The term “school age” commonly refers to children

between the ages of 6 and 12. Although, these years represent a

time of slow physical growth, cognitive growth and development
continue to proceed at rapid rates.

Children of school age may also be more influenced by the

attitudes of their friends than previously. Parents who make too
many of these like and dislikes may find themselves engaged in
unnecessary conflicts with their children.

The school-age period is usually the first time children

begin to make truly independent judgements. As parents may
not be prepared for this, this may create some very real
conflicts with parents.

GROWTH AND DEVELOPMENT OF A

SCHOOL-AGE CHILD
❖ Physical Growth
❖ Developmental Milestone
❖ Developmental Task
❖ Cognitive Development
❖ Moral and Spiritual Development

THE FAMILY WITH A SCHOOL-AGE CHILD

Unlike the infant and toddler, whose progress is marked by
obvious new abilities and skills, the development of a
school-age child is more subtle and may be marked by mood
swings, what the child enjoys on one occasion may not be
acceptable on the next.

The school-age period is usually the first time children

begin to make truly independent judgements. As parents may
not be prepared for this, this may create some very real
conflicts with parents.
NURSING ASSESSMENT OF GROWTH AND
DEVELOPENT OF A SCHOOL-AGE CHILD

PHYSICAL GROWTH
❖ School age children’s annual average weight gain is
approximately 3lb to 5lb (1.3 to 2.2kg); the increase in
height is 1 to 2 inches (2.5 to 5cm).
❖ By 10 years of age, brain growth is complete, so fine motor
coordination becomes refined. As the eye globe reaches its
final shape at about this same time, an adult vision level is
achieved.
❖ Children who did not lose the lordosis and knock-kneed
appearance of toddlers during the preschool period lose
these now. Posture becomes more erect.
❖ If the eruption of permanent teeth and growth of the jaw
does not correlate. With final head growth, malocclusion
with teeth malalignment may be present.
❖ The immunoglobulins IgG and IgA reach adult levels and
lymphatic tissue co it use to grow up until about age 9.
❖ The resulting abundance of tonsilar and adenoid tissue in
the early school years is often mistaken for disease during
Respiratory illness. Scoliosis may become apparent for the
first time in late childhood.
❖ The left ventricle of the heart enlarges to be strong
enough to pump blood to the growing body. All school-age
children over 8 should be screened for this at all health
appraisals.
❖ The pulse rate decrease to 70 to 80 bpm, blood pressure
rises about 112/60mmHg; Maturation of the respiratory
system leads to increased oxygen carbon dioxide
exchange which increases exertion ability and stamina.
SEXUAL MATURATION
❖ At a set point in brain maturity, the hypothalamus
transmits an enzyme to the anterior pituitary gland to
begin production of gonadotropin hormones, which
activates changes in testes and ovaries and produce
puberty.
❖ Puberty is occuring increasingly earlier, in a class of 10
year old sixth graders, it is not unusual to discover that
more than half of the girls are already menstruating.
❖ Timing of the onset of puberty varies widely, between 10
and 14 years of age. Sexual maturation in grils occurs
between 12 and 18 years, in boys between 14 and 20.
❖ This means that for sex education to be effective, parents
must introduce this material when their children are in
grade school, not in middle school or high school.

PHYSICAL AND SEXUAL CONCERNS

❖ The changes in physical appearance that come with
puberty can lead to problems and worries for both
children and their parents.
❖ Specific measures for children to help prevent sexual
abuse. School nurses can play a major role in this type of
education as well.
❖ School age is a time for parents to discuss with children
the physical changes that will occur and the sexual
responsibility these changes require.
❖ In both sexes, puberty brings changes in the sebaceous
glands. Under the influence of androgen, glands become
more active, setting the stage for acne.

TEETH
❖ Deciduous teeth are lost and permanent. Teeth erupt
during the school-age period.
❖ The average child gains 28 teeth between 6 and 12 years of
age.
DEVELOPMENTAL MILESTONES OF THE
SCHOOL-AGE

GROSS MOTOR DEVELOPMENT

❖ Age 6
➢ Children endlessly jump, tumble, skip, and hop
➢ Skip rope with practice
➢ They have enough coordination to walk a straight line
➢ Ride a bicycle
❖ Age 7
➢ Appears quiet compared with a rough and tumble 6
years old
➢ Gender differences usually begin to manifest in play,
there are ‘girl games’ such as dressing dolls and ‘boy
games’ such as pretending to be pirates
❖ Age 8
➢ Movement are more graceful than those of younger
children, although as their arms and legs grow, they
may stumble on furniture or spill milk and food
➢ They ride a bicycle well and enjoy sports such as
gymnastics, soccer, and hockey
❖ Age 9
➢ Are on the go constantly, as if they always have
deadline to meet
➢ They have enough eye-hand coordination to enjoy
baseball, basketball, and volleyball
❖ Age 10
➢ They are more interested in perfecting their athletic
skills than they were previously
❖ Age 11
➢ Many children feel awkward because of their growth
spurt and drop out of sports activities. This fall in
sports participation may bother parents who see
sports as the key to popularity or self-esteem.
 ❖ Age 12
➢ Plunge into activities with intensity and concentration
➢ They often enjoy participating in sports events for
charities

FINE MOTOR DEVELOPMENT

❖ Age 6
➢ Can easily tie their shoelaces
➢ Can cut and paste well and draw a person with good
detail
❖ Age 7
➢ Concentrate on fine motor skills more than previously
➢ This has been called ‘eraser year’ because children
are never quite content with what they have done.
❖ Age 8
➢ Children’s eyes are developed enough so they can
read regular size type.
➢ This makes reading a greater pleasure and school
more enjoyable
➢ They learn to write script rather than print
➢ They enjoy showing off this new skill in cards, letters,
or projects
❖ Age 9
➢ Their writing begins to look mature and less awkward

PLAY
❖ Play continues to be rough at age 6 years. However, when
children discover reading as an enjoyable activity that
open doors to other worlds, they can begin to spend quiet
time with books.
❖ By 7 years of age, children require more props for play
than when they were younger. To be a police officer - they
need a badge and gun.
❖ Many children spend hours playing increasingly
challenging video games, an activity that can either foster
 a healthy sense of competition or create isolation from
others.
❖ Girls begin to prefer teenage dolls. Around 7 years of age,
children also develop an interest in collectin items such as
baseball cards, dolls, rocks, or marbles.

LANGUAGE DEVELOPMENT
❖ Six year- olds talk in full sentences, using language easily
and with meaning.
❖ They still define objects by their use: a key is to unlock a
door, a fork is to eat with.
❖ They no longer sound as though talking is an experiment
but appear to have incorporated language permanently.

EMOTIONAL DEVELOPMENT
❖ Ideally, children enter the school-age period with the
ability to trust others and with a sense of respect for their
own worth.
❖ They can accomplish small tasks independently because
they have gained a sense of autonomy. They should have
practiced or mimicked adult roles.

DEVELOPMENTAL TASK: INDUSTRY VS

INFERIORITY
❖ During the early school years, children attempt to master
yet another developmental step: learning a sense of
industry or accomplishment
❖ If children are prevented from achieving a sense of
industry or do not received rewards for accomplishments,
they can develop a feeling of inferiority and become
convinced that they cannot do things they actually can do
❖ Gaining a sense of initiative can be defined as learning
how to do things. Gaining a sense of industry is learning
how to do things well
 ❖ 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 of a school-age child need to take a step forward
in development along with their child. For the first time,
they realize their child looks to other role models than
themselves
❖ Adjusting to and achieving in school are two of the major
tasks for this age group
❖ Eight or 9 years old begin to spend more and more time
with their peers and less time with their family. They forget
to do household chores they once enjoyed.
❖ Schools are increasingly assuming responsibility for
education. About sex, safety, avoidance of substances of
abuse, and preparation for family living.

STRUCTURED ACTIVITIES
❖ Girl scouts
❖ Boy scouts
❖ Campfire or clubs are respected for school-age activities
❖ Another problem to consider with organized contact
sports is the possibility of athletic injuries
❖ Urge parents to evaluate competitive sports programs as
well

PROBLEM SOLVING
❖ Important part of developing a sense of industry is
learning how to solve problems
❖ Parents and teachers can help children develop this skill
by encouraging practice
❖ When the child asks, “Is this the right way to do this?” the
parent can say, “Let’s talk about possible ways of doing it.”
LEARNING TO LIVE WITH OTHERS
❖ They are interested in tasks and in accomplishing physical
projects that they forget they must work with people to
achieve goals.
❖ Learning to give a present without receiving one in return
or doing a favor without expecting a reward is also a part
of this process

SOCIALIZATION
❖ Age 6
➢ Play in groups, but when they are tired or under
added stress, they prefer one-to-one contact
❖ Age 7
➢ Are increasingly aware of family roles and
responsibilities
➢ Promises must be kept because a 7-year-old views
them as definite, firm commitments
❖ Age 8
➢ Actively seek the company of other children
➢ Most of the girls have a close girlfriend, boys have a
close boyfriend
➢ Girls begin to whisper among themselves, annoying
both parents and teachers
❖ Age 9
➢ Take the valeus of their peer group very seriously
➢ They are much more interested in how other children
dress than in what their parents want them to wear
➢ This is typically the “gang age” because children form
clubs and usually “spite clubs”
❖ Age 10
➢ Enjoy groups, they also enjoy privacy
➢ They like having their own bedroom or at least their
own dresser, where they can store a collection and
know it is free from parents’ or siblings’ eyes
 ➢ One of the best gifts for a 10 year old is a box that
locks
❖ Age 11
➢ Girls become increasingly interested in boys and vice
versa
➢ Favorite activities are mixed-sex rather than
single-sex ones
❖ Age 12
➢ Feel more comfortable in social situations than they
did the year before
➢ Boys experience erections on small provocation so
may feel uncomfortable being pushed into boy-girl
situations

COGNITIVE DEVELOPMENT
❖ Concrete operational thought or the ability to reason
through any problem they can actually visualize
❖ Learn several new concepts:
➢ Decentering
■ the ability to project one’s self into other
people’s situations and see the world from their
viewpoints rather than focusing only on their
own view
■ Enables a school-age child to feel compassion
for other
➢ Accomodation
■ The ability to adapt thought processes to fit
what is perceived
➢ Conservation
■ Then 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
 ■ Necessary for learning mathematics and
reading, systems that categorize numbers and
words

MORAL AND SPIRITUAL DEVELOPMENT

❖ School age children begin to mature in terms of moral
development as they enter a stage of Preconventional
reasoning
❖ School age children begin to learn about the rituals and
meanings behind their religious practices
❖ During this stage. If asked “Why is it wrong to steal from
your neighbor?” School-age children will answer, “The
police say it’s wrong, or because if you do, you’ll go to jail.”
❖ Parent role modeling is also important, school age
children are rule-oriented.

PLANNING AND IMPLEMENTATION FOR HEALTH

PROMOTION OF A SCHOOL-AGE CHILD AND
FAMILY

PROMOTING SCHOOL-AGE SAFETY

❖ School-age children are ready for time on their without
direct adult supervision.
❖ Be certain school-age children know how to use seatbelts
in cars and bicycle safety around cars.
❖ Sexual abuse is an unfortunate and all-too common
hazard for chidlren.

PROMOTING NUTRITIONAL HEALTH OF A

SCHOOL-AGE CHILD
❖ Most school-age children have good appetites, although
any meal is influenced by the day’s activity.
 ❖ If a child had a full day of activities, he or she may come to
the dinner table ready to eat anything.
❖ If the day was full of frustration - he or she may pick and
poke at food.
❖ This is no different from the way adults feel at times. So
should be respected.

ESTABLISHING HEALTHY EATING PATTERNS

❖ School-age children need breakfast to provide enough
energy to get them through active mornings at school.
❖ They eat best if parents get up in the morning and eat
some themselves.
❖ Children react badly to the instructions, “Do as I say, not
as I do.”
❖ Teach parents to make every attempt to make mealtime a
happy and enjoyable part of the day for everyone.
❖ Most children are hungry after school and enjoy a snack
when they arrive home.
❖ BEcause sugary foods may dull a child’s appetite for
dinner, urge parents to make the snack nutritious: fruit,
cheese, or milk rather than cookies and a soft drink.

FOSTERING INDUSTRY
❖ As part of fostering industry, school-age children usually
enjoy helping to plan meals.
❖ They can prepare foods such as instant pudding, Jell-o,
salads, scrambled eggs, and sandwiches.
❖ Most parents would like children to develop better table
manners.
❖ They eat meals they have planned or prepared more
willingly.
RECOMMENDED DIETARY REFERENCE INTAKES
❖ During the late school years, boys require more calories
and other nutrients at this time.
❖ Both girls and boys require more iron in prepubertal than
they did between the ages of 7 and 10.
❖ Adequate calcium and fluoride intake remain important to
ensure good teeth and bone growth.

PROMOTING DEVELOPMENT OF A SCHOOL AGE

CHILD IN DAILY ACTIVITIES
With life centered on school activities and friends, a
school-age child still needs parental guidance for most daily
activities, because the habits and lifestyle patterns gained
during this period will form the basis for the patterns for living
later in life.

DRESS
❖ To teach children the importance of caring for their own
belongings.
❖ School-age children have definite opinions about clothing
styles, often based on the likes of their friends or popular
sports or rock star rather than the preference of their
parents.
❖ A child who wears different clothing than others may
become the object of exclusion from a school club or
group.

SLEEP
❖ Sleep needs vary among individual children. Younger
school-age children typically require 10 to 12 hours of sleep
each night, older ones require about 8 to 10 hours.
❖ Nighttime terrors may co to use during the early school
years and may actually increase during the first-grade
year as a child reacts to the stress of beginning school.
HYGIENE
❖ Children of 6 to 7 years of age still need help in regulating
the bath water temperature and in cleaning their ears and
fingernails.
❖ By age 8, children are generally capable of bathing
themselves but may not do it well because they are too
busy to take the time.
❖ Boys and girls become interested in showering as they
approach their teens.
❖ This can be encouraged as perspiration increases with
puberty, along with sebaceous gland activity.
❖ When girls begin to menstruate, they may be afraid to take
baths or wash their hair during periods if they had heard
this is not safe. They need information on the importance
and safety of good hygiene during their menses.
❖ Boys who are uncircumcised may develop inflammation
under the foreskin from increased secretions if they do not
wash regularly.

CARE OF TEETH
❖ With proper dental care, the average child today can
expect to grow up cavity-free.
❖ To ensure this happens, school-age children should visit a
dentist at least twice yearly for a check-up, cleaning, and
possibly a fluoride treatment.
❖ Have to be reminded to brush their teeth daily.
PROMOTING HEALTHY FAMILY FUNCTIONING
❖ Children from one-parent homes or those with a parent
who has difficulty being a good role model.
❖ May need help in finding a suitable adult to serve as this
important person in their life.

COMMON HEALTH PROBLEMS OF THE

SCHOOL-AGE PERIOD
Children in their early school years have one of the lowest
rate of deaths and serious illness of any age group. The two
leading causes of death:
a. Accidents
b. Cancer
 Minor illnesses are largely due to:
a. Dental caries
○ Caries (cavities) are progressive, destructive lesions
or decalcification of the tooth enamel and dentin.
○ The enamel on primary teeth is thinner than on
permanent teeth, so they are even more susceptible
to destruction that permanent teeth.
○ Malocclusion (a deviation from the normal) → may be
congenital and related to conditions such as cleft
palate, small lower jaw, or familial traits tending
toward malocclusion.

b. Gastrointestinal disturbances
c. Upper respiratory infections’

CONCERNS AND PROBLEMS OF THE

SCHOOL-AGE PERIOD
One of the most important disorders of the school-age
period is attention deficit hyperactivity disorder (ADHD),
because it interferes so dramatically with school progress.
Other problems concern language, fears, and responsibility.

PROBLEMS ASSOCIATED WITH LANGUAGE

DEVELOPMENT
 ❖ The most common problem of a school-age child is
articulation.
❖ The child has difficulty pronouncing s, z, th, l, r, and w or
substitutes w for r (“westroom” instead of restroom) or r for
l (“radioes room” instead of ladies room).
❖ This is the most noticeable during the first and second
grades, it usually disappears by the third grade.
❖ Unless it persists, speech therapy for the normal
developmental stage is not necessary.

COMMON FEARS AND ANXIETIES OF A

SCHOOL-AGE CHILD
❖ ANXIETY-RELATED TO BEGINNING SCHOOL
➢ Adjusting to grade school is a big task for 6 year olds.
➢ Even if they attended preschool, grade school is
different: the rules are firmer and the electinve feeling
(“If I don’t like it, I can quit”) is gone.
➢ Because school is an adjustment, a health
assessment of all school-age children should include
an inquiry about progress in school.
➢ These behaviors stop when the underlying stress is
discovered and alleviated.
➢ One of the biggest tasks of the first year of school is
learning to read.

SOCIAL PHOBIA
❖ It is the fear of attending school. It is a type of social
phobia similar to agoraphobia (fear of going outside the
home).
❖ Children who resist attending school this way may develop
physical signs of illness such as vomiting, diarrhea,
headache, or abdominal pain on school days.
❖ May occur from fear of separation from parents.
 ❖ Managing school phobia requires coordination among the
school, school nurse, and healthcare provider who
diagnose the problem.

HOME SCHOOLING
❖ Gives children a good deal of freedom– freedom in
scheduling, freedom to explore subjects that fascinate
them, and freedom to learn and work in their own style. Not
surprisingly, kids really enjoy this level of freedom, and
most wouldn’t trade it for a public school experience for
any reason.
❖ Because of religious or personal preference or because of
disillusionment with the school system.

LATCHKEY CHILDREN
❖ These are school children who are without adult
supervision for part of each weekday.
❖ The term alludes to the fact they generally carry a key so
they can let themselves into their home after school.

SEX EDUCATION
❖ It is important that school-age children be educated
about pubertal changes and responsible sexual practices
so they are well prepared for these.
❖ Topics to teach and discuss in a sex education course for
both preadolescent boys and girls include:
➢ Reproductive organ functions
➢ Secondary sexual characteristics
➢ Physiology of reproduction

STEALING AND SHOPLIFTING

❖ STEALING
➢ During early school age, most children go through a
period in which they steal loose change from their
mother’s purse or father’s pocket.
 ➢ This usually happens at around 7 years of age, when
children are first learning how to make a change and
also discover the importance of money.
❖ SHOPLIFTING
➢ Youngsters who continue to steal past 9 years of age
may require counseling because they should have
progressed beyond this normal developmental step
by this age.
➢ Some shoplifting occurs with early school-age
children, but the major problem with this arises
during preadolescence.

BULLYING AND OBESITY

❖ BULLYING
➢ A frequent reason school-age children cite for feeling
so unhappy that they turn guns on classmates is that
they were ridiculed or bullied to the point that they
could no longer take such abuse.
❖ OBESITY
➢ As many as 50% of school-age children are obese by
bode-mass index guidelines for ideal weight.
➢ Some of these children have been overweight since
infancy, their prepubertal natural weight gain makes
them obese.