School-age

7 – 11 yo
Growth and
development
• 3-5 lb/yr
• 1-2 in /yr
• 10 yo – brain growth
complete
• Adult vision
• Abundant tonsillar and
adenoid tissue
• “innocent” heart
murmurs
• HR 70 bpm
• BP 112/60
• 32 permanent teeth
• Pubertal onset
 SECONDARY SEX CHARACTERISTICS
AGE BOYS GIRLS

9-11 Wt gain Breast bud

11-12 Sparse pubic hair Pubic hair along

growth of penis & testis labia
Sebaceous gland sec Sebaceous gland
sec
Growth spurt
12-13 Pubic hair inc Pubic hair darker
Penis lengthens Breasts enlarge
Linear growth spurt Axillary hair
Breast enlargement menarche
 GROWTH AND DEVELOPMENTAL MILESTONES

• 6 yo – skip, jump, tumble, hop, ride bicycle, walk a

straight line; first molars

• 7 yo – central incisors; sexual differences seen in play;

quiet play

• 8 yo – improved coordination; playing w/ gang

important; eyes fully developed
GROWTH AND DEVELOPMENTAL MILESTONES

• 9 yo – all activities done w/ gang

- hero worship

• 10 yo – more improved coordination

- well mannered w/ adults

• 11 yo – active but awkward

- mixed sex activities

• 12 yo – coordination improves
- joins organizations
 PERSONAL/SOCIAL/PLAY
Competitive play and
recreational activities

Hobbies and personal

interests
• Arts and crafts
• Biking
• Board games
• Clubs
• Collecting items
• Chess
• Comic Books
 NUTRITION

• Good appetite

• Food w/ high nutritional value

- more calories and nutrients
- hungry after school – give snacks
and make mealtimes enjoyable
 DAILY CARE
- dressing – influenced by peers
- sleep – 8-12 hrs; no naps
- exercise – games, bike riding, walking
- hygiene – 8 yo – capable of bathing
alone
- care of teeth – 2x yearly visit to the
dentist; brush daily
- safety – bicycle, school bus safety,
prevention of falls and sports injuries
 CONCERNS

- problems w/ articulation – disappears 9 yo

- School anxiety and phobia
- Sex education
- Stealing – 7 yo – importance of money
- Violence/terrorism – education;reassurance
- Bullying
- Recreational drug and alcohol use
- Obesity
 REACTION TO ILLNESS
AND NURSING INTERVENTIONS

- Death and disability - Still need

comfort
- Unknown events & procedures -
Allow to help
w/ care & treatment
- Loss of ctrl & independence - Give
choices
- Loss of contact w/ peers - Allow visits
- Disruption of school - Talk about
interests
- nutrition – allow choices
- dressing – ask opinions on bulk of
dressing and where to apply tape
- medicine – teach name and action,
allow to choose form if possible
- pain – allow expression of pain, explain
source and cause
- stimulation
• Age 6 to 11/12 years old
• Constant progress in physical, mental,
and social development, skill,
competency, and self concept
• Physical
a. Continued slow growth
b. Begins losing temporary teeth early in
this phase and has all permanent teeth,
except final molars by the end
c. Bone growth exceeds that of muscle and
ligament, resulting in susceptibility to
injuries/ fractures
• Motor
a. Skips
b. Skates
c. Tumbles
d. Tandem walks backwards
e. Prints progressing to script
f. Ties knots then bows
• Psychosocial
a. Has significant peer relationships
b. Assumes complete responsibility for
personal care
c. Assumes complete responsibility for
personal care
d. School occupies most of time and has
social as well as cognitive impact
e. Developing morality, dominated by moral
realism with strict sense of right/wrong
until 9 years then development of moral
autonomy recognizing different points of
view
f. Able to acknowledge own strengths and
weaknesses
g. Developing modesty
• Play
a. Cooperative group play with leader and
organized rules/rituals
b. Usual activities include team games/
sports/ organizations
c. Board games, books, swimming, hiking,
bicycling, skating
• Stresses
a. Possible school phobia
b. Fear of death, disease/injury,
punishment
• Safety
a. Decreasing incidence of accidents
except for injuries associated with
sports/activities
b. Requires appropriate supervision and
education about proper use and
maintenance of equipment and hazards
of risk taking
 6 years
• Self-centered, show-off, rude
• Extreme sensitivity to criticism
• Begins losing temporary teeth
• Appearance of first permanent teeth
• Ties knots
 7 years
• Temporal perception improving
• Increased self-reliance for basic activities
• Team games/ sports/ organizations
• Develops concept of time
• Boys prefer playing with boys and girls
with girls
 8 years
• Friends sought our actively
• Eye development generally complete
• Movements more grateful
• Writing replaces printing
 9 years
• Skillful manual work possible
• Conflicts between adult authorities and
peer group
• Better behaved
• Conflict between needs for independence
and dependence
• Likes school
 10 – 12 years
• Remainder of teeth erupt
• Uses telephones
• Capable of helping
• Increasingly responsible
• More selective when choosing friends
• Develops beginning of interests in
opposite sex
• Loves conversation
• Raises pets
 Nursing Management during
hospitalization
• Reaction to illness
1. School-age children perceive external
forces as causes of illness
2. They are aware of the significance of
different illnesses
• Reactions to hospitalization
1. The primary defense mechanism of
school-age is reaction formation
 Nursing Management during
hospitalization
2. School-age children may react to
separation by demonstrating loneliness,
boredom, isolation and depression. They
may also show aggression, irritability,
and inability to relate to siblings and
peers
3. The sensed loss of control is related to
enforced dependency and altered family
roles
4. Fear of bodily injury and pain results
from fear of illness, disability and death
 Nursing Management during
hospitalization
• Nursing management
1. Provide general interventions
a. Encourage verbalization
b. Encourage self – care
c. Encourage peer interactions
d. Inform school-age children that it is “Ok”
to cry
 Nursing Management during
hospitalization
e. Give factual information; use models to
demonstrate concepts or procedures
f. Provide diversions
2. Provide physical comfort and safety
interventions
a. Allow the school-age child control over
body functions
b. Assist in developing fine motor skills.
Encourage:
 Nursing Management during
hospitalization
a) Construction toys, such as Lego sets
b) Drawing
c) Computer games
d) Drawing body parts
e) “taking notes” during patient education
c. Allow school-age children to participate
in treatment
 Nursing Management during
hospitalization
3. Provide cognitive interventions
a. Assist in developing rational thinking and
provide decision making
b. Assist the child with mastering concepts
of conversation, constancy and
reversibility, classification, and
categorization
c. Provide time for, and encourage,
verbalization
 Nursing Management during
hospitalization
4. Provide psychosocial and emotional
interventions
a. Provide opportunity to channel drives
b. Promote achievement of industry
 Expanding cognitive skills enable school-age children to
interact cooperatively in activities of an increasingly complex
nature, as shown by the children playing this board game.
Box 22-7 Health Promotion Guidelines for School-Age Children
Unnum Box 22-4 Developmental Assessment Guidelines: The School-Age Child