Babies and infants as whole beings
Children, with or without delay or challenges, have a right to be respected and treated as whole beings who bring all of their understanding and skills into each of their activities. An infant playing on the floor with a ball in the company of a parent, sibling or playmate functions as a whole being because it is the only way they can be. The child is using skills in posture, movement, dexterity, seeing, listening and understanding. They might be remembering yesterday’s game. They might be excitedly trying to reach the ball so they can pass it to a playmate. This is an infant’s ‘global’ or whole-child activity. It is happening in all natural baby and infant behaviour and is reflected in complex interconnected neurological networks – networks and patterns that strengthen as activities that are relevant to the child are practised and repeated.
Each baby and infant’s understanding, communication, emotions, and movement are all happening at the same time in the natural activities of dressing and undressing, mealtimes, play, etc. In these activities, each facet of child functioning depends on and supports the others in interconnection and interdependence. As an example, we can think of a baby lying in a cot seeing a bauble hanging within reach. The first contacts between hands and bauble might happen accidentally from random movements. If the baby notices the bauble moving after she has touched it, then in the coming hours, days or weeks contact can become less random and more purposeful. The baby’s hands and eyes gradually improve how they work together in this pleasurable activity. In this first learning (or education) arms, hands, eyes, attention, interest, intention, effort and emotions are all involved. If the bauble has a rattle inside, then ears are involved too. If an encouraging parent is nearby, then there will be the additional factors of relationship and encouragement.
But this interconnected and interdependent global functioning is not commonly recognised in traditional approaches to the babies and infants discussed in this website. In the world of childhood disability, some practitioners are trained to focus on a single aspect of child development, for instance communication or movement. This narrow focus gives rise to deep professional understanding and skills. But, also, it has led to the dangerous myth that to support learning in infants who have a multifaceted condition, we can work on separate bits as though they were not interconnected parts of the whole child. This does no favours to child or family and does not reflect how first learning/education happens in natural whole-child activity. Too easily, we fall into the trap of the historical and damaging fragmented approach.
The emergence of new understanding and skills in babies and infants
In common with others, I often use the phrase ‘development and learning’ but perhaps I should try to clarify it ans see how useful it is. We can think of development as a process that continues as we grow and learning as the knowledge, understanding and skills we accumulate dependent on what we experience in our family, school and culture. As an example, teenagers can learn chemistry, carpentry and cookery at the same time as they are developing biologically, socially and emotionally in puberty. Most babies and young children will go through the infant development stages of sitting, crawling and standing and then put the development to good use when they learn where the biscuit tin is kept. Obviously, development and learning are interconnected and interdependent in all of us.
In the cultures I know of, typically developing babies and infants are not taught how to crawl, stand or walk. Instead, these skills are left, more or less, to develop naturally – usually with encouragement and praise. But when a child has particular challenges, some basic skills, for instance in posture, movement, use of hands and communication, will be directly supported, taught or trained by early childhood practitioners rather than being left to develop naturally without help. So, the distinction between development and learning become less useful. A better phrase is ‘the emergence of relevant understanding and skills’. This phrase brings together understanding and skills that emerge with or without planned interventions.
It is well understood that young children learn through play. When we watch infants playing, we see them gaining understanding of their bodies and of the space around them. They become more skilful in moving, watching, listening and planning. They understand more and more about the children they are playing with and the adults watching over them. Their ability to communicate improves as they express frustration, success and pleasure. They learn how to ask for what they want, how to respond to requests made to them and how to work things out when their ideas conflict with others. They learn that actions have consequences.
We can see in our own lives and families that this emergence of relevant understanding and skills is a lifetime project beginning in babyhood during, for instance, feeding, nappy/diaper changing and bathing. Watching, listening, feeling and relating are happening at the breast or bottle. While being dressed and undressed babies are developing a first awareness of parts of the body, about the feel and smell of items of clothing and about changing position, feeling comfortable, managing balance, how to help (or not). In the rough and tumble of baby games with an energetic parent there is fear, excitement, moving excitingly through space and learning how to ask for more. At family mealtimes there is learning about routines, foods, waiting for one’s turn, and being with the family – and sometimes about not being the most important person in it.
So, we can extend important first learning back to babyhood and, if we wish, further back into the womb. When we consider the vast store of relevant understanding and skills that is built up during a new child’s first couple of years, we can see that it emerges:
under the care of parents and other family members
in the family home and other safe and familiar places
in the natural activities of feeding, dressing routines, socialising, play, etc.
In families all around the world this first learning happens without lessons or programmes. Understanding and skills emerge and grow during family activity in the domestic scene with the child feeling cared for, valued, relaxed and safe. Early support for babies and pre-school children who have delay, challenges and diffuiculties must, logically, follow this natural approach to their first learning.
Integrating separate approaches
An fully integrated early support system requires that the main practitioners involved with the infant’s development and learning integrate as appropriate their approaches and goals instead of working separately from each other. This can be planned in the team meetings. There are graded opportunities for this integration and how far to go is a team decision – not forgetting that parents are full members. Stages of increasing integration are as follows:
Stage 1
Practitioners and parents tell each other what they are working on with the child. This brings the benefit of seeing the pattern of interventions as a whole, resolving contradictory approaches and avoiding wasted time and effort when two people are offering similar work to the child. Judgements can be made about whether the child is being offered too many or too few people and programmes and, similarly, whether parents are being asked to do too many things at home. Parents, typically, are concerned when their infant’s practitioners do not talk to each other, leaving the parent as the go-between. This is disrespectful to the infant and family and puts yet one more demand on parents.
Stage 2
Practitioners and parents adopt relevant parts of each other’s approaches. This can increase the infant’s opportunities for learning and practising particular tasks and facilitates the interplay between their various activities and abilities. For instance, each can offer the infant practice in the agreed signs, symbols or spoken words, each can incorporate the same postures and movements into their work with the child when it is appropriate.
Stage 3
Practitioners and parents can work towards some degree of actually joining together the infant’s development and learning programmes. This can be helped by agreeing to move from planning a discipline-based ‘physiotherapy programme’ or ‘speech and language therapy programme’ to a child-based ‘getting dressed programme’, a ‘mealtime programme’ or ‘a playing on the floor and moving around the room programme’. In this way the infant gets whole-child learning opportunities in relevant situations and times and with natural opportunities to join abilities together. One outcome of this sharing process is ‘collective competence’ as explained below.
Stage 4
It might be decided that one person could take on the work of another using a consultant model in which one person hands over some part of their work with an infant to another team member who is competent to take it on with necessary support. This will reduce the number of people doing regular hands-on work with the child. This has direct advantage to the child, reduces the number of necessary sessions at home or in clinics, and supports service providers in their efforts to make the best use of their limited resources.
Stage 5
The consultant model described above can progress, by team decision, into agreeing one of the team will become practitoner doing most of the regular hands-on work with the child for a period of time. This is elaborated in the next section below.
Collective competence, mentioned above, answers the question, ‘Who can be competent to offer whole-child development and learning opportunities to an infant who has a multifaceted condition?’ Taking, for example, a baby with early diagnoses of blindness and cerebral palsy: the mother knows a lot more than anyone else about her baby but still has much to learn about both of these conditions and how they will impact on the growing infant. The paediatric physiotherapist might well have very little experience of blind children. Similarly, the vision specialist teacher might not yet have worked with any children with cerebral palsy. Competence only comes when these three people and the infant bring what they know and what they can do into a shared effort. Achieving this collective competence requires a degree of trust, shared aspirations and humility.
A new whole-child practitioner - the multifaceted early support Mentor
This role recognises that it is the right and responsibility of parents to bring up their children and the responsibilty of early support practitioners to help them when asked to do so. The Early Support Teacher promotes the child's acquisition of new understanding and skills and at the same time helps parents enhance their ability to help their new child develop and learn - all of this within the imperative to protect and improve child and family's quality of life.
It can be said that the role of the ES Teacher has partly developed from transdisciplinary teamwork in which a single practitioner works with the child on the various aspects of communication, movement, cognition, etc. In line with others, I have previously used the terms primary interventionist or primary worker. In effective joined-up early child and family support the ES Teacher role can be taken by a teacher, therapist, play worker, nursery worker or psychologist after qualifying in local or national early support training.
The foundation of the work is the relationship between the ES Teacher and the child and parents with empathy, honesty, respect, trust and genuineness. Working this closely with a family in their own home is a privilege calling for sensitivity and humility. Sensitive partnership replaces an expert mode in which parents can be undermined. Parents take the lead in saying what they want help with. This can be with any aspect of the child’s care, play, sleep, socialising, development and learning – from the first baby-care tasks to the infant cruising around the furniture, from nursery rhymes to establishing a bedtime routine.
Support in any activity starts with what the parents know and do already. Then suggestions are made to help parents help the child move along the necessary small steps towards the desired goal. In this way, parents are bringing up their child with relevant and timely support from someone they know well and trust. It is important that support is in response to parents asking for this help. If it is imposed, parents are undermined.
Natural baby and infant activities are always multifaceted. For instance, using a spoon at breakfast time involves hands, eyes, ears, sitting skills, communication, relationship, oral skills, intention, etc. All the necessary expertise, knowledge and skills for teaching these multifaceted activities reside in the team around the child practitioners and parents. It is these people who fully brief and support the ES Teacher to become competent in helping the child in all aspects of the chosen activity. Team discussions for this can be greatly helped by film of the level the child had already reached.