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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0009-GROWTH & DEVELOPMENT: INFANCY & CHILDHOOD, (TUFUULAT)

Lecture for 2nd year students on 15th September 2000 by Professor Omar Hasan Kasule Sr.

A. DEPENDENCE

CHILDHOOD

Childhood, tufuulat, is the period from birth to puberty. The period is divided into two parts: early childhood, 3-5 years, and late childhood, 6 years to puberty. It is a period of limited ability and responsibility (24:31, 24:59, 40:67). It is divided into three developmental stages: infancy, early childhood, and late childhood. A child or an infant is not a miniature adult. It has a distinct personality, identity, needs, and has to be handled differently. Infancy is the period of childhood that covers the first 2 years of life. It is a period of rapid growth that lays the foundation for later growth. Infancy is not a useless period. Great things happened to infants. Yahya was given wisdom while a baby 19:21. Isa spoke as a baby (19:29). The fetus is a person addressed as an individual by the Qur’an (53:32).

 

DEPENDENCE ON PARENTS:

Humans have a long period of dependence on parents. Humans are the slowest growing newborns and children. They reach adulthood after 22-25 years of rearing. Animals grow much faster some being able to live independently within a few days of birth. The slow growth of humans is the need for the brain to grow and also for social learning to transmit culture. The human brain is the fastest growing organ of the body but it still is relatively slower compared to animals. The human brain attains its 90% of adult size by age 6. There are two types of dependency: physical and psychological. It is a mistake to think of physical dependency and fulfill its needs while neglecting psychological dependency which is equally important.

 

PATERNITY:

Lineage, nasab, is very important. It is very important for the child to know who the parents are (Muslim #118, 120, 121). Adoption, tabanni, was forbidden in Islam (KS p. 134) because it distorts lineage. It is forbidden to deny or distort paternity (MB # 2157 & 2158 p 1007). The law makes sure that every child has a parent to protect its interests. In case of adultery, the baby belongs legally to the man who is the legal husband although there is a possibility that the biological father is different (KS p. 263). The husband must accept a child as legally his even if there is no physical resemblance (KS p. 263).

 

B. PARENTAL RESPONSIBILITIES:

SCOPE OF RESPONSIBILITY

Parenting is an occupation and a parent is very important. The fate of the child is in the hands of the parent. This must be considered when selecting a spouse (KS p. 546). Parenting is a full-time occupation and no short-cuts can be made. Modern industrial society by requiring both parents to be away most of the day working has undermined parental responsibility. The scope of parental responsibility is wide. Parental responsibility starts in pregnancy (39:6, 53:32). Parents are responsibility for material support of their children (2:233). Parents have an educational responsibility, tarbiyat al awlad (18:80-81, 19:28, 2:127-128, 2:132-133, 2:233, 2:24, 3:14, 3:33-39, 3:45, 3:61, 4:9, 4:11, 9:24, 11:42-46, 11:71, 11:74, 11:78-79, 12:4-5, 12:67, 12:87, 13:23, 14:35-40, 15:53-55, 16:72, 17:6, 17:24, 18:46, 19:7, 19:55, 20:132, 23:55-56, 25:74, 26:133, 28:12-13, 28:23-28, 29:27, 29:31, 31:13-19, 33:59, 37:100-113, 40:8, 42:45, 46:15, 51:28-29, 52:21, 58:22, 66:6, 66:12, 71:12, 74:13). Parents can be good or bad. The Qur’an has decribed good parents, aaba salihin,and good parenthood (12:133, 12:38, 6:87, 40:8). Good parents rear good children who become good adults. Bad parents rear bad children and future citizens. Exceptions do occur because in the end guidance, hidayat, is from Allah. Effects of parenting, good or bad, can extend to future generations. Well-reared children will in turn be good parents who will rear their children to be even better parents. The same can be said of bad parents. It is for this reason that changes of culture and tradition take a long time because the preceding generation affects those who come after them.

 

CHILD-REARING

Who and where: Islam emphasizes the rearing children, ri’ayat al awlad (12:21, 28:9, 71:21, 71:27). Children must be reared in a family (3:47, 4:1, 16:72, 19:20). Child rearing is best done by the natural parents and if this is not possible then by the nearest blood relatives. Institutional rearing of children is resorted to when all alternatives are exhausted and is an indication of the break-down of the social fabric of the community.

 

Love and empathy: Love for the child: 20:38-40, 28:7, 28:10-13. Many hadiths report the Prophet’s expression of love for Hasan and Husain (KS p. 199-200, MB#1011). Empathy and care for children are needed all the time and in all circumstances. Crying of children is not normal; it is a distress call that should be relieved promptly. The Prophet made salat more rapidly so that the mother could attend to her crying baby (MB # 420 p 234). Taking care of children is so important that a parent is allowed to carry a baby in the arms during prayer (MB # 323 p. 196, Muslim # 1107, 1108, 1109, 1110).

 

Equal treatment: Islam enjoins equal treatment of children, 'adl bayn al awlad (KS p. 576). It is a blemish on human history that most societies have mistreated their female folk and considered them less than males. This also occurs in the rearing of children in which females are worse off. Islam teaches good treatment of female children as a preventive measure against abuse (KS p. 575).  A good indicator of the civilizational level of a society is how it treats its female children. Pre-Islamic Arabia practiced feticide. In some countries of the world, pre-natal sex diagnosis is made and females are selectively aborted. Abuse of female children has a deleterious effect on the next generation. They will grow up to become in-confident mothers with low self-esteem that will be transferred to the children.

 

BREAST FEEDING:

Breast-feeding by the mother, ridha’at, has been emphasized by the Qur’an (2:233, 20:39-40, 28:10-13, 31:14, 46:15) and the hadiths of the Prophet (KS p. 249). It establishes both a biological and psychological bond between the mother and the baby. Breast-feeding is a biological and psychological necessity for proper growth and development that is why Islamic law imposes an obligation on the father to support the nursing mother materially whether she is married to him or not (65:6). In order to complete the infant’s biological and psychological growth and development, breast-feeding must continue for not less than 2 years (2:223, 31:14, 46:15). Fosterage, breast feeding by a woman other than the mother, establishes a relationship that is like blood relationship (Muslim #3395, 3396, 3397, 3398, 3400, 3401, 3405, 3406, 3407, 3409, 3411).  The biological link between the foster mother and the infant is so important that a foster children who were breast-fed by the same woman can not marry even if they are not close relatives (22:2).

 

C. CHILDREN IN QUR’AN and SUNNAT

CHILDREN WHO BECAME PROPHETS

Ismail was born when his father was advanced in age (14:39-40). He was a kind, haliim, and obedient child (21:85-86). He was brought up by his mother in Makka. His father visited often. He grew into a strong leader and prophet who stood by his father and helped him. Musa was born at a very difficult time; Pharaoh had ordered all Israelite male newborns to be killed. In desperation his mother put him in a box and threw him in the river (20:38-39, 28:7). He was picked up and was adopted into the pharaoh’s household where he grew up (20:39, 26:18, 28:8-9). Allah brought his mother back to him to be employed as his nurse and to look after him in pharaoh’s palace (20:40, 28:7, 28:11-13). Yusuf was much beloved by his aged father (12:4-6). His brothers were jealous and plotted to kill him (12:8-15). They sold him into slavery (12:19-21). His father was very sad (12:84-86) for missing his beloved son. Yahya was the son of Zakariyah. Zakariyah became a parent of Yahya at a late age (3:39-40, 19:7). Both Zakariyah and his wife were good persons (21:90). Yahya was given wisdom by Allah while still a baby. He was a kind, obedient, and God-fearing child (19:12-15). Isa’s mother was chosen, istafa, by Allah (3:42). She was chaste (21:91, 66:12). She was human (5:17, 5:75) and not divine (4:171, 5:17, 5:75, 5:117). Allah sent His word to her (4:171) and she was given glad tidings of a boy to be named Isa (3:45). She became pregnant (19:16-34). The Jews accused her of fornication (4:156) but Allah maintained her innocence (19:32). Isa’s conception was miraculous (3:33-37, 3:42-47, 5:75, 21:91, 66:12) but was born as a normal human (3:45-47, 19:16-33). Muhammad was born an orphan. His father died before his birth (KS 477). His mother did not live much longer (KS 477). He was brought up by Abd al Muttalib and Abu Talib (KS 477). He was breast-fed among the tribe of Bani Sa'ad bin Bakr (KS 477) who were blessed on account of him (KS 477). While a child living in an idolatrous society, he was protected by Allah from worship of idols (KS 477). The books of siirat report that while still a child, Jibril came to him, opened his chest, and washed it with the water of zam zam (KS 494).

 

CHILDREN OF THE RIGHTEOUS

Maryam was born and was given the name Maryam (3:33-38). She was brought up by Zakariyah (3:37, 3:44). Her sustenance was from Allah (3:37). Khidhr killed a child for fear that he would harm his righteous parents (18:74, 18:80). He also rebuilt a wall to protect the inheritance of two orphaned boys.

 

CHILDREN OF THE PROPHET MUHAMMAD (PBUH)

The prophet was a model of good parenting. He showed love and kindness to his children and children of others. None of his male children survived to adulthood. He loved his infant son Ibrahim and was very sad on his death. He was very close to his daughters even after their marriage. His love for his grandchildren, Hasan and Hussein, was legendary.

 

CHILDREN OF THE COMPANIONS

The companions learned from and emulated the prophet in child upbringing.

 

CHILDREN OF EVIL PEOPLE

Many children of  evil parents went astray because they did not get good guidance.

 

D. GROWTH: PHYSICAL, SOCIAL, and PSYCHOLOGICAL

PHYSICAL GROWTH

Growth is increase in size measured as length, weight, or volume. Growth velocity, the speed of growth,  varies by age period and also by organ. There is rapid overall growth in infancy and puberty. The brain grows fastest in the early years of life. Gonads grow very fast in the pre-pubertal period. Human and animal growth are different. Human babies are born less prepared for independent life and need a long time of training and dependency. The following are factors of growth: GH & somatomedin, thyroid hormone, androgens, estrogens, glucocorticoids, insulin, nutrition (essential nutrients), genetic factors, and general health. Child growth can be divided into 2 main stages. (a) Infancy includes the perinatal period, the first and second  years of life.  childhood: early childhood & late childhood

 

PHYSICAL DEVELOPMENT

Development is increasing functional ability. It involves increasing functional differentiation. The central nervous system is the most important aspect of development. The CNS is important for the integration of all bodily functions. Most lay people under-estimate the capacity of babies. They are more developed than we tend to think. They can learn and retain information. The injunction to make adhan in the right ear for the new-born is perhaps an indication of this (KS p. 71). Under-estimation of infants is the cause of under-stimulation. The new-born has capacities of vision, hearing, taste, smell, and learning and memory. The various organ systems are functional but at a sub-optimal level.

 

MORAL DEVELOPMENT

Children are born in a state of purity, fitra (KS p. 575). It is parents who can misguide them (Muslim #6428, 6429, 6430, 6432, 6433, 6434). Human children are born with an innate ability to tell right from wrong. This ability is however not 100% accurate because many situations are not so clear-cut into black and white. They will need guidance to make the right choices. Allah made a covenant with all humans while they were at the stage of ruh and all agreed and promised to obey. Allah showed humans the 2 highways, najdayn, of right and wrong. Humans are free which of the 2 to follow. Parents and the immediate society of a child have a very crucial role in guiding the child to the right choice. Good parents and a virtuous social environment will guide them to the good. Inadequate parents and a poor social environment will guide them to evil. At birth shaitan is ready to start misguiding. All new-borns are touched by shaitan except Maryam and her son (KS p. 575). The struggle against shaitan is a continuous battle from birth until death. He is relentless in his attempt to misguide humans. Some children die young brfore they have a chance to make their choice of which highway to follow. Children of Muslims who die go to jannat (MB # 695). There is debate about the fate of children of non-Muslims.

 

INTELLECTUAL DEVELOPMENT

Cognitive development: Cognitive development is correlated with the stage of brain development. Some cognitive skills are in-born whereas others are acquired. The environment, early experiences, and experiments carried out by children enhance the innate potentials. Several theories of cognitive development have been proposed. We find that Piaget's approach is the most empirical and is free of many pre-suppositions that are based on the judeo-chrisitian or greco-roman thought. Piaget's stages of cognitive development could fit into the islamic schema. Islamic law recognizes the age of 7 as the age of discrimination, sinn al tamyiiz. Full intellectual maturity is not reached until the age of puberty. Children are therefore ordered to start praying at the age of 7 and are punished for missing prayers at the age of 10. Full legal responsibility is at puberty and by this time they have, according to Piaget, acquired abstract thinking to supplement the concrete thinking on which children rely.

 

Language development: There are questions about acquisition of language that are not yet answered: is knowledge of language innate?, is the innate capacity to learn a language confined to humans only? Is there a primordial human language that mothered all languages? Is each language family developed independently? Were languages created or humans developed them through experimentation with different sounds and associating them with meanings? Do all human languages have the same basic structure?. Deeper research on the way in which children acquire languages may shed light of many of these questions.  It seems humans could speak much earlier that we normally think. The Qur’an tells us about babies who talked. These could have been exceptional miraculous situations. The limiting factor on earlier ability to speak may be undeveloped organs involved in producing sounds. Babies can hear clearly and distinguish all sounds that all humans all over the world can produce. This ability is gradually lost and eventually is confined only to the native language. At age 1 year children start speaking by mapping words to concepts but not always accurately. Phrases and sentences are produced at 1.5-2.5 years. At 1.5 years they have a vocabulary of 25 words. At age 6 the vocabulary is 16,000 words.

 

PSYCHO-SOCIAL DEVELOPMENT

Psychological development: Awareness of self and others in infants is different from older children and adults. Infants at first are very egoist. They are aware only of themselves and their needs. It is as if everybody is there for their service. As they grow they learn that there are others separate from them. A new-born baby has a lot of instincts that are necessary for survival in the earliest periods of life. Reliance on instincts decreases with cognitive development. Infants have a rich emotional life. Social development starts with awareness of the self then the family and the neighborhood. As the child grows older, it becomes aware of membership in larger groupings: the tribe, qabiilat; the nation, the ummah, and the universe. At a later stage it learns about the history and the future. Gender identity is acquired quite early but its meaning and implications become deeper as the child grows. ‘Aqiqat is a social occasion when the new-born is introduced into the community (KS p. 389). Development of social responsibility and accountability differ among children. That is why orphans are tested before they are given control over their inheritance (MB #1199).

 

Development of personality: Personality is the nafs. Personality is basically good. It is not neutral or evil.  Personality is basically fixed in the first years of life but a few changes could occur. The psycho-analytic, behavioral, and phenomenological theories of personality development are based on judeo-christian and greco-roman premisses. The Islamic view of personality in based on the Qur'anic concept of nafs.  Personality assessment:

 

Individual differences, fitrat and nurture: We use the word fitrat to refer to what some call nature; the term nature has atheistic connotations. Each individual has a distinctive fitrat. Nurture introduces even more differences among individuals.

 

Social behavior: cognition & affect, interaction & influence: Social behavior of children is the final pathway for many interacting forces and influences: cognition and affect, fitrat and environment. A lot of behavior is copied or is assimilated from parents and other social role models. That is why it is very important to provide children with positive role models. They should never be exposed to negative role models even for brief moments.

 

E. DISORDERS

DISORDERS OF INFANCY

Infants may have birth injuries due to dystocia or other causes. Congential malformations, single or mutliplte, are developmental anomalies that may be diagnosed in neonates. They may be due to genetic factors (chromosomal translocation or genetic mutation) or may be due to environmental factors (teratogenic drugs, infections). Congenital deformation must be distinguished from congenital malformations. Congenital deformations are due to structural changes caused by mechanical factors. Congenital malformations are in utero developmental anomalies such as hypogenesis, agenesis, aplasia, and atresia. Perinatal infections can be  transcervical or trans-placental. The common metabolic disorders are inborn errors of metabolism such as PKU, galactosemia, cystic fibrosis, SIDS. Tumors, benign and malignant. The malignant tumors are usually: neuroblastoma, retinoblastoma, and Wilm's tumor. RDS. HDN

 

DISORDERS OF CHILDHOOD

Disorders of childhood may be developmental, nutritional, behavioural, or injuries. Abnormalities of sexual development in girls are: breast hypoplasia, breast hyperplasia, and breast asymmetry. Abnormalities of sexual development in boys are: gynecomastia, hypospadias, micropenis, macro-orchidism, and crypto-orchidism (undescended testis). A distinction must be made between a true hermaphrodite and a pseudo hermaphrodite.  The situation may become clear with time. Definitive treatment may require surgery or hormones. The problem is how to bring up and give them a gender identity. The causes of hermaphroditism in females are: congenital adrenal hyperplasia, adreno-genital syndrome, maternal estrogen exposure, and idiopathic clitoromegaly. The causes of hermaphroditism in males are: androgen insensitivity, testicular regression, hypospadias, and micropenis.

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