THE SCHOOL-AGE CHILD AND

FAMILY
FREUD’S PSYCHOSEXUAL THEORY

SCHOOL-AGE CHILD
 Psychosexual stage: Latent stage
 Characteristics:

 Energy is directed to physical and intellectual

activities.
 Sexual impulses tend to be repressed. Develop
relationships between peers of the same sex.
 Unresolved conflict at this stage can result in
obsessiveness and lack of self-motivation.
 Nursing implications:
 Encourage child with physical and intellectual pursuits.

 Encourage sports and other activities ĉ same sex peers.

 Help children have positive experiences with learning so

their self-esteem continues to grow and they can prepare
for the conflicts of adolescent.
ERIKSON’S THEORY OF PSYCHOSOCIAL
DEVELOPMENT

SCHOOL-AGE CHILD
 Developmental Task: Industry vs. Inferiority. Child
learns how to do things well.
 Nursing Implications:

1. To build confidence, recognize the child’s

accomplishments.
2. Unrealistic expectation or excessively harsh criticism
leads to a sense of inadequacy.
3. Provide opportunities such as allowing child to
assemble and complete a short project so that child feels
rewarded for accomplishment.
 PREOPERATIONAL THOUGHT
 Age span: 2-7 years (emerging ability to think)
 Nursing Implications:
o Thought becomes more symbolic; can arrive at answers
mentally instead through physical attempt.
o Comprehends simple abstractions but thinking is basically
concrete and literal.
o Child is egocentric (unable to see the viewpoint of another)
o Displays static thinking(inability to remember what they
started to talk about so that at the end of a sentence children are
talking of another topic)
 Nursing implications:
 Concept of time is now, and concept of distance is only as far
as they can see.
 Centering or focusing on a single aspect of an object causes
distorted reasoning.
 No awareness of reversibility(for every action there is an
opposite action) is present.
 Unable to state cause-effect relationships, categories, or
abstractions.
 Good toy for this period: items that require imagination, such
as modeling clay.
 CONCRETE OPERATIONAL THOUGHT
 Age span: 7-12 years
 Nursing implications:

 Concrete operations includes systematic reasoning.

 Uses memory to learn broad concepts (fruits) and subgroups of

concepts (apples, oranges).
 Classifications involve sorting objects according to attributes
such as color; seriation, in which objects are ordered according
to increasing or decreasing measures such as weight;
multiplication, in which objects are simultaneously classified
and seriated using weight.
 Nursing implications:
 Child is aware of reversibility, an opposite operation or
continuation of reasoning back to a starting point (follows a
route through a maze and then reverses steps).
 Understands conservation, sees constancy despite
transformation (mass or quantity remains the same even if it
changes shape or position).
 Good activity for this period: collecting and classifying natural
objects such as native plants, sea shells, etc.
 Expose child to other view points by asking questions such as,
“How do you think you’d feel if you were a nurse and had a
boy to stay in bed?”
SCHOOL-AGE YEARS OR SCHOOL
YEARS(6-12 YEARS OLD)
 This period begins with entrance into the school
environment, which has a significant impact on
development and relationships.
 Physiologically the middle years begin with the
shedding of the first deciduous tooth and end at
puberty with the acquisition of the final permanent
teeth (with the exception of the wisdom tooth).
 Middle childhood is a time of gradual growth and
development with more even progress in both
physical and emotional aspects.
 BIOLOGIC DEVELOPMENT
 Growth in height and weight assumes a slower but
steady pace as compared with the earlier years.
 Between ages 6 and 12, children will grow an average
of 5cm (2 inches) per year to gain 30-60 cm (1-2 feet)
in height and will almost double their weight,
increasing 2 to 3 kg (4 ½ to 6 ½ pounds) per year.
 The average 6-year-old child is about 116 cm (45
inches) tall and weighs about 21 kg (46 lbs.)
 The average 12-year-old child is about 150 cm (59
inches) tall and weighs approximately 40 kg (88 lbs.)
 During this period, girls and boys differ very 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, to the acute
discomfort of both girls and boys.
 PROPORTIONAL 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 proportions, and a slower center of gravity.

 Posture is improves over that of the preschool period to

facilitate locomotion and efficiency in using the arms and

trunk.
 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 related to
the height.
 FACIAL CHANGES

 The skull and brain grow very slowly during this period
and increase little in size.
 Middle childhood is sometimes known as the age of the
loose tooth.
 The early years of middle childhood, when the new
secondary (permanent) teeth appear too large for the
face, are known as the ugly duckling stage.
ACQUISITION OF SKILLS
 School-age children demonstrate increasing fine motor
abilities and complex artistic skills.
 Handedness is well established by the beginning of the
school years and children make great strides in writing
and drawing during this period.
 It is a time of creative and vibrant creative productivity.
 With the tools of language and reading, children create
poems, stories and plays.
 With more advanced fine motor skills, they are able to
master an unlimited variety of handicrafts such as
needlework, beadwork, etc.
 School-age children are capable of assuming
responsibility for their own needs, although their
distaste for soap and water and “dress” clothes is
legendary.
 School-age children can and want to assume their share
of household tasks, which usually are related to the
male and female roles that have been defined by their
culture.
 Many children also assume many tasks outside the
home such as baby-sitting, etc.
MOTOR/SENSORY DEVELOPMENT
 Bone growth faster than muscle and ligament
development
 Susceptible to greenstick fractures

 Movements become more limber, graceful, and

coordinated
 Have greater stamina and energy

 Vision 20/20 by 6 to 7 years; myopia may appear by 8

years
COPING WITH CONCERNS
RELATED TO NORMAL GROWTH
AND DEVELOPMENT OF THE
CHILD
SCHOOL EXPERIENCE
 The school serves as the agent for transmitting the
values of the society to each succeeding generation of
children.
 School is also the setting for relationships with peers.
 After the family, the school is the second most
important socializing agent in the lives of children.
 Successful adjustment to school is related to the
physical and emotional maturity of the child and to the
parent’s readiness to accept the separation associated
with school entrance.
 TEACHERS
 Children respond best to teachers who possess the
characteristics of a warm, loving parent.
 Teachers in the early grade performs many of the activities
formerly assumed by the parent such as recognizing the
child’s personal needs and helping to develop their social
behavior (e.g., manners).
 Teachers, like parents are concerned about the psychologic
and emotional welfare of the child.
 Teachers may serve as models that children try to emulate.
 PARENTS
 Parents share responsibility for helping children achieve
their maximum potential.
 Cultivating responsibility is the goal of parental
assistance.
 Being responsible for school works help children learn to
keep promises, meet deadlines, and succeed at their jobs
as adults.
 Responsible children may occasionally ask for help, but
usually they prefer to think through their work by
themselves.
 Excessive pressure or lack of encouragement from parents
may inhibit the development of desirable traits.
Dishonest behavior

A. LYING
B. CHEATING
C. STEALING
1. LYING
During middle childhood, children become able to
distinguish between fact and fantasy. If children do not
develop this characteristic, parents need to teach them
what is real and what is make believe.
Young children may lie to escape punishment or to get out
of some difficulty even when their misbehavior is very
evident.
Older children may lie to meet the expectations set by
others to which they have been unable to measure up.
 Parents need to be reassured that all children lie
sometimes and that sometimes they may have difficulty
separating fantasy from reality.
 Parents should be helped to understand the importance of
being truthful in their relationships with children.
2. CHEATING

 Most common in young children 5-6 years of age.

 They find it difficult to lose at a game or contest, and so
they cheat to win.
 They have not acquired the realization that this behavior is
wrong, and they do it almost automatically.
 This behavior usually disappears as they mature.
 Children model observed behaviors, parents need to be
aware of their own behavior. When parents set examples
of honesty, children are more likely to conform to these
standards.
3. STEALING
 This is not an unexpected event in the younger child.
 Between 5 and 8 years of age, children’s sense of property
rights is limited and they tend to take something simply
because they are attracted to it or to take money for what
it will buy.
 They are likely to give something that is valuable to them.
 When young children are caught and punished, they are
penitent-they “didn’t mean to” and “promise never to do
it again”- but it is quite likely that they will repeat the
performance the following day.
 Often they don’t only steal but also lie about their
behavior or attempt to justify it with excuses.
 Children do not take responsibility for these behavior
until the end middle childhood.
REASONS:
 Young children may lack a sense of property rights or
attempt to acquire a specific object to bribe favors from
other children.
 A strong desire to own a coveted item, or a desire for
revenge ( to “get back at someone,” usually a parent for
unfair treatment)
 Older children may steal to supplement an inadequate
allowance.
 However stealing can be an indication that something
is seriously wrong or lacking in the child’s life. Ex.
Children may steal to make up for love or another
satisfaction that they feel is lacking.
MANAGEMENT
 It is seldom helpful to trap children into admission by
asking directly if they committed the offense.
 In most situations it is wise not to attempt to find a
hidden or deep meaning to the stealing.
 An admonition, together with an appropriate and
reasonable punishment, such as having the older child
pay back the money or return the stolen items, usually
takes care of the most cases.
 Most children can be taught to respect the property
rights of others with little difficulty despite numerous
temptations and opportunities.
 If children’s personal rights are respected, they are
likely to respect the rights of others.
 Some children simply need more time to learn the rules
regarding private property.
BULLYING
 Supervise recreation closely
 Intervene immediately to stop bullying

 Involve the parents and school if behavior will not stop.

 Advice parents to discuss bullying with their child and

help them understand that it should be reported to allow
adults to intervene.
 Parents should monitor their child’s social media and
texting interactions.
LIMIT SETTING AND DISCIPLINE
 Nurturant caregivers place discipline in a warm,
supportive, and empathetic relationship with their school-
aged child.
 By providing clear limits of behavior and positive
reinforcement for good behavior, the caregiver is better
able to help the child develop self-confidence.
 Implicit in discipline approaches is a fundamental
attitude toward the child.
 Taking the child seriously and treating the child as a
person whose feelings and questions matter is critical.
 The child’s preference, however, cannot always be
accommodated but should be considered and never
dismissed.
 The school-aged child is someone with a distinctive point of
view and unique set of needs. The caregiver needs to be not
only warm and empathetic but also needs to model for school-
aged child the values of honesty and prosocial
behavior(helping, caring ,sharing).
 Reasoning capabilities of the child are being developed, so
talking about and explaining a negative behavior or act should
be encouraged.
 Withdrawing privileges is often a satisfying method of
discipline.
 STRESS
 Sources:
 1. Conflict within the family

 2. Interpersonal relationships

 3. Poverty

 4. Chronic illness

 5. School environment
 To help children cope with stress, parents, teachers and
health care providers must:
 1. recognize signs that indicate a child undergoing
stress.
 2. promptly identify the source of stress.

 3. refer those children who need specialized treatment.

WORDS OR PHRASES USED BY
CHILDREN TO DESCRIBE THEIR
BODY’S REACTION TO STRESS
 Tight muscles
 Hot or red in the face

 Tingling

 Chills or goose bumps

 Shakiness

 Heart beating fast

 Headache

 Stomachache
MANAGEMENT
 Children should be taught to recognize the signs as
indicators of stress and to use techniques to manage their
stress.
 Parents can help to problem solve and to develop a plan
to cope with stress.
 Age appropriate chores are an excellent way to teach
children to face problems and learn to solve them.
FEAR
 Fears considered as normal for school-age children:
1. Fear of the dark
2. Excessive worry about past behavior
3. Self-consciousness
4. Social withdrawal
5. Excessive need for reassurance
 During the middle school years, children become less
fearful of body safety than they were as preschoolers,
but they still fear being hurt, being kidnapped, or
having to undergo surgery.
 They also fear death and are fascinated by all aspects of
death and dying.
 The fears of noises, darkness, storms, and dogs lessen,
but new fears related predominantly to school and
family bother children during this time.
TV, VIDEO GAMES AND INTERNET
 1. limit media time
 2. monitor content

 3. Increase access to games and information that are

educational
PROMOTING OPTIMUM
HEALTH OF A SCHOOL-AGE
CHILD
 NUTRITION
 Caloric needs are diminished in relation to body size
during middle childhood but resources are laid down
for growth needs of adolescence.
 Parents as well as children need to be aware of the
value of balanced diet to promote growth, because
children usually eat what their family members eat.
 The quality of child’s diet depends on the family’s
patterns of eating.
 Likes and dislikes established at an early age continue in
middle childhood, although preferences for single foods
subside, and children develop a taste for a variety of foods.
 The easy availability of fast-food restaurants, the influence of
mass media, and the temptation of junk foods make it easy for
children to fill up on empty calories.
 Foods that do not promote growth, such as sugars, starches, and
excess fats, are common in school-age diet.
 The easy availability of high-calorie foods, combined with the
tendency toward more sedentary activities, has also contributed
to an epidemic of childhood obesity.
MANAGEMENT
 Parents should monitor what their children eat when they
are away from home.
 Nutrition education should be integrated in the
curriculum through-out the school years.
 SLEEP AND REST
 The amount of sleep and rest required is highly
individualized.
 The amount of sleep depends on the child’s age, activity
level and state of health.
 School-age children usually do not require a nap, and
they sleep approximately 9 ½ hours at night.
MANAGEMENT OF BEDTIME
PROBLEMS
 Encourage quiet activity before bedtime such as coloring
or reading.
 Remind children frequently to go to bed esp. 8-11 year
old children
 EXERCISE AND ACTIVITY
Appropriate activities during school-age years are:
 Running

 Jumping rope

 Swimming

 Skating

 Dancing

 Bicycle riding
PLAY (COOPERATIVE)
 Comprehends rules and rituals of games
 Enjoys team play; helps learn values and develop sense
of accomplishment
 Enjoys athletic activities
 Provide construction toys: puzzles, erector sets, legos
 Good eye/hand coordination: interested in video and
computer games (needs monitoring and time limits with
this activity)
 Enjoys music, adventures stories, competitive activities
 Children with disabling condition or those who hesitate
to involve in active play require special assessment and
help so that activities that appeal to them, and that are
compatible with their limitations while also meeting
their developmental needs, can be determined.
 SPORTS
 School-age children enjoy competition. However,
teachers and coaches must understand their physical
limitations and teach them the proper techniques and
safety measures needed to avoid injuries.
 The most unskilled and non competitive child can
participate in safe, appropriate activities.
 Common activities for school-age children include
baseball, soccer, gymnastics and swimming.
 Equipment must be maintained in safe condition, and
protective apparatus should be worn to prevent serious
injury.
 Pre-adolescence is a time to teach fundamental motor
skills, develop fitness in a practical, safe, and gradual
manner; and promote healthy attitudes and values.
 Activities should include both practice sessions and
unstructured play.
 The actual game or event should be managed in a manner
that stresses mastery of the sport and enhancement of self-
image rather than winning or pleasing others.
 All children should have an opportunity to participate, and
special ceremonies should recognize all participants, not
just individuals who excel in sports or athletics.
 DENTAL HEALTH
 The first permanent (secondary) teeth erupt at about 6
years of age, beginning with the 6-year molar, which
erupts posterior to the deciduous molars.
 Other permanent teeth appear in approximately the same
order as eruption of the primary teeth and follow shedding
of the deciduous teeth.
 With the appearance of the second permanent (12- year
molar), most permanent teeth are present.
 Permanent dentition is more advanced in girls than in
boys.
 Correct brushing techniques should be taught or
reinforced.
 Be alert to possible malocclusion problems that may result
from irregular eruption of permanent teeth and that may
impair function.
 The most effective means of preventing dental caries is
proper oral hygiene.
 Teeth should be brushed after meals, after snacks, and at
bedtime.
 The best toothbrush for school-age child is one with soft
nylon bristles and an overall length of about 21 cm (6
inches).
 Flossing follows brushing.
 SEX EDUCATION
 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.
 Children are experimentalist by nature, and sex play is
incidental and transitory.
 Any adverse emotional consequences or guilt feelings
depend on how behavior is managed by the parents, if it is
discovered, or whether children view their actions as
wrong in the eyes of significant persons, particularly the
parents.
 Middle childhood is an ideal time for formal sex
education, and many authorities believe that the topic is
first presented from a life-span approach.
 Information about sexual maturation and the process of
reproduction helps minimize the child’s uncertainty,
embarrassment and feelings of isolation that often
accompany puberty.
 An important part 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 transmitted and exchanged in secret
conversation and contains a large amount of
misinformation.
NURSES ROLE IN SEX EDUCATION
 Sex should be treated as normal part of growth and
development.
 Questions should be answered honestly, matter-of-
factly, and to same extent as questions bout other
topics.
 Answers should be at the child’s level of understanding.
 There may be at times when boys and girls should be
taught content separately.
 Children need explanations of sexual information that is
provided via media or jokes.
HYGIENE
 6-7 yrs. – still need help in regulating bath water temp.
and in cleaning their ears and fingernails.
 8 yrs. – capable of bathing but may not do it because
they are too busy to take the time or they do not find
bathing as important as do their parents.
 Note: both boys and girls become interested in
showering as they approach their teen years.
DRESSING
 They are not skilled in taking care of their own clothes
until late school-age.
 This is the right age for teaching children the importance
of caring for their own belongings.
INJURY
PREVENTION
MOTOR VEHICLE ACCIDENTS
1. educate child regarding proper use of seat belts.
2. maintain discipline while a passenger in a vehicle.
3. Emphasize safe pedestrian behaviors.
4. insist on wearing safety apparels.
DROWNING
 1. Teach child to swim
 2. teach basic rules of water safety
 3. select safe and supervised places to swim
 4. check sufficient water depth for diving
 5. swim with companion
 6. use an approved flotation device in water or boat
 7. advocate for legislation requiring fencing around
pools.
 8. Learn CPR
BURNS
 1. make sure smoke detectors are at home.
 2. set water heaters to 48.9 degree Celsius to avoid scald
burns.
 3. instruct child in behavior in areas involving contact with
potential burn hazards.
 4. instruct child in proper behavior in the event of fire.

 5. teach child safe cooking.

POISONING
 1. educate child regarding hazards of taking
nonprescription drugs and chemicals including aspirin
and alcohol.
 2. teach child to say “no” if offered illegal or dangerous
drugs or alcohols.
 3. keep potentially dangerous products in properly
labeled receptacles preferably out of reach.
BODILY DAMAGE
 1. encourage playing in safe places.
 2. keep firearms safely locked up except during adult
supervision.
 3. teach proper care of, use of, and respect for devices
with potential danger.
 4. teach children not to tease or surprise dogs, invade their
territory, take dogs’ toys or interfere dogs’ feeding.
 5. Teach safety regarding use of corrective
devices(glasses); if child wears contact lenses, monitor
duration of wear to prevent corneal damage.
 6. Caution against engaging in hazardous sports.
 7. teach name, address, and phone number and
emphasize that child should ask for help in an
appropriate person.
 8. Teach stranger safety

 9. emphasize proper conditioning, safe practices and use

of safety equipment for sports or recreational activities.