Guidelines for child health: language development on focus

Lamego, Denyse Telles da Cunha; Moreira, Martha Cristina Nunes; Bastos, Olga Maria

doi:10.1590/1413-81232018239.04892016

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FREE THEMES • Ciênc. saúde colet. 23 (9) • Sept 2018 • https://doi.org/10.1590/1413-81232018239.04892016 copy

Guidelines for child health: language development on focus

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Abstract

Language disorders impact on child overall development. Policy directives for the child guide on ways to follow up child development for greater efficiency and effectiveness. The aim of this paper was to identify the policies positions of the proposals on the attention to language problems in the child health field. From a documental research, national and international guidelines were reviewed in order to identify actors, objectives, contexts, motivations, arguments, justifications and proposals regarding the follow of child development and child language. We performed a critical analysis in order to explain these positions and place on discussion the arguments that support them. The results point out to consensual aspects that place the problems of child development as vulnerabilities producers. Language problems cross the boundaries of political, scientific and social matters. These issues are challenges to interdisciplinary and intersectoral work and guide the need to promote the most effective responses of public policy for people requiring language support. The link of this discussion with the concepts of life cycle and human development for achieving full citizenship requires further deepening.

Child development; Language; Child health; Public policies

Country	Document	Year/Publisher	Actors involved	Objectives
Brazil	Manual for Child Development Monitoring in the context of Brazilian government Integrated Attention to Diseases Prevalent in Childhood (AIDPI, in the Portuguese abbreviation)¹⁶16. Lee W, Croos M, Duffy A, Freeman K, Hartshorne M, Parrot J. Speech, language and communication needs and primary school-aged children. I Can Talk Series (Issue 6). London: I Can; 2008.	PAHO/WHO (2005)	PAHO, Municipal and State Departments of Health, Society of Pediatrics, Department of Attention to Children with Special Needs, University, Health Care Units, School.	Incorporating the perspective of Child Development Monitoring to Brazilian government Integrated Attention to Diseases Prevalent in Childhood (AIDPI, in the Portuguese abbreviation) to assess children’s developmental conditions; present educational material to enable primary care professionals; strengthen an integrated view of children’s health; health promotion and prevention, early detection, counseling and treatment.
Brazil	CAB 33: Growth and Development²²22. Berkow J. The Bercow Report: A review of services for children and young people (0-19) with speech, language and communication needs. London: DCSF Publication Department for Children, School and Families; 2008. (Reference DCSF 00632-2008-DOC-EN).	Ministry of Health Publishing house: Editora MS (2012)	Professionals of several categories associated with family testimonials and scientific evidence.	To support and guide primary care teams; qualify care and development in systems.
United Kingdom	Bercow Report²³23. Veber F, Ringard J-C. Plan d’action pour les enfants atteints d’un trouble spécifique du langage. Paris: Ministère de la Santé et des Solidarité; 2001.	Department for Education and Department for Children, Schools and Families. 2008	Parliamentarian, A consultant group for speech, language and communication needs, A council for special educational needs, Speech-language therapy councils and associations, A pediatrician consultant for development and neurodisability Managers and regulators, professional and volunteering organizations, practitioners	To recommend to the government more efficient and effective measures to transform the offer of care and the experiences of children and young people with needs of speech, language and communication and their families.
France	Action Plan for Children Suffering from Language-Specific Disorders (Plan d’action pour les enfants atteints d’un trouble spécifique du langage)²⁴24. Brasil. Constituição da República Federativa do Brasil de 1988. Diário Oficial da União 1988; 5 out.	Ministry of Health and Solidarity 2001	Ministries of Health and Education and related organizations, doctors and other health professionals. – Representatives of associations of students’ parents and social movements, researchers in the areas of health and education, consultants.	To propose solutions to meet the needs of children, families and health and education professionals regarding oral and written language disorders; to contribute specifically to improving the prevention of these disorders, their detection, the most agile and safe diagnosis and the best support to the children concerned.

	Manual for Child Development Monitoring	CAB 33	Bercow Report – UK	Action Plan – France
Context	– 21st century: positive results of the AIDPI strategy in reducing child mortality; commitment to healthy growth and development in early childhood; deterioration of socioeconomic conditions, with poorer living conditions than expected.	Persistence of regional and social inequalities; demographic and epidemiological changes forcing the reorganization of priorities in the Brazilian public health agenda; lower priority for child health care.	Support and access to speech and language therapies are described as unsatisfactory, with many children and young people without care; prevalence of 7% of children in the United Kingdom presenting specific oral and written language disorders upon entry into primary school; 1% of severe cases.	Acknowledgment of this country’s delay in comparison with Anglo-Saxons and Northern Europe in the approach to specific language impairments (SLIs); thought leadership groups (individuals, associations) are lobbying but this requires measures at the national level.
Motivations	To provide that children reach their optimum potential, growing and developing as “healthy, socially productive adolescents, youth and adults.”	To provide references and guidelines for monitoring growth and development of children under 10 years of age and other priority topics such as immunizations, healthy eating, accident prevention, prevention and care for situations of violence, among others.	Personal experience of a parliamentarian; to increase national visibility to needs of speech, language and communication; to reform the provision of care for children, young people and families.	To make this field of action a priority in public health with a national policy for integration and schooling; to identify a specific governmental position, associating ministries of education, health and research without having to resort to laws; to propose actions, open up job prospects for health and education professionals and bring hope to families and children.

	Manual for Child Development Monitoring	CAB 33	Bercow Report – UK	Action Plan – France
Arguments and justifications	Increased exposure to injuries in the first two years of life; greater brain plasticity at this stage, with better response to therapies and stimuli; satisfactory child development contributes to developing subjects’ potentialities, breaking the cycle of poverty and reducing inequities, developing human capital and building social capital.	Identifying, diagnosing, and intervening early on developmental issues is critical to prognosis; delayed speech, relational changes, learning difficulties are more difficult to identify; low birth weight and prematurity increase the risk of developmental changes, such as language disorders, learning and neuropsychomotor retardation; language and cognitive changes are more difficult to identify, but have a greater correlation with developmental progress.	AAbility to communicate is essential to life and supports social, emotional and educational development of children and young people; there is insufficient understanding of the centrality of speech, language and communication among policy makers, managers, professionals, service providers and families; there is insufficient priority to address the needs of speech, language and communication; early identification and intervention are essential to support children and families and offer better chances of coping with problems; absence of early intervention incurs risks, such as lower literacy rates, emotional and behavioral problems, lower employment prospects, mental health challenges, and opting for crime.	Language mastery is essential to school success, social integration and job placement; SLIs generate suffering for students and families; difficulties in acquiring oral language, reading, writing and calculation generate cumulative delays and deficits that go beyond school learning; all severe disturbances in oral language acquisition should be considered of concern and requiring identification and screening; given the scientific gaps in terms of signs of manifestation, diagnosis and prognosis, school determinism and risk of hypermedicalization should be avoided.

	Manual for Child Development Monitoring	CAB 33	Bercow Report – UK	Action Plan – France
Proposals	To adopt developmental monitoring as the guiding principle for child care in strategizing with primary care, with the concept of health promotion and its strategies; to present criteria for evaluation of children with classifications: normal development, normal with risk factors, probable developmental delay; to guide on conduct in each case: time between consultations, advise to those in charge, referral for evaluation of development.	To follow up the development of children in primary care in order to promote, protect and detect early changes that may affect future life; to perform neonatal hearing screening, to guide parents to follow developmental milestones in the first year of life and to stimulate the children according to the Brazilian government Basic Care Brochure (CAB, in the Portuguese abbreviation).	To create a council and leadership position at a central level to monitor actions; stimulate awareness and dissemination of information and good practices on language and communication needs; consider financing local, regional and national support services; promote joint work between primary care (PC) and managers; ensure a consistent system for early identification, through monitoring of development in PC at the transition ages and emphasize information to parents; improve recording of children’s language development; train professionals for identification, evaluation and support and for multidisciplinary work; estimate the workforce required to provide adequate services; strengthen focus on needs of speech, language and communication in primary education and an inclusive approach to special education needs; promote research.	To strengthen specific policies of each government Ministry, giving prominence to the domain of oral and written language; advise from preschool by identification of warning signs; carry out screening at key ages in children with suspected oral and written language disorders, which should be left in charge of a childcare professional for children at the age of 4 and a school physician for children at the age of 7; perform a precise multiprofessional diagnosis at referral university hospital centers for better strategies of support and treatment; develop in regular school settings collective schooling mechanisms for children with moderate and severe difficulties; improve dissemination of information among society, authorities and education professionals about these disorders; train health and education professionals; ensure follow-up of the action plan.

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[1] Collaborations

DTC Lamego participated in the design and design, revision of the documents, preparation of the article and analysis and interpretation of the data. OM Bastos participated in the design and design and critical review of the article. MCN Moreira participated in the design and design, preparation and critical review of the article and approval of the final version of the text.