The child’s school years coincide with the time when his health needs and his general life situation are fairly stable. Medically, he will be exposed to a variety ofcontagious diseases which he usually copes with easily. There is, of course, always the risk of such a major illness as rheumatic fever, but actually the school-age youngster is more frequently in danger from automobiles than from serious diseases.
During this period, when the child is normally healthy, his need of a physician often will result from the major social change he makes when he starts to school. For many school-age children health problems are directly related to emotional adjustment to school. Going to school presents three major challenges to every child. He is confronted with leaving his home, adjusting to other children, and, above all, with learning. If he succeeds in this work, he may be able to go smoothly through school. If he fails, the failure may cling to him. The physician’s primary role is to interpret to the school and the family the abilities and speed that any one child has in going through school. Teachers welcome this information, and it is helpful to both the child and his family when it comes with the authority of the physician.
The major break the child makes with home when he goes into this new social area means separation from all of the supports on which he depends. For some children, going out of the home may be a very hazardous step. Abdominal pain, waking up and crying out in his sleep, and bed-wetting are typical symptoms a child may develop when he is getting acquainted with school.
The problem of adjusting to a large number of children and sitting with them throughout a school day curtails the child’s activities in comparison with his preschool life. The common symptomatology which this produces is restless ness. During the later years of this ageperiod, restlessness may manifest itself in terms of tics and bizarre habit patterns. A few children in this age period, with or without evidence of rheumatic fever, will show the less well-organized movements of chorea. This becomes important because children manifesting chorea must be put to bed. Most children who exhibit restlessness and tics, especially facial and arm tics, are children who are having difficulty adjusting to the pressures of school or home. Very often the physician becomes the person to cope with these problems, either by counseling the parents or by a direct discussion with the teacher. Only occasionally will psychiatric services be needed.
The chief learning problem which the child has in his early school years is that of learning the symbols we call reading. To many children, this becomes a real hazard. For a few children it is associated with emotional situations in the home. It may even relate to difficulties in learning to eat or in learning toilet training. Difficulty in reading is a particularly important aspect of the school situation, because much of the early learning in school concerns itself with reading. If a child is having difficulty learning to read, it is necessary to determine whether he is lacking in intellect or whether he is not using the intellect he possesses.
Failure to learn to read is associated with a child’s whole attitude toward himself and toward school. Frequently he is judged a failure by the school because of his difficulty. A feeling of failure accounts for the complaints of many school-age children. Somatic difficulties and bizarre behavior are two manifestations of this problem in early years. In later years more severe behavior problems, and even delinquency, can often be traced to a child’s feeling of insecurity and inadequacy.
It is important for the physician who is confronted with a child with many aches and pains to think of learning difficulty as the possible basis for these complaints. A thorough physical examination, reorientation of the child in relation to his ability to do school work, and helping the parents to understand the child are all part of the medical job. There is a very real reward for the physician who can help a child through these years. Children who have succeeded in early school-age adjustment develop an ability to work and to perform work satisfactorily.