MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
SCHOOL-AGED CHILD
PHYSICAL GROWTH
• Average annual weight gain
approximately 3-5 lbs (1.3- 2.2kg)
• The increase in height is 1-2 in. (2.5-5 cm).
• By 10 years of age, brain growth is
complete, so fine motor coordination
becomes refined.
• Adult vision level is achieved.
• IgG and IgA each reach adult levels, and
lymphatic tissue continues to grow in size
until about 9 years old.
• The left ventricle of the heart enlarges to
be strong enough to pump blood to the
growing body
• The pulse rate decreases to 70 to 80
beats/min; blood pressure rises to about
112/60 mmHg.
A. SEXUAL MATURATION
• Timing of the onset of puberty varies
widely, between 8 and 14 years of age
(Edmonds, 2012)
• GIRLS - usually occurs between the
years of 12 and 18.
• BOYS – between 14 and 20 years.
Precocious puberty
• is an abnormal onset of puberty.
SEXUAL AND PHYSICAL CONCERNS
A. Concern for Boys
• Genital Size
• Hypertrophy of breast tissue
(gynecomastia) can occur in
prepubescent boys, most often in
those who are stocky or obese.
• Chest and facial hair
• Increased seminal fluid termed
nocturnal emissions are
ejaculation during sleep
B. Concern for Girls
• Height
• Change in pelvic contour and hips
• Breast Development
• Menstruation
• Vaginal Secretions
B. TEETH
• Early school-age children typically
have a missing upper incisor as
deciduous teeth are replaced by
= permanent teeth.
• Permanent teeth erupt during the
school-age period.
• Average child gains 2 8 teeth between
6 and 12 years of age:
o The central and lateral incisors
o first, second, and third cuspids
o first and second molars
DEVELOPMENTAL MILESTONES
A. GROSS MOTOR DEVELOPMENT
• A 6-year-old endlessly jumps, tumble,
skip, and hop.
• A 7-year-old child appears quiet
compared and Gender differences
usually begin to manifest themselves
in play
• 8-year-olds are more graceful than
those younger children.
• 9-year-olds are on the go constantly,
as if they always have a deadline to
meet. They have enough eye–hand
coordination.
• By 10 years of age, children are more
interested in perfecting their athletic
skills than they were previously.
• At 11 years of age, many children feel
awkward because of their growth
spurt.
B. FINE MOTOR DEVELOPMENT
• Six-year-olds can easily tie their
shoelaces.
• Seven-year-olds concentrate on fine
motor skills. This has been called the
“eraser year” because children are
never quite content with what they
have done.
• 8-year-olds are more graceful than
those younger children.
• 9-year-olds are on the go constantly,
as if they always have a deadline to
meet. They have enough eye–hand
coordination.
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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
• By 8 years of age, children’s eyes are
developed enough so they can read
regular-size type.
• By age 9 years, their writing begins to
look mature and less awkward.
• Older school-age children begin to
evaluate their teachers’ ability and
may perform at varying levels
depending on each teacher’s
expectations.
C. PLAY
• At age 6 play continues to be rough
and tumble.
• By 7 years of age, children require
more props for play than when they
were younger. Children also develop
an interest in collecting items.
• As a child reaches 8 years of age; time
is spent sorting and cataloging. They
start to be more involved in simple
science projects and experiments.
• Nine-year-olds play hard. Play is rough;
children are not as interested in
perfecting their skills as they will be in
another year. During their 10th year,
children become very interested in
rules and fairness.
• Children aged 11 and 12 years enjoy
dancing to popular music and playing
table games.
D. LANGUAGE DEVELOPMENT
• Six-year-olds talk in full sentences.
• Most 7-year-olds can tell the time in
hours, but have difficulty with “half
past” and “quarter to.”
• Children discover “dirty” jokes and
“bathroom language,” at about age 9
• By 12, a sense of humor is apparent
and can carry on an adult
conversation.
E. EMOTIONAL DEVELOPMENT
Developmental Task: Industry Vs Inferiority
• The ability to trust others and with
respect for their worth.
• Gain a sense of industry by learning
how to do things well.
• They need reassurance they are doing
things correctly and this reassurance is
best if it comes frequently.
Home As A Setting To Learn Industry
• Parents should realize that their child
looks to other role models than
themselves.
• Eight-or 9-year-olds begin to spend
more and more time with their peers
and less time with their family.
School As A Setting To Learn Industry
• Adjusting to and achieving in school
are two of the major tasks for this age
group.
• Parents must monitor teachers and
school activities to make sure their
children are being led this way while
not being pushed too hard.
• Schools are increasingly assuming
responsibility for education about sex,
safety, avoidance of substances of
abuse, and preparation for family
living.
Learning To Live With Others
• Children may show empathy toward
others as early as 20 months, but
cognitively they cannot relate others’
experiences to their own until about 6
years of age.
F. SOCIALIZATION
• Six-year-old children play in groups.
• Seven-year-olds are increasingly aware
of family roles and responsibilities.
• Eight-year-olds actively seek the
company of other children.
• Nine-year-olds take the values of their
peer group very seriously.
• Although 10-year-olds enjoy groups,
they also enjoy privacy.
• Girls become increasingly interested in
boys and vice versa by 11 years of age
(children start to become insecure)
• 12-year-olds feel more comfortable in
social situations than they did the year
before (boys experience erections on
small provocations)
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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
G. COGNITIVE DEVELOPMENT
• 5-7 years old is a transition stage from
preoperational thought to operational
thought or it’s the ability to reason to
any problem they can visualize
Children can use concrete operational
thought with these concepts:
1. Decentering
2. Accommodation
3. Conservation
4. Class inclusion
H. MORAL AND SPIRITUAL DEVELOPMENT
• School-age children begin to mature in
terms of moral development as they
enter a stage of conventional
reasoning.
• Can be as early as 5 years of age.
• A stage of “The police say it’s wrong”,
“Why is it wrong to steal from your
neighbor “
• A child’s sense of morality is externally
controlled. Children accept and
believe the rules of authority figures,
such as parents and teachers, and they
can judge an action based on its
consequences.
• They concentrate on niceness or
fairness and cannot yet see that
stealing hurts their neighbors.
PROMOTING SCHOOL-AGED SAFETY
• School-aged children are ready for time on
their own without direct adult supervision.
This means that they need good education
on safety practices.
• As with adults, unintentional injuries tend
to occur when children are under stress or
when they are distracted.
• Sexual maltreatment is an unfortunate
and all-too-common hazard for children.
NOTE:
• Since they are actively on the go and
are curious little scientists, they would
love to try new things which they find
interesting, that is why parents must
teach their children proper safety
measures to prevent unintentional
injuries which could harm the children.
COMMON SAFETY MEASURES TO PREVENT
UNINTENTIONAL INJURIES
A. MOTOR VEHICLES
• Encourage children to use seat belts
and a booster seat if needed, model
seat belt use.
• Teach street-crossing safety; stress
that streets are no place for
roughhousing, pushing, or shoving.
• Teach parking lot and school bus
safety (e.g., do not walk behind
parked cars, wait for the crossing
guard)
B. BICYCLE COMMUNITY
• Teach bicycle safety, including wearing
of a helmet and not giving
“passengers” rides.
• Teach children to avoid unsafe areas,
such as train yards, grain silos, and
back alleys.
• Stress that children should not go with
strangers (parents can establish a
code word with the child and set that
the child does not leave school with
anyone who does not know the word)
C. BURNS
• Teach safety with candles, matches,
and campfires and that fire is not fun.
D. FALLS
• Educate that some activities, such as
climbing on fences or roofs, are
hazardous.
• Also teach skateboard, scooter, and
skating safety by wearing helmets and
safety gears
E. SPORTS INJURIES
• Teach the importance of wearing
appropriate equipment for sports.
• Stress that the child should not play to
a point of exhaustion or in a sport
beyond physical capability.
F. DROWNING
• Stress not to swim beyond the limits
of the child’s capabilities.
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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
G. DRUGS
• Teach the child to avoid tobacco,
alcohol, and drugs.
• Teach them to take prescription
medicine only as directed.
H. FIREARMS
• Teach firearm safety. Keep firearms in
locked cabinets with bullets separated
from the gun.
GENERAL PRECAUTIONS
• School-aged children should keep
adults informed as to where they are
and what they are doing.
• Be aware that the frequency of
unintentional injuries increases when
parents are under stress and therefore
less attentive.
• Special precautions must be taken at
these times.
• Some children are more active,
curious, and impulsive and therefore
more vulnerable to unintentional
injuries than others.
PROMOTING NUTRITIONAL HEALTH
ESTABLISHING HEALTHY EATING PATTERNS
• School-age children need breakfast to
provide enough energy to get them
through active mornings at school.
• If children take a packed lunch to
school, urge parents to allow the child
some say in the meal.
• Urge parents to make the after-school
snack nutritious.
• Teach parents to make every attempt
to make mealtime a happy and
enjoyable part of the day for
everyone.
FOSTERING INDUSTRY
• They enjoy helping to plan meals.
• Most parents would like children to
develop better table manners.
RECOMMENDED DIETARY REFERENCE
INTAKES
• Both girls and boys require more iron
in prepuberty than they did between
the ages of 7 and 10.
• Adequate calcium and fluoride intake
remain important to ensure good
teeth and bone growth.
DEVELOPMENT IN DAILY ACTIVITIES
A. DRESSING
• Teach children the importance of
caring for their belongings.
• Their clothing styles are often based
on the likes of their friends or a
popular sports or rock star rather than
the preferences of their parents.
B. SLEEP
• Younger school-age children typically
require 10 to 12 hours of sleep each
night, the older ones require about 8
to 10 hours.
C. EXERCISE
• Urge them to participate in some daily
exercise, or else obesity, or
osteoporosis later in life, can result.
D. HYGIENE
• By age 8, children are generally
capable of bathing themselves.
• Both boys and girls become interested
in showering as they approach their
teens.
E. CARE OF TEETH
• Should visit the dentist at least twice
yearly for a checkup, cleaning, and
possibly a fluoride treatment to
strengthen and harden the tooth
enamel.
• School-age children must be reminded
to brush their teeth daily.
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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
HEALTHY FAMILY FUNCTIONING
QUESTIONS TO ASK TO ESTIMATE THE
DEGREE OF INTERACTION THAT OCCURS IN
THE HOME AND WHETHER PARENTS ARE
STRENGTHENING A CHILD'S SENSE OF
ACCOMPLISHMENT ARE
• How do you correct John when he
does something wrong?
• Do you display his school projects?
• Does he have chores that are his to
accomplish?
COMMON HEALTH PROBLEMS
• Children in their school years may have
many small health concerns such as head
lice or ringworm.
• They have one of the lowest rates of
death and serious illness of any age group.
• The two leading causes of death in ages 5
to 9 are unintentional injury and malignant
neoplasms (CDC, 2018).
A. DENTAL CARIES
• Caries (cavities) are progressive,
destructive lesions or decalcifications
of the tooth enamel and dentin.
• Children must believe that they have a
stake in their teeth so that even if they
are cavity-free, they willingly
undertake the self-care measures
necessary to ensure healthy teeth with
parental support rather than parental
command (Greta et al., 2018).
B. MALOCCLUSION
• The upper jaw in children matures
during early childhood along with skull
growth; the lower jaw reaches
maturity more slowly, forcing teeth to
make a prolonged series of changes
until they reach their final adult
alignment and position.
CONCERNS AND PROBLEMS
A. PROBLEMS ASSOCIATED WITH
LANGUAGE DEVELOPMENT
1. Articulation
• The most common problem
• Causes children to mispronounce
certain sounds such as S or R
• Parents may be concerned that tall
tales of this nature can lead to
chronic lying if supported.
• Conveys the idea that the child has
not told the truth yet does not
squash imagination or initiative.
B. COMMON FEARS AND ANXIETY
1. Beginning School
• A health assessment should
include an inquiry about progress
in school.
• One of the biggest tasks is
learning to read.
• Pseudo Sophistication
TAKE NOTE:
• Scolding, nagging, threatening, or
punishing makes the problem
worse.
2. School Refusal or Phobia
• The Fear of attending school
• Type of “social phobia” like
agoraphobia (fear of going
outside the home) or separation
anxiety disorder (SAD)
• Occurs due to:
o A harsh teacher
o Bullying
o Overly dependent on parents
o Overprotective parents
C. HOMESCHOOLING
• Parents educate their children at
home instead of sending them to a
traditional public or private school.
Pros
• Children may be advanced in terms of
vocabulary.
• They think older than their actual age.
Cons
• Lack of qualified educators
• Lack of socialization
• Spiraling cost
• Lack of facilities
• No big milestone events.
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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109

D. CHILDREN WHO SPEND TIME I. RECREATIONAL DRUG USE

INDEPENDENTLY Illegal drugs
• Children without adult supervision for • marijuana
a part of each weekday. • cocaine
Major Concern: • amphetamines
• Increased number of Inhalants
unintentional injuries • airplane glue (toluene)
• Delinquent behavior • aerosolized cooking oil
• Alcohol or substance abuse
• Decreased school performance.
E. SEX EDUCATION
Topic To Teach Includes:
• Reproductive organ function
• Physiology of reproduction
• Secondary sexual characteristics
• Responsibilities of sexual maturity
F. STEALING
Topic To Teach Includes:
• Most children go through a period
during which they steal loose change
from their mother’s purse or father’s
dresser.
• Usually happens at 7 or 8 years old.
G. VIOLENCE OR TERRORISM
Recommendations:
• Assure children they are safe
• Observe signs of stress
• Prohibit footage of traumatic events
• Watch the news with children
• Explain and educate
• Prepare a family disaster plan
• Designate rally point
H. BULLYING
• A frequent reason for a child to be so
unhappy is that they experience
bullying to the point, they could no
longer take such abuse.
Suggestions for School Personnel to Deal
with Bullies Include:
• Supervise recreation periods closely.
• Intervene immediately to stop
bullying.
• Insist if such behavior does not stop.
• Advise parents to discuss bullying with
their school-age

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