NURSING CARE OF A FAMILY WITH A SCHOOL AGE - Over one in ten women experienced her first

menstruation before age 12

School Age
- Refers to children between the ages of 6 and 12
- Slow physical growth, cognitive growth, and
development continue to proceed at rapid rates
- The development of a school-age child is subtler
and may be marked by mood swings
- More influenced by the attitudes by their
friends
- The first time begin to make truly independent
judgements
GROWTH & DEVELOPMENT
Physical Growth
- Yearly average wt gain 3 to 5 lb (1.3 to 2.2 kg)
- Increase in ht is 1 -2 in (2.5 to 5 cm)
- Posture becomes more erect
- Fine motor coordination becomes refined (brain
growth is completed at 10 years old)
- Abundance of tonsillar and adenoid tissue in the
early school years (because the lymphatic
system grows rapidly)
- The left ventricle of the heart enlarges to be
strong enough to pump blood to the growing
body that can result to innocent heart murmurs
auscultated coz of the extra blood
- PR decreases to 70 to 80 bpm; BP rises to about
112/60 mmHg
- Increased oxygen-carbon dioxide exchange
because of the maturation of the respiratory
system
- Scoliosis may become more apparent for the
first time in late childhood (10- 12 yo)
Concerns for Girls
- Early preparation for menstruation for future
childbearing and for the girl’s concept of herself
as a woman
- A preadolescent who is experiencing consistent
irregularities in her period should be assessed
for malnourishment and obesity as possible
influences; an explanation of good hygiene
- Explain that any secretions that cause vulvar
irritation should be evaluated at a health care
facility, because this does suggest infection
- Inform them that breast development is not
always symmetrical (usually left is bigger than
the right)
Concerns for Boys
- If they do not know testicular development
precedes penis growth, they can worry that
their growth will be inadequate
- Assure them that pubic hair normally appears
first and that chest and facial hair may not grow
until several years later
- Nocturnal emissions – ejaculations during sleep
Teeth
- Deciduous teeth are lost and permanent teeth
erupt
- The average child gains 28 teeth between 6 and
12 years of age: the central and lateral incisors;
first, second, and third cuspids; and first and
second molars

Sexual Maturation

- Usually occurs between 12 and 18 years in girls;

in boys, between 14 and 20 years
- The changes in the physical appearance that
come with puberty can lead to concerns for
both children and their parents, this is the time
where parents will discuss to the children the
physical changes that will occur
- According to the Philippine National

Demographic and health Survey, in 2013, the

mean age at menarche among women ages 15
to 49 is 13.1 years
Developmental Milestones
Language Development
- Six-year-olds talk in full sentences
- Most 7-year-olds can tell the time in hours, but
difficulty with “half past” and “quarter to”
- Children discover “dirty” jokes and “bathroom
language,” at about age 9
- By 12, a sense of humor is apparent and can
carry on an adult conversation
Emotional Development
Developmental Task: Industry VS Inferiority
- The ability to trust others and with of respect
for their own worth
- Gain a sense of industry by learning how to do
things well
- If prevented, they can develop a feeling of
inferiority or become convinced they cannot do
things they actually can do
- They need reassurance they are doing things
correctly and this reassurance is best if it comes
frequently
- Hobbies and projects also are enjoyed best if
they are small and can be finished within a
short time
Home as a Setting to Learn Industry
- Parents should realize that their child looks to
other role models than themselves
- Eight-or 9-year-olds begin to spend more and
more time with their peers and less time with
their family
School as a Setting to Learn Industry
- Adjusting to and achieving in school are two of
the major tasks for this age group
- Parents must monitor teachers and school
activities to make sure their children are being
led this way while not being pushed too hard
- Schools are increasingly assuming responsibility
for education about sex, safety, avoidance of
substances of abuse, and preparation for family
living
Structured Activities
- Urge parents to evaluate competitive sports
programs
- Consider with organized contact sports the
possibility of athletic injuries
Problem Solving
- Help children develop this skill by encouraging
practice
- Encourage problem solving by saying, “Let’s talk
about possible ways of doing it”
Learning to Live with Others
- Children may show empathy toward others as
early as 20 months, but cognitively they cannot
relate others’ experiences to their own until
about 6 years of age
Socialization
- Six-year-old children play in groups, but when
they are tired or under added stress, they prefer
one-to-one contact
- Seven-year-olds are increasingly aware of
family roles and responsibility (they view
promises as firm commitments, diri
nangangalimot and they have a strong sense of
justice, they tattle because they think that’s the
right thing to do)
- Eight-year-olds actively seek the company of
other children
- Nine-year-olds take the values of their peer
group very seriously and are ready for activities
away from home (they are interested in how
other children dress)
- Although 10-year-olds enjoy groups, they also
enjoy privacy
- Girls become increasingly interested in boys and
vice versa by 11 years of age (children start to
become insecure)
- 12-year-olds feel more comfortable in social
situations than they did the year before (boys
experience erections on small provocations)
Cognitive Development
- 5 -7 y.o is a transition stage from preoperational
thought to operational thought or it’s the ability
to reason to any problem they can visualize
Children can use concrete operational thought with
these concepts:
1. Decentering
- Ability to project oneself into other people’s
situation and see the world from their POV
rather than focusing only on their own way
(they start to feel pity)
2. Accommodation
- Ability to adapt thought processes to fit what is
perceived such as understanding that their can
be more than one reason for other people’s
action
3. Conservation
- Ability to appreciate that a change in shape
does not necessarily mean a change in size
4. Class Inclusion
- Ability to understand that objects can belong to
more than one classification (helps in math,
categorizing, numbers)
Moral and Spiritual Development
Preconventional Reasoning
- Can be as early as 5 years of age
- A stage of “The police say it’s wrong”
- A child’s sense of morality is externally
controlled. Children accept and believe the
rules of authority figures, such as parents and
teachers, and they can judge an action based on
its consequences
HEALTH PROMOTION FOR A SCHOOL-AGE CHILD AND
FAMILY
Promoting School Age Safety
- They are ready for time on their own without
direct adult supervision (if they can reliably
follow instructions)
- Parents should look at the effect of carrying
heavy backpacks on children’s posture (>10%
body wt)
- Teaching points to help children avoid sexual
abuse
Promoting Nutritional Health of a School-Age Child
Establishing Healthy Eating Patterns
1. School-age children need breakfast to provide
enough energy to get them through active
mornings at school
2. If children take a packed lunch to school, urge
parents to allow child some say in the meal
3. Urge parents to make the after-school snack
nutritious
4. Teach parents to make every attempt to make
mealtime a happy and enjoyable part of the day
for everyone
Fostering Industry
1. They enjoy helping to plan meals
2. Most parents would like children to develop
better table manners
Recommended Dietary Reference Intakes
1. Both girls and boys require more iron in
prepuberty than they did between the ages of 7
and 10
2. Adequate calcium and fluoride intake remain
important to ensure good teeth and bone
growth
Promoting Development of a School-Age Child in Daily
Activities
Dress
1. Teach children the importance of caring for
their own belongings
2. Their clothing styles are often based on the likes
of their friends or a popular sports or rock star
rather than the preferences of their parents
Sleep
1. Younger school-age children typically require 10
to 12 hours of sleep each night, the older ones
require about 8 to 10 hours
Exercise
1. Urge them to participate in some daily exercise,
or else obesity, or osteoporosis later in life, ca
result
Hygiene
1. By age 8, children are generally capable of
bathing themselves
2. Both boys and girls become interested in
showering as they approach their teens
Care of Teeth
1. Should visit the dentist at least twice yearly for
a checkup, cleaning, and possibly a fluoride
treatment to strengthen and harden the tooth
enamel
2. School-age children have to be reminded to
brush their teeth daily
Promoting Healthy Family Functioning
COMMON HEALTH PROBLEMS OF THE SCHOOL-AGE
PERIOD
 The two leading causes of death are accidents
and cancer
 Minor illnesses are largely because of dental
caries, gastrointestinal disturbances, and
upper respiratory infections
 Health maintenance pattern or schedule for a
school-age child is available to maintain health
of a child (look it up at Pillitteri book at table
32.4 p. 874)
Dental Caries
- Progressive, destructive lesions or
decalcification of the tooth enamel and dentin
- When pH of the tooth drops to 5.6 or below,
acid microorganisms found in dental plaque
attack the cementing medium of the teeth and
destroy it
- The enamel on primary teeth is thinner than on
permanent teeth, so they are more susceptible
to destruction than permanent teeth
Malocclusion
- The upper jaw in children matures rapidly than
the lower jaw so sometimes it forces the teeth
to make a prolonged series of changes until
they reach their final adult alignment and
position
- Malocclusion is a deviation of tooth position
from the normal
- May be crossbite (sideways) or anterior or
posterior
- Children should be evaluated by an orthodontist
to see if orthodontic braces or other therapy is
necessary
- Some children develop mild, shallow ulcerations
on the buccal membrane from the friction of
metal wires, rubbing the wire with dental wax
can give relief
- Oral acetaminophen or an agent such as Orajel
rubbed on the ulceration may also offer relief
Concerns and Problems of the School-Age Period
- One of the most important disorders of the
school-age period is attention-
deficit/hyperactivity disorder because it
interferes so dramatically with school progress
- Other problems concern language, fears and
responsibility
Problems Associated with Language Development
- The most common problem is articulation
- Difficulty pronouncing s, z, th, l, r, and w or
substitutes for r (“westroom” instead of
“restroom”) or r for l (“radies’ room” instead of
“ladies’ room”)
- Most noticeable during the first and second
grades; it usually disappears by the third grade
- If it persists, speech therapy may be needed for
the child
Common Fears and Anxieties of the School-Age Child
1. Anxiety Related to Beginning School
- A health assessment should include an inquiry
about progress in school
- One of the biggest tasks is learning to read so it
is best for parents to prepare their child as early
as infancy, pointing to the words and pictures as
they read
- This helps children that sentences flow from left
to right, and that the words, not the pictures,
tell the story
- Sometimes children may develop “pseudo
sophistication”, they might present a mature
behavior at school but when they return home
they start biting their nails, suck their thumb or
baby talk
- This stops when the underlying stress is
alleviated
2. School refusal or Phobia
- Fear of attending school
- Similar to agoraphobia (fear of going outside
the home)
- Children resist attending school and they
develop physical signs of illness such as
vomiting, diarrhea, headache, or abdominal
pain on school days
- This fear may occur from fear of separation
from parents, the child may be overly
dependent to the parents or reluctant to leave
home because of worry that younger sibling will
usurp the parent’s affection, it can also be that
the parents are overly protective of the child
- Requires coordination between the parent,
school nurse and the healthcare provider who
identifies the problem
3. Home Schooling
- When discussing homeschooling with parents,
assess if children have peer experiences, ask if
they have exposure to other culture of families,
so they can better adjust to people different
from themselves later on at college or at a job
4. Latchkey Children
- Children without adult supervision for a part of
each weekdays
- The major concern is that of they are alone is
that they will experience an increased number
of unintentional injuries, delinquent behavior,
alcohol or substance abuse or decreased school
performance due to lack of adult supervision
 5. Sex Education - Help children to plan ways they could be
- It is important to be educated about sexual comfortable in social food-based settings such
changes during puberty as bringing a party snack that is easily eaten and
6. Stealing appropriate for the child, or politely declining
- Most children go through a period during which particular foods
they steal loose change from their mother’s - Help children to select a diet that is enjoyable as
purse of father’s dresser well as nutritious
- Usually happens at 7 or 8 years old
7. Violence or Terrorism
- Children view the world as safe so they get
shocked if they see any kind of violence
- Parents should assure children they are safe,
observe for signs of stress, do not let children
watch footage of traumatic events
- Watch news programs with children so it can be
explained what the situation portrays
- Explain that there are bad people in the world,
and bad people do bad things, but not all
people in a particular group or who look a
particular way are bad
- Prepare a family disaster plan
- Designate a rally point where the family will
meet if ever separated
8. Bullying
- A frequent reason for a child to so unhappy
because they experience bullying to the point
they could no longer take such abuse
9. Recreational Drug use
- Once considered as a college or high school
problem, but now illegal drugs are available to
children as early as elementary school because
they are available in so many homes, alcohol,
inhalants and prescription drugs have also
become commonly abused by this age group
10. Children of Alcoholic Parents
- Children feel guilty that they might be the
reason their parents are alcoholic
- Constant worry that their parents will become
sick or die
- A feeling of shame that prevents the child from
inviting friends’ home or asking for help
- Poor nutrition or decreased grades in school
- Anger at the alcoholic parent
- Helplessness to change the situation
11. Obesity
- 50% of school-age children are obese
- Some children gave been obese since infancy
- Obese children may be ridiculed and it may
develop poor self-image

Concerns of the Physically Challenged or Chronically Ill

School-Age Child

- Time lost from school that threatens not only

academic achievement but also children’s
relationships with peers
- Urge parents to assign them household chores
just like other children their age and to allow
them to participate in activities

Nutrition and the Challenged School-Age Child