Nursing Care of the Family

with a School-Age Child

Learning Objectives:
1.Know concepts on School-Age child growth and development,
and promotion of health

2. Use critical thinking to analyze methods of care for

school-age child to be certain care is family centered.

3. Assess a school-age child for normal growth and developmental

milestones.

4. Identify areas related to care of a school-age child that

could benefit from additional nursing research or application
of evidence-based practice.
School-Age Child
❑School-age child development describes the expected
physical, emotional, and mental abilities of children
ages 6 to 12.

❑During this time period observable differences in height,

weight and build of children may be prominent.
 Growth and Development
Physical growth
 School-age children’s annual average weight gain is approximately 3
to 5 lbs ( 1.3 to 2.2 kg) ; the increase in height is 1 to 2 inches.
 By 10 years of age, brain growth is complete, so fine motor
coordination becomes refined.
 If the eruption of permanent teeth and growth of the jaw do not
correlate with final head growth, Malocclusion with teeth
malalignment may be present.
 Growth and Development

 Teeth-Deciduous teeth are lost and permanent teeth erupts

during this period, the average child gains 28 teeth between 6 to
12 years of age.
 Growth and Development
Physiologic Changes

 Immunoglobulins IgG and IgA reach adult levels, and lymphatic

tissue continue to grow up until about age 9.
 The left ventricle of the heart enlarges to be strong enough to
pump blood to the growing body. Innocent murmurs may become
apparent because of the extra blood crossing heart valves.
 Pulse rate decreases to 70 to 80 bpm
 BP rises to about 112/60 mm Hg
 Maturation of respiratory system leads to increase O2-CO2
exchange, which increase exertion ability and stamina.
 Growth and Development
Sexual Maturation
 At a set point in brain maturity, the hypothalamus transmits an
enzyme to the anterior pituitary glands to begin production of
Gonadotropic hormones, which activate changes in testes and
ovaries and produce puberty.
 Timing of the onset of puberty varies widely, between 10 and 14
years of age. The length of time it takes to pass through puberty
until sexual maturity is complete also varies.
 Girls- sexual maturity occurs between 12-18 years
 Boys- sexual maturity occurs between 14-20 years
Sexual Physical Concerns:
 The changes in physical appearance that come during puberty can
lead to concerns for both children and parents.
 Girls:
• puberty for girls usually taller about 2 in or more than preadolescent
boys, because their typical growth spurt begins earlier.
• Changes in pelvis contour- misinterpret as gaining weight
• Conscious of breast development- either overdeveloped or
underdeveloped.
• Early preparation of menstruation is important- average age at which
menarche occurs is 12 years of age. Emotions can cause irregularity.
• Dysmenorrhea, vulvar irritation- due to vaginal secretions.
Sexual Physical Concerns:
 Boys:
• Testicular development precedes penis growth.
• Worry that their growth will be inadequate
• Boys should be informed that hypertrophy of breast tissue can
occur in puberty ( gynecomastia )
• Seminal fluid is produced, boys begin to notice ejaculation during
sleep termed as Nocturnal emissions.
• “ premature ejaculation”
 Chronological Development of Secondary Sex
Characteristics
Age Boys

9- 11 years old • Pre pubertal weight gain occurs

11- 12 years old • Spares growth of straight, downy, slightly pigmented hair at
base of penis.
• Scrotum becoming textured; growth of penis and testes
begins
• Sebaceous gland secretion increases

12- 13 years old • Pubic hair present across pubis

• Penis lengthens
• Dramatic linear growth spurt
• Breast enlargement occurs
 Chronological Development of Secondary Sex
Characteristics
Age Girls

9- 11 years old •Breast: elevation of papilla with breast bud formation, areolar
diameter enlarges
11- 12 years old • Straight hair along the labia, vaginal epithelium become
cornified
• pH of vaginal secretions acid; slight mucous vaginal discharge
present
• Sebaceous gland secretions increases
• Perspiration increases
• Dramatic growth spurt
12- 13 years old •Pubic hair grows darker, spreads over entire pubis
•Breast enlarge; still no protrusion of nipples
•Axillary hair present
•Menarche occurs
Developmental Milestones
Gross Motor Development

A school age child’s physical development has

increased considerably at this point.
Gross motor skills such as running, climbing etc. are
of ease and a need of challenging physical activities
are required (such as roller skating, bike riding,
tennis etc.). There is an increase in balance, co-
ordination and a confidence in using and
experimenting with outdoor equipment (monkey bars,
climbing frames, etc.).

School age children can sometimes push the

boundaries in their physical abilities and tend to
have frequent minor accidents during games and
while playing.
 Age Physical Fine Motor Play Psychosocial/
Development Cognitive

6 Year of Easily tie Play continue First grade

Constant shoelace, can to be rough; teacher
motion cut and paste often spend becomes
well; draw momentary authority
people with and quiet figure; school
good detail; can times with activities leads
print but may books to nervous
reverse letter manifestations
of fingernail
biting

Language Development:
- Talks in full sentences using language easily and with meaning
- Still define objects by their use
Age Physical Fine Motor Play Psychosocial/ Cognitive
Development
7 Have enough Eyes Requires A Quiet Year- called “
accuracy in developed more props Eraser Year”- striving for
jumping; skip enough to for play; perfection;
rope well; read collecting Cognitive development- “
difference magazines age begins Conservation and
between sexes Accommodation” can tell
becomes time; make simple
apparent in changes; aware of family
play; spends roles and responsibilities;
time in quiet promises must be kept.
places

Language Development:
-Can tell time in hours
-Can name months
-Can add subtract, make simple changes
Age Physical Fine Motor Play Psychosocial/
Development Cognitive

8 Movements more Learns to Collection more “ Best Friends

graceful; write rather structured; time develops”
coordination than print spent sorting and whispering and
definitely cataloging; enjoys giggling begin; can
improved; playing helping in kitchen; write and print;
with gang becomes becomes more understand concept
important; eyes involved in science of past, present
becomes fully projects and and future
developed experiment; enter
phase of reading
comics

Language Development:
- understand past, present and future
- Interested in dinosaurs and past civilization
Age Physical Fine Motor Play Psychosocial/
Development Development Cognitive
9 All activities Writing Play is “Gang Age” a 9 yr.
done with gang; begins to be hard and old club is formed to
constantly on the more mature rough spite someone; has
go as if they and less secret code,
have deadline to awkward password, secret
meet; have meeting. “ All girls” “
enough eye hand all boys”, gang
coordination disband and reform
quickly
 Psychosocial/
Age Physical Fine Motor Play Cognitive
Development
10 Coordination Many spend Ready for camp
improves; time reading; away home,
secondary sex boys and girls collecting age,
changes develop; play remain like rules, ready
girls usually taller separate at for competitive
than boys; gross 10; interested games; enjoys
motor activity in the privacy (like
declines; becomes opposite sex having their own
less tomboyish; apparent room)
boys interested
in perfecting
sporting skills
Age Physical Fine Play Psychosocial/ Cognitive
Development Motor Development
11 Active but Require more Girls become
awkward and companionship; increasingly interested
ungainly talking in boys and vice versa;
“hanging mixed parties are
around” simply organized rather than
being with single sex parties;
others insecure with members
of opposite sex
 Physical Psychosocial/
Age Development Fine Motor Play Cognitive
Development
12 Coordination A child’s first Enjoy table Year often describe
improves; exposure to reading games & as “lull before the
interested in as a fulfilling & accommodating storm”, child can
participating worthwhile enough to be carry an adult
in sports experience rather able to play conversation;
events; can than just something with younger easygoing manner;
handle to do as an siblings who boys experience
responsibilitie assignment; begins needs rules sexual erection small
s; can carry to evaluate ability modified to provocation & feel
tasks to of her teachers & their uncomfortable being
completion performs at advantage; use pushed into boy- girl
different levels bedroom as situations.
depending on what place to meet
an individual their friends
teacher might like
 Developmental Task

Industry vs Inferiority
During the industry versus inferiority stage,
children become capable of performing
increasingly complex tasks. As a result, they
strive to master new skills. Children who
struggle to develop this sense of competence
may emerge from this stage with feelings of
failure and inferiority.
HOME- as a setting to learn “Sense of Industry “
In Erikson's theory of psychosocial development, industry is a sense
of competence with skills and tasks presented in life.
Children become capable of performing increasingly complex tasks. As
a result, they strive to master new skills.
Children who are encouraged and commended by parents and
teachers develop a feeling of competence and belief in their
abilities.
❑ A school-age child might not accept parents as complete authority.
❑ Parents feel frustrated when school children begins to conform to
rules and “insist on the right way to do things”
❑ At 8 or 9 years, children begin to spend more and more time with
their peers and less time with their families.
❑ Forgot to do household chores.
SCHOOL- as a setting to learn “Sense of Industry “

During the school-age years, children are thinking about

themselves in a new way. They begin evaluating themselves,
their performance and achievements, in addition to comparing
them to their peers.
 Creative activities can encourage your school-age child's
creative play and boost learning and development.
SCHOOL- as a setting to learn “Sense of Industry “

A. Structured activities
❑Girls Scout/Boys Scout, Campfire girls and 4-H club are respected
school age activities.
❑Competitive sports must be evaluated carefully

B. Problem Solving
❑Learn how to solve problems - encourage practice

C. Learning to live with others

- Urge children to learn compassion and thoughtfulness;
developing empathy towards other
❑ Writing “Thank you” letters
❑ Shoveling a neighbor’s sidewalk
❑ Learning to give a present
Socialization:

❑ Six-year-old: play in groups, prefer one-to-one contact

❑ Seven-year-old : increasingly aware of family roles and
responsibility. Promises must be kept, because they view them as
definite, firm commitments.
❑ Eight-year-old: actively seeks the company of other children, close
girlfriends and close boyfriends, share secrets with close friends.
❑ Nine-year-old: take the value of peer group seriously. They are
more interested on how the other children than what their parents
want them to wear. This is typically the “gang age”- form clubs “spite
clubs”
Ex: if there are 4 girls in the block, three form a club and exclude the
fourth- the reason often is unclear.
Socialization:

❑ Ten-year-old: enjoy groups, they also enjoy privacy, they like having
their own room
❑ Eleven-year-old: girls become interested in boys and vise versa.
Favorite activities are mix sex rather than single-sex ones. At this
period, they particularly insecure, feel awkward, uncomfortable.
❑ Twelve–year-old: feel more comfortable in social situations than they
did a year before. Boys feels erection in small provocation
 Cognitive Development
Capable of using Concrete Operational thought because they learn several new
concepts such as:
 Decentering - the ability to project the self into other people’s situation and see
the world from their view point rather than focus only on their view.
 Accommodation - the ability to adapt thought processes to fit what is perceived
(understanding that there can be one or more reason for other
people’s action)
 Conservation - the ability to appreciate that a change in shape does not
necessarily mean a change in size.
 Class inclusion - the ability to understand that objects can belong to more than
one classification.
 Moral and Spiritual Development
Between the ages of 6 and 12 years, a child is in what is known as middle
childhood, the time just before teenage adolescence. His moral development
can involve honesty, loyalty, responsibility, kindness, empathy, respect
and forgiveness.

❑ Children enter a stage of Pre-conventional reasoning sometimes as early

as 5 years old.
❑ They concentrate on fairness and cannot see yet that stealing hurts their
neighbor, the highest level of moral reasoning.
❑ School age children begin to learn about the ritual and meaning behind
their religious practice so that the distinction between right and wrong
becomes more important than they were during preschooler age.
❑ School age children are Rule Oriented- when they pray they expect GOD
to follow rules also. (Makes children of this age confused if a prayer is not
answered immediately).
 Health Promotion for a School-Age
Child and Family
❑Promoting School Age Safety
Motor vehicle accident prevention
❑ Encourage children to use seat belts in a car, model their use
❑ Teach street crossing safety, stress that streets are no place for
roughhousing, pushing or shoving
❑Teach bicycle safety, including advice not to take “passengers” on a
bicycle and to use helmet
❑Teach parking lot and school bus safety
 Health Promotion for a School-Age
Child and Family
 Burns
❑ teach safety with candle, matches, campfires- fire is not
❑ teach safety with beginning cooking skills
❑ teach not to climb electric poles
 Falls
❑ teach that roughhousing on fences, climbing on roofs, etc. is hazardous
❑ teach skateboard safety
 Sports injuries
❑ wearing appropriate equipment for sports
❑ teach not to play to a point of exhaustion or in sport beyond their “physical
❑ capability”
 Health Promotion for a School-Age
Child and Family
 Sexual abuse
 Drowning
❑children should learn how to swim, dares and roughhousing when
diving or swimming are not appropriate
❑teach not to swim beyond limits of capability
 Drugs
❑ Teach to avoid all recreational drugs and to take prescription
medicine only as directed
❑avoid smoking and alcohol
 Firearm
❑Teach safe firearms, parents should keep firearms in locked
cabinets with bullets separate from guns.
Promotion Nutritional Health of a School-Age Child
 School-age children (ages 6 to 12) need healthy foods and
nutritious snacks. They have a steady but slow rate of growth
and usually eat 4 to 5 times a day.
 Recommended Dietary Intake:
❑ Calories
❑ Iron
❑ Calcium and Fluoride
❑ Protein
❑ Vitamin B12 supplements
❑ Also, encourage outside activities for sun exposure to
increase
❑ Vitamin D
Promotion Nutritional Health of a School-Age Child

 School-age children (ages 6 to 12) need healthy foods and nutritious

snacks. They have a steady but slow rate of growth and usually eat 4
to 5 times a day (with snacks). Many food habits, likes, and dislikes
are set during this time. Family, friends, and the media (chiefly TV)
effect their food choices and eating habits.
 School-age children are often willing to eat a wider variety of foods
than their younger siblings. Eating healthy after-school snacks is
important, too, as these snacks may contribute up to one-fourth of
the total calorie intake for the day.
 School-age children usually enjoy helping to plan their meals
Promotion Nutritional Health of a School-Age Child

 Grains. Foods that are made from wheat, rice, oats, cornmeal, barley, or
another cereal grain are grain products. Examples include whole-wheat,
brown rice, and oatmeal. Aim for mostly whole-grains.
 Vegetables. Vary your vegetables. Choose a variety of colorful vegetables,
including dark green, red, and orange vegetables, legumes (peas and beans),
and starchy vegetables.
 Fruits. Any fruit or 100% fruit juice counts as part of the fruit group.
Fruits may be fresh, canned, frozen, or dried, and may be whole, cut up, or
pureed. The American Academy of Pediatrics recommends children age 7
to 18 should limit juice to 8 ounces or 1 cup of juice per day.
 Dairy. Milk products and many foods made from milk are considered part
of this food group. Focus on fat-free or low-fat products, as well as those
that are high in calcium.
 Protein. Go lean on protein. Choose low-fat or lean meats and poultry. Vary
your protein routine. Choose more fish, nuts, seeds, peas, and beans.
Promoting Development of a School-Age Child
in Daily Activities
Dress
❑ Capable of fully dressing
❑ Not capable of taking care of their clothes until later in school age
years.
❑ Have definite opinion about style in clothing
❑ Style of clothing are often based from their friends than
preference of parents
Sleep
❑ Younger school children require 10- 12 hours of sleep per night
❑ Night time terror may continue during the early school years
Exercise
❑ Walking with parents
❑ Bicycle riding
Promoting Development of a School-Age Child
in Daily Activities

Hygiene

❑ 6- 7 years still need help in bathing

❑ age 8- generally capable of bathing themselves but may
not do it well
❑ boys and girls becomes interested in showering

Care of the Teeth

❑ should visit a dentist at least twice a year

❑ need to be reminded to brush their teeth
Common Health Problems of the
School Age Period
 Common Health Problem of the School Age Period

1.Dental Carries
- progressive, destructive lesion or decalcification of tooth enamel
> proper brushing of teeth and use of fluoridated water or fluoride
application
2. Malocclusion
- a deviation from normal, may be congenital and related to conditions
such as cleft palate, a small lower jaw, or familial traits tending towards
malocclusion
- Good teeth occlusion- the upper teeth overlap the lower teeth by small
amount and teeth are evenly spaced and in good alignment
> condition can result from constant mouth breathing or abnormal
tongue position (tongue trusting)
> malocclusion may be either be crossbite
(sideways) or anterior/posterior
Common Problems and Concerns of the School Age Period
1.Problems associated with Language Development
- Common problem is articulation- child has difficulty in
pronouncing s ,z ,th ,l, substitutes w for r and r or for l-
most noticeable during the first and second grade.
2. Common Fears and Anxiety
a. Anxiety related to beginning school
- Big task of 6 year children- is adjusting to school and learn
and how to read
- Health assessment to include inquiry about progress in school
b. School Phobia
- A type of social phobia
- Children may develop a physical signs of illness
- Cause of resistance to school must be determined
- May be fear of separation from parents
- May be reacting to a particular teacher/ situation
 Common Problems and Concerns of the School Age Period

c. Latchkey Children
- Children who are without adult supervision for a part of each weekday.
- The term means- children carrying with them the key to their home
- Boy Scout and Campfire Girls-help children to adjust being alone at home
d. Stealing
- attractive to the younger school-age
- limited sense of what belongs to him commonly lie
- end of middle childhood sign that something is missing/lacking in the
child’s life- causes financial means/attention from parents/sense of
property rights
e. Obesity
- There should be an active exercise program
- Counseling program to discuss aspects such as self image and motivation to
reduce weight.
Common Problems and Concerns of the School Age Period

f. Violence /Terrorism
- School shooting/terrorists
- Assure children their parents are actively involved in
keeping them safe
- Observe for signs of stress
- No footage of traumatic events
- Watch news program with children
Common Problems and Concerns of the School Age Period

g. Bullying
- Traits of school-age bullies
- Advanced physical size/strength for their age
- Aggressive temperament
- Parents who are indifferent
- Parents permits aggressive behaviors
- Parents who resort to physical punishment
- Presence of a child who is natural victim( underweight.,
small , anxious, insecure, cautious, sensitive, low self
esteem)
 Common Problems and Concerns of the School Age Period

- Supervise recreation period closely

- Intervene immediately
- Insist if behavior does not stop, both school and parents will
become involve
- Therapy needed to correct bullying

h. Sex Education
- Pubertal Changes
- Responsible sexual practice (if appropriate to cultural setting)
- Health care personnel – resource person
Common Problems and Concerns of the School Age Period

i. Recreational Drug Use

- Marijuana , cocaine, amphetamines
- Alcohol ,cigarette smoking ,steroids
- Glue sniffing – irritable ,inattentive, drowsy
- School personnel – aware
- Associated with suicide
- Parents: Role Model
Children of Alcoholic Parents
 IMMEDIATE PROBLEMS:
- Feeling of guilt that they are the cause of the parents drinking
- Worry that alcoholic parent will become sick
- Shame – prevents child from inviting friends
- Decreased ability to trust adult
- No regular bedtime and mealtime exists
- Anger at alcoholic parent
- Helplessness to change situation
EFFECTS:
Failing marks , withdrawal from friends ,delinquent behavior , depression ,suicidal
thoughts ,drug abuse.
- School Nurse – identify such children ,monitor school progress, refer
organization.
Thank you!
Activity-Exercises
1. According to Erikson, the developmental task of the
school-aged years is to gain a sense of:

A. Professionalism. C. Initiative.
B. Accomplishment. D. Learning style.
2. Many children in Candy’s class at school spend time alone (latchkey
children) in their home after school. What is important advice for such
children?

A. Let everyone know you are alone so they will offer to help you.
B. Cook something every day to give the house a “lived-in” smell.
C. Memorize the phone number of a responsible adult you can call.
D. Practice lighting candles so if power fails, you can have light.
3. Candy tells you a boy in her class at school has breasts as
big as hers. You would explain to her that:

A. it is a normal phenomenon in preadolescent boys.

B. it is an indication he is taking steroid hormones.
C. it sounds like the effect of a pituitary tumor.
D. she shouldn’t be so interested in boys at her age.
4. Candy has not begun menstruating as yet.
You could alert her that:

A. She should not begin this until 14 to 15 years.

B. Periods are often irregular for the first year.
C. A normal flow soaks two pads each hour.
D. Menstrual pain will fade after the 1st year.
5. Candy shares the following beliefs with you. She is following mid-
school-aged moral development according to Kohlberg.
Which statement would alert you?

A. “People who work harder have a right to have more things.”

B. “I should have more than others because I’m better than others.”
C. “It isn’t fair for some people to have more things than others.”
D. “We should consider each person as to what he or she deserves.”