HEALTH PROMOTION OF THE

SCHOOL-AGE CHILD AND FAMILY

(6-12 Y.O)
LATE CHILDHOOD

• Age: 6-12 years old

• Conflict – Industry vs. inferiority
• Physical development– slow but steady. Muscle coordination
is well developed and children can engage in physical activity
that require complex motor-sensory coordination
• Mental development – developing quickly and much of the
child’s life centers around school. Reading and writing skills
are learned, understand abstract concepts like honesty, loyalty,
values and morals
LATE CHILDHOOD

• Emotional development -- the child achieves greater

independence and a more distinct personality. Fears are
replaced by the ability to cope.
• Social development – changes from activities by themselves
to more group oriented. They are more ready to accept the
opinions of others and learn to conform to rules, and standards
of behavior. Needs are the same as infancy and early
childhood along with the need for reassurance, parental
approval, and peer acceptance.
BIOLOGIC DEVELOPMENT

• PHYSICAL GROWTH GETS SLOW

• Between 6 and 12 years old, children grow an average of 5 cm (2
inches) per year
• Almost double their weight, increasing 2 to 3 kg (4.4 to 6.6 pounds)
per year.
• The average 6-year-old child is about 116 cm (46 inches) tall and
weighs about 21 kg (46 pounds)
• The average 12-year-old child is about 150 cm (59 inches) tall and
weighs approximately 40 kg (88 pounds).
BIOLOGIC DEVELOPMENT

• PHYSICAL GROWTH GETS SLOW

• During this age, girls and boys differ little in size, although
boys tend to be slightly taller and somewhat heavier than
girls.
• Toward the end of the school-age years, both boys and girls
begin to increase in size, although most girls begin to surpass
boys in both height and weight
BIOLOGIC DEVELOPMENT

By 9 years old:
• Lymphatic tissue growth, IgG and IgA in adult level

By 10 years old:
• Complete brain growth, adult vision level, refined motor
coordination
PHYSICAL CHANGES

• School-age children are more graceful than they were

as preschoolers, and they are steadier on their feet.
• Their body proportions take on a slimmer look, with
longer legs, varying body proportion, and a lower
center of gravity.
• More erect posture
PHYSICAL CHANGES

• Fat gradually diminishes

• Eruption of Permanent teeth
PHYSICAL CHANGES

• The most pronounced changes that indicate increasing

maturity in children are a decrease in head
circumference in relation to standing height, a
decrease in waist circumference in relation to height,
and an increase in leg length in relation to height.
• Eruption of Permanent teeth
MATURATION OF SYSTEMS

• Preadolescence is the period that begins toward the end of

middle childhood and ends with the 13th birthday.
• Puberty signals the beginning of the development of secondary
sex characteristics, and prepubescence, the 2-year period that
precedes puberty, typically occurs during preadolescence.
SEXUAL MATURATION

• Puberty onset: 10 -14 years old

• Females: 12 -18 years old
• Males: 14 - 20 years old
DEVELOPMENT OF SECONDARY SEX
CHARACTERISTICS
DEVELOPMENTAL MILESTONES

• Fine Motor:
• Fine motor is refined
• 6 years old: able to tie shoe laces
• 7 years old: “eraser year”; dissatisfaction with
work done
• Writing skills improve
DEVELOPMENTAL MILESTONES

• Fine Motor:
• Fine motor with more focus:
• Building: models – legos
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
DEVELOPMENTAL MILESTONES

• Gross Motor (gender differences)

At 6–8 years, the school–age child:
• Rides a bicycle.
• Runs Jumps, climbs and hops.
• Has improved eye-hand coordination.
• Prints word and learn cursive writing.
• Can brush and comb hair.
DEVELOPMENTAL MILESTONES

At 8–10 years, the school–age child:

• Throws balls skillfully.
• Uses to participate in organized sports.
• Uses both hands independently.
• Handles eating utensils (spoon, fork, knife) skillfully.
DEVELOPMENTAL MILESTONES

At 10–12 years, the school–age child:

• Enjoy all physical activities.
• Continues to improve his motor coordination.
8 to 10 years: team sports
Age 10: match sport to the physical and emotional
development
PLAY

Play involves increased physical skill, intellectual ability, and

fantasy. Belonging to a group is of vital importance.
7 years old:
• decline of imaginative play, as symbolized by use of more props by
playing
• Collecting props for sorting

10 years old:
• Competitive play
COGNITIVE DEVELOPMENT

At 7-11 years, the child now is in the concrete

operational stage of cognitive development..
Greater ability to concentrate and participate in self-
initiating quiet activities that challenge cognitive skills,
such as reading, playing computer and board games.
COGNITIVE DEVELOPMENT (PIAGET)

Concrete operational thought

• When children enter the school years, they begin to acquire the ability
to relate a series of events to mental representations that can be
expressed both verbally and symbolically.
• Thinking is now logical and there is an ability to relate external
events to each other without being egocentric
• Children develop an understanding of relationships between things
and ideas.
SCHOOL PERFORMANCE

• Ask about favorite subject

• How they are doing in school
• Do they like school
• By parent report: any learning difficulties, attention
problems, homework
• Parental expectations
LANGUAGE DEVELOPMENT

• Ability to tell time, simple math

• 9 years old: understand dirty jokes, bathroom language
• 12 years old: development of sense of humor
EMOTIONAL DEVELOPMENT

• Industry vs. Inferiority

• Problem solving skills: exploration for solutions rather
than finding solutions
• Living well with other; empathy
PSYCHOSOCIAL DEVELOPMENT: DEVELOPING A SENSE OF
INDUSTRY (ERIKSON)

INDUSTRY VS INFERIORITY
• A sense of industry, or a sense of accomplishment, occurs somewhere
between 6 years old and adolescence.
• Children need to cope with new social and academic demands. When they are
successful with this, they feel COMPETENT and achieve INDUSTRY.
When they are not successful with handling task, they feel inferior and
develops INFERIORITY
• EGOCENTRISM decreases and importance of RELATIONSHIPS increases.
HOW TO DEVELOP INDUSTRY?

• Children gain satisfaction from independent behavior in exploring

and manipulating their environment and
from interaction with peers. Reinforcement in the form of grades,
material rewards, additional privileges, and recognition provides
encouragement and stimulation.
• A sense of accomplishment also involves the ability to cooperate,
to compete with others, and to cope effectively with people.
HOW TO DEVELOP INDUSTRY?

• Middle childhood is the time when children learn the value of

doing things with others and the benefits derived from
division of labor in the accomplishment of goals.
• Peer approval is a strong motivating power.
• Children achieve a sense of industry when they have
access to tasks that need to be done and they are able to
complete the tasks well
PSYCHOSEXUAL STAGE
LATENCY 6 Y.O. TO PUBERTY

• decrease libido
• less conflict
• sexual urger are suppress or sublimated into other
social activities or channeled into schoolwork, hobbies,
friends
SOCIAL DEVELOPMENT

Peer group identification is an important factor in gaining independence

from parents.
SOCIAL DEVELOPMENT

Conformity is the core of the group structure.

Each child must abide by a standard of behavior established by the
members. Conforming to the rules provides children with feelings of
security and relieves them of the responsibility of making decisions.
By merging their identities with those of their peers, children are able to
move from the family group to an outside group as a step toward seeking
further independence.
SOCIAL DEVELOPMENT

• Bullying is any recurring activity that intends to cause harm, distress, or

control towards another in which there is a perceived imbalance of power
between the aggressor(s) and the victim
• Poor relationships with peers and a lack of group identification can
contribute to bullying.
• Cyberbullying involves an electronic medium to harm or bother another
individual and can be more harmful than traditional bullying, because the
attack can instantly reach a wider audience
DEVELOPING A SELF-CONCEPT:
BODY IMAGE

• Physical impairments, such as hearing or visual defects, ears

that “stick out,” or birthmarks, assume great importance.
• Increasing awareness of these differences, especially when
accompanied by unkind comments and taunts from
others, may cause a child to feel inferior and less
desirable. This is especially true if the defect interferes with
the child's ability to participate in games and activities.
DEVELOPMENT OF SEXUALITY

• Many children experience some form of sex play during or before

preadolescence as a response to normal curiosity, not as a result of love or
sexual urges.
• Any adverse emotional consequences or guilt feelings depend on how the
behavior is managed by the parents.
SEX EDUCATION

• An important component of ongoing sex education is effective

communication with parents.
• If parents either repress the child's sexual curiosity or avoid dealing
with it, the sexual information that the child receives may be acquired
almost entirely from peers.
• When peers are the primary source of sexual information, it is often
transmitted and exchanged in secret conversation and contains
misinformation.
SEX EDUCATION

• Reproductive organ function and physiology of reproduction, so

children understand what menstruation is and why it occurs.
• Secondary sexual characteristics, so children will understand
what is happening in their bodies
• Male sexual functioning, including why the production of
increased amounts of seminal fluid leads to nocturnal emissions
SEX EDUCATION

• The physiology of pregnancy and the possibility for unintended

pregnancies, which will come with sexual maturity
• Social and moral implications of sexual maturity
NURSE'S ROLE IN SEX EDUCATION

• Nurses should treat sex as a normal part of growth and development.

Questions should be answered honestly at the child's level of understanding.
• Exercises on clarifying values, identifying role models, engaging in problem-
solving skills, and practicing responsibility are important to prepare children
for early adolescence and puberty.
• Information about anatomy, pregnancy, contraceptives, and sexually
transmitted diseases, including human immunodeficiency virus and human
papillomavirus, should be presented in simple, accurate terms.
• Nurses can be open and available for questions and discussion
SCHOOL EXPERIENCE

• School serves as the agent for transmitting the values of society

to each succeeding generation of children and as a setting for
many peer relationships. After the family, schools are the
second most important socializing agent in the lives of
children.
• Latchkey children is used to describe children in elementary
school who are left to care for themselves before or after school
without the supervision of an adult.
DISHONEST BEHAVIOR

• Young children may lie to escape punishment or to get out of

some difficulty even when their misbehavior is evident.
• Older children may lie to meet expectations set by others to
which they have been unable to measure up. However, most
children know that lying and cheating are wrong, and they are
concerned when it is observed in their friends. They are quick to
tell on others when they detect cheating.
DISHONEST BEHAVIOR

• They find it difficult to lose at a game or contest, so they

may cheat to win. This behavior usually disappears as they
mature. However, when children observe parental behaviors
such as boasting about cheating, they assume this to be
appropriate behavior. When parents set examples of honesty,
children are more likely to conform to these standards.
STEALING

• Early childhood stealing is best handled without a

great deal of emotion.
• Shoplifting must be taken seriously by parents.
• Parents should set good examples.
VIOLENCE OR TERRORISM

• Assure children they are safe.

• Observe for signs of stress.
• Do not allow children or adolescents to view footage of traumatic
events repeatedly.
• Watch news programs with children; explain the situation portrayed.
• Prepare a family disaster plan; designate a “rally point” to meet if ever
separated.
RECREATIONAL USE OF DRUGS

• 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.
CAUSES OF STRESS AND FEAR

• Stress in childhood comes from a variety of sources:

• conflict within the family
• parental criminality or psychiatric disorder
• low socioeconomic status
• The demands from teachers and parents with school work
and standardized proficiency testing
• Peer pressure, can cause stress on school-age children
CAUSES OF STRESS AND FEAR

• Children in the middle school years are often overcommitted

with activities such as dance, music, athletics, and other
activities until the cumulative effect is overwhelming.
These fears are considered normal for children this age.
• Encouraging them to “blow off steam” through physical activity
reduces tension and anxiety.
DENTAL PROBLEMS

Limited or inadequate dental care results to:

Dental caries, Malocclusion, and Periodontal disease.
Dental caries (cavities) is the principal oral problem in children and
adolescents.
• Is a multifactorial disease involving susceptible teeth, cariogenic microflora,
and an appropriate oral environment.
Intervention
• Oral inspection is an integral part of the physical assessment of every child
DENTAL PROBLEMS

Periodontal disease, an inflammatory and degenerative condition

involving the gums and tissues supporting the teeth, often begins in
childhood and accounts for a significant amount of tooth loss in
adulthood.
The more common periodontal problems are :
Gingivitis (simple inflammation of the gums)
Periodontitis (inflammation of the gums and loss of connective tissue
and bone in the supporting structures of the teeth)
DENTAL PROBLEMS

Intervention
• Management is directed toward prevention by conscientious
brushing and flossing, including the use of fluoride.
• Children should see a dentist at any signs of inflammation or
irritation.
SAFETY

• Allow independence if they can follow the rules

reliably and can occupy ourselves for an hour’s time.
NUTRITION

• Provide healthy snacks

• Allow the child to have a say in meals, allow him to
help prepare and plan meals.
• Right time to improve table manners
DAILY ACTIVITIES

• Teach the child regarding care for belongings

• Debunk beliefs in menstruation/puberty
• Dental visits twice a year
• High protein snacks
• Establish house rules
• Involve in doing house chores
• Strengthen child’s sense of accomplishment
COMMON CONCERS OF SCHOOL AGE
CHILDREN
• Caries
• Progressive destruction decalcification of tooth enamel or dentin because of
proliferation of acidic microorganisms in acidic oral environment
• Malocclusion
• Language development problems
• Common fears: school beginning, bullying
• Obesity
• Sex education (best time)
RED FLAGS: SCHOOL AGE

• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting, animal abuse
• The END