Sexual development and parental attitudes in preschool children

SUMMARY

Sexuality is an important concept that affects our personality from birth to death. In line with this, we assume an identity and acquire roles under that identity. Gaining roles suitable for our sexual identity is possible by acquiring this education in the appropriate age range and with appropriate approaches. Preschool period is an ideal period to give this education. It is necessary to evaluate this period when children develop cognitively and begin to recognize themselves.

In this study, document analysis was performed to collect data. The characteristics of the preschool child were discussed and examined in all developmental areas. Sexual development was discussed as a separate topic, the importance of this area and the sexual development stages in preschool children were mentioned, and sexuality-related issues that we could see in children of this period were discussed.

In this regard, families were also discussed and it was emphasized that the role of the family in sexual education and the attitudes of the child to the child are of great importance in terms of how the child will get through this period. It was concluded that he could gain an identity.

Preschool period has a critical importance in the acquisition of behavior, attitudes and skills in all areas of development. Many knowledge and skills such as self-knowledge, self-care, gaining sexual identity, learning social rules, recognizing and expressing emotions, and developing interpersonal relationships are acquired in this preschool period, which covers the first six years of life (Özgün, 2017).

During this period, children explore their environment, communicate with others and produce ideas against the stimuli around them. During this period, rapid changes occur in the field of sexual development, as in all areas of development.

When it comes to sexual development, almost everyone thinks of the development of genital organs and sexual activity. However, sexual development is not just an area of ​​development with physiological dimensions. On the contrary, sexual development that begins at birth continues to change throughout childhood and adolescence and is reflected in adult sexual behavior and attitudes. In this sense, sexual development is defined as a developmental area with physiological, social, emotional and cognitive dimensions, including physical differentiation such as the growth of reproductive organs, deepening of the voice, forming a sexual identity, gaining gender roles, and understanding the transfer of sexual information (Akalın, 2008).

Parents, relatives, teachers, family and other factors outside the school (neighborhood, child’s friends) are often uneasy about child sexuality and child sexual education. Without realizing it, they give sexual education to children starting with birth. When the child is born, they give sexual education by buying pink colored goods and clothes, dolls for girls, and blue colored goods and clothes and toy trucks for boys, answering or not answering the children’s questions about birth and pregnancy (Yörükoğlu, 1979). ).

In our country, the number of parents who give the necessary importance to the development of sexual identity in children’s sexual education is so few that it can be pointed out. In the traditional Turkish family, sexual issues are not spoken, customs and traditions condemn sexual life and family life is surrounded by prohibitions. Sex education and behaviors are like non-existent. Sexual issues are only discussed in great secrecy among close friends (Yörükoğlu, 1979).

This issue has been regarded as a taboo until today, and both educators and parents did not know how to approach their children. In this extremely important issue, it should be kept in mind that a mistake made by parents or educators will cause many problems in the future. In this field, which is as foreign as it is important, first of all, parents and teachers should be informed about sexual development and education (Aydoğmuş, 2001).

A healthy sexual development is a necessity for human beings. Because sexual ill health affects the physical, cognitive, emotional and social developments of a person, in short, his personality. Sex education is a vital need of people (Basaran, 1994). The most important role in meeting this vital need belongs to the parents. The importance of parents in child development and education is too great to be discussed. Misinformation, attitudes, behaviors and beliefs of parents affect sexual development and education as well as other developmental areas of children and cause negative results. For example, incorrect answers to questions about sexuality or not being answered, and as a result the child learns the answers from other places, pave the way for situations such as sexual deviations, behavior and personality disorders, psychological problems, and unhappy marriage. For this reason, parents should be informed about sexual development and education, which have an important place in personality development.

1.1. DEFINITION OF PRESCHOOL SEMESTER

The preschool period is a period in which the foundations of lifelong learning are laid, and many developmental experiences and skills are acquired, covering the 0-6 age group (0-72 months), which requires ample support in line with the needs and individual characteristics of the child.

This period is a critical period in many respects. During this period, rapid changes are experienced in all dimensions of development. While physical development creates a wide range of movement for children of this age, language development enriches the interaction of the child with the environment. In this period, mental development increases the awareness of the child’s physical and social environment, and the child now experiences the desire for socialization more intensely. In this period of rapid changes and critical development processes, emotions gain different meanings for the child and the child seeks a place in the social environment (Target publishing, Pre-school education in all aspects, 2015).

1.2. TERM FEATURES OF PRE-SCHOOL CHILDREN

Preschool period includes 0-6 years (0-72 months). Although it is less than a tenth of an average person’s life, it is the most critical period in a person’s life. We learn everything from the environment except for some behavioral patterns that are unique to human beings that we have genetically. What we learn in this period, also called early childhood, constitutes 70-80% of what we learn throughout our lives. Some experts even say that this figure is over 90%. Many of the basic skills such as speaking, walking, eating and drinking are acquired during this period. In this period, we learn many behaviors that we see as simple in daily life and that we do not even feel the need to think about how we do it.

A newborn baby can distinguish his mother’s voice from other sounds. When he is hungry or hurts somewhere, he communicates with the environment by crying in different tones. At the end of the second month, it makes dove-like sounds called “chirping”. These sounds form the cornerstones of speech. Between 6 and 9 months, the first syllables such as “ma-ma, da-da” appear. Children whose parents talk frequently can make better vocalizations during this period. At 9 months, he knows his own name and turns his head towards the source of the sound. In addition, during this period, he begins to recognize the characteristics of his native language. After the age of 1, the first meaningful words begin to emerge. The more the child interacts with adults during this period, the more beneficial it will be for the child. When the child says a single word, the family can form a meaningful sentence from that word. When the child says “water”, the family may make meanings such as “I want water, the water has been spilled”. When he is 1.5-2 years old, he creates simple sentences (telegram speech) by bringing two words together. At the age of 3, he/she can speak clearly. At the age of 4, he can make understandable sentences in accordance with the grammatical structure of the language. At the age of 5-6, a vocabulary that is close to adult speech and constantly expanding has been formed. Speech cannot be at the same speed and level in all children. Children who are talked to and shown interest and love learn to speak more quickly and properly.

The foundations of the child’s sense of trust begin with the mother’s first hug, and continue with her being next to her when she starts to cry. Physical development also takes place largely in the pre-school period. When children reach the age of 6, they reach an average of seven times their birth weight and 15 cm more than twice their height at birth.

Preschool period is the period when people develop the fastest, change and learn the most. Since this period is so important, children should go through a conscious and careful education process. During this period, parents should have an idea about all kinds of information about their children’s development areas. Because child development develops very quickly, it also includes the balanced development that comes after crisis periods. For example, when everything is going in a certain course, a 2.5-year-old child may emerge who is unstable, indecisive, rebellious and opposes everything. In this temporary period of the child’s so-called “restlessness period”, displaying an unsympathetic and rigid attitude towards the child may cause this period to be prolonged.

Again, a 4-year-old child is in the age of “asking questions”. In this period when he asks a lot of questions, he tries to understand the world and learn new things. The family should be aware of this period, patiently answer the questions asked, not to skimp and turn this period into an advantage. When he is 5 years old, he is experiencing the golden age, and when he is 6 years old, he looks lazy and indecisive. It is necessary for the parents to know the characteristics of this period for both themselves and the child.

1.3. PRE-SCHOOL DEVELOPMENT AREAS

  • ENGINE DEVELOPMENT

From the moment the child is born, he acquires many motor skills such as controlling his head, moving his hands and arms, turning, crawling, balancing. Reflexive movements become controlled over time. Primitive movements observed from birth to the first two years of age are the first form of voluntary movements. As time passes, the child’s control focuses on movements. The child, who is standing with support, takes his first steps and learns to walk over time (Pre-school education in all aspects, 2015).

Most motor skills agree that a child’s gross motor skills develop significantly during the first eight years of life (Payne and Isaacs 1999; Haywood, 1993). In this period, children’s upper and lower body coordination increases. For example, a child aged 3 to 4 can jump by stretching the upper part of his body, a child of 4 to 5 years old can control his body and throw the ball forward by putting his weight forward. Ball skills are very important for children in this period. Balls provide benefits for the child’s body control, development of locomotor and non-locomotor movements, and balance control (Pre-school education in all aspects, 2015).

In terms of small muscle development, preschool children begin to use their hands and fingers more coordinated. In this period, the use of play dough and mud materials helps the development of muscles; Doodles made using pencil, paint and brush help the development of the skill of using pen and paper. Coordination in fine motor skills also helps children acquire self-care skills. He can wash his hands, unbutton and unbutton his own clothes. Children acquire pencil holding skills between the ages of 3-5. During this period, he can hold pens in different ways. From the age of 4 they start to draw realistic pictures. Toomela (2000) states that as children’s perception, interest, memory and motor skills develop, reality emerges in drawings. When children reach the age of 5, they can hold a pencil, draw lines and write like an adult (Greer and Lockman 1998). During this period, children are also interested in building games and puzzle games (Preschool education in all aspects, 2015)

  • COGNITIVE DEVELOPMENT

Cognitive development is a field that includes all mental processes in the phase of acquiring, using, storing, interpreting, rearranging and evaluating information that interacts with the environment and enables the understanding of the environment, starting from birth (Senemoğlu, 2007).

Piaget argues that as a child’s knowledge of the world is shaped, he passes through interconnected stages of mental development. In the first 18 months of life, the baby’s learning consists of his perception and movements in the form of a movement chart or a sensory movement chart. In the first two years, the baby appears to have moved from a creature state to an individual with automatic reflexes and discovering new ways to solve problems.

Piaget emphasizes that the child is apparently egocentric in the preoperational period. Although the child around the age of 3 has started to think symbolically, these symbols cannot be expressed by organizing them in the form of definite concepts and rules. Again, in front of the children in the pre-procedure period, glasses of the same length and width were filled with the same amount of water, and the children agreed that the amount of water in the two glasses was equal. The child was then asked to pour the water from one of the glasses in question into a tall, thin glass. Although the amount of water in the glass does not change, the water surface will be higher than that in the thin and tall glass. This is called conservation or immutability. In the preoperational stage, the child begins to use objects as symbols for other things. For example, he can get on a stick and walk around as a horse. This phase is a preparatory phase for concrete operations and constitutes the transition phase from sensory-motor structures to the operational phase. In this period, especially with the development of language, prevalence and speed in thought are seen. This ability enables the child to use language, to interpret, to draw pictures, to expand towards symbolic and construction games in his games, and to be able to read and write later. At this stage the child still fails in real conceptual forms. At the age of 2-7, thinking is still not operational. In other words, during this period, children still cannot make mental comparisons. Children’s thinking during this period is still egocentric. They cannot distinguish between the subjective and the objective (Yavuzer, Child Psychology, 1984)

  • LANGUAGE DEVELOPMENT

From just a few weeks old, babies perceive and begin to respond to audible warnings. He can pay attention to the sounds and turn his head in the direction of the sound. At the end of the second month, there is less crying compared to the first time, and babies begin to make sounds like doves. From the third month, they can distinguish their mother’s voice from the voice of others. In the fifth and sixth months, the dove sounds are replaced by monosyllabic meaningless sounds. First words usually begin to be used at the end of the first year. From the age of two, the child speaks in small incomplete sentences. These sentences are completed at the age of four (Yavuzer, Child Psychology, 1984).

At the age of 3-4, children gradually acquire adult syntax structures in this period when the difference against the basic structures of the mother tongue increases and many basic structures are acquired. Language skills are mostly manifested by egocentric speech in imaginary games. This egocentric speech continues from time to time in the later period, but its frequency decreases. In addition to the sound games observed in the previous periods, word games that contribute significantly to language skills are also seen in this period (Dönmez, 2000).

At the age of 4-5, it is observed that the ability to understand and use complex structures related to language becomes easier, and the accuracy in the use of phonemes in words increases. In this period when egocentric speech continues, it is striking that language is used more effectively and in a complex way in games (Dönmez, 2000).

At the age of 5-6, it is a period in which many adult-like structures are acquired. There is a significant improvement in the use of complex sentence structures compared to previous age periods. Parallel to the progress in cognitive development, an increase is observed in the use of abstract words. Towards the end of the period, there may be about 2600 words in the expressive vocabulary and 20000-24000 words in the receptive language vocabulary (Owens, 2001).

  • SOCIAL-EMOTIONAL DEVELOPMENT

Social and emotional development are so intricately combined in the preschool period that it becomes a puzzle of whether the egg comes from the chicken or the chicken out of the egg. Social relations formed during this period affect and shape the child’s emotions and emotional development. Emotional development occurs in a communicative context involving young children and the people around them. Emotional development is often overshadowed by mental development. When the programs implemented in schools are examined, it is seen that the programs according to the dimensions of social and emotional development are ranked second next to academic learning and success (McCombs, 2004). In recent years, many researchers criticize this and emphasize the importance of social and emotional development in the life of the individual and the personality traits and behavioral skills associated with these development areas.

A 3-year-old is eager to please adults and is committed to their love and authenticity. For them, the people who provide their basic needs are very important, but there may be short-term separation from them. He defends his toys and possessions, and may sometimes exhibit aggressive behavior such as picking up a toy, hitting another toy, or hiding a toy. From time to time, he can participate in group games and show interest in children who are younger and hurt. At the age of 4, he begins to form close relationships with his playmates and participates in group activities. He may test frequently to see who will take care of him when he becomes aggressive or cries. He insists on doing everything alone. Seeks ways to exclude other children from the group by name-calling, teasing. Often prefers verbal aggression over physical aggression. When he is 5 years old, he enjoys making friends and has found special playmates. It can show a fear reaction to the dark, to falling, to the dog. Continues to need adult comfort and approval. She may be frightened when the mother or primary caregiver does not return. It usually fulfills the requests of parents and caregivers, obeys the instructions and mostly fulfills its responsibilities (Target publishing, Pre-school education in all aspects, 2015).

SECTION 2: SEXUAL DEVELOPMENT

2.1. DEFINITION OF SEXUAL DEVELOPMENT

”With physiological, social, emotional and cognitive dimensions; It is an area of ​​development that includes physical differentiation such as growth of the reproductive organs, deepening of the voice, forming a sexual identity, gaining gender roles, and understanding the transfer of sexual information.” (Akalın, 2008)

Sexual development encompasses the sexual feelings, beliefs, and behaviors expected in a particular life period. For this reason, it is necessary to know the sexual development processes that are specific to every age. It includes the knowledge and skills that help the individual to develop sexually, to adopt a healthy attitude towards sexual growth, to overcome sexual problems and to control negative sexual impulses.

2.2. BASIC CONCEPTS OF SEXUAL DEVELOPMENT

2.2.1. GENDER

It is the characteristics of being male or female with sex chromosomes, gonads, internal reproductive organs and external reproductive organs components that express the biological identity of individuals (WHO, 2010).

2.2.2. SEXUALITY

Sexuality is an expression and experience that also deals with the dimensions of fantasy, thought, belief, relationship, attitude, role, practice, which are affected by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors (WHO, 2006). Although sexuality is inherited, it is affected by society. The hereditary aspect is related to the birth of a person as a boy or a girl and the sexual glands. The social aspect depends on the environment in which people live and their ability to imitate.

In short, sexuality begins with birth, continues throughout our lives, and in this process, people’s attitudes and thoughts about sexuality are affected by family, religion, school, media, friends and economic level.

2.2.3. SEX EDUCATION

It is a lifelong process that includes learning about the cognitive, emotional, social, interactive and physical aspects of sexuality and developing attitudes and behaviors related to sexuality (WHO, 2010).

2.2.4. GENDER

Roles, behaviors and expectations imposed on individuals by society in connection with our innate biological characteristics.

2.2.5. SEXUAL IDENTITY

Gender identity is the individual’s awareness of his/her gender, his/her perception of his/her body and self in a certain sexuality, his/her acceptance, and his/her orientation in emotions and behaviors accordingly. In other words, it is the realization of being a woman or a man and accepting it.

Being born a boy or a girl is the first condition for gaining sexual identity. The child will adopt the identity of a boy or a girl as long as the tendencies of his own gender are supported. It is important that the individual adopts a gender role rather than joining the male or female group biologically.

The child begins to realize his personality at the age of three or four. Perceives the difference between a boy and a girl, the differences between a child and an adult. Knows which type of item belongs to which gender. He can decide whether it is a girl or a boy. The child encounters many characteristics exhibited by many people of the same sex in his environment. In order to adopt her own gender role, she first realizes her own gender and understands whether it is a girl or a boy. The boy perceives his own physical and behavioral aspects similar to other men, and the girl perceives her own physical and behavioral aspects similar to other girls and women. Girls begin to behave like their mothers and boys like their fathers.

2.3. THE IMPORTANCE OF SEXUAL DEVELOPMENT

Development is a whole. The areas of physical development, mental development, emotional development, social development and sexual development are interconnected. The disruption seen in a developmental period naturally affects other developmental areas as well.

It takes time for the newborn baby to try to get to know himself and the outside world. The little boy discovers the organs of his body while trying to get to know himself. He tries to recognize the organs he has by touching his hands, eyes and ears. Begins to recognize objects, colors, people and shapes around him. Usually around the age of 3, he starts to ask everything he is curious about, since he is able to speak to a large extent. “How does the bus go?”, “What is this?”, “Why does the ferry go at sea?” “Why is this a girl, why am I a boy?” etc. begins to seek answers to questions such as: Questions do not stop until he is satisfied with the answer he received. The type of toys he plays and the difference in clothes bring up the issue of where this difference comes from in boys and girls. According to Eisenberg, Murray, and Hite (1982), games and toys, experiences and experiences have a great impact on the acquisition of sexual roles. According to Damon (1977), 4-9 years are the ages when sexual identity is formed in children. By imitating their parents, boys and girls begin to assemble the characteristics of their own sexual identity. The child, who is constantly curious and imitated, will develop this curiosity even more and will begin to ask where the difference between boys and girls originates and how they came into the world. If the family behaves uneasily and shy about this issue, if they try to ignore these questions, if they say that these are shameful and that children should not ask such questions; The child who is disturbed by this situation will meet the concepts of “Shyness and Shame”.

Questions such as “How was I born and why are girls different from boys?” are innocent and intriguing questions. A clear, clear and simple explanation of these questions will often satisfy children’s curiosity. The measure of this openness is to give detailed information to every question the child asks, to walk around naked. Because children who are over-informed and see their parents naked are children who are unnecessarily equipped with too much information and warned early.

Sex education is a continuous education that starts from birth until adolescence and even continues throughout life. According to Razon (1988), this training should neither start too early nor should it be too late. Giving early information does nothing but confuse the child.

2.4. THE CHILD’S SEXUAL DEVELOPMENT BY AGE PERIOD

  • SEXUAL DEVELOPMENT OF A CHILD AGED 0-1

The child is born with certain sexual impulses from birth. These develop and progress in a known process and become observable towards the third or fourth year of life (Freud, 1983).

The child has his first sexual experience at his mother’s breast. She screams when she’s hungry, clenches her fists, looks for her nipple. When his stomach is full, his fists relax, he calms down. His mother’s sight, warmth, and closeness are all part of this first experience. As the child grows, he can develop feelings independent of sucking. These feelings indicate the beginning of individuation. From the first years of life, it has been observed that the baby enjoys this process during the cleaning of the genitals. Boys start playing with their genitals earlier than girls. These movements aiming to explore the body can turn into a pleasurable pursuit over time. There is a transition from sexual games to masturbation (Nelson, 1978). Genital hardening from birth in 0-2 month-old boys; At 9-12 months, he may show behaviors such as touching his genitals while naked, starting masturbation, asking for his diaper to be changed when it gets dirty, and laughing at the mother or the person who takes care of himself when he puts his diaper under it in girls.

Some parents are uncomfortable with their children touching their genitals, they are worried that this is abnormal behavior. These behaviors are completely natural and healthy (Yavuzer, 2001; Yörükoğlu, 1979; Çaplı, 1993).

  • SEXUAL DEVELOPMENT OF A CHILD AGED 1-3

Consciousness about sexual organs increases between 15-24 months. Children in this age range often expose their genitals during this period. At the end of the age of 2, the child begins to self-stimulate. While boys tend to continue this behavior, girls may end masturbation during this period or make it a habit (Kağıtçıbaşı et al., 1991).

In the first year after birth, the first sexual feelings of the baby occur during bathing and changing the diaper. The pressure and movement that occurs in the genital area when diapered can be enjoyed by the baby (Yavuzer, 2002).

An important event in this period is toilet training. As the baby learns that the diaper should not be wet, he realizes that the bladder is full and the pressure on his genitals, which causes a kind of sexual sensation. When the diaper is removed and placed on the seat during toilet training, the pressure and pleasure will feel better. So the baby will enjoy the passage of his pee in the urethra. Boys like to hold their penis while they pee. Wiping with toilet paper will also be a pleasant new sensation, especially for girls (Yavuzer, 2002).

It has been observed that some precautions taken by mothers during toilet training have negative effects on the sexual life of the child. Children who cannot acquire toilet habits during this period often soil their diapers or underwear because their toilets do not inform them. Children start to play with their genitals when they are naked while changing dirty diapers or underwear. Children who discover this pleasure may make it a habit to repeat it as long as they are alone and empty. The anxiety, excitement and nervousness shown by the parents may cause the child to repeat these behaviors frequently instead of preventing them (Çaplı, 1993).

Showing affection to the mother or caregiver at an early age when tired, wet or distressed; kissing before going to sleep at the age of two, not going to the toilet in foreign places, noticing one’s own genitals, interest in gender differences, watching others when going to the bathroom or toilet or undressing; At the age of two and a half, they can show interest in the differences in body postures and physical differences between the sexes while urinating (Ilg & Ames, 1995).

  • SEXUAL DEVELOPMENT OF A CHILD AGED 3-6

At age three, children notice physical differences related to gender. They may ask questions such as “why don’t dads wear dresses, why don’t girls pee standing up”. At the age of 3-4, questions about birth begin to be asked. He wants to learn the answers to questions such as “where do babies come from, how babies are born”. Again in this period, sexual games are started to be played (Bayhan and Arthan, 2005).

At the age of four, behaviors such as showing excessive interest in the navel, under stress, showing the genitals to another child, and choosing certain words in verbal games, especially in the genitals, can be seen.

Awareness of male/female differences and reproductive organs at age five, masturbation, decreased interest in others’ bathrooms and less sex play, less self-disclosure; At the age of six, showing an interest in the differences between the sexes, sex games, talking about special parts of the body and using slang words that he does not know what it means, exhibitionism can be observed.

Many children display abusive speech behavior at some point in their lives. Parents and teachers should warn the child not to say these words that contain swearing and slang everywhere. While describing this, the word “shame” should not be used (Tuzcuoğlu, 2004).

Basic sexual identity is formed before the age of three and does not change easily after that. From the age of two, children realize that there are two genders, and they know that they belong to one of them. However, the phenomenon of sexual identity is slightly different from that of adults. Children’s perception of gender is generally not related to the physical characteristics of the individual (Selçuk, 2007).

Children exhibit the characteristics of their own gender in their games and interpersonal relationships. There are two approaches here. The first is the social learning factor in the development of gender roles, and the second is the view that focuses on cognitive factors. The social learning approach has adopted gender roles as well as other behaviors related to modeling (Selçuk, 2007).

It can be seen to exhibit attitudes and behaviors specific to the opposite sex. Boys are not allowed to act like girls, talk, put on makeup, etc. For girls, cutting their hair short, wearing men’s clothes, playing games preferred by men, etc. Behaviors can be seen. There is no need to be worried because they are short-lived (Tuzcuoğlu, 2004).

SECTION 3: ISSUES RELATED TO SEXUAL DEVELOPMENT IN PRE-SCHOOL CHILDREN

3.1. TOILET TRAINING

Toilet training; It is the child’s gaining control of stool and urine in the state of sleep and wakefulness, noticing that the toilet is coming without help and reminding, going to the toilet and meeting his needs. The period when toilet training will begin corresponds to the age range of 1-3. This period (1-3 years) is the period when the child realizes himself. There is no valid date for every child for when toilet training will begin. Voluntary control of the anal and urethral system is usually 18-24 weeks after the child starts walking. It is provided between months (Deniz and Görak, 2018).

Signs of Toilet Training Readiness in Children

  • Ability to take off and wear clothes on their own

  • Willingness to use the seat

  • Keeping the gold dry for 2 hours and reducing the wet diaper

  • Development of gross motor skills such as walking, sitting and squatting

  • Ability to express the need for evacuation with verbal or non-verbal communication methods

  • He is uncomfortable with his dirty diaper and wants it changed immediately

  • Having regular and predictable bowel movements (Çavuşoğlu, 2013).

Things to Consider While Giving Toilet Training

While the child’s ability to hold his urine or feces receives great attention from the environment, his bedwetting or defecation may cause a negative reaction from the society. In the face of these reactions, the child; encounters moral concepts such as right, wrong, shame (Kavaklı, 1992).

When to start toilet training may differ from person to person. Trying to introduce the toilet habit to the child ahead of time may cause fear and conflicts that can last for a long time in the child.

It is very important for their children that the parents adopt an encouraging and encouraging attitude in acquiring toilet habits. Exhibiting a very strict and oppressive attitude in toilet training can be considered as child abuse, and it can also cause behaviors such as perfectionism and extreme meticulousness in adulthood (Aydın, 2011).

Children generally learn to hold their stools at the end of the second year and to hold their urine at the end of the third year. However, until they reach the age of four or five, they can wet the bed during the day and often at night. Parents should be understanding towards these children and avoid behaviors such as scolding, blaming or punishing them. Otherwise, the child may experience urinary retention, insistence on urinating only in the diaper, panic attacks, hiccups and tantrums after urinary incontinence, and the functioning of the child and family may deteriorate and cause physical abuse (Küçük, 2010).

After starting toilet training, the child should never be put on diapers. If the diaper is removed during the day and put on at night, the child may be undecided about when to hold his urine and when to leave it.

In the spring and summer months, some of the water in the body is excreted with sweat and the child’s bladder is not filled enough to force him, so toilet training in spring or summer will be successful in a short time.

Factors Affecting Toilet Training

The age of starting toilet training, which was started at an earlier age in the past years, has gradually shifted to the advanced period. While toilet training started under 18 months in the 1940s, new studies from the West show that this training is now started between 21 and 36 months. Brazelton, in his study of 1,000 children in the 1950s, found the average age for children with daytime toilet control to be 28.5 months. In a study conducted with 266 children in the mid-1980s, the age of completion of toilet training was found to be between 25 and 27 months. Recent studies have shown that the rate of completing toilet training at 36 months is between 40% and 60%. In a study conducted on 406 children in 2004, the average age of toilet control during the day was found to be 36.8 months (Taubman, 2003). Male gender has also been stated as a delaying factor in toilet training in some recent studies. In addition, the widespread use of diapers has been identified as a factor delaying toilet training.

3.2. WET GOLD (ENURESIS)

Enuresis; It is the situation in which a child or adult, who can manage to hold his urine even for a short time, and who can control the bladder function, leaves his urine in inappropriate situations and environments (Apley, 1968). Involuntary urination in enuresis; It is called “Enuresis Nocturna” if it happens at night, “Enuresis Diurna” if it happens during the day, and “Enuresis Continua” if it happens both during the day and at night (Öztürk, 1981).

Enuresis is mostly seen as nocturnal enuresis. According to Kanner, the rate of enuresis nocturna is 63%, enuresis diurna is 7% and enuresis continua is 30%. In a study conducted on 252 enuretic children in Hacettepe hospital, these rates were 88% for enuresis nocturna, 3.1% for enuresis diurna, and 8.9% for enuresis continuum (Burke, 1980).

In the vast majority of children, 85%, the enuresis never ceases since infancy. This is called “Primary Enuresis”. Children in this group; These are children who have never been able to gain urinary control and cannot hold their urine. In as few as 15% of children, urination begins after toilet training is completed and control is achieved. This condition is called “Secondary Enuresis”. It is seen in children who lose this ability and start wetting the bed after at least six months of urinary control. It is mostly seen at the age of 5 or 6, and at the age of 7 in boys (Mikkelsen, 1980).

In addition, temporary bedwetting may occur due to reasons such as sibling birth, fears, and coldness. Age-related incidence is 14-20% at the age of 5, 5% at the age of 10, and 2% at the age of 18.

Enuresis is more common in boys than girls. The rate of peeing on the bed in boys is two times higher than in girls.

The incidence of enuresis is even higher in socioeconomically low and broken families. Night urination is more common in villages, slums, orphanages. Its high rate in these environments is due to inadequate and irregular toilet training (Yörükoğlu, 1978). When the life stories of children with primary nocturnal urination are examined in detail; An anxiety-provoking event such as illness, change of home, hospitalization, or the birth of a sibling has been observed, usually around the age of 3 years. It has therefore been suggested that the primary source of nighttime voiding may be the occurrence of an alarming event in the “sensitive period” (Mac Keith, 1964).

Causes of Enuresis

  • Extends

Genetic factors are important in terms of the frequent occurrence of enuresis among family members. In cases where both parents are enuretic; 77% of children are likely to be enuretic, if only one of the parents is enuretic; The probability of being found in children is 44%. If none of the parents are enuretic; In the first three years after starting school, the probability of eniresis is 15% (Burke, 1980).

There is a growing consensus that the structural, familial, physiological and psychological characteristics of many enuretics and maturation retardation are determined in bladder control (Kutsal, 1971).

  • organic causes

In the organic etiology of enuresis, the disorder of the urinary tract comes to mind first. Eniresis may also be related to bladder function and structural abnormalities. Bladder length or urethral stenosis, destruction of bladder sensation, thickening of bladder musculature, may cause enuresis. Again, in terms of organic etiology, infection of the kidney and urinary tract may cause enuresis (Öztürk, 1981). Among organic causes, epileptic seizures may be the cause of night urination, albeit very few (Yörükoğlu, 1978).

  • sleep depth

Parents of enuretic children report that the child’s sleep is deep and difficult to awaken. Many researchers have examined the relationship between enuresis and sleep and found that wetting mostly occurs in the third and fourth stages of sleep and during REM sleep (Öztürk, 1981).

  • psychological reasons

Studies have suggested that psychological factors have a significant share in the incidence of enuresis. Rutter et al. compared psychiatric disorders in enuretic and non-enuretic children and found that the deviation rate in enuretic children was significantly higher than that in non-enuretic children. Although psychological reasons have a significant impact, not all children who pee at night are considered maladaptive children. In other words, peeing on the bed alone is not evidence of spiritual maladjustment. Among these children, there are those who show severe behavioral disorders, as well as those who are very adaptable. For this reason, it would be appropriate to deal with organic causes first and then investigate psychiatric causes in nighttime voiding seen in primary school age (Yörükoğlu, 1978).

Treatment of Enuresis

According to research, when children reach the age of 3, urine controls can reach full maturity. However, until they reach the age of 4-5, they may wet themselves occasionally during the day and very often at night. However, it would be a problem to continue after this age. When faced with such a situation, first of all, it should be checked whether there is an organic disorder or not (Çağlar, 1974).

The urinary tract of every enuretic child should be examined in case of infection in the urinary organs. Bladder-length obstruction should also be considered. However, if the child does not wet the bed some nights, we can say that the bladder control system is normal.

Urologists do not want to involve the child in intensive research immediately. For this reason, the case is evaluated after a period of two to three months. First, it is checked whether the cause is organic. If the cause is organic, it can be easily treated. If this approach does not produce results, then it is conceivable that the cause may consist of an emotional disorder. When children are watched carefully, 90% of them tell their story. The remaining 10% can be treated with antibiotics. After diagnosis; Methods such as therapeutic treatment, drug therapy, conditioning method, spontaneous treatment, reward and punishment method, limiting fluid intake, waking the child at night can be used.

3.3. FEET INCONTINENCE (ENCOPRASIS)

Without an organic reason, the child’s condition of not being able to control his stool from the age of 3-4 and soiling the bottom is called “Encopresis”. This disorder, which is less common than enuresis, can usually be caused by reasons such as improper toilet training, family conflicts, and excessive care of the mother. Fecal incontinence is a rare condition and is more common in boys than girls (Yavuzer, 1982).

For a diagnosis of encopresis to be made, incontinence must continue for at least 3 months and occur at least once a month. If the child’s ability to hold poop is not developed at all, it is called primary encopresis, and if the child has gained the ability to hold his poop for at least one year and then lost it, it is secondary encopresis. Encopresis may be due to organic causes such as neurological, cognitive and physical developmental delays, and disorders in anal or rectal excretion dynamics. If encopresis is not due to any cause, it may be due to psychological reasons such as sibling jealousy, traumatic events, loss, divorce, oppressive parental attitudes and inappropriate toilet training. The mother’s excessive emphasis on cleanliness and meticulousness, the use of the defecation method in a very pressured way, and the child’s getting into the process of being stubborn with the mother may also cause pooping. Some children resist going to the toilet. Even if he needs to defecate while playing outside or at home, he postpones it until the last time and finally slips it into his underwear. Attention deficit hyperactivity disorder, oppositional defiant disorder, behavioral disorder, urinary incontinence and masturbation are the thresholds of the problem in children with poop. Children with encopresis may exhibit behaviors such as avoiding social activities related to the disorder, decrease in self-confidence, as well as hiding the clothes they have contaminated with their poop.

Unnecessary pressure should be removed before treatment, and an overly meticulous attitude should be abandoned. After a positive communication with the child is established, it becomes easier to regulate defecation. The calendar keeping method, which can also be used in urinary incontinence, can be used. The active participation of the child in treatment is important. With a determined attitude, it is necessary to sit on the toilet two or three times a day at regular intervals. Even if there is no defecation, sitting on the toilet at that time every day, especially after meals, makes it easier to defecate after a while. There are cases where drug therapy is also beneficial. Depending on the nature of the family and the child, it may sometimes be necessary to direct the child to individual therapy, play therapy or family therapy.

“A nine-year-old girl did not want to go to school in rainy weather and avoided going out when the roads were muddy. When the reason for this obsession is investigated, it is seen that it stems from a fear acquired by the mother at a young age. When the child is two years old, the child performs his defecation on the ground, and his mother presses the child’s face to the dirty floor with great anger. Then, of course, the child obeys the rule, becomes a person who needs the toilet alone and in the desired way, but this emotional wound has turned into the obsession in question” (Yavuzer, 1982).

3.4. MASTURBATION

Masturbation, which is one of the issues that families have difficulty in talking to their children, is the conscious stimulation of the sexual organ of the individual in order to provide sexual satisfaction (Özgüven, 1997). Masturbation, which is common in the phallic period during the preoedipal development of the child, is a natural behavior (Yörükoğlu, 1979). It occurs in both humans and some animals. Very young children also masturbate (Yörükoğlu, 1979).

According to Hurlock (1964), masturbation for young children is a form of sexual exploration that occurs mainly to satisfy the child’s curiosity about his genitals. Hurlock (1972) stated that masturbation does not have any physical harm, but it can cause psychological harm, and that children who feel unhappy and powerless meet their feelings of inadequacy by turning to masturbation.

Masturbation is not a behavior to be learned in a situation that must be taught. It is discovered spontaneously due to the sensitivity that develops due to maturation in the genitals. It is undesirable to punish this situation severely. The applied pressure may cause it to turn into an inappropriate behavior. Similarly, masturbation can be seen in girls. The appropriate time and place for masturbation should be determined within a time period that will not affect their social and academic life (Düzkantar, 2010).

Almost all children take special pleasure from playing with their genitals. Mothers who walk their children naked to do a little laundry are preparing a bad opportunity for their children. The child, whose genitals are exposed, starts to play with it. The child, who feels a special pleasure during this play, may make it a habit to repeat it as long as he is alone and empty. In such cases, adults may play a role in giving birth to a thought that the genitals are “dirty, bad”; The anxiety, excitement and nervousness of the parents in such situations may cause the child to repeat these behaviors frequently instead of preventing them. The child may resort to this behavior more in order to attract the attention and interest of his parents. On the other hand, the threats that parents throw randomly have negative effects on children that they cannot easily forget until adulthood (Çaplı, 1993).

Some children do not care, others carry out the dealings in secret. Some children stimulate themselves by lying on the ground and rubbing back and forth. He is panting, sweating; It seems to provide sexual satisfaction. This appearance frightens the mothers and provokes strong reactions. The reaction shown is proportional to the mother’s delusion and anxiety on this issue. Fearing that her daughter will turn out to be a man-crazy woman in the future, the mother shows great anger. He scolds, beats and scares the child. There are even mothers who try to prevent this by tying their children’s hands (Yörükoğlu, 1993).

This frequently used type of sexual stimulation is not something to be feared as much as mothers think. However, there is also a problem that needs to be resolved. This is more common in children who are left on their own for too long in infancy. It is more common in children who have not been breastfed or given a pacifier. In other words, the child with a lack of arousal tries to fill the void of being pacified by self-stimulation. This can also occur in children whose pacifier is forcibly taken away. Reasons such as the birth of a new sibling and lack of interest may also create a need for self-gratification in the child. Pinworms or inflammation of the foreskin, which sometimes cause itching, cause the child to enjoy this stimulation and repeat it. It would be the most appropriate way to reveal these causes and take measures to eliminate them. This cannot be prevented by frightening and intimidating the child. At best, it forces the child to secrecy. If she continues this job, she should avoid frightening her with words such as her penis will fall or she cannot become a mother. Mobbing and intimidation cause permanent mental conflict and obsession in the child.

Instead of getting angry when children touch their genitals, parents should explain that genital organs are special parts of their body, that touching them feels good, but because it is private, it should be done alone when not in public.

If we do not want this behavior to settle in the child; If we start to engage him in games and activities in which he may be interested, the child will spontaneously stop playing with his genitals. It is not right for the child to lie in his bed for a long time after being embarrassed. Very tight trousers or underwear should not be worn (Çaplı, 1993).

3.5. PRIVACY

Privacy means the state of being hidden (private), that is, the hidden aspect of something. In another sense, it can be called human inviolability. It is a concept that the concepts of intimacy and privacy have gained a special use in the relations between men and women, especially meaning sexual immunity (TDK Genel Turkish Dictionary).

In this context, the most important point we need to know is that sexual education is not privacy education and that privacy education should be given in the family at the age of 0-6. Privacy education is a broader concept than sex education. Sex education includes the child’s recognition of his own sexuality, learning the physical and emotional differences that he will experience during development, as well as questions and answers about sexuality he asks his parents. Privacy education, on the other hand, includes information such as being aware of oneself and other people’s private/private space, protecting their private space in social life, respecting other people’s privacy, and setting healthy boundaries between themselves and their environment, as well as sexual information. Privacy education is given by the parents and this education is important for the mental and sexual protection of the child.

Things to Consider While Giving Privacy Education to Children

Step 1. Define the Custom Field

In order for the child to protect his/her privacy and private area, it is necessary to define this area to the child first. The parts of the body that are private to the person and that these areas should be hidden can be gradually started to be explained to the child from the age of two. The child should be taught that this area should be hidden from others and that no one should touch this area except parents and doctors.

In order for the concept of “private space” to be formed in the child, children from the age of 3 should not be allowed to be at home or out of the house naked. A child who is not used to seeing himself naked in front of others will begin to feel very uncomfortable when someone has his clothes taken off.

Step 2. Respect the Child’s Private Spaces

Not dressing children in front of others from a young age and taking them to another room even when changing their diapers shows respect for the child’s own privacy. Especially after the age of four or five, taking the child’s bath and washing with underwear during the bath, not with the parents or siblings, while taking a bath, making the child feel that we respect that area by squinting or turning the head slightly while removing and cleaning the underwear is positive for the development of a sense of privacy in children. will contribute.

Step 3. Not Making the Child’s Sexual Organs an Object of Love

When young children are loved by touching their genitals, the child both violates privacy and begins to believe that other people’s private areas can be used to prank them. In addition, loving children with the subject of their genitals can make them ineffective in protecting themselves from malicious strangers. The child may not be able to distinguish whether it is good or bad when someone else wants to touch their private area. For this reason, it is necessary not to overdo it even in cases of diapering, applying diaper cream and cleaning. Making a joke about the child’s genitals, asking them to show them, trying to touch them is an objectionable situation in terms of sexual identity development.

Step 4 Teaching To Keep the Toilet Door Closed

Children are expected to acquire the toilet habit at the age of two, and to learn how to clean after the toilet at the latest at the age of four. Parents can take these periods into account and give the child toilet training, and as a part of the training, the child can be told to be alone in the toilet and not to do the toilet in a way that others can see. If the child uses a potty seat, this seat should not be placed in the common areas of the house, but should be used in the toilet or bathroom.

Step 5 Teaching You to Enter Your Room with Permission

Children should be taught from the age of four to five that if the parents’ room is closed, they should enter the room by knocking on the door and obtaining permission. Because this room is the private area of ​​the parents and permission must be obtained to enter the private areas. Knocking on the door of the child while entering the room will set a good model for the child. When he enters the room without permission, it should be explained to the child, “We may be getting dressed in our room, so if the door is closed, you must click and get permission to enter”.

Step 6 Separating Beds with Parents and Siblings

By the age of two, children gradually gain independence and begin to want to eat on their own and walk on their own. This period is also a period of time when the child’s room can be separated in terms of development. However, for children who are overly sensitive and anxious about issues such as loneliness, separation from their mother, and darkness, bed separation should be made with the help of a specialist. Siblings who sleep together in the same bed can separate their beds from the age of four or five. The rooms of sisters and brothers should be separated with the primary school period. Because they can violate each other’s private space while they are in the room they are together, while they are dressing, sleeping, and cleaning.

Step 7 Express Your Response to Private Domain Violation

While traveling with the child or watching television, you may encounter situations that violate privacy. In such cases, the reaction to the person who violates the privacy can be made clear to the child. For example, a person who touches his friend’s private area in the television scene may become angry loudly. Reactions can be expressed with sentences such as “People’s private parts are not touched”. Thus, the child becomes sensitive to violations of privacy by modeling the reactions of the parents. Because children learn more easily by modeling their parents.

Children who receive privacy education know their own private space, protect this space and respect the private spaces of others. This situation also lays the groundwork for a healthy personality development of the child. In today’s world where sexual harassment is increasing, the first step to protect children is privacy education. Thanks to this training, they can become healthier individuals by learning to protect their own and others’ private space.

SECTION 4: FAMILIES WITH PRE-SCHOOL CHILDREN

4.1. FAMILY

The family is a small community that forms the subsystem of husband and wife, parents, children and siblings that affect and are influenced by each other. Especially for preschool children, the family factor is very important in terms of the relations between the child and the family established in this period. In addition to the relationship of parents with the child, the relationship between each other also has a positive effect on the child. In this direction, it is predicted that children will be in a psychologically harmonious relationship in family structures where the relations between the subsystems in the family are healthy and there are no destructive conflicts (Difilippo JM, 2002).

With the twentieth century, there have been significant changes in the view of the family. Even parenthood has begun to be considered independent of marriage. In addition, it is stated that the emotional value of the child has increased during this period. In modern families, parents focus all their material and emotional resources, energies and attention on raising children. For women, parenting becomes a personal decision rather than a duty. A woman no longer has children just because she is married; it is a defined situation where having a child becomes not a routine of marriage but an independent decision of the woman (Nock SL, 2000).

4.2. FAMILIES WITH PRESCHOOL CHILDREN

Perhaps our biggest neglect in child education is not giving the necessary importance to the first years. In these years, the child is seen only as a being to be loved, fed and raised. However, scientists named the first six-year period as the “vital period”. During this period, children develop very rapidly, not only biologically but also spiritually.

This is the period in which the most basic characteristics and abilities of the child are shaped. His intelligence, perception, personality and social behaviors show improvement and become effective in forming his character in the following years. He learns to walk, cry, laugh, talk, fear, grieve, and rejoice during this period, and he completes most of his brain development before the age of seven. What is this

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