WEEK 16

THE FAMILY WITH A SCHOOL AGED CHILD

The family with a School- Aged Child
The Nursing Process:
1. Assessment:
 Interview: history questioning on school progress and extracurricular activities
 They are capable to contribute to their own health history
 they can be interviewed with or without their parents
 During physical assessment, be alert on the child’s privacy
 Parents concern: children are showing behavioral issues or conflicts, they begin to
express their own opinions and beliefs
2.Nursing Diagnosis:
 Health seeking behaviors related to normal school age growth and development
 Readiness for enhanced parenting related to improved family living conditions
 Anxiety related to slow growth pattern of child
 Risk for injury related to deficient parental knowledge about safety precautions for
a school- age
3.Outcome identification and Planning
1. Remember: they enjoy small or short-term projects rather than long
2. Identify first the problems such as behavioral problems as part of normal growth and
development
3. Parents can be referred to helpful websites and other resources when appropriate.
4.Implementation:
They are interested in learning adult role
They are interested in knowing the “hows” and “whys” of actions: they will not cooperate
with the procedure until they are given a satisfactory explanation of why it must be done
4.Outcome Evaluation
• Attending yearly health visits covering physical and psychosocial development
Parent states that he permits the child to make his own age-related decisions
Child identifies books he has read together with parents in the past 2 weeks
Child states he understands the variations of growth as related to the growth chart
Child does not sustain injuries from sports activities
I. Physical Assessment/Development: 6-12 y/o
 Annual weight gain: 3 to 5 lbs (1.3 -2.2 kg)
 Increase in height: 1-2 inches ( 2.5 50 5cm)
 No more lordosis and knock-kneeled appearance
 10 y/o: brain growth is complete- with refined fine motor coordination
 VISION: adult vision is achieved: 20/20
 Malocclusion with teeth malalignment may be observed if the eruption
of permanent teeth and growth of the jaw do not correlate with final
head growth.
 No more deciduous teeth/ 28 teeth are present between 6 and 12 years
of age
 Immune globulins IgG and IgA
 *SEXUAL MATURATION:
During Brain Maturity

Hypothalamus: transmits enzyme

APG (Anterior Pituitary Gland)

Production of gonadotropic hormones

Activates changes in testes and ovaries to cause puberty (stage of life at which secondary
sex changes begin)
Onset and length to pass through this period vary widely
Sexual maturation in girls: 12-18 y/o
Sexual maturity in boys: 14-20 y/o
Not unusual to discover more than half of the girls of 11 y/o sixth graders are already
menstruating
Sex education in school and through parental guidance can be introduced using materials on
this.
Parents can discuss physical changes and the sexual responsibility these changes dictate.
Reinforce teaching with children that their body is their own to be used in the way they
choose
In both sexes: under the influence of androgen, sebaceous glands more active causing acne
CONCERNS OF GIRLS:
Conscious on breast development
Preparation for menstruation-normal function that occurs every month/ emphasize on
personal hygiene/can use sanitary napkin or tampons (take precautions to avoid toxic shock
syndrome (an infection caused by Staphyloccocus aureus)
Vaginal secretions will begin to be present
Irregular periods, dysmenorrhea; if continues beyond year, check on her nutrition, overall
health
Concerns of boys:
Increasing genital size: start sharing information on testicular development precedes penis
growth
Gynecomastia(hypertrophy of breast) if obese
Growth of pubic hair but not beard or mustache
Ejaculation during sleep – due to increased seminal fluid produces also known as nocturnal
emissions
Concerns of Transgender Children
Children identify themselves that is not their natal (sex assigned at birth)
Mental health of transgender children reported a higher incidence of psychosocial disorders
such as depression
Children who are supported by the parent may have less anxiety and depression
Transgender who are treated unique and with respect just like other children who are not
transgenders are most likely to adapt a healthy child development
The family with school-aged child
6.Psychoscial Development by Erick Erickson:
Development task: Industry V/S Inferiority
 Attempt to master their new developmental step
 Learning as a sense of initiative; learning how to do things, gaining a sense of industry by
learning how to do well
 If children are prevented from achieving this, or do not receive rewards for
accomplishment, they can develop a feeling of inferiority or believe they cannot do
anything on their own
Home as a Setting to learn activity
 Children 8 & 9 y/o begin to spend more and more time with their peers and less time with
their family
 Forget household chores they once enjoyed , a sign of independence away from the parents
and into the larger world
 A sign of new role the child is trying out
a.School as a setting to learn industry
Adjusting to and achieving in school are two of the major tasks : topics on sex, safety,
avoidance of substances of abuse and preparation for family living are discussed by teachers
and making these experiences fun, enjoyable and encourage a child to plunge into new
experience
b.Structural activities: Boy Scouts, Girl Scouts
c.Problem Solving: parents and teachers can help by encouraging practice. Showing possible
ways on how to solve problems rather than showing the solutions at hand
d.Learning to live with others: teach children the art of compassion and thoughtfulness
towards others in the early years when children are exposed to large groups of other
youngsters: writing thank you letters, helping someone with loads of things on hand, learning
to give a present without receiving one in return, doing a favor without expecting a reward;
thought by examples/role modeling
Teaching children to learn to put themselves in another shoe
e.Socialization
6 y/o: play in groups but when they are tired or under stress, they usually prefer
one to one contact
7y/o: aware of family roles and responsibility
Promises must be kept because they view as definite, firm commitments
8y/o: seek the company of other children
Girls have close girlfriend and boys have a close boyfriend
9 y/o: values peer group very seriously
Interested in how other children dress than what their parents want them to
wear; typically the friend or club age because children form groups usually “spite
clubs”, meaning if there are four girls in the block, three will form a group and
exclude the fourth
• They have a secret password and secret meetings
• Membership is generally all girls or all boys
The family with a School-Aged Child
7.Cognitive Development:
 Children a can use concrete operational thought because they learn several new
concepts during school age:
a. Decentering – the ability to project one’s self into other people’s situations and see
the world from their view point rather than focusing only on their own view.
Example: if a child is offered with two lollipops, he or she might choose based on how
one flavor is better than the other even though the other is the same size and color.
b.Accomodation- the ability to adapt thought processes to fit what is perceived such as
understanding that there can be more than one reason for other people’s action.
Example:
 Preschooler might expect to see the same nurse in the morning who was there the
evening before
 School –aged child will understand that different nurses work different shifts
c,Conservation- the ability to appreciate that a change in shape does not necessarily
mean a change in size.
Example: the bigger the size or height or length, the biggest the amount there is
d. Class Inclusion:
The ability to understand that objects can belong to a more than one
classification
Example: preschooler: stones and shells can be found in the beach
School aged child can categorize them in many ways
The family with a School-Age Child
2.Motor Development
a.Gross Motor Development:
* 6 y/o – endlessly jumps, rumble, skip and hop
 Have the coordination to walk a straight line
 Can ride a bicycle
• 7 y/o –appears to be quiet
Play:
 girls: playing more traditional female roles and activities
 Boys: playing more traditional male roles and activities
• 8 y/o- more graceful movements
 Rides a bicycle, plays hockey, gymnastics
• 9 y/o – on the go constantly, as if there is a deadline to meet
> Enough eye-hand coordination: baseball, basketball and volleyball
. Fine Motor Development:
6 y/o- tie shoe laces, can cut and paste well
7 y/o – known as the “eraser year”-children are not content with what they
have done, set a high standard for themselves
8 y/o – eyes are developed enough so they can read regular size type
Makes reading and school more enjoyable
Can write script: making cards, letters, or projects
9 y/o – writing becomes more mature and less awkward
The family with school age child
8.Moral Development
Example:
When ask : “why it is wrong to steal from your neighbor?”
School –aged child answers: “The police say it is wrong.,
 They concentrate on the “niceness” or “fairness” of things and cannot see that
stealing would hurt their neighbor, which is the highest level of moral reasoning
 They are limited in their ability to understand other’s views
 They just interpret being right because it is good for them not for humanity as a
whole
 They are also rule oriented
 They believe that if they ask for something, since they were good, they will
receive the favor they are expecting
 A stage known as “preconventional reasoning” , level 1 by Kohlberg.
 Obedience and punishment orientation
The family with a school-age child
4.Language Development:
 6 y/o: talk in full sentences
 Uses language easily and with meaning
 Defining objects with their use
 7 y/o: can tell time by the hours but may have trouble with concepts such as “ half
past” and “quarter to” especially with the prevelance of digital clocks.
 Know the names of the months and can name months in which holidays fall
 Can add and subtract, can go to a store with parent and make simple purchases
 They practice them and show off for family or friends
 9 y/o: learn “dirty jokes” use swear words when angry or show other children that
they are growing up
 Using “bathroom language”: is very common because children are learning
about their bodies and bodily functions.
 > they like the shock value because it gives them power.
How to handle:
Teach them what’s appropriate and not appropriate in public, for
example, “we don’t talk potty talk at the dinner table” and “we only talk
about potty words in the bathroom”
Tell your kids, “we don’t use words bathroom words outside the
bathroom”
Try not to make a big deal about it; if you give it too much attention and
get visibly upset, they will continue to use it.
12 y/o: can carry on adult conversations but stories are limited due to
lack of experiences
The family with a school-age child
Type of Play
 6 y/o- once open to an opportunity to a new world, spends quiet time with books
 Video games: can create a healthy sense of competition or isolation from others
 7 y/o : more props are needed: role models imitating adult activities
• before finger pointing is enough but now they are interested with guns to imitate
a police officer.
• Start a decline in “imaginative” play
 Interested in collecting objects: cards, paper dolls, rocks or marbles
 The type of item is not as important as the quantity
 8 y/o: spent cataloging and sorting those objects collected
 Enjoy helping in the kitchen
 Start to be involved in simple science projects and experimentation
 Enjoys table games but hate to lose, so they avoid competitive games
9 y/o: play hard
Wake in the morning, do some activity before school and plan something the
moment they arrive home again
Have difficulty going to bed at night because they want to play one more game
Want to perfect their skills that’s why conflicts can arise
Begin music lesson
10 y/o- begin to play separately
Begins to be interested in opposite sex
Becomes more interested in rules and fairness; gives younger children breaks in
games
Club activities become more structured: with president, vice president, secretary,
etc.
11 & 12 y/o: enjoy dancing and playing table games
Talking with friends
Doing jobs in the house for money
The family with a school age child
Promoting Nutritional Health of School-Age Child
 They have good appetites
 Encourage to eat healthy breakfast to ensure the ability to concentrate on
the school activity
 Parents: role modeling
 Encourage children to help in preparing a nutritious lunch to take school
 If to purchase from school, healthy choices should be encouraged
• milk (8 oz)
• Protein (2 oz)
• 1 starch serving
• Vegetable (3/4 cup)
• Fruit (3/4 cup)
• Food allergies- use allergy free-table at school
Fostering Industry and nutrition
Children can prepare simple meals with healthy ingredients
Development of proper etiquette in the school age years
Parents: role modelling
Encourage to ear at the table instead while watching television-can lead to obesity
Recommended Dietary Intakes
Iron requirements for both boys and girls between ages of 7 – 10 years
Calcium and fluoride intake remains important to ensure good teeth and bone growth
Vegetarian Diet
Must learn how to obtain nutrients whether they pack their lunch or purchase it at
school
Choices:
> Green leafy vegetables
Breads and cereals
Protein: soy beans, legumes, grains, green peas and corn
Encourage outside activities-for sun exposure to increase vit D
Supplemental iron for girls with heavy menstrual flow
The family with school age child
Promoting Healthy Family Functioning
 Children quotes their teacher as the final authority on all subjects
 Children also cite their friends as guides for behavior
 Parents must remember that even simple tasks at home needs repeated practice before
they can be accomplished well
 Find redeeming characteristics in a project
Common Health Problems:
1. Dental caries – are progressive, destructive lesions or decalcification of the tooth enamel
and dentin
 Can be prevented with proper brushing, fluoridated water or fluoride application
 Dental visits every 6 months
 Sealants can be applied at dental visits to lessen the development of dental decay
Concerns and problems of the schoolage child
On language development
• Broken fluency – articulation: r for l; s, z, th, l, r and w
• Common during the 1st and and grade but disappears by the 3rd grade
• If persists, consult a speech therapy
Common Fears
1. Anxiety related to beginning school
2. School refusal or phobia
• Fear of attending school
• “social phobia” also known as “agoraphobia” or fear of going outside the home or
separation anxiety disorder
Cause:
Harsh teacher
Facing a class bully everyday
Mgt: counseling
3.Violence or terrorism
Mgt:
Assure children they are safe
Observe for signs of stress such as sleep disturbance, fatigue, lack of
pleasure in activities or signs of beginning substance abuse
Do not allow children to watch traumatic footage over and over again
 watch news with children so parents can explain that the event is far
from them and that they are safe
Explain that there are bad people in the world and bad people do bad
things but not all people are bad
Prepare emergency things
Designate a “rally point”
4.Bullying
Safety Points for Children
1. Always lock doors and never show keys to others or indicate you stay home
alone
2. When answering a phone, say a parent is busy, not absent from home
3. Have a plan in the event your key is lost; stay with the neighborhood
4. Don’t go into the house if the door is broken or open or if window is broken
5. Learn fire safety
6. Check in with parents by telephone or lap tap when you first arrive home
7. Identify a caller before opening the door. Agree on a secret code
8. Learn how to change light bulbs safely if it will be dark before parents return
home
9. Learn how to report a fire and telephone police
Safety Responsibilities for Parents:
1.Prepare a safety kit, flashlight.
2. Plan after school snacks that do not require cooking to prevent burns
3. Keep firearms locked
4.Arrange with a neighbor who is usually home during the late afternoon for
the child to stay there in an emergency
5.If an older child watching a younger one, be certain both children
understand the rules laid down and the degree of responsibility expected
6.Be certain the child understands the rules that apply during other times
also apply during independent time.
Parental Actions to prevent Loneliness:
1. Leave messages on the refrigerator or bathroom that just say “HI”
2. Leave a tape or video recorded messages for the child to play when
she or he first arrives home , make sure it is not full of tasks
3. Be certain to make parent-child time available after work
4. Allow special privileges
5. Consider getting a pet
6. Call the child if there will be a delay in arriving home
7.Encourage the child to read
8.Urge the child to network with other children who spend time alone as to
how they use time effectively
Parental Actions to Increase Self-esteem
1. Praise the child for the ability to take care of himself.
2. Walk with the child through the empty house and together identify
sounds
3. Help the child to view the quiet as a beneficial time in which they can
do some things more efficiently such as home work
4. Do not allow child to use their time alone role to provoke parental guilt.