PEDIA

NURSING CARE OF A FAMILY WITH A SCHOOL-AGE CHILD

Growth and Development of a School-Age Child #1 Teeth

❖ Deciduous teeth are lost and permanent teeth erupt during the school-age
Physical growth
period at 6 years of age.
• Sexual maturation ❖ The average child gains 28 teeth between 6 and 12 years of age: the central
• Sexual, physical concerns and lateral incisors: first, second, and third cuspids; and first and second
o Concerns of girts molars
o Concerns of boys
• Teeth Growth and Development of a School-Age Child #3

Physical growth Developmental milestones

• Gross motor development

• General growth is slow until puberty. The child shows progressive lower in
• Fine motor development
growth in height and rapid gain in weight
• Play
• School-age children's annual average weight gain is approximately 1.3 to
2.2 kg. The increase in height is 2,5 to 5 cm.
• As the eye globe reaches its final shape at about this same time, an adult Growth and Development of a School-Age Child
vision level is achieved.
• The term "school age" commonly refers to children between the ages of 6
• At 6 years 117cm& 22kg in weight
and 12.
• At 12 years 150 cm & 44 kg.
• Although these years represent a time of slow physical growth, cognitive
• Posture becomes more erect, lordosis and knock-knee appearance
growth and development continue to proceed at rapid rates
disappear
• Children of school age may also be more influenced by the attitudes of
• Scoliosis may become apparent for the first time in late childhood.
their friends than previously.
• By 10 years of age, brain growth is complete, so fine motor coordination
becomes refined
Developmental Milestones
Physiological growth
Gross Motor Development
• Vital signs T: 37 degrees Pulse 70-80 B/m
• At the beginning of the school-age period (age 6), children endlessly jump
• Bp: 112/60 Respiration 20Breath/m
and hop. They have enough coordination to walk a straight line. Many can
• GIT mature to digest food
ride a bicycle.
• Kidney system mature to concentrate urine
• 6-year-old. Gender differences usually begin to manifest in play: there are
• Circulatory system heart beat are shifts from fourth to fifth intercostals
"girl games," such as dressing dolls, and "boy games,
space
• A 7-year-old appears quiet
• Neurological system are improved memory and ability to understand
• The movements of 8-year-olds are more refined than those of younger
• Immunological system: the main function of this system is elimination of
children. They ride a bicycle well and enjoy sports such as gymnastics
substance that are foreign to the body. So lymphoid tissue reach of
soccer and football,
greater amount in school than adult
• Nine-year-old are on the go constantly, as if they always have a deadline
• IgG & IgA reach adult levels
to meet
• lymphatic tissue continues to grow up until about age 9.
• By 10 years of age, they are more interested in perfecting their athletic
• Frontal sinuses develop at about 6 years, so sinus headache becomes a
skills than they were previously.
possibility (before that, headache in children is rarely caused by a sinus
• Twelve-year-old fall into activities with intensity and concentration
infection).

The left ventricle of the heart enlarges to be strong enough to pump blood to Fine Motor Development
the growing body.
• By 6 years, easily tie their shoelaces. They can cut and paste well and
❖ Innocent heart murmurs may become apparent due to the extra blood draw a person with good detail
crossing heart valves. • by 7 years this has been called the "eraser year" because children are
❖ Maturation of the respiratory system leads to increased oxygen-carbon never quite content with what they have done.
dioxide exchange. • By 8 years, children's eyes are developed enough so they can read
regularize type.
Growth and Development of a School-Age Child #2 • By age 9, their writing begins to look mature and less awkward
TABLE 32.1 CHRONOLOGIC DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS • Older school-age children begin to evaluate their teachers' ability

Age (in Years) Boys Girls Play

9-11 • Prepubertal weight gain • Breasts: elevation of
occurs. papilla with breast bud • Play continues to be rough at age 6 years,
formation; areolar
• By 7 years of age, children require more props for play than when they
diameter enlarges.
11-12 • Sparse growth of straight, • Straight hair along the were younger.
downy, slightly pigmented labia; vaginal epithelium • To be a police officer, a 7-year-old needs a badge and gun, whereas
hair at base of penis. becomes cornified. before a pointed finger sufficed.
• Scrotum becomes textured; • pH of vaginal secretions
• Most girls and boys of this age also enjoy helping in the kitchen with jobs
growth of penis and testes becomes acidic; slight
begins. mucous vaginal discharge such as making cookies and salads or frosting cakes
• Sebaceous gland secretion is present. • 8-year-olds like table games but hate to lose, so they tend to avoid
increases. • Sebaceous gland competitive games.
• Perspiration increases. secretion increases.
• 9-year-olds play hard. They wake in the morning. squeeze in some activity
• Perspiration increases.
12-13 • Pubic hair present across • Dramatic growth spurt. before school, and plan something the moment they arrive home again, D
pubis. • Pubic hair grows darker; • Many 10-year-olds spend most of their time playing hand-held or television
• Penis lengthens. spreads over entire pubis. remote control games. Boys and girls play separately at age 10, although
• Dramatic linear growth spurt. • Breasts enlarge, still no
interest in the opposite sex is apparent
• Breast enlargement may protrusion of nipples.
occur. • Axillary hair present. • Eleven- and 12-year-old children enjoy dancing to popular music and
• Menarche occurs. playing table games and are accommodating enough to be able to play
with siblings who need the rules modified to their advantage.
Eruption Pattern of Permanent Teeth
Growth and Development of a School-Age Child #4
• Language development
• Emotional development

Language Development
• 6-years-old talk in full sentences, using language easily and with meaning.
• Most 7-years-old can tell the time in hours, but they may have trouble with
concepts such as "half"
• at about age 9, They use swear words to express anger or just to show
other children they are growing up.
• By 12 years of age, a sense of humor is apparent. They can carry on an
adult conversation, although stories are -limited because of their lack of
experience.
Vocalization Growth and Development of a School-Age Child #6
• At 6 years Talk full sentence • Socialization
• At 7 years: orient time and place season, month • Cognitive development
• At 8 years: understand past present future o Decentering
• At 10-12 years vocabulary depend on intelligent o Accommodation
o Conservatism
Emotional Development o Class inclusion

They should have learned to share, to have discovered that learning is fun and Growth and Development of a School-Age Child #7
an adventure, and have learned that doing things is more important and more
rewarding than watching things being done. • Moral and spiritual development
o Preconventional reasoning
Socialization o Rule orientation

• Six-year-old children play in groups, but when they are tired or under Parental Concerns During the School-Age Years #1
added stress, they prefer one-to-one contact
• Seven-year-old are increasingly aware of family roles and responsibility. • Language development
Promises must be kept because 7-year-olds view them as definite, firm • Fears and anxiety
commitments, child aware to family, family roles, responsibilities, less o School phobia
resistance, less stubborn • Home schooling
• Eight-year-old actively seek the company of other children. They like the • Lack of adult supervision
reward systems. • Sex education
• Nine-year-old take the values of their peer group very seriously • Stealing
• Although 10-year-old enjoy groups, they also enjoy privacy. Girls become • Violence or terrorism
increasingly interested in boys and vice versa by 11 years of age • Bullying
• Twelve-year-old feel more comfortable in social situations than they did • Recreational drug use
the year before.
Promoting School-Age Safety
Learning to Live with Others
School-age children are ready for time on their own without direct adult
❖ A good time to urge children to learn compassion and thoughtfulness supervision.
toward others is during the early school years D
❖ Learning to give a present without receiving one in return or doing a favor Promoting Nutritional Health
without expecting a reward is also a part of this process,
❖ Children may show empathy toward others as early as 20 months, but Most school-age children have good appetites, although any meal is
cognitively they cannot relate others' experiences to their own until about influenced by the day's activity.
6 years of age.
School-age children need breakfast to provide enough energy to get them
Mental development through active mornings at school.

• At 6 years count to 20, obey command as open door know right arm Most children are hungry after school and enjoy a snack when they arrive
• At 7 years read clock home
• At 8 years Know month days, number count from 1-20
• At 10-12 years write short letter to friends, use telephone read story, books Needs

Development of sexuality in the school age • Sleep and rest

• Bathing
• School age is a process of resolving oedipal situation • Nutrition
• Less egocentric direct his energy to others • Exercise and activity
• Child in activities they receive engage satisfaction. • Dental health
• Failure leads to sense of inferiority or inadequacy. • Education
• Sex education
Sexual Maturation • Religious education

• Puberty is provoked in this period in response to gonadotropin hormones. Promoting Development of a School-Age Child in Daily
• Sexual maturation in girls occurs between 12 and 18 years; in boys, Activities
between 14 and 20,
• Prepubertal girls are usually taller, by about 2 inches (5 cm) or more, than Dress
preadolescent boys because their typical growth spurt begins earlier
• Although school-age children can fully dress themselves, they are not
Concerns of Boys good at taking care of their clothes until later in the school-age years.
• This is the right age, to teach children the importance of caring for their
• Boys are aware of increasing genital size. Hypertrophy of breast tissue own belongings.
(gynecomastia) can occur in pre-puberty, most often in heavy boys.
• They become worried about their chest and facial hair that not appear Sleep
yet, so they must be assured that this hair will be developed latterly in the
• Younger school-age children typically require 10 to 12 hours of sleep each
puberty years.
night, and older ones require about 8 to 10 hours.
• As seminal fluid is produced, boys begin to notice ejaculation during sleep,
• Night time terrors may continue during the early school years and may
termed nocturnal emissions.
actually increase during the first-grade year as a child reacts to the stress
of beginning school.
Concerns of Girls
Exercise
• A girl notices the change in her pelvic contour when she tries on a skirt or
dress from the year before and realizes her hips are becoming broader • Exercise need not involve organized sports. It can come from
• She may misinterpret this finding as a gain in weight and at tempt a crash neighborhood games, walking with parents, or bicycle riding.
diet She can be reassured that broad bone structure of the hips is part of
an adult female profile. Hygiene
• Girls are usually conscious of breast development. Breast development is
not always symmetrical • Children of 6 or 7 years of age still need help in regulating the bath water
• preparation for menstruation is important preparation for future temperature and in cleaning their ears and fingernails.
childbearing and for the girl's concept of herself as a woman. • By age 8, children are generally capable of bathing themselves but may
• Most girls have some menstrual irregularity during the first year or two after not do it well because they are too busy to take the time or because they
menarche (the start of menstruation). do not find bathing as important as their parents do.
• Girls also need to know that vaginal secretions will begin to be present.
Care of Teeth
Growth and Development of a School-Age Child #5
• school-age children should visit a dentist at least twice yearly for a
• Developmental task: Industry vs. Inferiority checkup, cleaning, and possibly a fluoride treatment to strengthen and
o Home harden the tooth enamel
o School
o Structured activities Health problems of school age
o Problem solving
o Living with others 1. Phobia from school manifested by vomiting abdominal pain, regression
2. Learning difficulties: Reading and writing problems
3. Behavior problems:
- Lie
- Cheating - stealing
 4. Sexual problems parents are under stress and
5. Nutritional problems therefore less attentive. Special
6. Communicable disease as hepatitis precautions must be taken at these
7. Allergy as asthma, sinusitis, Streptocoocal infection times.
8. Dental problems • Some children are more active,
9. Skeletal problems as bone fracture & scoliosis curious, and impulsive and
therefore more vulnerable to
10. Accident electric shock, drowning, motor accident
unintentional injuries than others.

Nursing Diagnoses: School-Age Children

• Health-seeking behaviors related to normal school-age growth and
Health Promotion: Safety #2
development
• Readiness for enhanced parenting related to improved family living
BOX 32.4
conditions
• Anxiety related to slow growth pattern of child Nursing Care Planning Based on Family Teaching
• Risk for injury related to deficient parental knowledge about safety TEACHING POINTS TO HELP CHILDREN AVOID SEXUAL MALTREATMENT
precautions for a school-age child Q. A parent who wants to protect their child from being sexually abused
asks you, "What are good rules to teach children without scaring them?"
Health Promotion: Safety # 1 A. A number of suggestions include:
1. You decide who can touch your body.
BOX 32.3 2. If a person asks you not to tell anyone about an activity that made you
uncomfortable, that is not a secret you need to keep. It is important to
Nursing Care Planning Based on Family Teaching tell a trusted adult about it as soon as possible.
COMMON SAFETY MEASURES TO PREVENT UNINTENTIONAL INJURIES DURING 3. Don't go anywhere without your parent's knowledge.
THE SCHOOL YEARS 4. Avoid communicating with people you don't know on social media
Q. A parent tells you, "My child is constantly on the go. How can I keep my because you don't really know who they are or what their motives are.
child free from accidents always with them?". 5. A "private part" is the part of you a bathing suit covers. If anyone asks
A. Putting preventive steps in place, such as the ones that follow, is the key. you to show them a private part, touches a private part, or shows you
Source of Unintentional Injuries Injury Preventive Measure. their private parts, tell them to stop, and tell a trusted adult about the
Motor vehicle • Encourage children to use seat experience.
belts and a booster seat if needed; 6. If the person you share concerns with doesn't believe you, tell someone
model seat belt use. else.
• Teach street-crossing safety; stress
that streets are no place for
roughhousing, pushing, or shoving. Health Promotion: Family Functioning #2
• Teach parking lot and school bus
safety (e.g., do not walk behind BOX 32.6
parked cars, wait for the crossing
guard). Nursing Care Planning to Respect Cultural Diversity
Bicycle • Teach bicycle safety, including With the activities of children in modem cultures turning more toward
wearing a helmet and not giving electronic games than opening books, reading for pleasure is threatened
"passengers" rides. with becoming a lost art. A number of tips for making reading more
Community • Teach children to avoid unsafe enjoyable and increase cultural understanding for children include:
areas, such as train yards, grain
silos, and back alleys. • Read books yourself to set an example so your child thinks of reading as
• Stress that children should not go an adult activity. If you spend most of your free time watching television,
with strangers (parents can your child will think reading is mainly for children and assume that it is not
establish a code word with the important.
child and set a rule that the child • Make reading more fun by encouraging your child to make practical
does not leave school with anyone use of what he or she reads. Ask the child to read culturally different
who does not know the word). recipes while you cook or to read road signs during a car trip
• Teach children to say "no" to • Play a treasure hunt game where you hide a small object, such as a
anyone who touches them if they favorite toy, and then write simple clues on slips of paper: "Look under a
do not wish it, including family lamp," "Lock in a book," and so on until your child has been led to the
members (most sexual hidden object. Your child can develop writing skills by playing the same
maltreatment is by a family game for you to follow
member, not a stranger). • Suggest to relatives that a gift certificate from a bookstore would be a
• Teach children not to arrange a good present. Let your child browse the store to select the book
meeting with a person they meet • Talk about books the child has read-what was good, what was bad, or
on the internet. what the child learned while reading.
• For older school-aged children, • Read a book together as a bedtime family activity.
teach rules of safer sex so that they
know these rules before they need
to use them.
Health Promotion: Family Functioning #3
Burns • Teach safety with candles,
matches, and campfires and that Sexual education
fire is not fun. Also teach safety with
beginning cooking skills (be certain • Reproductive organ function and physiology of reproduction, so children
to include microwave oven safety, understand what menstruation is and why it occurs
such as closing firmly before turning • Secondary sexual characteristics, so children will understand what is
on oven; not using metal happening in their bodies
containers). • Male sexual functioning, including why the production of increased
• Teach safety with sun exposure and amounts of seminal fluid leads to nocturnal emissions
the importance of using sun block. • The physiology of pregnancy and the possibility for unintended
• Teach the child to not climb pregnancies, which will come with sexual maturity
electric poles.
• Social and moral implications of sexual maturity
Falls • Educate that some activities, such
as climbing on fences or roofs, are
hazardous Stealing
• Teach skateboard, scooter, and
skating safety. • Early childhood stealing is best handled without a great deal of emotion.
Sports injuries • Teach the importance of wearing • Shoplifting must be taken seriously by parents.
appropriate equipment for sports. • Parents should set good examples.
• Stress that the child should not play
to a point of exhaustion or in a sport Violence or terrorism
beyond physical capability.
• Use trampolines only with adult • Assure children they are safe.
supervision. • Observe for signs of stress.
Drowning • Stress not to swim beyond the limits • Do not allow children or adolescents to view footage of traumatic events
of the child's capabilities. repeatedly.
Drugs • Teach the child to avoid tobacco, • Watch news programs with children; explain the situation portrayed.
alcohol, and drugs. Teach them to
• Prepare a family disaster plan; designate a "rally point" to meet if ever
take prescription medicine only as
separated.
directed.
Firearms • Teach firearm safety. Keep firearms
in locked cabinets with bullets
separate from the gun.
General • School-aged children should keep
adults informed as to where they
are and what they are doing.
• Be aware that the frequency of
unintentional injures increases when
Health Promotion: Family Functioning #7 • Explain the source and cause of pain to give the
child a sense of mastery.
BOX 32.7 Stimulation • Encourage school work.
• Encourage activities that end in a product (e.g.,
Nursing Care Planning to Empower a Family putting together a picture puzzle rather than
TIPS FOR CHILDREN WHO SPEND TIME AT HOME UNSUPERVISED listening to a CD).
Q. A school-aged child stays alone after school for a half hour each week • Encourage paper-and-pencil games, such as
day. The parent asks, "What can I do to ensure my child is safe until get connect the dots or tic-tac-toe.
home?" • Card games provide social interaction and also
encourage simple addition skills (make a deck
A. Laws vary by states as to the age when a child can be home
from paper if one is not available).
unsupervised and at what age they can supervise younger children. Even if
• Don't suggest competitive games for children
the child is above the age for staying home unsupervised, parents may
younger than age 10 years.
decide their child is too immature to be home unsupervised. Consider
• Encourage using the playroom for socialization.
having the child take a self-supervision course.
• Encourage the child to keep in contact with
Safety Points for Children
school friends by texting or e-mailing them.
• Keep doors locked when inside the house. Never show keys to others or
indicate you stay home alone. Don't share the key code with others if
using that method to unlock the door.
• Have a plan in the event you lose your key (e.g., stay with a neighbor).
• Don't go into the house if the door is open or a window is broken.
• Learn fire safety. Review use of appliances such as the microwave if the
child is permitted to use it unsupervised.
• Check in with parents upon arrival. If affordable, security systems permit
parents to monitor the home and lock and unlock the door remotely.
• Identify a visitor before opening the door. Agree on a secret code word;
you should not open the door or go with a person unless the person
knows the word.
• Learn how to report a fire and telephone police.

Safety Responsibilities for Parents

• Prepare a safety kit; include a flashlight in case of a power failure.
• Plan after-school snacks that do not require cooking.
• Keep firearms locked, with the key in a place unknown to the child
• Keep a list of emergency telephone numbers (including parents' work
numbers).
• Arrange with a neighbor who is usually home during the late afternoon
for the child to stay there in an emergency.
• If an older child will be watching a younger one, be certain both
children understand the rules and degree of responsibility expected
• Be certain the child understands the rules that apply during other times
also apply during independent time (e.g., never swim alone).

Parental Actions to Increase Socialization

• Help the child plan after-school activities.
• Explore sports programs.
• Explore after-school programs.
• Provide opportunities for the child to socialize with friends when adults are
home.

Parental Actions to Increase Self-Esteem

• Praise the child for the ability to take care of themselves for short time
intervals.
• Walk with the child through the empty house and together identify
sounds (e.g., the click of the furnace turning on, the refrigerator starting
to defrost), so they can determine the cause of sounds when home
alone and not be frightened.
• Help the child to view the quiet as a beneficial time in which they can
do some things more efficiently, such as homework.

Health Promotion: Family Functioning #8

Recreational drug use

• Suspect if child regularly appears irritable, inattentive, or drowsy.
• Counsel against use of steroids; highlight future cardiovascular irregularities,
uncontrollable aggressiveness, and possible cancer.
• Teach to recognize tobacco advertising manipulation; caution against
experimenting with smokeless tobacco.
• Role model excellent nonsmoking health behavior.

Health Promotion: Family Functioning #9

TABLE 32.5 NURSING ACTIONS THAT ENCOURAGE A SENSE OF INDUSTRY IN THE
PHYSICALLY CHALLENGED OR CHRONICALLY ILL SCHOOL-AGED CHILD

Category Actions
Nutrition • Allow choice of food when possible and respect
food preferences.
• Provide small food servings that child can finish,
which encourages a sense of accomplishment.
Dressing • Ask for suggestions as to how bulky the child wants
the dressing and where to apply tape.
Medicine • Teach the child the name and action of
medicine.
• Encourage the child to keep track of medication
times by clock or record.
• The child may feel more in control of injections or
intravenous insertions if allowed to choose the site
from among options offered.
• Allow the child to choose oral medicine form
(capsules or liquid) if possible.
Rest • Establish clear rules for rest periods (e.g., reading
or watching television is acceptable; playing
video game is not).
Hygiene • Respect the modesty of a school-aged child at an
adult level.
• Allow as much choice as possible such as own
clothing and timing of self-care.
Pain • Encourage the child to express and rate pain.
• Encourage the child to use distraction techniques,
such as counting backward from 100 or imagery,
during episodes of pain.