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This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice.

Transcultural health care practice with children and their families

Part one: Well-being, health and development across cultures

Section One: Family life And Child rearing practices

Aims and objectives

The aim of this section is to explore the cultural diversity of child rearing beliefs and practices.

The main learning outcomes include:

  • To consider your personal beliefs and practices in relation to child rearing.
  • To compare your personal beliefs and practices with those held by people from a different ethnic or cultural background.
  • To identify how an understanding of different child rearing beliefs and practices might influence your clinical practice.

The aim of this section is to explore the cultural diversity of child rearing beliefs and practices. As Weller (1994:103) informs us, "beliefs about child rearing are usually bound up with beliefs about life itself. They are culturally transmitted and culturally learned". It is important, therefore, that nurses who work with children and their families are familiar with different child rearing practices, in order that they can make accurate assessments, plan culturally appropriate care arrangements, deliver safe and competent health care, and evaluate their practice to the advantage of clients for whom they care.

Recommended Reading

Before embarking upon child rearing, you will need to refresh your knowledge concerning the process of migration. A theoretical underpinning will enable you to explore the impact that migration has had upon all families in Britain.

We recommend that you now read section 1, 'The Nature/Origin of Diversity' in Charles Husband's publication The Politics of Diversity. This section examines the processes by which societies become multi-ethnic - the process of migration. You'll learn about some of the factors that lead people to migrate - sometimes based on factors drawing them to a new country, sometimes on factors pushing them away from their country of origin. You will be encouraged to relate the five main patterns of migration to the demographic make up of your own area - and your own family history. You will find, no doubt, that most family histories include experiences of emigration and immigration.

Exercise 2.3 activity

In activity 1.1, you were asked to consider the cultural diversity in your neighbourhood. To follow on from this activity:

· List the various ethnic and cultural backgrounds represented in your neighbourhood.
· What are some of the differences in child rearing practices that you have observed or encountered; or that may be present?
· Reflect on how such differences may have implications for your health care practice.

Many of our most deeply held and cherished cultural values and rituals are displayed at the time of important life-events such as birth, marriage and death (Dobson 1991). Some of these are seen as rites of passage marking a change in a person`s status and are often linked to childbirth, child-rearing and 'coming of age'. As nurses of children and families, we are likely to encounter children, their parents and their wider family at these important times. Therefore, an awareness of various cultural practices is essential if a good standard of care is to be provided. Ignorance will lead to naive assumptions, stereotyping and discrimination. Being misinformed, or relying upon information which is now regarded as out of date, is also dangerous. Culture is never static but constantly changing and evolving and often involves the assimilation of aspects of two or more cultures.

Exercise 2.4 Reflective activity

Discuss your own childhood and upbringing with a colleague. What similarities and differences are there in your experiences? How different are they to the experience of young children today?

Birth customs And rituals

Customs and rituals surrounding childbirth usually have the intentions of welcoming the baby into the family and community, and of ensuring protection and well-being. These customs and rituals are diverse in practice; for example, Dobson's study among Sikh women living in Britain (Dobson 1991) found that birth was followed by a period of seclusion when the mother was considered ritually unclean. Both the mother and the new-born baby took a series of ritual baths to reduce cultural pollution and on the fortieth day, following their final bath, they attended the Sikh temple and were "reincorporated formally into the Bhatra community" (Dobson 1991:157). An equivalent custom of 'churching' was common in the UK until recently, when an Anglican service of thanksgiving was held, often in the hospital chapel, to give thanks for the safe delivery of mother and child.

Exercise 2.5 Reflective activity

(a) Think for a moment about your own family. How do you celebrate the arrival of a new baby? Are there 'rituals' specific to your immediate family, or are they customs that have been passed down the generations? Do they form part of the recognised rituals of a specific group of people, belong to a certain faith, or form part of the belief system of a wider cultural group? Who would be affected, and how, if these 'rituals' were not honoured?
(b) Now research one specific minority ethnic group in your area to find out how birth is recognised in the family and ethnic community.

There are many different customs and rituals associated with birth. It is important that you familiarise yourself with these, but essential that you do not form assumptions about families and their practices. Take the time, with your client, to make enquiries about cultural differences to avoid racist stereotyping. For example, a familiar, western custom in Britain is to praise a baby's appearance and to compare them to other family members. This could cause offence to some Asian Mothers who fear it may invite harm to the child.

In some contexts the application of a black spot to the baby's face or body to make the baby less attractive is done to protect the infant from bad luck and danger (Schott & Henley 1996). In the Bhatra Sikh community tying the thaga, a black thread on the infant's wrists, ankles and/or waist and placing a black mark on the forehead ensure protection from harm (Dobson 1991). Protecting the new-born child may be expressed in many different ways; for example, Richardson (1993) suggests a number of traditional, diverse expressions:

"A Christian family may wish to have the baby christened, a Hindu family might wish to write the mantra 'Om' on the baby's tongue with honey (Henley 1982), while a Muslim family may wish that a male relative whisper the Islamic call to prayer into the baby's ear and perhaps attach an amulet round the baby's neck or wrist"

(Richardson 1993:81)

As you can see, customs vary across different cultures; however they can also differ within cultural groups. These may include "wetting the baby's head" (a euphemism for having an alcoholic drink to celebrate the birth), baby 'showers' and the giving of gifts and cards, restricted visiting by male members for the family for up to ten days following the birth, or preparing special foods for the mother to eat.

Exercise 2.6 Activity

What other customs or rituals associated with childbirth are you aware of?

Recommended further reading

  • Schott J and Henley A (1996) Culture, Religion and Childbearing in a Multicultural Society: A handbook for health professionals, London: Butterworth-Heinemann
  • Katbamna S (2000) Race and Childbirth, Buckingham: Open University Press

These texts are very valuable resources and should be seen as necessary complementary reading to this chapter.

Naming the baby

Giving a baby a name has meaning and significance for most people. Names chosen may include names of family members (parents/grandparents), religious characters or Gods and Goddesses, pop-stars, footballers or national figures. Names may have specific meaning, indicate the time of birth (Joy or Noel for a Christmas baby) or the position in the family (eldest, middle or youngest, son or daughter). They can include a religious name (Mohammed, Allah or Ullah for South Asian, Muslim boys) or a male or female title (Holland & Hogg 2001). Some children may never be called by their 'given' name but may be known by a family 'nickname' or title indicating position within the family structure. It is important, therefore, for the nurse to clarify not only what the child's name is, but also by what name the child should be called whilst in hospital. The same principle also applies to establishing the parents' names.

Exercise 2.7 Reflection

Consider your own name. Do you like it? Does it have a meaning? Do you have a nickname or preferred form of address? How does it make you feel when someone forgets, abbreviates or mispronounces your name?

Our identity is established, in part, through the naming process and it contributes to our sense of heritage and self-esteem. It is important to realise that the health-care worker is a role model for children and other visitors to the ward, and that to laugh or joke about a name may set off ridicule among the other children. Names that are long or difficult to pronounce should not be shortened or varied, except on the suggestion of the child or family, as it can be interpreted as disrespectful and can indicate a lack of interest in trying to get the name right. Do not fall into the trap of avoiding the use of a difficult name by referring to 'the boy with the appendix', or 'that Asian girl' or 'the one in cot five' and the like. Be willing to practice pronunciation, as any attempt, however incorrect, is usually appreciated and can help to build relationships. Do not be afraid to ask how to pronounce a name correctly; for example, Gaelic names do not easily reveal their pronunciation via their spelling for none Gaelic speakers. You can develop your competence in this area by taking the time to familiarise yourself with names that are likely to be used in your local minority ethnic communities.

Infant feeding and weaning

Despite encouragement from doctors and midwives that 'Breast is best', infant breast-feeding is declining world-wide. Breast-feeding is more common and lasts longer in rural communities and declines in both length and frequency in urban industrialised countries. Reasons not to breast-feed can include poor maternal health, especially in countries where there is a high incidence of HIV infection, mothers return to work, the perception that breast milk is inferior to formula milks, social embarrassment or intolerance, lack of privacy and overcrowding, pain or insufficient breast milk production (Helman 2000).

Colostrum is still considered by some Asian mothers to be inferior, and not good for the baby, as it appears thin and weak. This results in the discarding of the 'first milk' and not breast-feeding until three or more days after delivery when the thicker breast milk is produced. This should not be interpreted as a lack of desire to breast-feed, and information should be given in a sensitive and tactful manner which allows the mother and her female relatives to make an informed choice. The resulting decision needs to be respected and formula milk made available if required. Older female members of the family are often highly regarded and their advice and opinion sought after; they can be the defenders of cultural norms and exert a great deal of influence with regard to health care practices and beliefs (Schott & Henley 1996). This can be particularly helpful for ensuring that the mother receives the diet and rest she requires in the postnatal period.

Weaning is an important milestone in most cultures and the progression from milk feeds to solids may be marked by specific ceremonies. For Hindus, there is a rice feeding ceremony at six months of age when various members of the family, usually starting with the grandparents, feed the infant its first rice. Congee, a traditional Chinese weaning food of rice boiled in watery meat broth, is introduced at 6-10 months (Helman 2000). Rice alone is an insufficient infant food and should not be given in isolation, as it cannot provide the calories required by a growing child, but it can be given as part of a mixed diet that includes milk and other nutrients.

Respecting cultural values and practices as they impact upon the care of young children is not just a matter of health care staff having appropriate insight and a positive attitude toward diverse cultural practices. It may also demand a reasonable willingness to challenge the routines of care management in a busy ward in order to accommodate to the needs of a particular child and their family.

Diet and illness

Many cultural groups divide foods into 'hot' and 'cold' foods and there are restrictions and recommendations about which should be eaten at different times, especially during ill health. China, Latin America, the Indian subcontinent and many parts of the Islamic world interpret health as the balance between these two categories: which does not describe their actual temperature but refers to their symbolic power. This may help to explain why many people have strong views about what should and should not be eaten by the sick person and even a refusal to follow certain recommended diets.

Exercise 2.8 Reflection

Think back to a time when you were ill as a child. What did you like to eat and why?
What were you recommended to eat by your parents/family? Why?

One study (Chevannes, 1995) identified foods children liked to eat when unwell. 'White' children were likely to eat food such as soup, toast, eggs, ice cream, and mashed potatoes. African-Caribbean children added pumpkin and chicken soup and soup with yam to the above list, and Asian children mentioned soup, dhal, lentil, curry and vermicelli. Although this study highlights diverse cultural differences, to assume this applies to all children from different cultural backgrounds could reinforce institutionally racist practice. It is essential that the nurse is aware that preferences for food may differ amongst children from different minority ethnic groups, and within particular groups; and it is necessary to enquire about the child's preferences as part of the cultural assessment.

Food is important as it provides us with the nutrients required for health, growth and activity. It also provides comfort, creating a favoured meal can be used to express care and concern for a person who is unwell. Therefore, physically and psychologically, the food we eat when ill is an important aspect of the healing process. Many patients are not provided with appropriate diets because some nurses are sometimes unaware of what can be ordered. For example, is provision made for Halal or Kosher diets? Is an alternative offered to 'vegetable curry'? In many hospital wards the 'vegetarian' option may be restricted to sandwiches. Some vegetarians (including some Muslims, Hindus, Sikhs and Jews, who all follow dietary restrictions) find it unacceptable to eat vegetarian dishes that have been prepared and served with meat dishes; for example removing a slice of ham from a salad is totally unacceptable.

The lack of choice can restrict some children from having a nutritious diet while in hospital and can be a source of anxiety for parents. A little thought can correct this, and it is equally important not to assume that parents can always bring food in for their child. While individual nurses can, and should, demonstrate their own sensitivity to the dietary requirements of children in their care, ultimately this concern can frequently only be expressed in practice if there is an institutional policy of responding to differing dietary needs. The dieticians and catering staff must have the skills, means and willingness to respond to these needs.

For more detail on diet and illness read:

  • Helman C (2000) Culture, Health and Illness London: Arnold
    Chapters 2 & 3 contain useful information.

Exercise 2.9 Activity

In your clinical area, what dietary provision is made for children of various religious and cultural backgrounds? Find out what specialist diets can be ordered and whom to contact - the kitchen or dietician. What choice currently exists on the menu?

Eating customs and habits

Customs and habits related to meal times vary, and some people prefer to eat alone while for others it is a social activity. A child may refuse to eat if the mother or another family member is not present. To watch someone eating can be considered rude and some mothers may cover their baby's head while breast or bottle-feeding to prevent someone casting the 'evil eye' on the infant. A little time taken on admission, to ask about preferred meal times and customs related to eating, could help to establish good dietary intake whilst in hospital. Maintaining a fluid balance chart can be problematic, but the majority of parents and relatives co-operate and even take the responsibility for keeping it up to date, once they understand its significance in their child's care.

A Chinese child may prefer to use chopsticks or their hand. For Muslims, Hindus and Sikhs the right hand is used for eating and the left hand for toilet and hygiene purposes. It is important for the nurse on a children's ward to be aware of this and to avoid either offering a child or the parents food with the 'unclean' hand, or expecting a child to eat when the right hand cannot be used either because of injury or due to insertion of an intravenous cannula.

For many, fasting is an important religious activity. This can include Muslims during the month of Ramadan, Jews during the fast of Yom Kippur and the Christian fast observed during Lent. Throughout the month of Ramadan all healthy Muslims over the age of 12 should fast, but those who are sick, pregnant or breast-feeding mothers are exempt. Parents of children on the ward may be observing the fast between dawn and sunset and will not eat or drink until evening. Some older children may wish to participate in the fast and conflict can arise for outpatients on medication, as anything that "enters through the mouth into the intestines nullifies the fast" (Sheikh & Gatrad 2000). However, dispensation not to fast is available for those who must take medication or it can be accommodated by seeking sympathetic medical advice and adjusting the times of medication or changing from short-acting to long-acting drugs where possible.

'Fasting' is a cultural practice which should be addressed in the nursing assessment during the initial stages of admission and planning.

For further information read:

  • Sheikh A & Gatrad AR (eds) 2000 Caring for Muslim Patients, Abingdon: Radcliffe Medical Press
    Pages 73-87 provide additional information

Child-rearing practices

Read the following text

Cultural values and child-rearing practices are shaped by a variety of influences. These may range from: the structure of the society (agricultural or urban), through infant mortality, beliefs about the intrinsic 'goodness' of children, to perceptions about the value and purpose of childhood.

Further reading

Read Chapter 2: 'Temperamental and behavioural differences' in:

  • Keats D M. (1997) Culture and the Child: A Guide for Professionals in Child Care and Development. Chichester: John Wiley & Sons.

Expectations regarding a child's behaviour and interpretations about what is 'good' or 'bad' vary across cultures. Studies strongly suggest that the following values are rated highly within some cultures and less so in others (Hofstede 1984).

Table 2A: A comparison between Individualistic and Collective Approaches to Child Rearing

Individualistic

Collectivistic

Looking after self and immediate family, independent, achievement and goal orientated. There is a strong group identity to the extended family and community, with the expectation that the needs of the group come before personal needs.

Masculine/feminine identity less clearly defined with sharing or exchange of 'traditional' roles

Male/female roles are more clearly defined with men being dominant and authoritative and women passive and nurturing. (However, these traditional roles often merge in societies where the male workforce have to travel and work away from home for long periods of time. It can also be a point of conflict when families immigrate to another country).

Conflict is used as a dynamic force to spur new thinking, find solutions to problems or eliminate the unnecessary.

Avoidance of interpersonal conflict and the maintenance of group harmony.

All people are equal and respect is based upon personal achievement.

Social hierarchies where parents are considered superior to children, men to women, and rulers to subjects (Bee 2000). Respect for elders.

Examples of different value systems have been reported by Swanwick (1996) who looked at a number of studies that consider child-rearing across cultures. A comparative study by Stopes-Roe and Cochrane (1989) compares the views of Asian (Muslims, Sikhs and Hindus) and indigenous, white, British parents and young people. They found that conformity and conformist qualities such as obedience and sexually-appropriate behaviour were valued by Asians and particularly the older rather than younger generation, and self-direction was valued less than by the indigenous white British group. Stopes-Roe and Cochrane (1989) suggest that this 'traditional' viewpoint is found throughout the Indian subcontinent, especially in rural areas where decisions are made for the benefit of the whole group, and respect for elders and support to siblings and parents are expected. Minority ethnic groups continue to be influenced by their traditional family and community values but also assimilate the values of the majority culture.

In contrast,

"in the indigenous white population in Britain, the individual constitutes the most important unit and self-sufficiency, personal autonomy and independence were highly valued"

(Lau 1984, cited by Swanwick 1996:15)

Expectations regarding the behaviour of children are reinforced in child-rearing practices. Dependence or independence can be either nurtured or discouraged. Differences between Japanese and American mothers are observed by Caudhill and Frost (1973 cited by Swanwick 1996) who found that:

"Japanese mothers spent a long time soothing and lulling their infants rather than stimulating them with active chatting as the American mothers did. They viewed quiet, contented babies as the desired norm, whereas the American mothers encouraged open, expressive, assertive and self-directed behaviour"

(Swanwick 1996:15)

Exercise 2.10 Activity

· Observe and compare the interpersonal interaction of two children from different cultural backgrounds. Reflect upon how culture might influence their behaviour.

NB: Observations could be undertaken in the hospital play room, the outpatient waiting area, a school environment (with a school nurse) or on home visits (with a Health Visitor or Community Paediatric Nurse). Observation within the child's own/familiar environment would be ideal.

In many African and Asian cultures, direct eye-contact is considered rude in certain circumstances, for example, when the status of two people is different or when a women greets a man. In European and North American countries, eye-contact conveys honesty and sincerity and is encouraged; thus it could be easy to misinterpret the behaviour of a child who avoids eye contact with the nurse or doctor when spoken to.

Exercise 2.11 Self reflection activity

Identified within this text are just some of the ways in which cultural values can differ. Can you think of others? What values can you identify in your own cultural background?

Examples may include: societal expectations regarding length of schooling; the age at which adult responsibilities are assumed, including paid employment; laws relating to the age of political voting or consent to sexual activity; and when marriage is permissible.

Further reading

It is recommended that you refer to the module 'Transcultural Communication in Health Care Practice' by Charles Husband and Edwin Hoffman. This module specifically examines the importance of communication skills and interpersonal interaction.

Discipline and child protection

The role of disciplining children in a family often lies with the parents, and one may be more active in enforcing discipline than the other. However, in many communities it is accepted that members of the extended family will also discipline a child, particularly if they participate actively in the care of that child. Older siblings can fall into the category of carers and, therefore, punishers of undesirable behaviour. And, in some families the employment of a nanny extends the disciplinary responsibilities to other adults supervising the child.

A child's behaviour can be shaped by some commonly used methods of discipline, such as encouragement, punishment or modelling, for example (Keats 1997). Just as the desired behaviour expected from a child is influenced by many things, including environmental factors and societal norms, so undesirable behaviour and methods of punishment also vary.

For further information on patterns or styles of child rearing, and a useful discussion on spanking (smacking) see Chapter 13 'The Ecology of Development: The Child within the Family System' in Bee (2000).

Exercise 2.12 Self Reflection Activity

Within the UK when does discipline become unacceptable and defined as abuse? What does the law clearly state? Look at The Children's Act 1989, the United Nations Rights of the Child (1989) and the need for a European Convention on Children's Rights (1989).

Facilitators notes:

Encourage the students to discuss their own views on disciplining children. If this includes physical forms of punishment then get them to think about the difference between punishment and abuse. You may wish to refer to newspaper articles on cases of child abuse such as the Victoria Climbie case. Consider the significance of culture with regards to the discipline of children.

Definitions of abuse

When considering discipline and abuse it is important to clearly define what we mean. The World Health Organization (WHO) defines child abuse as:

"All forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power."

(WHO, 1999)

Meadow (1993) make the helpful comment that the child who is abused is one who is treated in an unacceptable way within a certain culture at a certain time. This reflects the changing attitudes towards discipline and punishment. Many adults may have grown up in an age when physical chastisement, such as smacking or hitting a child with a slipper or other implement, was acceptable, whereas in current UK culture this is no longer widely accepted and is reflected in present governmental policy. The NSPCC (1987) highlights four categories of abuse - physical, emotional, sexual and neglect. Each of these crosses cultural divides and examples can be found in recent press reports of abuse by and towards children of all backgrounds. (See for example the case of eight-year-old Victoria Climbie in January 2001 and six-year-old Lauren Wright in October 2001.)

Abuse affects a child's health, growth and development and it is important for any nurse to be able to recognise the signs of abuse. This will not be discussed extensively here as many Health Trusts run child protection courses and study days and the student is advised to find out what local policies and guidelines there are within their own work environment. This should include recognising injury and bruising on different skin colours and how to avoid misdiagnosis. An example is the Mongolian blue spot that is a bluish discoloration of the skin over the base of the spine (sacrum), in the new-born baby of South East Asian origin, which can be mistaken as a bruise.

Female genital mutilation (sometimes referred to as female circumcision) is typically carried out in some parts of Africa, and can be interpreted within the UK as both physical and sexual abuse. Schott & Henley (1996) suggest that this debate is sensitive as it embodies cultural values and beliefs. The procedure is performed on female babies or young girls before the onset of puberty. It is illegal to perform female genital mutilation in Britain under the 1985 Prohibition of Circumcision Act and can be punished by a fine or imprisonment (Schott & Henley 1996). However, parents who fail to conform to the custom may find their daughter stigmatised, unable to find a husband and assumed to be promiscuous. The cultural implications of being seen to be acceptable to marry means that the practice continues and many young girls are taken abroad to have the procedure carried out.

The Royal College of Obstetricians and Gynaecologists provide a thorough introduction of the extent and impact of Female Genital Mutilation in a good practice Statement No 3 (May 2003), along with a comprehensive reading list. This can be found on the following website: www.rcog.org.uk.

As previously stated, abuse crosses cultures and unfortunately affects children from diverse backgrounds. However, for children from minority ethnic groups, some may also suffer from bullying and racism, a form of emotional and physical abuse. For a further discussion of this, Jackson (1996) is recommended.

Issues around discipline and abuse in a cross-cultural context typically are likely to be amongst the most challenging phenomena that must be negotiated in transcultural health care. Both of these issues have a capacity to directly address strongly held beliefs and values about human rights and the integrity of the individual's body. These are values that have particularly enjoyed widespread visibility in Western European societies in the last four or five decades. And for many women health care practitioners they have been given a very special edge because of the advance and impact of feminist theory and practice.

Consequently the challenge of responding to cultural practices that are seen to deny respect for the individual, and for their bodily integrity, requires all practitioners to confront the question of where they stand on the issue of cultural relativity. Transcultural health care practice requires us all to have knowledge of other cultures, the values and practices. And it invites us to have respect for other cultures and to be sensitive to the health care needs of people from differing cultures. But the question arises when other cultural practices are in conflict with the values of the health care provider; must the health care professional suspend their own values in favour of those of the patient? Such a demand for absolute cultural relativity disempowers the health care professional and generates conflict, anger and resentment. We should be clear that such absolute cultural relativity is not an appropriate or necessary response to providing sensitive transcultural health care. It is possible to be strongly judgmental of cultural values and practices that generate forms of abuse, whilst being positive and sensitive in your interaction with those who have experienced it.

We recommend you read the section on Cultural Relativity in the module 'The Politics of Diversity' by Charles Husband. This will further your awareness and understanding of cultural relativity.

In responding to perceived abuse it is important to be aware of the potential role of cultural values and norms in legitimating problematic behaviour. It is necessary to be explicitly aware of the possible conflicts of value and perception between the carer and the abuser; and to retain an awareness of this in managing the process of defining the situation as abusive and in confronting the abuse. Abuse cannot be condoned by reference to cultural norms, but its origin may be better understood by recognising the cultural context of the abuse. And equally the individual criminality of a specific abuser should not routinely be attributed to 'their culture'. If the child encounters abuse in a specific context it is not appropriate to ignore the reality that that child may remain in that context on release from the health care environment.

Further reading

  • Jackson V (1996) Racism and Child Protection. The Black Experience of Child Sexual Abuse. London: Cassell.

Exercise 2.13 Case study

You witness a parent on the ward smacking their child severely with their shoe. The child also has a number of bruises on their back.
· Find out what procedures are in place in your clinical area if you suspect there is possible child abuse taking place.
· Identify the members of the multidisciplinary team who would be notified and involved in such a case.
· In what ways is a sensitivity to cultural diversity built into these procedures?

Transcultural Communication With Children And Their Families.

Recommended reading

Child development

  • Bee H (2000) The Developing Child (ninth edition) Boston: Allyn and Bacon.
  • Davenport G C (1989) An Introduction to Child Development London, Unwin Hyman Ltd

Application to Children's nursing

  • Moules T & Ramsay J (1998) The Textbook of Children's Nursing UK, Stanley Thornes Ltd
  • Wong et al (2000) Nursing care of Infants and Children 6th edition St Louis, Mosby Year Book

Other Transcultural Modules

  • Husband C and Hoffman E Transcultural Communication and Health Care Practice
  • Rajamanickam B Mental Health and Ethnic Minorities

An essential part of childhood development is the acquisition of language and how children communicate depends upon their age and stage of development. The health care professional caring for children and their families needs to have a good working knowledge of the average language development of children of all ages. Although, the major part of language acquisition takes place between birth and approximately five years of age, children continue to develop their language ability throughout childhood and on into adulthood.

Exercise 2.14 Case Study

A 4 year old boy is admitted to A & E. He is from a different part of the UK (i.e., Scotland, Ireland, or Wales). You are unable to make out any of the words he is speaking, despite his pointing at different objects in the cubicle. There is some concern expressed by medical staff that he may be delayed in his development.

How will you make a basic assessment of this boy's language achievements, with reference to the main stages of language acquisition and development? What questions will you ask the parents? How might culture influence language?

NB: consider accent, slang terms, different languages used, first languages spoken at home.

Action

Familiarise yourself with the main languages spoken in the UK (in addition to English). Learn a few basic phrases, eg, greetings, yes/no or questions in the minority languages you are likely to frequently encounter.

The young baby communicates their needs mainly by crying but they also quickly discover how to communicate their pleasure and contentment through smiles and laughter. With increased independence the older child will communicate not just through words but also by their choice of clothes, preferred leisure activities or choice of music. The adolescent learns how to communicate abstract thoughts, ideas, feelings and emotions. The younger child may know how they feel but not yet have the words to express those feelings; this can often be seen in the frustration displayed by toddlers between the ages of 18 months to three years. Studies conducted among a variety of language groups indicate that language development follows a similar pattern for all children regardless of their cultural background. However, the bilingual child may initially be slower to verbalise than their monolingual peers, possibly even mixing words or grammar from the different languages, but quickly they catch up (Bee 2000).

Exercise 2.15 Reflection activity

Consider how different cultures communicate verbally and non verbally. How are feelings communicated?

Some cultural groups make greater use of gestures during conversation than others and emotions are expressed more readily, whereas, others consider emotions to be private and may therefore appear to be more controlled. Use of touch might be limited and considered to be inappropriate between the sexes and this is particularly important to consider in nursing where touch may be wrongly interpreted. For some shaking the head from side to side indicates no or disagreement but for others it may mean the opposite. Some gestures, such as pointing the finger can be interpreted as being very rude and offensive. Being aware that such differences may exist is the basis upon which to build effective communication. Reading a child or parent's body language can often tell us more than their verbal response about how effective our communication with them has been.

Key practice points:

  • Making the effort to learn key words or phrases not only helps communication with a child but is also appreciated by their anxious family.
  • When caring for children and families from diverse cultural backgrounds remember that facial gestures, intonations of speech and body posture will communicate more than the words you speak. Care and concern can be conveyed even in the absence of language.
  • As for any child get down to their eye level but do not be over anxious if they avoid eye contact as this may be a sign of respect.
  • Speak clearly but avoid raising your voice, as this is unhelpful and can distort your words.
  • Wherever possible use trained interpreters and avoid using family members, especially children, to interpret, as they may be selective in what they tell an adult either from embarrassment, lack of understanding or verbal ability