School Age is 6-12 years: Industry vs Inferiority (Erikson) Pain Assessment

Basic Principles: • What are signs a school age child may be in pain?

• The child starts to place importance on privacy. Plays mostly with • They can understand disease or injury causes pain
same sex peers. When caring for this age be sure to provide gowns
– Muscle rigidity – Clenched fist – Wrinkled forehead
and covers when performing procedures. Always knock on the door
before entering. • Has an increased need to understand the body and – Able to verbalize pain by telling you location and intensity
functions of thebody.
– Stalling behaviors
School age – Does not reason logically, may use symbols or objects,
either words or images. Understands relationship between things Pain Scales
and ideas, allow the child to handle equipment-this will help increase Faces-
their understanding.
• Used for age 3 and up
• Children become more flexible. They are now able to see and
understand things from another point of view, no longer rigid Oucher
thinkers. They are no longer so egocentric. This is the beginning of • Used for children age 3-12 years
logical thought formation which leads to the development of
morality. Numeric Scale

hey use cooperative play. They work hard in school, sports, and in
their family to fill a sense of accomplishment.
– They want to be productive and successful!!
– The goal of this stage of development is to develop a sense
• Use for children ages 5 and up
– Uses straight line with end points identified as no pain and worst
pain – Be sure the child is able to count!! Some 5 year
olds haven’t mastered this skill yet.

industry.

This will help in building self-confidence. They continue to improve

their social skills.

If the child DOESN’T develop a sense of accomplishment this may

result is a sense of inferiority.

As children move from egocentrism to more logical thinking they are

also developing a conscience and moral standards. These standards
are based on the teachings and beliefs of others such as teachers and
parents.

Assessment Guidelines

• Important things to focus on when assessing the school age child:

– Height and weight gain slows, appears in bursts, can grow at least 2
inches in height per year.

Developmental Milestones

• Some important developmental milestones to remember:

– Repeats activities in order to master them.

– Develops concept of numbers, knows when its morning or night,

by age 8 gives similarities and differences between two things from
memory, can repeat days of the week.

Developmental Milestones

– Age 6 able to use knife to spread butter, by age 8 helps with

Play
routine housework, looks after own meals. Type: Competitive

– Socially at age 6 can share and cooperate, likes to compete in
games, enjoy spending time with others of the same age
on projects and discussing the activities of the day, develops
modesty: these are important consideration when they are
in an acute care setting.
6 years old - Play continues to be rough and tumble.
- Some spend quiet time with books .
- Reading as enjoyable activity, opens door to other world.
- Video games – spend hours playing, can either foster healthy sense
of competition or create isolation.
* 7 years old - collecting items such as basketball cards, dolls,
rocks, marbles * 8 years old like table games (hate losing) *9 years
old play hard , tough, some go into music or art lesson - Finds out
about chat room – parents need to supervise. *10 years old – boys
and girls play separately - interested in rules and fairness - interest
with opposite sex are apparent.
*11 to 12 years old- enjoy dancing to popular music & playing a. Dental Caries
table games. ▪ Caries (cavities) are
progressive, destructive
Promoting School Age Safety lesions
▪ School children are ready for time on their own w/o or decalcification of
tooth enamel
direct adult supervision.
or dentin.
▪ Means they need good education on safety practices. ▪ Neglected caries result
in poor chewing and
▪ Sexual maltreatment is an unfortunate and all-too-common therefore
hazard for children poor digestion, abscess
and pain
▪ Preventable with
Common safety measures to prevent unintentional Injuries during proper brushing and
the school years . use of
fluoridated water.
Source of Unintentional Injury Preventive measures ▪ Child dental hygiene
Motor vehicle • Teach parking lot and practice should
school bus safety be evaluated

• No passenger rides, B. Malocclusion

Bicycle wear helmet ▪ A good tooth occlusion-
upper teeth overlap on
• Educate that lower teeth by a small
roughhousing on amount and teeth
Fall fences or climbing on are evenly spaced and
roofs is in good alignment.
hazardous. Teach ▪ A deviation of tooth
skateboard, scooter, position from the
and skating safety normal. Due to
Community 1. Congenital –cleft palate
• Teach to avoid unsafe 2. Familial traits
areas such as 3. Small lower jaw
train yards 4. Extraction or unintentional
Burns injury
• Teach safety with ▪ Should be evaluated
cooking skills by orthodontist
• Safety w/ sun
exposure, use sun
block
• Teach not to climb on
electric poles. Concerns and Problems of School Age Period
Sports injuries a. Problems associated with Language development
• Wear appropriate
equipment for • Broken fluency
sports, not babyish but
smart management • Articulation, has difficulty pronouncing s, z, th, l, r and
• Use trampolines with w. substitute w for r ( westroom instead of restroom)
adult supervision
• Disappear by third grade

• Persist , speech therapy is not necessary

Drowning • Teach how to swim,
dares
and roughhousing
b. Common Fears and Anxiety of a School age Child
when diving are
not appropriate. 1. Anxiety related to Beginning School
• Don’t swim beyond
limits of capabilities • Adjusting to grade school is a big task.

• Urge parents to spend some time to child after school or

in the evening , for them to feel secure.
Drugs • Avoid all
recreational drugs.
• Prescription
medications should be 2. School refusal or phobia – fear of attending school
taken as prescribe.
• Teach to avoid tobacco social phobia – similar to agoraphobia (fear of going outside the
and alcohol home)
Firearms - resist attending school develop physical illness like vomiting,
• Teach firearm safety.
diarrhea, headache, abdominal pain on school days.
c . Stealing - most children go through , they steal loose change Basic Principles:
from mother or father purse.
• Adolescents primary focus is on peers and developing relationships
d. Violence or terrorism outside of the family.

- children basically view their world as safe , so it is shock
when violence such as school shooting or reports of terrorism enter
their lives.
D. Bullying
- a frequent reason school age children cite for feeling so unhappy
that they turn guns on classmates or commit suicide.
-could o longer take such abuse.
- alert parents that Internet or texting bullying are both possible.
Bully doesn't have to be fact –to – face contact to be harmful.
- advise parents to discuss bullying with their child and help them
understand that it should be reported.
– Have the ability for mature abstract thoughts and ideas, can think
in hypothetical terms
– As the adolescent physically matures and thought and ideas
become more complex, a new sense of identity is developed.
This identity consists of a picture of oneself that includes past,
present, and future.
– Peer groups play a large role in developing a sense a self and
self-esteem, with the key to identity achievement being based
on interaction with others.

e. Recreational Drug Use – Barriers to developing identity would be lack of role models,

illegal drugs such as marijuana, cocaine, and amphetamines are
now available as early as elementary school.
Inhalants like airplane glue and aerosolized cooking oil , sniff from
paper bag , sniff fumes to experience the feeling of exhilaration.
- Parents should suspect recreational drug use if their child regularly
appears irritable, inattentive, or drowsy.
inability to identify a meaningful sense of self, and lack of
opportunities to explore alternative roles.
• Establishes personal ethics on which to base decisions. Increase in
reasoning and social cognition.
• Understands abstract thoughts and understands opinions of others.

f. Overweight or obese child Takes into account the opinions of others when making decisions.

• Many families rely on fast food meals several times a week.

• By preteen years, may develop health problem Developmental Milestone

like hypertension, Type 2 diabetes and elevated Play or Recreation
total cholesterol.

• May be bullied or ridiculed at school 13 years old – listening to
music, texting or chatting,
• Unable to participate in sports game. following a sports team wins or
losses
Weight reduction program should be long term lifestyle change and - team loyalty becomes
contains features such as: intense, following coach
instructions
• Intake of 1,200 calories a day.
becomes mandatory.
• An active exercise. - spend a great deal of time
just talking to peers as social
• A counselling program to discuss aspects such as self interaction. For them it is a
image and motivation to reduce weight. major way to learn about values
and responsibilities.
Nursing Care of Family With an Adolescent
Emotional development
16 years- most wants a part
time job to earn money. Teach
them how to work well,
accept responsibility, how to
save and spend money).
• During middle to late
adolescent many
engages in
charitable endeavors.
This activities fulfil their
need for
satisfying interaction
with others.
Emotional development

Body Image- adjustment to Career Decision

changes in body image is not
easy, they may fell disappointed
with their final height or
general appearance.
Self- Esteem – adolescent can
be challenge by all the changes
that occur during this period.
Value System – develop values
by talking to peers,
- need attentive adult ear, to
discuss fears, hopes and
pressures.
Social Coupling-
- at early adolescents, girls tend
adolescents are age 12-18 years: Identity vs. Confusion (Erikson) to band together with girls, and
boys with boys.
-Part of knowing what kind of
person you want is knowing
what kind of occupation you
want.
- Emancipation from parents-
2 reasons for major issue:
a. parents not ready for their
child to be independent
b. adolescent not sure if they
want to be on their own.
 -adolescent who are different Unintentional Injury Sports
are excluded
Health teaching measure
SOCIALIZATION • Use protective equipment.

• Both male and female • Do not attempt to participate beyond limits.

early adolescent tend
to be loud • Keep well hydrated by drinking fluid before and after play.
and boisterous. Promoting Healthy Family Functioning
• 13 years old – crushes
or infatuation • Early adolescents may have many disagreements with
with schoolmate. parents.
• 14 years old – more
quieter and a. Wanting independence
introspective, become
b. Disappointed with their bodies
use to body changes
- watch adults carefully as role • Council parents to appreciate their adolescent.
model.
• 15 years old - most fall • It is not easy to live with teenagers and it is equally difficult
in love 5 to 6 times a to be a teenager
year, base on
• 15 – fallen angel syndrome
attractions.
• 16 years old – boys • 16 - comprehend how hard it was for parents to get
become sexually where they are.
mature. Both sexes are
better able to trust • 17 – looking ahead to leave school, some begin
their bodies. experimenting with drugs.
• 17 years old – have
adult values and Common health Problems of an Adolescent
response to events. 1. Hypertension –adolescents who are susceptible to develop
this condition.

a. obese,

b. eat diet in high salt,

MEASURES TO PRVENT UNINTENTIONAL INJURIES c. with family history of hypertension

Unintentional Injury Motor vehicle - Provide health assessment, education plus medication to reduce
great number of incidence.
Health teaching measure
2. Poor posture –
• Always use a set belt whether a driver or a passenger. No cell
phone while driving. • assess posture , detect difference between simple
poor posture or scoliosis
• No alcohol, refuse to ride with anyone who has been
drinking. 3. Body piercing and tattoos –

• Wear a helmet or long trousers as driver or passenger • strong mark of adolescence, way of making a statement, they
are different from parents.
• Accepting dares are no place in safe driving.
• Assess knowledge for symptoms of infection.
Unintentional Injury
Firearms • Caution that sharing of needles carries risk for
Health teaching measure contacting blood borne disease.

• Always consider all guns loaded and potentially lethal. 4. Fatigue –

• Learn safe gun handling before attempting to clean a gun. • Assess diet, sleep pattern, and activity schedule.

Unintentional Injury Drowning 5. Menstrual irregularities-

• Major health concern, adjust to individual body cycles.

Health teaching measure
6. Acne – a self limiting inflammatory disease wc involved
• Learn how to swim.
sebaceous gland
• Follow safe water rules, such as never swim alone, no diving
into the shallow end of the pools, 7. Obesity –
• no hyperventilating before swimming under water, no • inheritance and environment plays a part .
swimming beyond one’s own limit
• Interfere with developing sense of identity.
• Taking dares has no place in water safety.
8. Stalking – intrusive and unwanted action at an individual to gain
attention or to evoke fear.
9. Bullying – - become Politically active

10. Hazing – help adolescent make a sound decision about what type
of hazing their organizations advocates.
11. Substance abuse – use of chemicals to improve a mental state
Assessment of substance abuse
• If adolescents trust health care personnel they will generally
admit if they have engaged in drug experimentation
• Clues are poor school attendance, general flawed
reasoning, diagnosed with Hepatitis b, HIV positive.
Concerns Regarding Sexuality and Sexual Activity
- solve environmental concerns,
- far reaching community
Older adult - Integrity versus Despair
Plays a role in child rearing because many of them give child
care to grandchildren while parents work.
Older adults with integrity feel good about the life choices they have
made,
Those with despair wish life could start over again so things
could turn out differently.

• Due to increase exposure to and acceptance of pre

marital sexual relations leads to higher risk for STD
or conception.

• Adolescent also a time when teenagers deal with realization

that they are gays or lesbian.

• Must have a routine assessment if sexually active.

• Assess practice of safer sex measures

• Contraception

• Provide information on date rape or rape prevention.

• Flunitrazepam ( Rohypnol) – date rape drug

• Ketamine

Concerns regarding depression and self injury

• Self injury includes a range of self destructive actions from

cutting to suicide.

• The planned intent to end once life.

• Cutting is found more frequently in girls than boys, can begin

as early as grade school.

• Successful suicide occurs more on males than in females.

• Apparently more females attempt suicide than males ( ratio

8:1).

Reasons for adolescent suicide are incest, maltreatment, increased

chemical dependency, marital instability in the family, poor problem
solving ability.

Decided death maybe an easier coping with overwhelming problems.

ASSESSMENT

• Adolescent need a thorough physical examinations at

health maintenance visit to assure them they are in good
physical health.

• Assess at these visit signs of depression such as anorexia,

insomnia, excessive fatigue or weight loss.

• A family assessment is helpful.

• Caution parents not to ignore report from their child’s friend

who tell them their concern.

Young Adult - Intimacy versus Isolation

relate well with other people, not only with members of the opposite
sex but also with ones’s own sex to form long lasting friendship

Middle Adult - Generativity versus Stagnation extend their concern

from just themselves and their families to the community and the
world.