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HEC101V/501/3/2013

Tutorial letter 501/3/2013


HEALTH EDUCATION
HEC101V/501/3/2013

Semesters 1 & 2
Department of Curriculum and Instructional
Studies
IMPORTANT INFORMATION:
This tutorial letter contains important information
about your module.

HEC101V/501

TABLE OF CONTENTS
Page
1

Course overview

Study unit 1:

Introduction to health and health education

Study unit 2:

Suitable health education topics

22

Study unit 3:

Special topics in health


Child abuse and neglect
Hospitalisation
Chronic illness
Childhood stress
Loss, death and dying
HIV/AIDS

28

Conclusion

51

Revision questions

52

List of sources

56

Layout of the tutorial letter:


The following icons are used in the text:
This denotes a written activity.
2

This refers you to your prescribed book.

This means that you must reflect on or think about something


.

!!

You should take note of this information as it is important.

HEC101V/501
Dear Student
1

COURSE OVERVIEW
Welcome to Health Education (HEC101V). I trust that you will find this module
interesting and of practical use in your teaching career.
Please note that this module was consolidated in 2006 to replace two previous
modules, PRS3019 and PST403P, and is thus now also applicable for the BEd (ECD)
and the BEd (Intermediate and Senior Phase) programmes. This means that some of
the information in study unit 1 will be a repetition of that in the BEd (ECD) module
PRS1023 .
As mentioned in Tutorial Letter 101/2013, there is no study guide for Health
Education; you will be guided through this module by tutorial letters. Tutorial letters in
the 500-series take the place of a study guide.
PRESCRIBED BOOK
Please remember that it is essential that you study the prescribed book because it
forms the core of this module:
Weinstein, E & Rosen, E. 2003. Teaching children about
health. Second edition. Belmont, CA: Wadsworth.
Students doing the BEd (ECD) degree should also use the book that was prescribed for
their first health module (PRS1023). Intermediate and senior phase students can make
use of this book, where indicated in this tutorial letter, as recommended reading.
Marotz, L, Cross, M & Rush, J. 2005. Health, safety and
nutrition for the young child. Sixth edition. Albany, NY: Delmar.

HEC101V/501
THE STUDY UNITS
Please use the study units as guidelines for the main topics that will be included in the
examination.
Remember too that the assignments and any additional information given in other tutorial
letters during the year are important content for this course. The information and comments
about the various study units given in these tutorial letters are useless without the prescribed
book.
STUDY UNIT 1:

Introduction to health and health education


(Weinstein & Rosen 2003: ch 1)

STUDY UNIT 2:

Suitable health education topics


(Weinstein & Rosen 2003: chs 2, 3, 5, 6, 7, 13, 14, 15)

STUDY UNIT 3:

Special topics in health


(Weinstein & Rosen 2003: chs 5, 8, 9, 11, 12)
-

Child abuse and neglect (chs 11, 8, 9)

Hospitalisation

Chronic illness (ch 5)

Childhood stress (ch 8)

Loss, death and dying (ch 12)

HIV/AIDS (chs 5 & 12; Tutorial Letter 102)

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STUDY UNIT 1: INTRODUCTION TO HEALTH AND HEALTH


EDUCATION
LEARNING OUTCOMES
The purpose of this study unit is to help you think about and
understand the ways in which you can improve and maintain the
health of children and adults in the ECD centre or primary school
through health promotion and health education.
After studying this unit, you should be able to

explain the term health

explain how the quality of the health, safety and/or nutritional status of the
young child is interrelated

describe how heredity, behaviour and lifestyle, environment, health care


systems and development can affect health in the South African context

explain the relationship of health to the childs emotional, social and


cognitive (or intellectual) development

explain the difference between health promotion and health education

discuss the concept of health promoting schools

explain factors affecting school health education

identify the main health educators of children

discuss parental involvement in health education

explain criteria for determining appropriate health experiences

2.1 WHAT IS HEALTH?


The United Nations World Health Organization defines health as a state of
complete physical, mental and social wellbeing, and not merely the absence of
disease and infirmity (WHO 1947:3).
This means that one can maintain health by caring for ones own health and the
health of others and by making positive health decisions. This also has to do with
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ensuring a healthy environment, as this will help create the conditions that will allow
all members of society the opportunity to attain optimum health.

Do you think that it is possible for a person to attain this


standard of health in all aspects of life?
BEd (ECD) students can refer back to study unit 1 of module
PRS1023 to revise the factors that affect the health of the child.

The WHO definition clearly stresses health, and not illness. Furthermore, this definition
states that health does not depend on physical wellbeing alone and that the physical
aspect of health, although important, should not be viewed in isolation. However, a
persons physical health can, to a greater or lesser extent, influence all aspects of
development.
Hoyman (1975:514) describes health as existing on a continuum, ranging from optimal
health to death. For various reasons our state of health fluctuates constantly along this
wellness continuum because it is impossible to be in a state of total physical,
environmental, economic, social and mental health all the time.

Read pages 18 to 20 in your prescribed book (Weinstein & Rosen, 2003) and
then complete the following written activity.

In your opinion, how does the wellness continuum differ from the definition of
health given by the World Health Organization?
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2.2

THE CHILDS RIGHT TO HEALTH CARE

On 16 June 1995, South Africa signed the United Nations Convention on the Rights of the
Child, of which 171 countries now form part. This convention upholds the basic rights that
should apply to all children so that they can live and develop safely and be protected from
harm and exploitation without any discrimination. South Africa has since entrenched these
childrens rights into section 28 of the Bill of Rights of the South African Constitution. This
requires suitable measures to be taken in order to provide for the best interests of children,
especially with regard to basic nutrition, shelter, health care and social services (Initial Country
Report, South Africa 1997:8, 16).
An important basic right is the childs right to survive, which encompasses the right to life and
the right to health and health care. What this means is that each child should have access to
health care through primary health care services in order to prevent disease and malnutrition.
Another basic health-related right is the childs right to be protected against abuse and neglect
by parents or other caregivers (National Childrens Rights Committee).

2.3 FACTORS AFFECTING HEALTH


According to Kibel and Wagstaff (1991), children differ from adults in that children are growing
and developing and are dependent on others for sustenance and protection. To grow
optimally children need ... adequate nutrition, protection from the environment and an
emotionally nurturing family setting (Kibel & Wagstaff 1991:2).
The early years of life are critical for growth and development. It is during this period that
neurological (brain and nervous system) and muscular growth and development occur most
rapidly and these are all factors that will determine, to a large extent, the childs future
intellectual and physical skills.
The state of a persons health is determined by a variety of factors which interact with each
other and this means that it is possible for an individuals health status to change continually
for better or for worse. From the time of conception a number of factors may influence health
at various times. Some of these earliest influences are the following:

Prenatal factors (affecting the developing foetus from the time of conception until
birth), which include genetic conditions, infections in pregnancy, poor nutrition of
the pregnant mother, certain medication taken during pregnancy, alcohol
consumption, drug abuse or smoking while pregnant, exposure to radioactivity,
the age of the mother (very young or over 40 years) as well as prematurity of the
baby.

Perinatal factors (around the time of birth), which include problems such as a
lack of oxygen to the baby during the birth process, birth injuries, rhesus
incompatibility or haemorrhage.

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Postnatal factors (after birth), which could include damage to the central nervous
system as a result of infections, injury, poisoning, lack of oxygen or metabolic
disturbances.

Heredity
Heredity determines what you can become (in other words what your maximum potential is)
and the child receives this from his/her parents at the time of conception.
There are many genetic disorders that may cause abnormal conditions in the child and these
can result in intellectual impairment and/or physical handicap (e.g. Downs syndrome,
porphyria or haemophilia). The following explanation is a very basic explanation of the
hereditary basis of life:
The nucleus of each of the cells in the human body contains 23 pairs of chromosomes (i.e.
each cell contains 46 chromosomes) except for the reproductive cell which only contains 23
chromosomes. After conception the cells of the new embryo contain 23 pairs of
chromosomes, one of the pair comes from the mother and one from the father.
The chromosomes are threadlike structures containing thousands of genes. The
development, structure and functioning of every human depends on the genes received from
both parents, which will determine physical attributes such as eye and hair colour, body shape
and the like. In each pair of genes, one comes from the mother and the other from the father.
Some of the genes may be abnormal probably every one of us has some abnormal genes.
Fortunately the normal gene for a specific body attribute usually dominates the abnormal
gene. Very seldom do both parents have the same abnormal gene and so transmit it to the
child.
Birth defects and genetic diseases can result from abnormal chromosomes, abnormal cell
division or from the interaction of many genes with the environment. A person may inherit the
genetic predisposition for a particular disease which will only become evident if specific
environmental influences occur (this is multifactoral inheritance). Some examples of
multifactorial defects include diabetes, cleft lip and cleft palate, club foot, asthma and spina
bifida.
Many of the major killer diseases in the developed world have a genetic component and are
suspected of being multifactorial in origin. This is one reason why it is important for effective
health education to begin at an early age.

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Environment
In 1994 the National Childrens Rights Committee (NCRC) stated that
... for the majority of South Africans who live in depressed rural areas or in overcrowded
townships and informal settlements, the environment is one which is unsafe and unhealthy, is
devoid of basic amenities and recreational facilities and where open spaces are filled with litter
rather than trees and parks.
The most important factors in the environment that contribute to disease, disability and death
in South Africa are the following (NCRC, 1994; Von Schirnding, 1995):

a lack of sewers, drains and services for disposing of solid and liquid waste

Approximately 50% of the South African population lack adequate


sanitation and, in 2001, 17% of households had no sanitation
(Statistics South Africa, 2003).
a lack of a safe and sufficient water supply

Approximately 12 to 15 million people (30% of the population) have no


access to clean drinking water, including 50% of people in the rural
areas. The 2002 South African Education for All assessment stated
that nearly 25% of primary schools had no access to water within
walking distance (Human Rights Watch 2004:18).

overcrowded and inadequate living conditions

More than five million people in South Africa are homeless or live in
squalor in inadequate accommodation.

insufficient safe and clean fuels for domestic cooking and heating, which means that
expensive and often unhealthy fuels are used (coal, paraffin and wood) which cause
pollution, as well as health problems for infants and children

Approximately 60% of South African households have no access to


electricity.

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poor control of workplace environments, in both the formal and informal sectors,
leading to chemical and biological contamination of land, air, water and food resources
which result in unacceptable levels of pollution
In South Africa today many of the environmental health issues revolve around poverty.
People who are disadvantaged by poverty are the most vulnerable to disease and are
the least able to access the available health resources.
Von Schirnding (1995) maintains that
... the urban poor in South Africa, being simultaneously exposed to a myriad
of agents of environmental diseases, will suffer increasingly from the worst of
both first and third worlds, and being frequently nutritionally deprived, are the
most vulnerable to the effects of these diseases.

Refer also to your prescribed book (ch 13) for other


environmental influences on health.
Lifestyle and behaviour
In 1988, Dr H Nakajima of the WHO stated that ... most of the worlds major health problems
and premature deaths are preventable through changes in human behaviour and at low cost.
Many of the major decisions that people make are influenced by important people in their
social network and this is particularly true about health decisions. It is a well-known fact that
people who are highly valued in a community can either help or hinder personal health
decisions. Many of us rely on the advice of family members, religious leaders or friends when
making important decisions.
Lifestyle and behaviour are influenced by aspects such a personal health knowledge,
customs, cultural and religious beliefs, the influence of the media and beliefs about disease
causation. In many cultures in Africa, the cause of disease and the aim of healing focuses on
three aspects spiritual or magical aspects, physical phenomena and psychological
phenomena. Illness is believed to be caused by an imbalance in any of these and healing
occurs when these imbalances are corrected.

Refer to page 19 of your prescribed book for more


information on health risk factors and lifestyle.

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Health care systems
The availability (or lack) of preventative primary health services, the existence of a national
health policy and the influence of traditional medicine will affect a persons health to a lesser
or greater degree. As a result of past inequalities in the provision of health care systems,
millions of disadvantaged South Africans (especially children and those living in rural areas)
have been without adequate health care.
Development
Poverty and low socioeconomic status caused by single-parent families, teenage parents,
unemployment, lack of education, rapid urbanisation and similar factors may also affect the
health of the child.
The Birth to Twenty Study (BTT) is a long-term research project undertaken by the University
of the Witwatersrand, which is studying 3 770 children born in the Johannesburg and Soweto
areas between 23 April 1990 and 8 June 1990. It was initiated to investigate the biological,
environmental, economic and psychosocial factors associated with the survival and health of
children living in an urban environment.
The report back on the initial findings stated that one of the most important factors influencing
a childs health is the level of education of the childs mother. It was found that each additional
year of schooling for a woman is associated with a 5 to 10% decrease in the under-five child
mortality rate (i.e. the number of children under the age of 5 who die in a specific period of
time) for any of her children under the age of five years.
The under-five child mortality rate among children of uneducated mothers is 80% higher than
among the children of mothers who have a Grade 10 education (Yach, Richter, Cameron, Von
Schirnding & De Wet, 1993).
The BTT study found the following to be true:
Women with higher levels of education make better use of antenatal and
postnatal services.
Their children have higher rates of immunisation.
Their children are better nourished when compared to children of mothers with
lower education levels.
Educated women have fewer children.
These findings correlate (i.e. add to and agree with) with research in other parts of the world
which shows that the education of females is linked to a lower infant mortality rate, a lower
birth rate and improved child nutrition (Morley & Lovel 1986).

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If you read the above section again, as well as the relevant sections in the
prescribed book, you will probably agree that many of the factors mentioned that
damage peoples health is beyond their control. You will probably be able to
name other factors that also affect the health of the child. Make a mind map of all
these factors in the space below.

Factors affecting the health of the child

2.4
THE RELATIONSHIP OF HEALTH TO ASPECTS OF THE
CHILDS DEVELOPMENT
Changes in the childs physical health may also affect social, emotional and intellectual
aspects of the childs development. Some examples are given below:
Physical health and emotional development
There are many emotional reactions that might be caused by problems with physical health:
The ill child may be irritable and anxious and this could affect adaptation to school and
the development of peer relationships.
The hungry or poorly nourished child may be short-tempered and irritable and unable to
concentrate.
The obese child may become very self-conscious and withdrawn as a result of teasing
from friends.
The tired child who has had insufficient sleep may overreact at the slightest
provocation.
The overprotected, chronically ill child may become very demanding.
All of these emotional responses may have a greater or lesser impact on the child and will
influence his/her scholastic success. Alternatively, emotional problems can result in physical
symptoms think about the emotionally disturbed child who wets his/her bed, vomits or shows
other physical symptoms caused by emotional distress.

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Physical health and social development
It is important for the child to be able to relate well to peers and to be accepted in a group if
he/she is to adapt well to the school situation. The child who is healthy and feels confident is
most likely to succeed in this respect.
Illness often isolates the child from the peer group for a period of time with the result that the
child may have to re-establish social contacts upon return to school. A child may also be
socially ostracised by the peer group because of being physically different in appearance or
ability, for example the obese child may be excluded from the group because of an inability to
compete physically on equal terms with other children or be ridiculed because of his/her size.
In addition, today children are sometimes socially ostracised because of chronic illnesses like
HIV/AIDS. Apart from the negative effects of social isolation, children who are discriminated
against in this way often develop a poor self-image.
Physical health and intellectual development
Children with health problems like haemophilia (i.e. severe bleeding and bruising because of
the inability of the blood to clot effectively) may be deprived of learning opportunities because
their physical mobility is restricted. Research has shown that a relationship exists between
motor skills and academic achievement (Gallahue, Werner & Luedke 1975:242). The young
child who is thus denied sufficient movement experiences owing to illness or immobility could
be hindered in later academic achievement. This lack of opportunity to use ones body is
particularly detrimental during the first few years of life when the child uses his/her body to
explore the world.
Some infections also affect the functioning of the brain and this can lead to decreased
intellectual function. For example, some children with HIV infection may have neurological and
learning problems resulting from the effects of the HI virus on the brain tissue.
Most teachers will agree that learners with almost any health problem from poor vision, a
common cold, hunger or child abuse will not learn effectively.

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Can you add any examples of your own?


Emotional: ..........................................................................................................
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Intellectual: .........................................................................................................
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2.5 HEALTH PROMOTION VERSUS HEALTH EDUCATION


These two terms are often confused but, simply stated, health education is only one of the
strategies used for health promotion (Reddy & Tobias 1994:19
Health education is usually defined as
... the deliberate structuring of planned learning opportunities about health which are
aimed at voluntary changes in health-related behaviours to give individuals the
opportunity of achieving a more favourable position on the health continuum (Reddy &
Tobias 1994:20).
Health education includes all of the following (Hubley 1994):
being motivated to adopt health-promoting behaviours
helping individuals to make and implement informed health decisions
changing behaviour voluntarily to improve health
However, health education will not be successful if only knowledge of health issues is given
to another person (the information-giving model of health education) without understanding
the political, social and economic situation in which a person lives. Crewe (1992:16) cites the
following example:

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Most mothers will know instinctively when their children are malnourished. All
the information available about malnutrition and good feeding will be of no use if
the mother cannot afford the food, the sugar or even the matches to light the fire
to sterilise the water.
The school teacher has an important role to play in providing knowledge and developing
healthy attitudes and behaviours for learners at an impressionable time of their lives.
Health promotion, on the other hand, takes a broader approach and involves more than just
health education. It may be defined as
... any combination of health education with related organisational, political and
economic interventions designed to facilitate behavioural and environmental
adaptations that will improve or protect health in individuals, groups or
communities (Reddy & Tobias, 1994:20).
In 1986, the Ottawa Charter of the WHO described health promotion as the the process of
enabling people to increase control over and improve their health".
The draft Health Promotion policy of the South African Department of Health describes health
promotion as
... helping people to gain and maintain good health through promoting a
combination of education and environmental supports which influence peoples
actions and living conditions (1999:4).
Health promotion helps or empowers people to increase control over and improve their health
on an individual level and also tries to influence communities and decision makers to make
changes in the policies that affect other peoples health (Hubley 1994; WHO 1984). Health
promotion includes all of the following:

community participation
education
intersectoral collaboration
multidisciplinary teamwork
community development
mass media campaigns
prevention of specific diseases
the provision of basic services (sanitation, water and the like)

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Read pages 21 and 22 in your prescribed book on the goal of health education.
Can you briefly summarise in the space below what "prevention through
promotion" means?
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2.6 HEALTH POLICY DEVELOPMENT AFFECTING SCHOOLS


2.6.1 Health promoting schools
The concept of health promoting schools was originally introduced by the WHO (1991) as a
result of a proposal in 1988 by the European Community Council of Ministers of Education
who resolved
to make appropriate arrangements for co-ordinating health promoting measures
between schools, families, health institutions and services, and the community, so that
health education can be seen by children as a practical and not only theoretical part of
their lives (European Commission 1989).
The WHO (1993:1) defines a health promoting school as one which
.. .aims at achieving healthy lifestyles for the total school population by developing
supportive environments conducive to the promotion of health. It offers opportunities for
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and requires commitments to, the provision of a safe and health-enhancing social and
physical environment.
International criteria for health promoting schools
Internationally, the criteria for a health promoting school are the following (Morton & Lloyd
1994:6):

commitment to the improvement of the physical, social and psychological environment


of the school
promotion of learners self-esteem
good teacherlearner and peer group relationships
positive and productive links with the school, family and community
a stimulating and well-balanced health education curriculum
the way in which adults present themselves as role models to learners
the use of specialist community services for advice and support in health matters
the active involvement of any school health services in the health education curriculum
the way in which the school promotes the health of its staff
the support and commitment of senior management to the concept of the school as a
health-promoting institution

The development of the health promoting school approach in South Africa


The need for a health promoting school policy in South Africa was realised because of the
history of poverty and discrimination, which exposes many children to unsafe and unhealthy
school and home environments, both of which have a negative impact on childrens physical,
emotional, intellectual and social wellbeing.
In 1996, the South African Department of Health convened a national workshop, in
collaboration with the Ministries of Education and Welfare, at the University of the Western
Cape to begin planning a policy of health promoting schools for South Africa, which would
eventually involve health services, the community, teachers, parents and children
(Department of Health 1997:19).
Since 1999 many workshops have been held in South Africa and have revolved around the
development of policy guidelines for the creation of health promoting schools in the South
African context. Currently, this approach is being implemented at schools in the Western
Cape.
According to the Department of Health (2003:4) the Health Promoting Schools (HPS) initiative
in South Africa is underpinned by a philosophy of health promotion and has five components
which provide the basis for school health:

The development of healthy school policies that will assist the school community in
consistently addressing its health needs.
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Access to appropriate services to address the health needs of the school community.
The development of personal skills of members of the school community, thus enabling
them to improve their own health and influence the healthy development of others.
The development of the school as a supportive environment for the development of
healthy attitudes and practices.
Community action that involves the school and the broader community in taking
ownership of and seeking ways to address their collective health needs by accessing
resources for health.

2.6.2 National School Health Policy


In 2003 the Department of Health published the School health policy and
implementation guidelines. The stated vision of the policy is the promotion of the
optimal health and development of school going children and the communities in which
they live and learn (Department of Health 2003:viii).
According to this document: Children are in schools at least 40 weeks a year over a
12 to 13 year period of their lives. Through the infrastructure provided by schools,
health and other social services are afforded the opportunity to collaborate with
educators in addressing childrens critical health, developmental and social needs
(Department of Health 2003:iii).

? Find out what is being done to implement the National School Health policy in
your own school district/primary school.
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2.7 FACTORS INFLUENCING SCHOOL HEALTH EDUCATION


There are a number of factors that make the teaching of health education topics difficult. This
is discussed in your prescribed book.

Summarise this section in Weinstein and Rosen (2003:56).


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2.8 HEALTH EDUCATORS IN THE SCHOOL ENVIRONMENT

Parents and other family members play an important formative role in health education
for children because of the care they give in the home environment and the example
they set their children. It is thus accepted that health education begins in the home and
the teacher must have a supportive relationship with the family in this respect (Morton
& Lloyd 1994:134).

The teacher is the primary health educator during school hours and can provide health
education for children, parents and other staff categories.

Other professionals such as those from the health or welfare field doctors, dentists,
nurses, dieticians, paramedical staff, social workers, psychologists and the like can
provide expert knowledge about health and related matters and should be called upon
when necessary.
Children are usually regarded as recipients of health education rather than as health
educators. However, in 1979, the CHILD-to-Child Programme was launched worldwide
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to celebrate the International Year of the Child and thiswas one of the first times it was
recognised that ... children learn many things from each other and not only from adults
(Young 1987: 155). This programme uses children to teach their siblings and other
family members about topics such as child care, accident prevention, nutrition and
immunisation and is based on the following three assumptions (Hubley, 1994):

Education is most effective if it is closely linked to things that matter most to


children and their families.

Education within a school and education outside of school should be linked so


that learning becomes integrated as a part of life.

Children have the will, skill, potential and motivation to help educate each other
and they may be trusted to do so.

Peer education becomes important towards the end of the Foundation Phase and throughout
the Intermediate and Senior Phase where information and modelling provided by the peer
group are often more acceptable to learners than that provided by adults.

Many associations, organisations and commercial companies produce education


material that the teacher can use.

? Find out which organisations in your area produce educational material that
teachers can use for health education purposes. Do not forget to keep
health-related newspaper supplements.
Collect as many of these as you can and place them in a file as the start of
your own health resources collection.
Use the topics mentioned in the study units of this tutorial letter as
organisational themes for your resource collection.
2.9 THE ROLE OF PARENTS IN HEALTH EDUCATION
Parent involvement in school matters and especially in the potentially sensitive issues that
often relate to health should be encouraged.
Schurr (1992) recommends the following ways in which parents can be included in the life of
the school:

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Ask parents to share their stories or feelings about personal health issues.Establish a
school parent centre which can supply resources and serve as a meeting place for staff
and parents.

Encourage school and community interaction through activities, such as displays in


shopping areas, in which parents, learners and teachers are involved.
Create and disseminate a booklet of tips and guidelines for parents.

Arrange weekend or evening information sessions so that parents know how to


become involved in the school.

Arrange for two to three parent-teacher contact sessions throughout the year.

Publish a monthly parent newsletter.

Suggest that learners each have a parent/teacher notebook for communication


purposes.

Can you think of any other good ideas that can be used to
encourage parental involvement?
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2.10 CRITERIA
FOR
EXPERIENCES

DETERMINING

APPROPRIATE

LEARNING

According to Robertson (1998:449) and Bender and Sorochan (1997:6667), the following
criteria can be used to determine if the health, safety and nutrition curriculum is appropriate for
learners:

Is the activity appropriate for the age, culture and developmental


level of the learner?
Does it provide for a holistic approach?
Does it provide an opportunity for learners to make choices?
Does it promote positive choices?
Is it flexible?
Are learners able to explore and interact (i.e. is it actionorientated)?
Is there a variety of different activities?
Is a variety of different presentation methods used?
Does the learning experience impart both knowledge and healthrelated skills and attitudes?
Does it teach through two or more senses?
Is it economical in terms of time and cost?
Is the information presented in an unbiased manner?

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STUDY UNIT 2: SUITABLE HEALTH EDUCATION


TOPICS
LEARNING OUTCOMES
The purpose of this study unit is to help you think about the health education
curriculum for your particular phase.
After studying this unit, you should be able to

NB!

identify health education topics that are suitable for the learner in either the
Foundation or the Intermediate and Senior Phase

plan suitable learning experiences, related to these topics for the learner in
either the Foundation or the Intermediate and Senior Phase

For this study unit make sure that you know what information you would include on the
following topics when planning learning activities for Foundation or Intermediate Phase
learners. Please also remember that multiple-choice questions in the examination can
come from any chapter and may not be phase specific.
Study the following chapters in Weinstein and Rosen (2003):
the human body and its development (ch 2)
nutrition (ch 3)
keeping kids active, keeping kids healthy (ch 4)
communicable and chronic diseases (ch 5)
mental health (ch 6)
preventing school violence (ch 9)
use of alcohol, tobacco and other substances (ch 10)

environmental health (ch 13)


safety, injury prevention and first aid (ch 14)
consumer health (first part of ch 15)

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HEC101V/501
Please note: Just read through chapter 7, as this topic is dealt with in the
module on guidance, counselling and life skills.

FOUNDATION PHASE ASSESSMENT STANDARDS FOR THE FIRST


OUTCOME
HEALTH PROMOTION

1.

The learner is able to make informed decisions about personal, community and
environmental health.
We know this when the learner
GRADE R

explains the
importance of
drinking only
clean water and
eating fresh food

describes the
steps that can be
taken to ensure
personal hygiene

demonstrates
precautions
against the
spread of
communicable
diseases

GRADE 1

GRADE 2

identifies
nutritious choices
from a range of
commonly
available foods
and drinks

explains steps to
ensure personal
hygiene and links
these steps to
environmental
health

describes
sources of
clean and
unclean
water and
simple purification
methods

explains safety in
the home and at
school

explains the right


of children to say
no to sexual

distinguishes
between situations that are safe
and those that
require
precautions
against communicable
diseases

identifies dangers
24

suggests
and investigates
actions to
make the
home and
school
environment
healthier
identifies
communicable
diseases
and explains
measures to
protect self
and others

GRADE 3

compares
healthy and
poor dietary
habits and
describes
the effects
of such
habits on
personal
health

participates
in a recycling project
and
explains
how
recycling
contributes
to
environment
al health

discusses
myths
surrounding
communica-

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abuse and
describes ways
in which to do so

and appropriate
precautions on
the route to
school

recognises
situations that
may be, or may
lead to, sexual
abuse and names
a person to whom
this can be
reported

identifies
road signs
relevant to
pedestrians
and explains
their
meaning

ble diseases
and the
causes and
prevention
of these

identifies
relevant
people and
their contact
details to
report cases
of
accidents,
abuse,
crime, fire,
illness and
injury

INTERMEDIATE PHASE ASSESSMENT STANDARDS FOR THE FIRST


OUTCOME
1.

HEALTH PROMOTION:
The learner is able to make informed decisions regarding personal, community and
environmental health.
We know this when the learner
GRADE 4

investigates
menus from
various cultures
and suggests
plans for healthy
meals
explores and
reports on links
between a
healthy
environment and
personal health

GRADE 5

explores and reports on


ways to protect the
quality of food and
water in various
contexts

investigates a local
environmental health
problem using different
data sources, and plans
a strategy to address
the problem
25

GRADE 6

interprets food labels and


critically discusses health
effects of listed
ingredients

participates in a problemsolving activity to address


an environmental health
issue to formulate
environmentally sound
choices and/or actions

rxplains causes of

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explains
childrens health
rights and
responsibilities,
and suggests
ways in which to
apply these in a
familiar situation

recognises the
symptoms and causes
of locally occurring
diseases and discusses
prevention strategies

explains the individual


health and social
effects of substance
abuse

communicable diseases
(including HIV/AIDS) and
available cures and
evaluates prevention
strategies in relation to
community norms and
personal values

lists and
explains traffic
rules relevant to
road users

identifies different forms


of abuse and suggests
strategies to deal with
them

SENIOR PHASE ASSESSMENT STANDARDS FOR THE FIRST OUTCOME


1.

HEALTH PROMOTION
The learner is able to make informed decisions regarding personal, community and
environmental health.
We know this when the learner
GRADE 7
proposes ways
to improve the
nutritional
value of own
personal diet
evaluates
actions to address an
environmental
health problem
describes
strategies for
living with
disease,

GRADE 8

GRADE 9

plans an action in which


laws and/or policies for
protecting environmental
health are applied to
address an
environmental health
issue
critically analyses the
causes of common
diseases in relation to
socioeconomic and
environmental factors
describes what a healthy
lifestyle is in own
26

illustrates and evaluates the


influence of ecological,
social, economic, cultural
and political factors on own
personal choice of food

develops and implements


an environmental health
programme

investigates personal and


social factors that contribute
to substance abuse and
suggests appropriate
responses and rehabilitation
options

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personal situation as a
way to prevent disease

including
HIV/AIDS
discusses the
personal
feelings,
community
norms, values
and social
pressures
associated
with sexuality

demonstrates informed,
responsible decision
making about health and
safety
dxamines a health and
safety issue related to
violence, and proposes
alternatives to violence
as well as counterstrategies

critically evaluates
resources on health information, health services and
a range of treatment
options, including HIV/AIDS

discusses ways to apply


insights gained from
participating in an activity
related to national health or
a safety promotion
programme

A LAST THOUGHT ABOUT HEALTH EDUCATION


In these study units I have attempted to make you aware of how difficult it is to change
peoples health behaviour without the cooperation of all the stakeholders. hink about
James Yens words from the 1930s (Morley & Lovel 1986:202) as they describe the
responsibilities of the ideal health education teacher:
Go in search of your people
Love them
Learn from them
Plan with them
Serve them
Begin with what they know
Build on what they have
But the best of leaders
When their task is accomplished
Their work is done
The people all remark
We have done it ourselves.

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STUDY UNIT 3: SPECIAL HEALTH TOPICS


The special health topics which we will deal with in this unit are
child abuse and neglect
hospitalisation
chronic illness
childhood stress
loss, death and dying
HIV/AIDS

4.1

CHILD ABUSE AND NEGLECT


LEARNING OUTCOMES
The purpose of this section of the study unit is to help you think about and
understand the issues of child abuse and child neglect.
After studying this unit, you should be

able to explain the difference between the various categories of child abuse
and child neglect

able to describe the characteristics of abusive adults and abused and


neglected children

able to explain the role of the teacher in terms of the abused and/or neglected
child and the abusive parent

able to explain the actions the teacher should take in a case of suspected
child abuse or neglect

familiar with relevant legislation related to child abuse

The topic of child abuse is discussed under a variety of terms in the current
literature. Some of the most common are battered baby syndrome; child
battering; child maltreatment; non-accidental childhood injury and child
abuse.
A useful definition of child maltreatment is given by Locke (1984:53). This definition
states that any interaction or lack of interaction between a child and his or her
caregiver which results in non-accidental harm to the childs physical and/or
developmental state.
Study chapter 11 in Weinstein and Rosen (2003). ECD students can
supplement this information with chapter 11 of Marotz et al (2005).
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HEC101V/501
HISTORICAL INCIDENCE OF CHILD ABUSE
Although child abuse seems to be more prevalent today, it is not a recent social phenomenon.
According to Langor (1974:353367) infanticide has been an acceptable method of population
control for many centuries among some cultural groups. In the more recent past, there is
evidence to show how children were exploited in the 18th century during the Industrial
Revolution. We even find this reflected many of the traditional nursery rhymes. One example
is the following:
There was an old woman
Who lived in a shoe
She had so many children
She didnt know what to do
She gave them some broth
Without any bread
And whipped them all soundly
And put them to bed.
(Opie & Opie 1951:355)

Can you think of any recent legislation in South Africa (or your own country) which
gives rights to children?
............................................................................................................................
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............................................................................................................................
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INCIDENCE OF CHILD ABUSE IN SOUTH AFRICA


In 1996, the Child Protection Unit dealt with 35 838 cases of crimes against children, which
represents an average increase of 36% per year since 1983. Between 1995 and 1996,
officially reported sexual crimes against children demonstrated an increase of 38% for rape,
35% for sodomy and 15% for incest (Initial Country Report 1997:104). By the year 2000
72 000 crimes were reported against children (Berry & Guthrie 2003:30). There are a number
of possible reasons for this increasing incidence of child abuse (Initial Country Report
1997:104105):
increased reporting of child abuse and neglect owing to increased public
awareness of the problem
family poverty forcing children into prostitution (called survival sex)
the HIV/AIDS epidemic in South Africa which has resulted in the myth that sex with
a virgin will cure or prevent AIDS
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CLASSIFICATION OF CHILD MALTREATMENT
There are various common classifications of child abuse. Halperin (1979:2130) uses
the following classification:

physical abuse
physical neglect
emotional abuse
emotional neglect
sexual abuse
medical neglect
educational neglect
abandonment
multiple maltreatment

Please consult chapter 11 of your prescribed book for the categories of abuse and
indicate if you think this classification is compatible with that of Halperin, which is
listed above.
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HEC101V/501
FACTORS CONTRIBUTING TO CHILD ABUSE AND NEGLECT
Study this section (pp 285287) in the chapter on child abuse
in the following book (which is available in the Study Collection
of the Unisa library):
Marotz, LR, Cross, MZ & Rush, JM. 2005. Health, safety and
nutrition for the young child. Sixth edition. Albany, NY: Delmar.
(5th edition may also be used pp 258261).
THE ROLE OF THE TEACHER
The teacher has an important role to play with regard to child abuse:
Identification of the abused child
The teacher must be able to recognise all the physical and behavioural symptoms that
indicate abuse.
Study this section on page 279 of Marotz et al (2005) or pages
251 to 254 of Marotz et al (2001).

Identification of the abusive adult


The teacher should be on the lookout for behavioural characteristics in a parent that
could indicate that their child is at risk of abuse.

Study this section in Marotz et al 2005 (pp 285286) or 2001


(p 259).

The teacher should keep written records of all observations about suspected or actual
abuse.
Study this section in Marotz et al 2005 (pp 283 & 288) or 2001
(pp 261).

31

Reporting of child abuse


According to Robertson (1989:78) the following procedures are important to ensure that
the correct legal course is taken:

Record the childs version of the event, in his/her own words, as soon as possible.

In the case of sexual abuse, the first report is important evidence. This is the
statement of the person to whom the child first reported the assault. If this first
report is given to the teacher, he/she should make a written note of it so that it can
be accurately recalled in the case of legal proceedings.

The teacher should report her suspicions to the principal of the school as well as to
a social worker, medical doctor, nurse or police officer so that a proper investigation
can be undertaken. The teacher should never confront the parents herself as this
could anger them, possibly increase the abuse and destroy the parentteacher
relationship.

?
Find out from a child welfare official or a police officer what
legislation exists in South Africa (or your own country) for the
compulsory reporting of child abuse.
Helping abused or neglected children

Study this section in Marotz et al (2005:287290) or


(2001:261264).
Also look at any applicable sections in chapters 6 and 8 of
your prescribed book.
Robertson (1989:383384) states that there are several critical things which a teacher
should provide to support and help an abused child so that the child develops a ... sense
of wellbeing to progress beyond the abuse.
These are

trust
predictable routines
consistent behaviour
safe boundaries
confidence
good communication skills

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HEC101V/501

Can you think of a few ways in which you can implement each of these in your
classroom in order to provide support and help to a learner?

Trust
....................................................................................................
....................................................................................................
Predictable routines ..............................................................................................................
....................................................................................................
....................................................................................................
Consistent behaviour .............................................................................................................
....................................................................................................
....................................................................................................
Safe boundaries
....................................................................................................
....................................................................................................
Confidence
....................................................................................................
....................................................................................................
Good communication
skills
............................................................................................................
.............................................................................................................

In addition to the information on this topic in Marotz et al (2005), the following practical
considerations should be remembered when dealing with children who have been abused or
neglected:

Provide an early snack for those children who come to school hungry.

Allow the child who has had insufficient sleep at home an extra rest period if
necessary.

Provide enriched educational experiences for children who may be educationally


deprived.

Provide opportunities for children to care for plants and pets as this makes them
feel wanted and helps them to develop a caring attitude towards others.

Plan activities that encourage the development of self-help and self-care skills
which no one might have taught them at home. This can be done by allowing them
to wash dishes, bath dolls and so on, as well as during routine activities.
33

For younger learners provide opportunities for sensopathic activities (clay, water,
mud, fingerpaint, playdough and the like) and for physical activity so that their
feelings of success and competence are enhanced and they are able to express
their emotions in a non-threatening manner.

Can you think of any other ways in which you can help learners who have
been abused? Refer also to chapter 8 of your prescribed book (dealing with
stress).
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Child education regarding sexual abuse


According to Koblinsky and Behana (1984:3) children should be actively educated about
sexual abuse because it is no longer sufficient to simply warn them of stranger danger.
These authors recommend a number of ways in which children can be prepared to avoid
potentially abusive situations:

Children should be taught that some parts of their bodies are private, for example,
those parts of the body covered by a swimming costume. They need to know that
no one has the right to touch these areas --- even when wearing clothing --except a teacher, parent or health professional who is helping with, or conducting,
a medical examination. They should also know that no one has the right to ask
them to touch these parts on another person.

Children should be helped to identify and differentiate between different types of


touching:
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good touches, like hugs, kisses and handshakes which make children feel
positive about themselves

confusing touches which make the child feel uncomfortable

bad touches, such as hitting, prolonged or excessive tickling or touches to


private body areas

Children should be taught to say NO to unwanted touches, for example, NO, I


dont like that, dont touch me. Children also need to know that bad touches may
come from someone they know.

Children need to be encouraged to communicate openly so that secrets are


discouraged and they should know who they can go to if something is bothering
them.

It is recommended that the teacher use games and stories to constantly reinforce
prevention concepts by, for example, playing what if games which present a
hypothetical situation.

Helping parents
Teachers and schools should, over the long term, provide support for parents and
community education on appropriate child-rearing practices, discipline and the like, and
try to encourage the development of parent-support groups to prevent or counteract the
social isolation of some parents which could contribute to abuse.

Study this section in Marotz et al (2005:290291) or


(2001:264).

RAPCAN
(Resources Against Prevention of Child Abuse and Neglect)
This is a Cape Town-based organisation that provides adult education
on child abuse. They have pamphlets available and offer courses on
the topic.
They can be contacted at:
RAPCAN
Tel (021) 712 2330 Fax (021) 712 2365
Website: www.rapcan.org.za
e-mail: inforapcan.org.za

35

OVERT AND COVERT FORMS OF TEACHER MALTREATMENT


Paulson (1982) maintains that there are various covert and overt forms of maltreatment often
unwittingly practised by preschool teachers (and parents). These have the effect of denying the
child the opportunity to develop a good self-image and, indeed, humiliate and embarrass the
child.
Paulson implores teachers to re-evaluate their own behaviour and attitudes because of the
overwhelming influence they have on children in the early years.
Covert forms of maltreatment by preschool teachers:
Insistence that children learn to be independent in some areas and dependent in
others. (When a preschool teacher is in a hurry she does things for children that they
are capable of doing for themselves.)

Overemphasising academic skills and school-readiness activities before the child is


developmentally ready for them.

Relying excessively on packaged educational materials, such as workbooks or


plastic materials, which rob the child of the opportunity to discover and experiment
with natural materials.

Restricting the use of materials that have an intrinsic interest for children, such as
water, mud, paint, woodwork and the like because they are too messy, too noisy or
too dangerous

Rapid staff turnover which prevents the young child from developing a secure and
stable relationship with a teacher.

Blaming certain children (whom the teacher dislikes) for behaviour that is overlooked
in a favourite child.
Overt forms of maltreatment:
Direct verbal attack, for example If you dont stop crying your mother wont come
and fetch you or How can you be so stupid? Yesterday was Monday, tomorrow is
Wednesday so what is today?

Physical coercion such as pulling, pushing or shaking a child (when hitting a child is
forbidden).

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Take five minutes to think about what Paulson says regarding covert and
overt forms of preschool teacher maltreatment. Can you add anything to
this list from your own experience as a Foundation Phase or Intermediate
and Senior Phase teacher or student?
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4.2 HOSPITALISATION

LEARNING OUTCOMES
The purpose of this section of the study unit is to help you think about
and understand the ways in which the experience of illness and
hospitalisation may affect the younger child.
After studying this unit, you should be able to

explain the possible emotional effects of hospitalisation on the


young child

discuss the various ways in which a child can be prepared for the
experience of hospitalisation

explain what is meant by post-hospitalisation stress and


regression

describe some of the responsibilities of the teacher who works in


the hospital environment

explain the effect of illness on the family

37

THE EMOTIONAL EFFECTS OF HOSPITALISATION ON THE YOUNG CHILD


Hospitalisation can be a very traumatic experience for the young child. American research
shows that 50% of all children under the age of seven will spend at least one night in hospital
(Lerwill 1983:4).
Children under the age of five are particularly susceptible to the stresses of hospitalisation
because of their developmental level and age.
Because very young children are more prone to illness they are more likely to require
hospitalisation at the exact time when they are least able to cope with it.

For Foundation Phase students: Can you think of two reasons why the young
child is more prone during to illness during the first few years of life? (You can
refer to module PRS1023 if you need to jog your memory.)
(1)
........................................................................................................................
(2)
........................................................................................................................

According to Wolff (1981:63), illness is a universal cause of childhood stress which threatens a
childs emotional stability as a result of the unfamiliar experiences and persons to which he/she
is subjected.
Illness, regardless of the length of the hospital stay, causes anxiety because the child is forcibly
separated from family and friends. Additional factors, such as being subjected to pain, intrusive
procedures (e.g. injections) and the unpleasant side effects of medication and treatments,
contribute to the stress experienced by the child (Gibbons & Boren 1985:83).
Before the age of seven the child is developing rapidly and new intellectual, physical and
emotional abilities are developing. These include speech, locomotion, independence, symbolic
thought and autonomy and they are easily disrupted when the child is under stress.
Young childrens coping abilities are limited by their level of language and cognitive
development, as well as by their limited life experiences. According to Maccoby (1983:220),
specific events are less likely to cause stress to the child than changes in patterns of family
interaction and relationships caused by the events.

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HEC101V/501

Study the whole of chapter 8 (Childhood stress) in connection with this


section on hospitalisation.
Hospitalisation is not, however, the only life event that can cause significant stress for a child;
other stressful events are the death or illness of a parent or sibling, divorce, marital problems,
moving house, severe injury and specific school stressors such as bullying, excessive
competition, test anxiety, peer rejection and so on.
Read the section on mental health again in Marotz et al (2005:3741 or
2001:3339).
Also study your prescribed book (ch 8 pp 275279) on other sources of
childhood stress specific to various grades.
The following factors have been found to affect the childs experience of hospitalisation (Orr
1992:6586):

Age
Research shows that the negative effects of hospitalisation appear to be the greatest for
children between the ages of seven months and four years (King & Ziegler 1981:22).

The childs perception of illness, medical procedures and the hospital


The childs understanding of illness is mainly determined by his cognitive maturation.
Concepts such as the cause of illness, the need for treatment and the role of health
personnel are not understood by the very young child. It is only with increasing age that
the child is better able to understand concepts related to illness (Brewster 1982)
It is generally accepted that the childs health knowledge is best explained in terms of
Piagets stages of cognitive development, where the childs concept of illness causation
will progress from primitive and egocentric reasoning to a more abstract view. It is only
when the child enters the stage of concrete-operational thought (from the age of 6 to 12
years) that we can expect them to begin to understand the relationship between their
symptoms and treatment (Perrin & Gerrity 1981:842).

Fear of pain and death


Physical pain is a common stressor for any person (adult or child) because of the
unpleasant sensory, physical, emotional and motor responses it causes. This is
particularly true of the preschool child who is too young to understand what is happening.
Young children often develop fantasies and fears, the nature of which depends largely on
their developmental stage. According to Servonsky and Opas (1987:361), the following
fears are common in young children:
39

AGE
Birth to 3 months

CHARACTERISTIC FEARS
Fear of sudden movement, loud noises and loss of support
(being dropped)

4 to 12 months

Fear of strangers, strange objects, height, pain and any


previously unpleasant situations

1 to 3 years

Fear of strangers, pain, the unknown, very loud machinery,


the dark, fear of being left alone, fear of certain animals

4 to 6 years

Fear of the unknown, supernatural beings (such as ghosts


or the latest TV monster), separation from family, strange
routines, bodily mutilation (such as injections), death

Bodily intrusion and mutilation


Because the young child does not have a completely developed body image, any
intrusion into the bodily space of a young child --- as happens with surgery, injections,
rectal temperatures or suctioning threaten the self-integrity and self-esteem of the child
(Becker 1980:23; Rae 1982: 1065).
In research conducted by Erikson (1972:113), it was found that four-year-old children
considered all anal and skin procedures to be acts of hostility directed at them by health
personnel and that a blood transfusion is required only because the doctor has
withdrawn too much blood.

Altered motor and sensory activity and loss of self-control


Hospitalisation often requires the restriction of physical mobility or even the complete
immobilisation of the young child and thus limits the childs sensory stimulation and
interaction with the environment. The child is also forced to become dependant again
and his or her self-esteem may be threatened when the child is not allowed to participate
in self-care activities.

Separation from parents and family


This is probably the most significant cause of hospital stress experienced by young
children. Children feel anger towards their family for deserting them and leaving them
alone in a strange environment. The following age-related responses are often present:

40

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AGE

CHILD RESPONSES

Birth to 6 months
of age

Babies are aware of changes in the environment and


changes of caregiver. If separated for lengthy periods
from their mothers (or primary caregivers) children may
lose interest in their surroundings, and their activity level
and babbling may decrease.

7 months to
4 years of age

By now most children have developed a close emotional


bond with their mothers (or primary caregivers) and are
very disturbed when separated from them. They do not
understand the reason for the desertion and this is the
age at which children show the most extreme signs of
separation anxiety.

4 years of age
and older

By this time children have developed a concept of time


and can understand that parents will return and may have
some understanding of the reason for hospitalisation.

Robertson (1977:1013) has described three classic stages in childrens reaction to


separation from their mothers, which can last for varying periods, depending on the
individual child:

A phase of protest
During this phase the child is miserable, confused, angry and frightened of the strange
surroundings. The child will refuse all comfort by hospital staff because of the strong
conscious need for his or her mother. Gradually, as the child realises that his parents are
not returning, the outward intensity of his/her reactions decrease (this stage can last for
days or weeks).

A phase of despair
During this time the child cries uninterruptedly and gradually becomes withdrawn and
apathetic. The child appears to be in a state of mourning for the parents whom the child
feels have abandoned him/her. When the parents visit, the child will cry pitifully when
they leave. The child will generally avoid interaction with other staff members during this
phase.

A phase of denial
This when separation is repeated and prolonged. It will appear as if the child has
adjusted to the unfamiliar surroundings and will interact with persons around him or her.
When parents visit, the child will show disinterest and little distress when they leave and
will appear to be more attached to hospital staff.
According to Rutter (1979:149151), not all children manifest the above three stages of
separation anxiety and many hover between the stages of protest and despair.

41

The outcome of the effect of separation depends upon many factors such as:
the age of the child at the time of hospitalisation
the quality of the motherchild relationship before hospitalisation
whether the separation is total or whether the parents maintain contact with the
child
whether it is an acute or chronic illness (i.e. the number of previous hospital
experiences and the degree of physical suffering)
the amount of appropriate preparation which has been given
the length of the hospital experience
The unfamiliar hospital environment
According to Poster (1983:121), the hospital is a unique environment that is unfamiliar to
children and is filled with mystery. At a time when young children need the security of a familiar
routine and environment, they are confronted with strange sounds, people, sights and smells.
The following aspects have been found to improve the childs ability to cope with the strange
hospital environment:

familiarising the child with the hospital environment and allowing the child to
explore the area

allowing the child to handle and investigate common medical equipment

providing the child with honest answers to any questions, yet answering simply so
that the child understands the explanation given

verbally acknowledging that the child is entitled to feel scared, yet reassuring him
or her about these fears and clearing up any misconceptions

explaining treatments accurately, but without undue emphasis on pain or


discomfort

encouraging parents to remain in hospital with the child and encouraging them to
be present during invasive or frightening procedures like blood tests, lumbar
punctures and X-rays

PREPARING A CHILD FOR THE EXPERIENCE OF HOSPITALISATION


Research has shown that developmentally appropriate preparation of the child reduces his or
her anxiety levels while in hospital, as well as reducing the degree of regression after discharge.
However, it is accepted that this preparation is more successful for the older child and that the
child under two years of age probably benefits more if parents and staff are sensitive to the
childs emotional needs and understand what separation means to the young child (Goslin
1978; Stacey, Dearden, Pill & Robinson 1970).

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POST-HOSPITALISATION STRESS AND REGRESSION


When a child is discharged from hospital he or she may often show symptoms of regression.
According to Audette (1974:31) regression may be defined as a coping mechanism whereby
the individual reverts temporarily to an earlier, previously abandoned developmental stage of
behaviour in order to retain or regain mastery of a stressful, anxiety-producing or frustrating
situation, thus achieving self-gratification and protection.
Audette (1974:32) maintains that there are four main reasons why a child uses regression to
cope with the stress of hospitalisation:

The factor of individual differences which will determine whether a specific child uses
regression because of a low frustration tolerance or whether the child fails to regress
because of a previous opportunity to practise coping with the stress of hospitalisation.

The age factor, which makes it more likely that the child between the ages of two and six
years will regress rather than the older child.

The parental-child relationship which affects the childs ability to cope with stress

The degree of stress experienced

Typical signs of regression are bed-wetting, wanting to be dressed, fed or bathed again, thumb
sucking, whining, temper tantrums, crying, clinginess, nightmares, new fears and increased
demands for attention.
It is understandable that these behavioural symptoms can make the post-hospitalisation period
extremely difficult for family members. However, research has shown that the non-acceptance
of regressive behaviour will only prolong it (Audette 1974). Parents should be advised to allow
the child time to regain his or her sense of security and trust in the family and home
environment.
RESPONSIBILITIES OF THE TEACHER IN A HOSPITAL ENVIRONMENT
The teacher working in a hospital environment is a member of the total health team and should
regularly have discussions with other team members so that she/he can make a meaningful
contribution to the childs recovery.
The organisation of the daily activities for a hospitalised child should provide opportunities for
play as this is an essential part of the childs life. In a hospital programme each child receives
individual attention as large group activities are less common.
Activities can be provided for hospitalised children either in a centralised playroom or at each
childs bedside, although if the child is able to leave the ward environment for a while this does
much to alleviate hospital stress. The teacher should provide as many of the usual preschool
and school activities as possible, depending upon the childs abilities, condition and mobility.
Foundation phase students may refer to the study material for module PRS101Y for more
information on developmentally appropriate activities for young children.
43

THE EFFECTS OF ILLNESS ON THE FAMILY


Illness or the hospitalisation of a child has the potential to disrupt family life and many parents
experience guilt and helplessness when their child is hospitalised.
Young siblings (bothers and sisters) may think that they are responsible for causing the illness
or fear that they might become ill themselves. Gibbons and Boren (1985:94) maintain that
illness in one family member reverberates throughout the entire family system.
Research has shown that parents experience anxiety owing to the following factors:
lack of information about their childs illness
lack of support from health personnel
guilt feelings because they are angry at the child for being ill or because they believe
they might have caused the illness
they are often excluded from care giving and decision making while their child is in
hospital
they are unfamiliar with the hospital environment and apparatus
the cost of hospitalisation often incurs great financial hardship for a family
The siblings of hospitalised children often feel that they have caused their sick brothers or
sisters illness, or fear that they may be rejected or abandoned by their parents who are
preoccupied with the sick child (Craft & Wyatt 1986; Fife, Huhman & Keck 1986).
4.3

CHRONIC ILLNESS

Chronic illness has been defined as a condition that interferes with the daily functioning of a
person for more than three months in a year or that causes hospitalisation for extended periods
(Marlow 1977). This may, however, be a somewhat limiting definition because a person can
have a chronic illness like high blood pressure without feeling ill or, in the first few years of HIV
infection, may have no observable symptoms of ill health. Kibel and Wagstaff (1995:391) state
that chronic illness may be ... protracted but stable, or progressive and life threatening, or a
non-fatal handicapping condition.
Chronic illness causes a multitude of problems for all family members. Parents or primary
caregivers often react with shock, disbelief, denial or guilt and may become demanding,
accusatory or aggressive. Once parents have accepted the situation, they may either
overprotect or reject their child.
The childs own degree of acceptance of the illness will depend upon factors such as age, level
of intelligence, family attitudes, frequency of hospitalisation and the like. It is usually advisable
to tell children as much as they can understand about their illness without creating unnecessary
anxiety and children will usually learn from experience what limitations the illness imposes on
their daily life.
THE ROLE OF THE TEACHER
It is always useful if the teacher knows as much as possible about the particular chronic illness
and the demands it will make on the child and fhis/her amily so that he/she is able to provide
sympathetic and suitable support for both the learner and his/her family.
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The teacher should be supportive to both child and parents with regard to the learners
need for medication during school hours, extra rest periods, specific toileting needs,
absences from school, extra help with school work, embarrassment about physical
appearance and the like.

The teacher should maintain the confidentiality of any information given to him/her
regarding the childs condition written parental permission is required to divulge any
information to other staff.

The teacher should determine from the parents the learners own understanding and
knowledge of his/her illness (e.g. some HIV-infected learners will not be aware of their
own illness status) and it is NOT the responsibility of the teacher to inform the child of
this.

The teacher should modify the school programme so that, for example, longer rest
periods or dietary adaptations are made possible if required. Likewise the teacher should
liaise with parents on any specific precautions required for school outings or excursions
so that, wherever possible, the learner can participate in these activities.

The teacher must ensure that the school and classroom environment makes allowances
for the childs specific chronic disease. For example, wheelchair-bound learners should
have easy access to the classroom and classroom activities, while the level of specific
allergens (e.g. pet hair, chalk dust, pollen or moulds) should be eliminated if there are
asthmatic or allergic children in the class.

The teacher should be aware of the effects of any medication that could cause
alterations in the learners behaviour such as drowsiness, hyperactivity and the like.

The teacher should be able to cope with any specific health emergencies related to a
specific chronic illness such as a severe asthma attack or hypoglycaemia resulting from
low blood sugar levels in a diabetic learner.

Children with a chronic disease or disability should be treated the same as healthy
children. It is important to remember that the way in which the teacher deals with the
child will go a long way to determining the childs attitude to illness and to his or her own
self-image.

Study this topic on pages 164 to 171 in Weinstein and Rosen


(2003).

45

4.4

LOSS, DYING AND DEATH

Study chapter 12 in Weinstein and Rosen (2003).


Coming to terms with the impending death of a child is a difficult experience for any adult, but
especially for the childs parents or primary caregivers. Parents will pass through many of the
same stages of grieving as mentioned in the next section and this often starts at the time of the
initial terminal diagnosis.
It is important for parents to fully understand the childs illness so that they can channel their
energy into the present and not agonise about an unknown future. The teacher has an
important role to play as she can provide a sympathetic ear.
THE CHILDS CONCEPT OF DEATH
The very young child has a poor concept of time and space and thus finds it difficult to
distinguish between fantasy and reality. This makes it difficult for the child to distinguish
between a permanent and a temporary separation.
By the age of four, most children are interested in death and will talk about it without having a
real understanding of the finality of death. The child will often describe death as being asleep
and thus believes that the deceased person can return to life. This concept is unwittingly often
reinforced by the adult who often uses this analogy of sleep to try and describe the meaning of
death to a child. During these early years the child may also feel that he/she is responsible for
the death of someone close to them.
Between the ages of five and eight, most children begin to realise that death is permanent but
do not view death as a frightening reality which could affect themselves personally. An
important fear now is that their parents will die and leave them alone.
From the age of eight to ten years, most children begin to grasp the abstract concept that all
living things die and that death is irreversible and will affect them one day. They often become
very interested in the mystery surrounding death and related rituals.
From nine to eleven years most children are able to accept death as a part of life and become
very interested in what happens after death.
COMING TO TERMS WITH DEATH
Childhood bereavement may result in a number of emotional, cognitive, social and physical
problems, so it is important that the child resolves his or her grief. Grieving is considered to
have three main phases, although these may not necessarily follow each other in the same
order and individuals may fluctuate between one phase and another. It is generally believed that
recovery is facilitated by allowing people to express what they are feeling.

The protest phase


During this phase the individual is usually reluctant to acknowledge and accept the loss
and may appear dazed or show behavioural symptoms such as fear of being alone,
sleep disturbances, changes in appetite or depression. At this time it is best to maintain
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HEC101V/501

the childs normal routine and the teacher should give the child extra reassurance during
the school day.
The family should be advised to include the child in the funeral preparations and to give
the child the opportunity to say a last goodbye, as this enables the child to appreciate the
finality of the situation and makes it easier to accept the situation in the months ahead.
However, many of these decisions will be based on the familys own outlook and
religious beliefs.
The child may try to keep active to stop thinking about what has happened. The teacher
should ensure that there are sufficient activities and opportunities to keep busy. The child
should also be given the opportunity to talk, but should not be forced into doing this. A
secure environment will have the most therapeutic effect during the next few months.

The stage of despair and grief


The child may show some overt emotions such as sadness, crying and loneliness. Some
children may regress to a more infantile stage of behaviour or may experience anger and
guilt. Children may also show other signs of being unable to settle at school. This stage
may last for up to a year.
The teacher should provide the child with emotional support and should provide
opportunities for discussions about the deceased person. The teacher should also accept
the childs feelings of hopelessness and should reassure the child that it is a normal
reaction to feel upset. Suitable childrens books dealing with the topic of death should be
provided as these often help a child to gain insight into the emotions being experienced.

Acceptance
During this stage children come to terms with their loss and begin to view the situation
more realistically and look to the future. It is important to encourage the child to speak of
the deceased person and to allow him/her to recall both positive and negative feelings
about that person.

The teacher should encourage the parents to share their grief with the child because this helps
restore healthy new life patterns. The child should be spared the intensity of parental grief and
should be given simple tasks to do to make him/her feel part of the family.

47

Read the poem: The cry guy on page 423 of your prescribed
book. Write down what this poem means to you with regard to
any personal losses that you may have experienced.
..................... .................................................................................................
......................................................................................................................
..................... .................................................................................................
......................................................................................................................
..................... .................................................................................................
......................................................................................................................
..................... .................................................................................................
......................................................................................................................

If a school friend dies, the death should be discussed openly with the children and the teacher
should deal with the topic in a sensitive but factual manner. The parents or family of the
deceased child could be given a book of remembrance, containing messages or drawings done
by the other children in the class. Also refer to your prescribed book (ch 12) for more ideas on
this.
The teacher should offer support for the parents of the child who has died and, as a mark of
respect, should attend the funeral.

Study chapter 12 of your prescribed book: Childrens


experiences with loss, death and dying. This is an excellent
chapter on this important topic.
As the HIV epidemic in South Africa progresses, most teachers
will experience the death of children, parents or colleagues as
a result of this illness (current figures estimate that there are
between 600 and 1000 HIV-related deaths per day in South
Africa).
Keep yourself informed on how to deal with this issue.

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HEC101V/501

4.5

HIV/AIDS

!! The information that follows supplements the information that


appears on pages 163 and 164 of your prescribed book
(Weinstein & Rosen 2003).
Recent figures on the estimated number of people infected with HIV at the end of 2006 in South
Africa were given as approximately 5,4 million adults and children. The Pretoria News (June 26,
1998 stated that 200 babies infected with HIV are born every day in South Africa. From these
figures it can be predicted that the possibility of having an HIV-infected child in a primary school
is increasing rapidly.
HOW IS HIV SPREAD?
The human immunodeficiency virus (HIV) is spread through

unprotected heterosexual or homosexual intercourse with an infected person (including


rape or sexual abuse)

direct contact with blood that is infected with HIV (e.g. blood transfusions, surgery, organ
transplantation)

by maternal transmission (from mother-to-child) during pregnancy, childbirth or


breastfeeding

HIV IS NOT SPREAD BY


hugging, shaking hands or touching an infected person
contact with the urine, faeces or sputum of an infected person (provided
that these body fluids are not blood-stained)
sharing the food and eating utensils of a person with HIV/AIDS
sharing toilets with a person with HIV/AIDS
casual contact with other children or adults in schools or workplaces
mosquitoes or biting insects

49

THE ROLE OF THE TEACHER WHEN DEALING WITH A LEARNER WITH HIV/AIDS
The teacher should consider EVERYONE (child and adult) as potentially HIV infected; this
involves taking the following precautions:

Keep all sores or cuts on your hands covered with a waterproof plaster.

Do not share items that may become contaminated with blood (e.g. toothbrushes and
razors).

Take universal precautions when treating any bleeding wound or dealing with any
blood-contaminated body fluids or articles.

UNIVERSAL PRECAUTIONS FOR SCHOOLS

All blood, blood products and blood-stained body fluids must be regarded
as potentially infectious.
NB: This does not apply to faeces, nasal secretions, sputum, sweat,
tears, urine and vomitus unless they contain visible blood.

Everyone must use every possible method available to prevent direct


contact with blood or blood-contaminated fluids, for example using
waterproof gloves or plastic bags to protect hands.

Non-porous gloves should also be worn when cleaning up blood spills.

Hands should be washed thoroughtly after the gloves are removed or


after any accidental blood contact.

Disinfect all blood spills or blood-stained body fluids with the following:
A solution of 1:10 ordinary household bleach (one part bleach to nine parts
water) that is freshly mixed every day.

Make sure that gloves are used when handling any blood-contaminated clothes or cloths
and soak these items in the bleach (hypochlorite) solution before washing them with hot
water and soap.

Always put up a notice warning parents and staff about any chickenpox (or other
communicable disease) outbreaks in the school, as people with a low immunity are
particularly sensitive to some infections.

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HEC101V/501

PLEASE NOTE

A teacher should not discriminate against any person (child or adult) on the basis of
his/her HIV status. These persons pose NO risk to anyone in the school, provided the
normal blood-handling precautions are taken for everyone.

Absolute confidentiality is required if you are given information about a person's HIV
status. No one in the school needs to know and no other parents need to know. In fact, it
is not necessary for you to even know who in your school (child or staff) is HIV-positive.

The written consent of the parent is required before you may divulge confidential
information (e.g. that a child is HIV-positive) to anyone (even another teacher).

It is ILLEGAL (against the new Constitution) to discriminate in any way against HIVpositive people. Remember that in terms of the new Constitution children have
the right to health care
the right to freedom from discrimination
the right to education
the right to parental care
Please refer also to
(1) the School Policy on HIV/AIDS
(2) the HIV/AIDS emergency: Guidelines for educators
which were sent to you in Tutorial Letter HEC101V/102/2013
NB: This tutorial letter forms part of your study material on HIV/AIDS
and will be part the material examined in the examination

CONCLUSION

Good luck with your study programme! Please contact me (your lecturer) before the
examination if you have any problems. I am here to help you but please don't wait until it is too
late!

Your Lecturer

51

TEST YOUR KNOWLEDGE AND INSIGHT WITH THESE REVISION QUESTIONS

Explain how education and health are interrelated.

Analyse the implications of the World Health Organizationss definition of health.

Explain the way in which health influences all aspects of the childs development. Can
you think of examples that are relevant to the area in which you live?

How do the following factors influence the health of the child: heredity, environment,
behaviour, lifestyle and development?

Discuss the most common environmental factors that influence health in South Africa (or
your own country).

Explain how illness affects the childs nutritional status.

Discuss the relationship between health and learning.

Briefly discuss three environmental factors that have a negative or positive effect on
health in your community.

Discuss the meaning of prevention through health promotion.

Explain what is meant by


health
health education
a healthy lifestyle
the Health Belief Model
health risk factors
the three levels of locus of control

Explain how you could involve parents in the health education curriculum of the
Foundation Phase OR the Intermediate and Senior Phase.

Discuss, giving relevant examples, the criteria for determining appropriate learning
experiences for health education in the Foundation Phase OR the Intermediate and
Senior Phase.

Explain in detail why health education should be done by classroom teachers.

Discuss the following statement: physical activity can reduce the risk of some chronic
diseases.

Discuss the main attributes of emotional health.


Discuss the role of the teacher in establishing emotional wellbeing for learners in the
Foundation OR Intermediate Phase classroom.
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HEC101V/501

Discuss the following statement: teachers can be a source of support for a learners
emotional health.

Describe how chronic stress can contribute to the development of disease.

Describe some positive and negative ways in which children cope with stress.

Critically discuss the following statement: Medication is an effective way to manage


stress.

Explain the effects of the following on the body:


- alcohol use
- tobacco use
- cocaine use
- dagga (marijuana) use

Describe the various categories of child abuse and neglect.

Critically discuss some of the factors that have been linked to the increasing incidence of
child abuse in South Africa.

Discuss the signs and symptoms of the following:


- physical abuse
- physical neglect
- emotional abuse
- emotional neglect
- sexual abuse

How would you identify an abused child at school?

Discuss the role of the teacher when confronted with an abused child?

Explain how you would educate Foundation Phase OR Intermediate Phase learners
about sexual abuse.
The stress of modern living has resulted in an increase in child abuse. Critically analyse
this statement.

Describe the effects of hospitalisation on the young child.

Discuss the way in which the teacher can prepare children for hospitalisation.

Explain what you understand by the concept of regression as a symptom of posthospitalisation stress.

Discuss common sources of stress in the Foundation Phase OR Intermediate and Senior
Phase learners and explain how you could help children cope with stress.
53

A child in your class has recently died from a chronic illness. Explain how you would deal
with this in the classroom situation.

Give some examples of ways in which the teacher can explain the concept of death to a
young learner.

Discuss the following statement: Children react to death according to their


developmental stages.

Discuss the ways in which the teacher can support the family of a child who is suffering
from a chronic illness.

Discuss the role of the teacher in the care and support of learners who are infected or
affected by HIV/AIDS.

Discuss the role of the teacher when dealing with the HIV-infected child during sporting
activities.

Discuss the implications of the official school policy on HIV/AIDS for the Foundation
Phase OR Intermediate and Senior Phase teacher.

Explain in detail the implications of universal precautions for the primary school
situation.

Briefly indicate what appropriate information you would include when planning the
following learning activities for Foundation Phase learners
- pedestrian safety
- bicycle safety
- home safety
- school safety
- dental health
- food safety
- healthy food for school lunches
- consumer health
- physical fitness
- prevention of poisoning
- food guide pyramid
- fire safety

What is the role of the ECD teacher in providing nutrition education activities for the
young child?
Discuss four ways in which nutrition education activities can aid child development.
Discuss the criteria used for choosing appropriate nutrition education concepts for young
children.
Explain why health and safety education are important for young children.

How can teachers decide whether health, safety and nutrition resource materials are
reliable?
Describe how you would deal with the following emergency situations:
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HEC101V/501

a learner who is choking


a learner with a nosebleed
an adult with a suspected heart attack
a learner with a first-degree burn
a learner with a second-degree burn
a learner with a third-degree burn
a learner with an epileptic seizure
a learner with an asthmatic attack
a learner with a hyperglycaemic (diabetic) coma
a learner with a hypoglycaemic (insulin) coma

How would you ensure the safety of learners on the primary school playground?
How would you ensure the safety of learners during sporting activities?

55

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