if needs are more readily apparent.
Children’s needs as seen through the lens of community social pediatrics
- Children need to feel comfortable in their own skin and grow in a healthy environment where they can develop to their full potential (physical needs).
- Children need to feel loved, important, appreciated, respected, grounded and attached to a family and a community (emotional needs).
- Children need to develop their intellectual abilities to understand the world they live in and lead fulfilling lives (intellectual needs).
- Children need to develop trusting relationships with friends and family and to have positive social interactions with others in order to create a network they can count on (social needs).
- Children need to feel a sense of attachment to a culture, to have their own personal identity, a set of values and their own language (cultural needs).
- Children need to find meaning in their lives (spiritual needs).
A day in a child’s life living in vulnerable conditions.References
- Bass M. (2010). Évaluation des besoins de l’enfant ou évaluation des problèmes : passer d’une démarche technobureaucratie d’expert à un système de coopération équitable, le rôle du cadre dans l’évaluation des situations préoccupantes, ENACT d’Angers-France.
- Brazelton T.B., Greenspan S.I. (2003). The Irreducible Needs of Children: What Every Child Must Have To Grow, Learn, and Flourish. Cambridge, MA.: Da Capo.
- Julien G. (2004). A Different Kind of Care: The Social Pediatrics Approach. Montreal: McGill-Queen’s University Press.
- Julien G. (2004). Soigner différemment les enfants : méthodes et approches, 2nd Québec City: Les Éditions Logiques.
- Laporte D., Sévigny L. (2002). L’estime de soi des 6-12 ans, Montreal: Éditions du CHU Sainte-Justine.
- Schor E.L. (1995). The Influence of Families on Child Health. Family Behaviors and Child Outcomes, Pediatric Clinic of North America, 42 (1): 89-102.
The Alliance Droit Médecine Sociale(ADMS) component was incorporated into the community social pediatrics model in 2007 by Hélène (Sioui) Trudel to boost the effectiveness of community social pediatrics teams. This component facilitates access to justice for clients of social pediatrics centres and ensures the respect of their fundamental rights, in the spirit of the Convention on the Rights of the Child (1989) and the Charter of Human Rights and Freedoms. Community social pediatrics is based on 41 articles of the Convention, which are grouped together under seven key principles. The first two principles preface and encompass the others. All children have fundamental rights set out in the Convention and each need is transposed into law.
The 7 children’s rights principles in community social pediatrics (Trudel, 2010)
- Children are born equal before the law, and their growth and development must be assured irrespective of differences.
- The child’s best interests must be the overriding concern in all decisions made concerning him or her.
- Children must enjoy the rights and freedoms to which every human being is entitled.
- The entire community must be concerned with families in need in order to better support children.
- Children must have every opportunity to be born in good health and to develop their full potential.
- Children must be able to get educated, to have fun and to be open to the world.
- Children must be protected.
To learn more
Listen to Hélène (Sioui) Trudel explaining how to integrat law into community social pediatrics [in French only]References
- Trudel H. (2013). Making the Convention on the Rights of the Child Part of Our Practice, 2nd Community Social Pediatrics Symposium, April 12, 2013.
- Julien G., Trudel H. (2009). Tous responsables de nos enfants : Un appel à l’action. Montreal: Bayard Canada.
- Zuckerman B. (2012). Medicine and Law: New Opportunities to Close the Disparity Gap, Pediatrics, 130 (5): 943-944.