Mothers’ Knowledge about Child Development

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Vol. 403 September 2016 Print: ISSN 0304 4904 Online: ISSN 2305-820X PAKISTAN PEDIATRIC JOURNAL A JOURNAL OF PAKISTAN PEDIATRIC ASSOCIATION Indexed in EMBASE/Excerpta Medica Index medicus WHO – IMEMR www.pakpedsjournal.org.pk http://www.pakmedinet.com/PPJ

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www.pakpedsjournal.org.pk ORIGINAL ARTICLE Mothers’ Knowledge about Child Development ATIQ UR REHMAN SYEDA FARHANA KAZMI FARRUKH MUNIR ------------------------------------------------------------------ Pak Pediatr J 2016 403: 176-81 Correspondence to: Atiq Ur Rehman Department of Psychology Govt. Post Graduate College Jaranwala District Faisalabad Pakistan Email: atiq0004yahoo.com Received: 4 th March 2016 Accepted for publication: 16 th Sept. 2016 ABSTRACT Objectives: The first objective of this study was to assess mother knowledge about child development and the second objective was to identify their sources of knowledge. Study Design: Cross sectional survey research design. Place and duration of study: The study was conducted among the urban community of Faisalabad and Jaranwala during the month of January 2016. Participants Methods: A sample of 392 mothers was taken by convenient sampling technique among the urban community of Faisalabad and Jaranwala. The Caregiver Knowledge of Child Development Inventory with the addition of five questions taken from Developmental Milestones Pediatric Orthopedic Society of North America about child development was used to assess the mothers knowledge about child cognitive sensory motor and language developmental milestones. Results: It was observed that mothers have inadequate knowledge about child development. It was observed that knowledge of majority of the mothers is based on informal experiences only. Only 3.57 mothers claimed that their source of knowledge about child development was formal education/experiences and 9.44 mothers told that their source of knowledge about child development was television radio magazines and discussing with a pediatrician. Conclusion: It was concluded that mothers knowledge about sensory and motor development was better than language and cognitive development. Mothers need to be more knowledge about child development. Knowledge of majority of the mothers is only based on informal experiences. Key words: Mothers Knowledge Child Development Language and Cognitive Development Sensory and Motor Development Community. INTRODUCTION Mothers’ knowledge about child development is assumed to play a key role in motivating how mothers behave with respect to their children. Mother child interactions involve several domains of development 1 . Awareness of mothers support a broad scope of positive developmental effects 2 . Still a very inadequately is realized about Pakistani Mothers’ knowledge of child development and key matters of parenting and their state of mind about being a mother. Similar not as much is known about how mothers educate themselves about child development parenting and exactly how capable they wisdom in the parenting task. The level of knowledge to which mothers are capable to be aware of their children is mostly

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www.pakpedsjournal.org.pk  177 Mothers’ Knowledge about Child Development subjective to their family credentials culture and generation. Mothers from different cultures act in their own way to get information about children 3 . Cultural environments affect the approach how parents believe about their children their parenting ambitions and values 4 . A mother who has the proper knowledge of a child’s development may be helpful for early screening of developmental delays of her children. The previous studies exhibit that mothers with better knowledge of child development are more probable to deliver developmental incentive to their children. The children of such mothers consequently have healthier developmental outcomes 5 . It is essential for mothers to be aware of their childs necessities individuality and development. Mothers should have knowledge that every child is unique in his/ her abilities. Mothers having more knowledge about child`s uniqueness bring up and development proves to be more efficient mothers. Researchers have realized that those parents who have knowledge about the childs development is positively reported to their competence to conceive homes with learning conditions and to cooperate with their children in manners that accelerate positive development. Furthermore health care professionals may be dependent in somewhat on parent’s knowledge about the development and health of their children for counseling and recommendations 6 . Parents are well capable to don liability for their children’s development if they are informed of the effect of a constructive and fostering home environment and convinced in their capabilities to provide their children’s learning 7 . Children who born with a low birth weight below 2500 grams are more probable to suffer a massive physical and developmental problems as well as delay in motor and social development 8 and such children remain poor in intelligence and lower in school performance 9 . Children who born under 1500 grams birth weight are at higher risk of dying within a year 10 . Children with a low birth weight are at higher risk for iron deficiency in their childhood 11 and hold lower IQ scores 12 . Awareness about child development is improving in developing countries. The agencies are supporting the primitive child development programs for low birth weight children 13 and developmental delays 14 as well as supporting the children born in a poor income environment 15 . Child development facts are regularly recorded in child development monitoring charts. For the purpose to calculate normal development among healthy children world health organization has construed frames of milestone development with variation in the ages 16 . Developmental delay means childrens development behind an ascertained normal span for their age. A childs physical development delay may disrupt childs behavioral emotional cognitive and social development as compared to normal children. Mostly children crawl with the age of 8 months and walk before the age of 18 months 17 if a child 4 or 5 months behind in attaining these milestones is said to developmental delayed concerned to mobility. The mothers who suffer with medical complication during the pregnancy and at the time of delivery their children may have more chance to be encountered with the developmental problems. The children of such mothers may be kept in a follow-up plan to track their progress within a certain developmental period. Mostly children assume to speak the first words before attaining the age of 18 months and speak short sentences by the age of 3 years if a child is behind in attaining these milestones is said to developmental delayed concerned to speech 18 . The educational and social development is also effected with delayed speech and language development. The children with developmental disabilities speech and language development delays are mostly prevalent hence without delay detection and intervention is crucial. With other possible cause of delayed speech and language congenital hearing loss can be the one of the causes of delayed speech and language. Children with the most hearing loss have the most language deficits. If the earlier the hearing loss is detected then it has better curative. Cognitive abilities also affected among those children who diagnosed with delayed speech and language development. It is believed that a relationship exists among sensory motor cognitive social and language development 19 . Delays in language and cognitive development may be the cause of deficits in a Neuro development. In such

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www.pakpedsjournal.org.pk 178 Rehman AUr Kazmi SF Munir F situations a child may be suffering in visual spatial perceptual disabilities. Early motor developmental delay may be a most frequent indicator of neurological dysfunction. If a child is reported with largely motor delays cerebral palsy 20 spina bifida taxia myopathy and spinal muscular atrophy may be appeared 21 . If a motor delay coexists with delays in added developmental capacities the child may be assessed for visual deficiency or mental impairment. Grown up children with inadequate motor abilities may be markedly lower than in their cognitive abilities 19 . OBJECTIVES The first objective of this study was to assess mother knowledge about child development and the second objective was to identify their sources of knowledge. METHODOLOGY This study is based on cross sectional survey research design. A sample of 392 mothers was taken by convenient sampling technique among the urban community of Faisalabad and Jaranwala during the month of January 2016. The Caregiver Knowledge of Child Development Inventory with the addition of five questions The age at which a child can hold his/her head at 90 0 in ventral position the age at which child can sit alone without support the age at which a child can stand the age at which a child can climb stairs and the age at which child can kick a ball taken from Developmental Milestones Pediatric Orthopedic Society of North America 22 23 about child development was used to assess the mothers knowledge about child cognitive sensory motor and language developmental milestones. The Caregiver Knowledge of Child Development Inventory has a good reliability and as internal consistency of the item scale α 0.61 was observed 5 . The participants of the study were also asked about their source of knowledge about child development. Information about the demographic characteristics of sample was also recorded in the form of age educational level and vocation of the participants. The inclusion criteria of the sample were the mothers whose age were above 18 years and below 61 years and who can read the inventory at least in Urdu version and resident of urban areas of Faisalabad or Jaranwala cities. The exclusion criteria of the sample were the mothers whose age were under 19 years and above 60 years and who cannot read the inventory at least in Urdu version and not residing under the urban area of Faisalabad or Jaranwala cities. The data were analyzed in the form of frequency and percentage through the SPSS version 20. RESULTS A sample of 392 mothers was the part of this study with the age 19 year to 60 year educational level below secondary to post graduation level and four major types of vocations. The detail classification of age educational level and vocation in the form of frequency and percentage has been presented in table 1. TABLE 1: Demographic Characteristics of Sample Demographic Character Number Percentage Age 19-30 years 031 07.91 31-40 years 097 24.74 41-50 years 147 37.50 51-60 years 117 29.85 Educational Level Below secondary level 012 03.06 Secondary level 076 19.39 Higher secondary level 134 34.18 Graduation level 103 26.28 Post graduation level 067 17.09 Vocation Teachers 112 28.57 Bank employees 039 09.95 Lady health workers 017 04.34 Housewives 224 57.14 As depicted in table 1 the maximum part of the sample according to age was 37.50 mothers were 41-50 year followed by 29.85 mothers were 51-60 year and the least part of the sample according to age was 7.91 mothers were 19-30 year. The maximum part of the sample according to educational level was 34.18 mothers were inter followed by 26.28 mothers were graduated and the least part of sample 3.06 mothers were below secondary level. Similarly the 57.14 mothers were housewives followed by 28.57 mothers were teachers/ professors and the least

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www.pakpedsjournal.org.pk  179 Mothers’ Knowledge about Child Development part of sample 4.34 mothers were lady health workers. In response to the question about the source of knowledge of mothers about child development only 14 mothers 3.57 claimed that their source of knowledge about child development was formal education/experiences and 37 mothers 9.44 told that they have gained knowledge about child development from television radio magazines and discussing with a pediatrician” while 341 mothers 86.99 told that they have obtained knowledge from involving oneself in such deeds as watching have a discussion with relatives and cooperating with siblings. TABLE 2: Language and Cognitive Developmental Milestones n 392 Q. Language and Cognitive Developmental Milestones Correct Answers F Correct Answers 1. The age at which brain of a child makes a start to develop and learn 64 16.33 2. The age at which a child starts to vocalize in reply to somebody speaking to him 127 32.40 3. The age at which a child starts to smile with response to other persons in smile face 116 29.59 4. The age at which a child starts to speak solo meaningful words 186 47.45 5. The age at which mothers should start to talk with their children 125 31.89 6. The age at which mothers should start to train their children for counting 224 57.14 7. The age at which mothers should start to educate their children about colors 211 53.83 As depicted in table 2 the highest correct answered 57.14 question was “the age at which mothers should start to train their children for counting” followed by 53.83 the question “the age at which mothers should start to educate their children about colors. The lowest correct answers 16.33 question was ”the age at which brain of a child makes a start to develop and learn.” Overall correct answered percentage about language and cognitive development was assessed 38.37. TABLE 3: Sensory Motor Developmental Milestones n 392 Q. Sensory Motor Developmental Milestones Correct Answers F Correct Answers 1. The age at which a child begins to see 272 69.39 2. The age at which a child start to track a moving person with his/her eyes or when he/she hears a sound 232 59.18 3. The age at which a child is able to approach for a toy putting before him 203 51.79 4. The age at which a child starts to grip little objects with his/her fingertips 192 48.98 5. The age at which a child starts to walk by him/ herself in a good way 240 61.22 6. The age at which mothers should start to display colorful things before their children for the purpose of practice to reach 134 34.18 7. The age at which mothers should begin to hand a spoon their children for eating themselves 191 48.72 8. The age at which mothers should start to train their children for drawing and coloring 226 57.65 9. The age at which child can sit with curved back or with support 221 56.38 10. The age at which child can hold his/her head at 90 0 in ventral position 247 63.01 11. The age at which child can sit alone without support. 234 59.69 12. The age at which child can stand 239 60.97 13. The age at which child can walk alone 244 62.24 14. The age at which child can climb stairs 230 58.67 15. The age at which child can kick a ball 248 63.26 As depicted in table 3 the highest correct answered 69.39 question was “the age at which a child begins to see” followed by the 63.26 the question “the age at which child can kick a ball”. The lowest correct answers 34.18 question was ”the age at which mothers should start to display colorful things before their children for the purpose of practice to reach”.

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www.pakpedsjournal.org.pk 180 Rehman AUr Kazmi SF Munir F Overall correct answered percentage about sensory motor development was assessed 57.02. The comparison about child development knowledge was made on the basis of age education and vocation of participants but no significant difference was observed on these three factors. DISCUSSION The countries such as Pakistan where health facilities are not delivering about developmental surveillance in a right way it is the obligatory for parents to detect developmental delays of their children. We have observed that a large number of mothers were deficient in knowledge about developmental milestones of their children as they thought that generally developmental skills and movements befall at delayed than normative ages. Overall correct answered percentage about language and cognitive development was assessed 38.37 and about sensory motor development was assessed 57.02. Only 16.33 mothers rightly know about the age at which brain of a child makes a start to develop and learn. If mothers consider that developmental proficiencies acquire in a later age as compared to normative age so they cannot be as much to be expected from their children. In this study it was seen that only 3.57 mothers claimed that their source of knowledge about child development was formal education/ experiences. Formal education/ experiences means the knowledge learned from experts in academic/ professional institutes i.e. schools colleges and universities. According to this study it was observed that knowledge of majority of the mothers is only based on informal experiences. Informal experiences means knowledge evolves from involve one self in such deeds as watching have a discussion with relatives and cooperating with siblings. Only the 9.44 mothers told that they have obtained knowledge about child development from television radio magazines and discussing with a pediatrician. The comparison about child development knowledge was made on the basis of age education and vocation of participants but no significant difference was observed on these three factors. In our view points perhaps its may be due to mostly mothers knowledge is based on informal experiences within a family conversation with relatives and watching siblings. MacPhee 24 conducted a study to know how parents acquired knowledge about their child development and found that the most parents developed their knowledge through other parents books relatives and pediatricians. Parents with low socioeconomic position obtained information within a family i.e. conversation with relatives and watching siblings while middle class parents obtained knowledge from formal experiences. In the study of MacPhee it was observed that the knowledge obtained from formal experiences was more accurate as compared to knowledge obtained from informal experiences. CONCLUSION It was concluded from this study mothers have inadequate knowledge about child development as overall correct answered percentage about language and cognitive development was assessed 38.37 and about sensory motor development was assessed 57.02 so mothers need to be more knowledgeable about child development. Knowledge of majority of the mothers is based on informal experiences alone. LIMITATIONS This study was conducted on a small scale sample only among the two cities of Punjab Faisalabad and Jaranwala. Secondly the data were collected from the residents of the urban areas of these cities. In future a large scale study should be conducted at country level including Azad Jammu and Kashmir territory. RECOMMENDATIONS • Information about child development should be made as a part of school and college syllabus. • Lady health workers should be properly educated about child development so that they may better educate the community. • Informational Programs about child development should be launched on television radio and newspapers. -------------------------------------------------------------------------------- Author’s affiliations

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www.pakpedsjournal.org.pk  181 Mothers’ Knowledge about Child Development Atiq Ur Rehman Department of Psychology Govt. Post-Graduate College Jaranwala District Faisalabad Pakistan Syeda Farhana Kazmi Department of Psychology Hazara University Manserha Khyber Puktunkhwa Pakistan Farrukh Munir Institute of Education and Research University of the Punjab Lahore. REFERENCES 1. Ramey CT Ramey SL. Early intervention and early experience. American Psychologist 1998 532:109- 20. 2. Smith KE Landry SH Swank PR. The influence of early patterns of positive parenting on childrens preschool outcomes. Early Education and Development 2000112:147-69. 3. Huang K Caughty M O Genevro J L Miller T L. Maternal knowledge of child development and quality of parenting among White African- American and Hispanic mothers. Journal of Applied and Developmental Psychology 2005 26: 149–70. 4. Luster T Okagaki L. Parenting: An ecological perspective. Routledge 2006. 5. Ertem IO Atay G Dogan DG Bayhan A Bingoler BE Gok CG Ozbas S Haznedaroglu D Isikli S. Mothers knowledge of young child development in a developing country. Child: care health and development 2007 336:728-37. 6. Glascoe FP Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics 1995 95: 829–36. 7. Halle T et al. Understanding and Choosing Assessments and Developmental Screeners for Young Children Ages 3-5: Profiles of Selected Measures 2011. 8. Hediger ML Overpeck MD Ruan W Troendle JF. Birthweight and gestational age effects on motor and social development. Pediatric and perinatal epidemiology 2002 161:33-46. 9. Liaw FR Brooks-Gunn J. Patterns of low-birth-weight childrens cognitive development. Developmental Psychology 1993296:1024. 10. Mathews TJ Menacker F Mac Dorman MF. Infant Mortality Statistics from the 2000 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports 50. 2002. 11. Story M Holt K Sofka D Clark E M eds. Bright Futures in Practice: Nutrition Pocket Guide. Arlington VA: National Center for Education in Maternal and Child Health 2002: 62. 12. McCormick M Richardson D. Premature Infants Grow Up. The New England Journal of Medicine 2002 3463: 197-98. 13. Malekpour M. Low Birth-Weight Infants and The Importance of Early Intervention: Enhancing Mother-Infant Interactions a Literature Review. The British Journal of Development Disabilities 20045099:78-88. 14. Kohli T. Impact of home-centre based training programme in reducing developmental deficiencies of disadvantaged children. Indian J Disab Rehab 1990 4: 65–74 15. Nair MK Radhakrishnan SR. Early childhood development in deprived urban settlements. Indian Pediatric 2004 413: 227–38. 16. WHO Multicentre Growth Reference Study Group Motor Development Study: Windows of achievement for six gross motor development milestones Acta Pediatrica 2006 S450: 86-95. 17. Bril B. Motor Development and Cultural Attitudes. In Themes in motor development 1986 pp. 297-313. Springer Netherlands. 18. Whitehurst GJ Fischel J Arnold DS Lonigan CJ. Evaluating outcomes with children with expressive language delay. Causes and effects in communication and language intervention 19921:227-313. 19. Houwen S Visser L van der Putten A Vlaskamp C. The Interrelationships between Motor Cognitive and Language Development in Children with and without Intellectual and Developmental Disabilities. Research in developmental disabilities 2016 53:19- 31. 20. Parker S Zuckerman BS Augustyn M editors. Developmental and behavioral pediatrics: A handbook for primary care. Lippincott Williams and Wilkins 2005. 21. Sarnat HB. Spinal muscular atrophies. In: Kliegman RM Behrman RE Jenson HB Stanton BF. Nelson Textbook of Pediatrics. 19th ed. Philadelphia Pa: Elsevier 2011. 22. Bellman M Byrne O Sege R. Developmental assessment of children. BMJ 2013 346 :e8687. 23. Developmental Milestones Pediatric Orthopedic Society of North America. 24. MacPhee D. The pediatrician as a source of information about child development. Journal of Pediatric Psychology 1984 9: 87–100.

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