Bringing Up Healthy Women: Age 5 to 10
In this series on women’s wellness, we bring you the specific needs of the girl child, adolescent girls, young, middle-aged women and the elderly who need geriatric care. In this part of the series, we focus on what girls between the age of five and ten need and what their parents must watch out for.
The joint family system is disintegrating and parents have to rely on their own resourcefulness, the help of nannies and day care, and the internet to bring up their children.
With no way to benchmark the growth of their children against that of other children in the family and with pressure from peers, permissive parenting and over-indulgence by guilt-driven parents have created a new breed of physical and mental health issues amongst the young ones, especially the girls.
Obesity, overweight and early puberty when they are not old enough to be able to deal with the sometimes overwhelming transition - these are becoming an increasing cause for concern.
A Weighty Problem
An unavoidable consequence of high caloric intake and sedentary habits are overweight children and obesity.
“After two years of age, children should be lean, and if chubbiness goes unchecked, then they may well grow up to be overwight or obese teens and adults,” Dr Shyamala, Consultant Paediatrician at Apollo Children’s Hospital points out.
“This is becoming a serious concern, seen in about 15-20 % of Chennai school children. However, many parents equate chubbiness with good health and are reluctant to rectify the problem.”
It is in fact categorised as a global epidemic, imposing a considerable social and health burden worldwide.
A research report in Karger estimates nearly 4 million deaths and 120 million disability-adjusted life years (DALYs) caused in 2015 due to excess body mass index (BMI) globally.
It goes on to stress how obesity in childhood is responsible for many chronic conditions later on, with a poor quality of life and significantly higher health care costs, and shorter life span.
Childhood obesity leads to metabolic disorders, creates mental disorders, respiratory problems and glucose intolerance.
“We have seen that in 60 percent of children who are obese or overweight, lipid profile is abnormal and some even show fatty changes in the liver, changes we believed would start much later in life” Dr Shyamala says. “It becomes hard for us to point it out sometimes since the parents are also overweight. It is important for parents to be eat right, maintain a healthy BMI and ‘be the change they want to see’,” she adds.
Obesity is known to be a precursor for Type 2 Diabetes and Coronary Heart Disease. While 30 per cent of obesity has its origins in childhood, nearly 50-80 per cent of these continue to be obese in adulthood as well.
Between 5 and 10, a child’s strength and muscle coordination improve and they learn to focus and perform complex tasks such as throw and hit a ball, kick a soccer ball and even play basketball or dance.
Their thinking becomes more mature and logical. While they may pursue structured classes for physical and or mental development, they need at least an hour of unstructured play.
Their diet should contain portions from all the five food groups – carbohydrates, proteins, fat, vitamins and minerals. Therefore, a balanced diet that includes fibres, fruits, vegetables, pulses, dairy products are important.
Taking them fresh instead of from tins is better. Therefore, parents can take children vegetable shopping rather than to the departmental store where they are tempted by the processed foods.
Intake of junk food and lack of physical activity are clearly established causes of overweight and obesity.
Girls as young as six and seven may show signs of puberty and attaining maturity due to lifestyle changes. Obesity has been identified as one of the causes though it is usually idiopathic.
In addition to being too young to understand what these changes imply or how to handle them, the girls’ growth potential is also curtailed as they tend to plateau after attaining maturity.
“Timely intervention can help stem the changes of early puberty and enable it to resume at the appropriate time,” says Dr J Shyamala, Consultant Pediatrician at Apollo Children’s Hospital.
While it may seem the new normal, it brings with it a host of other issues apart from growth and development. Such girls tend to be vulnerable to undue attention.
“A teenager is better equipped to challenge or handle such unsavoury incidents than younger children,” points out Dr Shyamala. Talking to them about ‘right and wrong touch’ becomes critical.
“But most importantly, communicating with the child and encouraging her to share is very important as most predators groom the child and caution them against sharing it with adults. The child should be taught that ‘don’t tell anyone about it’ and secretiveness are red flags and that they should share such happenings with the mother or a trusted adult,” she adds.
Preparing the girls for puberty is also important for them to have a positive body image as during this stage, the body undergoes several changes.
Mothers can discuss puberty and what to expect with their daughters from the age of eight. Schools also have a role to play on creating awareness by discussing openly the changes to expect and how it is normal part of growth.
Watch Out For Bedwetting
Most children are dry by night by 6 years and girls attain this earlier than boys.
On occasion, parents seek a consult for ‘occasional accidents’ past the age of seven or for recurrence of bedwetting after a few years of normalcy.
“However, this is always worrisome,” Dr Shyamala cautions. ‘We cannot simply wish it away. Oftentimes taking a simple history and employing a few corrective measures may sort out the problem rather than using medications which are thought to help. We even picked up diabetes in one such child !”
Urinary tract infection is another common problem in girls this age as they tend to avoid the school toilet. A study of 200 children, of which 93 were in the age group of 6 year to 12, revealed 45 of them suffering from UTI.
The incidence was higher in girls than boys that age because they have short urethras that enable the bacteria to move up the urinary tract more easily.
“Girls tend to suppress the urge to urinate because the school toilets are dirty. But using a dirty toilet is better than not using one at all,” Dr Shyamala stresses.
Timely and Apt Diagnosis
When children enter school, the teacher has a unique role and responsibility in picking up problems which may have been missed by the parent.
“We must ensure that the child can ‘look, see, hear and listen’. I cannot forget a child referred to us with supposed learning disability, while a simple screening revealed myopia and spared the family much heartache!” Dr Shyamala recollects.
Children tend to have recurrent colds, adenoid and tonsillar infections which may cause a glue ear and reduced hearing. The teacher may complain that the child is not being attentive in class.
Audiometry and a thorough ENT exam may identify a ‘glue ear’ which may be simply corrected.
Autistic spectrum disorder, behavioural problems, hyperactive tendencies can all be picked up or at least suspected on school entry. So a teacher’s observations should never be taken lightly.
Nearly 15-25% of the students in this age group were also seen to lack value based education that teaches the qualities of empathy and sharing, lack of awareness and stress.
Dr Shyamala suggests role play to sensitise young children that will help them become gender sensitive and correct errant behaviour.
No doubt parents want the best for their children. Knowing what is truly good and becoming role models are important to have a healthy and happy child.
Nothing can replace attention from parents, a nurturing environment, balanced diet and physical activity for girls between 5 and 10 to grow up into well-adjusted and happy teens and womanhood.