THE SCHOOL-AGE

CHILD AND THE

FAMILY
SCHOOL-AGE

 refers to children between the ages of 6 and 12 years.

 This period begins with entrance into the school
environment.
 The school-age years can be a spectacular journey filled
with joys and successes as the child continues to grow and
mature.
 They can also be marked by challenges, as the child
struggles to make sense of physical and psychological
changes, his emerging identity, and the way he sees himself
and is viewed by others (especially his peers).
GROWTH AND DEVELOPMENT
• Biologic Development
• Psychosocial Development
• Cognitive Development
• Moral Development
• Spiritual Development
• Social Development
• Self-concept Development
BIOLOGIC DEVELOPMENT
 During middle childhood, growth in height and weight assumes a slower
but steady pace as compared with the earlier years.
 Between ages 6 and 12 years, children grow an average of 5 cm (2 inches)
per year.
 Weight increases by 2 to 3 kg (4.5–6.5 pounds) per year.
 The average 6-year-old child is about 116 cm (45.7 inches) tall and weighs
about 21 kg (46 pounds)
 The average 12-year-old child is about 150 cm (59 inches) tall and weighs
approximately 40 kg (88 pounds).
 During this period, girls and boys differ 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
 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
proportion, and a lower center of gravity.
 Posture improves over that of the preschool period to facilitate locomotion and
efficiency in using the arms and trunk.
 Fat gradually diminishes, and its distribution patterns change, contributing to the
thinner appearance of children during the middle years.
 Accompanying the skeletal lengthening and fat diminution is an increase in the
percentage of body weight represented by muscle tissue.
 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 in relation
to height.
 Facial proportions change as the face grows faster in relation to the remainder of
the cranium.
 The skull and brain grow very slowly during this period and increase little in size.
 Deciduous teeth are lost and permanent teeth
erupt during the school-age period.
 Because of this, the average child gains 28 teeth
between 6 and 12 years of age: the central and
lateral incisors; first, second, and third cuspids; and
first and second molars.
 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.
 Physical maturation is evident in other body tissues and organs.
 The heart grows more slowly during the middle years and is smaller in
relation to the rest of the body than at any other period of life.
 Heart and respiratory rates steadily decrease, and blood pressure
increases from ages 6 to 12 years.
 The immune system becomes more competent in its ability to localize
infections and to produce an antibody–antigen response.
 Bones continue to ossify throughout childhood but yield to pressure
and muscle pulls more readily than with mature bones.
 Wider differences between children are observed at the end of
middle childhood than at the beginning.
 Physical maturity is not necessarily correlated with emotional and
social maturity.
Prepubescence
 Preadolescence is the period of approximately 2 years that begins
at the end of middle childhood and ends with the thirteenth
birthday.
 Because puberty signals the beginning of the development of
secondary sex characteristics, prepubescence typically occurs
during preadolescence.
 Toward the end of middle childhood, the discrepancies in growth
and maturation between boys and girls become apparent.
 On the average, there is a difference of approximately 2 years
between girls and boys in the age of onset of pubescence. This is a
period of rapid growth in height and weight, especially for girl.
 There is no universal age at which children assume the
characteristics of prepubescence.
 The first physiologic signs appear at about 9 years of age (particularly
in girls) and are usually clearly evident in 11- to 12-year-old children.
 Although preadolescent children do not want to be different,
variability in physical growth and physiologic changes among
children of the same sex and between the two sexes is often striking
at this time. This variability, especially in relation to the onset of
secondary sexual characteristics, is of great concern to
preadolescents. Either early or late appearance of these
characteristics is a source of embarrassment and uneasiness to both
sexes.
 Preadolescence is a period of considerable overlapping of
developmental characteristics of both middle childhood and early
adolescence.
 Generally, puberty begins at 10 years in girls and 12 years in boys,
but it can be normal for either sex after the age of 8 years. Boys
experience little visible sexual maturation during preadolescence.
PSYCHOSOCIAL DEVELOPMENT
 Freud described middle childhood as the latency period.
 During this time, children experience relationships with same-sex peers
following the indifference of earlier years and preceding the
heterosexual fascination that occurs for most boys and girls in puberty.
 Successful mastery of Erikson’s first three stages of psychosocial
development is important in terms of development of a healthy
personality. These experiences prepare the child to engage in
experiences and relationships beyond the intimate family group.
 A sense of industry or a stage of accomplishment is achieved
somewhere between age 6 years and adolescence.
 School-age children are eager to develop skills and participate in
meaningful and socially useful work.
 They acquire a sense of personal and interpersonal competence;
receive the systematic instruction prescribed by their individual
cultures; and develop the skills needed to become useful, contributing
members of their social communities.
 Children want to engage in tasks that can be carried through to
completion.
 They gain satisfaction from independent behavior in exploring and
manipulating their environment and from interaction with peers.
 Often the acquisition of skills provides a way to achieve success in
social activities. Reinforcement in the form of grades, material rewards,
additional privileges, and recognition provides encouragement and
stimulation.
 A sense of accomplishment involves the ability to cooperate, to
compete with others, and to cope effectively with people.
 Middle childhood is the time when children learn the value of doing
things with others and the benefits derived from division of labor in the
accomplishment of goals. Peer approval is a strong motivating power.
 The danger inherent in this period of development is the occurrence of
situations that might result in a sense of inferiority.
 When the reward structure is based on evidence of mastery, children
who are incapable of developing these skills risk feeling inadequate
and inferior.
 Even children without chronic disabilities may experience feelings of
inadequacy in some areas.
 No child is able to do everything well, and children must learn that they
will not be able to master every skill they attempt.
 All children, even children who usually have positive attitudes toward
work and their own abilities, will feel some degree of inferiority when
they encounter specific skills that they cannot master.
 Children need and want real achievement. Children achieve a sense
of industry when they have access to tasks that need to be done and
they are able to complete the tasks well.
COGNITIVE DEVELOPMENT
 When children enter the school years, they begin to acquire the ability to relate
a series of events to mental representations that can be expressed both
verbally and symbolically. This is the stage Piaget describes as concrete
operations, when children are able to use thought processes to experience
events and actions.
 The rigid, egocentric view of the preschool years is replaced by mental
processes that allow children to see things from another’s point of view.
 During this stage, children develop an understanding of relationships between
things and ideas.
 They progress from making judgments based on what they see (perceptual
thinking) to making judgments based on what they reason (conceptual
thinking).
 They are able to master symbols and to use their memories of past experiences
to evaluate and interpret the present.
 One cognitive task of school-age children is mastering the concept of
conservation.
 They learn that simply altering their arrangement in space does not change
certain properties of the environment, and they are able to resist perceptual cues
that suggest alterations in the physical state of an object.
 School-age children also develop classification skills.
 They can group and sort objects according to the attributes they share, place
things in a sensible and logical order, and hold a concept in mind while making
decisions based on that concept.
 School-age children learn the alphabet and the world of symbols called
words, which can be arranged in terms of structure and their relationship to
the alphabet.
 They learn to tell time, to see the relationship of events in time (history) and
places in space (geography), and to combine time and space relationships
(geology and astronomy).
 The ability to read is acquired during the school years and becomes the most
significant and valuable tool for independent inquiry.
 Children’s capacity to explore, imagine, and expand their knowledge is
enhanced by reading.
MORAL DEVELOPMENT
 As children move from egocentrism to more logical patterns of
thought, they also move through stages in the development of
conscience and moral standards.
 Children 6 or 7 years of age know the rules and behaviors expected
of them; however, they do not understand the reasons behind
them.
 Rewards and punishments guide their judgment; a “bad act” is one
that breaks a rule or causes harm.
 Young children believe that what other people tell them to do is
right and that what they themselves think is wrong.
 Consequently, children 6 or 7 years old may interpret accidents or
misfortunes as punishment for “bad” acts.
 Older school-age children are able to judge an act by
the intentions that prompted it rather than just its
consequences.
 Rules and judgments become less absolute and
authoritarian and begin to be founded on the needs
and desires of others.
 For older children, a rule violation is likely to be viewed
in relation to the total context in which it appears.
 The situation, as well as the morality of the rule itself,
influences reactions.
 Although younger children judge an act only
according to whether it is right or wrong, older children
take into account different points of view. They are
able to understand and accept the concept of
treating others as they would like to be treated.
SPIRITUAL DEVELOPMENT

 Children at this age think in concrete terms but are avid learners and have a
great desire to learn about their God.
 They picture God as human and use adjectives such as “loving” and
“helping” to describe their deity.
 They are fascinated by the concepts of hell and heaven, with a developing
conscience and concern about rules. They may fear going to hell for
misbehavior.
 School-age children want and expect to be punished for misbehavior and,
when given the option, tend to choose a punishment that “fits the crime.”
 They may view illness or injury as a punishment for a real or imagined
misdeed.
 The beliefs and ideals of family and religious persons are more influential than
those of their peers in matters of faith.
 School-age children begin to learn the difference between the
natural and the supernatural but have difficulty understanding
symbols.
 Prayer or other religious rituals comfort them, and if these activities
are a part of their daily lives, they can help them cope with
threatening situations.
 Their petitions to their God in prayers tend to be for tangible rewards.
 Although younger children expect their prayers to be answered, as
they get older, they begin to recognize that this does not always
occur, and they become less concerned when their prayers are not
answered. They are able to discuss their feelings about their faith and
how it relates to their lives.
SOCIAL DEVELOPMENT

 One of the most important socializing agents in the school-age years is the
peer group.
 Peer groups have a culture of their own with secrets, traditions, and codes of
ethics that promote feelings of solidarity and detachment from adults.
 Through peer relationships, children learn how to deal with dominance and
hostility, how to relate to persons in positions of leadership and authority, and
how to explore ideas and the physical environment.
 Peer group identification is an important factor in gaining independence
from parents.
 The aid and support of the group provide children with enough security to
risk the moderate parental rejection brought about by small victories in the
development of independence.
 Six-year-old children play in groups, but when they are tired or under stress,
they usually prefer one-to-one contact. At the end of a day, they enjoy
spending individual time with parents. You may have to remind parents that
this is not babyish behavior but that of a typical 6-year-old.
 Seven-year-olds are increasingly aware of family roles and responsibility.
Promises must be kept because 7-year-olds view them as definite, firm
commitments. Children this age tattle because they have such a strong sense
of justice.
 Eight-year-olds actively seek the company of other children. Most 8-year-old
girls have a close girlfriend; boys have a close boyfriend. Girls begin to whisper
among themselves as they share secrets with close friends, annoying both
parents and teachers.
 Nine-year-olds take the values 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 friend or club age because children form groups, usually “spite clubs.”
 This means if there are four girls on the block, three form a club and exclude the fourth.
 The reason for exclusion is often unclear; it might be that the fourth child has a chronic
disease, she has more or less money than the others, she was at the dentist’s the day the
club was formed, or simply that the club cannot exist unless there is someone to exclude.
 Such clubs typically have a secret password and secret meeting place. Membership is
generally all girls or all boys.
 If an excluded child does not react badly to being shut out, the club will probably
disband after a few days because its purpose is lost.
 The next day, the excluded member may meet with two others and snub a different child.
 Parents need to use caution deciding whether to intervene with this type of play because
loyalties shift quickly: The child who is club president today may be the excluded one
tomorrow.
 Because they are so ready for social interaction, 9-year-olds are ready for activities away
from home, such as a week at camp.
 They can take care of their own needs and are mature enough to be separated from
their parents for this length of time. Going to camp before this age usually results in
homesickness and can be a negative introduction to being away from home.
 Although 10-year-olds 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.
 Girls become increasingly interested in boys and vice versa by 11 years of
age. Favorite activities are mixed-sex rather than single-sex ones.
 Children of this age are particularly insecure, however, and girls tend to dance
with girls, whereas boys talk together in corners. Better socialization patterns
need not be rushed.
 Eleven-year-olds must attempt many awkward and uncomfortable social
experiences before they become comfortable forming relationships with the
opposite sex.
 Twelve-year-olds feel more comfortable in social situations than they did the
year before.
 Boys experience erections on small provocation and so may feel
uncomfortable being pushed into boy–girl situations until they learn how to
better control their bodies.
 Because some children develop faster than others, every group has some
members who are almost adolescent and some who are still children, making
social interactions sometimes difficult.
SELF- CONCEPT DEVELOPMENT
 The term self-concept refers to a conscious awareness of self perceptions, such as
one’s physical characteristics, abilities, values, self-ideals and expectancy, and
idea of self in relation to others.
 It also includes one’s body image, sexuality, and self-esteem.
 Although primary caregivers continue to exert influence on children’s self-
evaluation, the opinions of peers and teachers provide valuable input during
middle childhood.
 With the emphasis on skill building and broadened social relationships, children
are continually engaged in the process of self-evaluation.
 Each small success increases a child’s self-image. The more positive children feel
about themselves, the more confident they will be in trying for success in the
future.
 A positive self-concept makes children feel likeable, worthwhile, and capable of
significant contributions. These feelings lead to self-respect, self-confidence, and
happiness.
 Negative feelings lead to self-doubt.
Development of Body Image
 School-age children have a relatively accurate and positive perception of
their physical selves, but in general, they like their physical selves less as they
grow older.
 The head appears to be the most important part of the school-age child’s
perceived image of self, with hair and eye color the characteristics used
most frequently to describe the physical self.
 Body image is influenced, but not solely determined, by significant others.
The number of significant others that influences children’s perception of
themselves increases with age.
 Children are acutely aware of their own bodies, the bodies of their peers,
and those of adults. They are also aware of deviations from the norm.
 Physical impairments assume great importance. Increasing awareness of
these differences, especially when accompanied by unkind comments and
taunts from others, may cause a child to feel inferior and less desirable.
COPING WITH CONCERNS
RELATED TO NORMAL
GROWTH AND DEVELOPMENT
SCHOOL EXPERIENCE
 School serves as the agent for transmitting the values of
society to each succeeding generation of children.
 School is also the setting for relationships with peers.
 After the family, schools are the second most important
socializing agent in the lives of children.
 By the time they enter school, most children have a fairly
realistic concept of what school involves. They receive
information regarding the role of a student from parents,
siblings, playmates, and the media.
 Classmates have a significant impact on the socialization
of children. School is the first time that most children
become members of a large group of individuals their
own age. Peer relationships become increasingly
important and influential as children proceed through
school.
Teacher
 Children respond best to teachers who possess the characteristics of a warm, loving
parent.
 Teachers, like parents, are concerned about the child’s psychologic and emotional
welfare. However, the teacher’s primary responsibility involves stimulating and guiding
children’s intellectual development.
 Teachers serve as models that children try to emulate.
 Children seek their teachers’ approval and avoid their disapproval.
 The teacher is a significant person in the life of the early school-age child, and hero
worship of a teacher may extend into late childhood and preadolescence.
 Teachers who make supportive statements that reassure or commend children, use
accepting and clarifying statements that help children refine ideas and feelings, and
provide assistance that aids children with their own problem solving contribute to the
development of a positive self-concept in the school-age child.
Parent
 Parents share responsibility for helping children achieve their maximum potential.
Parents can supplement the school program in numerous ways.
 Responsible children may occasionally ask for help (e.g., with a spelling list), but
usually they prefer to think through their work by themselves. Excessive pressure or lack
of encouragement from parents may inhibit the development of these desirable traits.
LIMIT SETTING AND DISCIPLINE
 Many factors influence the amount and manner of discipline and limit setting
imposed on school-age children.
 Some of these factors are the parents’ psychosocial maturity, the parents’ childhood
and childrearing experiences, the children’s temperament, the context of the
children’s misconduct, and the children’s response to rewards and punishments.
 When children develop an ability to see a situation from another’s point of view, they
are also able to understand the effects of their reactions on others and themselves
 Discipline should take place in a positive, supportive environment with the use of
strategies to instruct and guide desired behaviors and eliminate undesired behaviors.
 Reasoning is an effective technique for middle school–age children. With advancing
cognitive skills, they are able to benefit from more complex disciplinary strategies.
 For example, withholding privileges, requiring compensation, imposing penalties, and
contracting can be used with great success.

 Problem solving is the best approach to limit setting, and children themselves can be
included in the process of determining appropriate disciplinary measures.
DISHONEST BEHAVIOR
 During middle childhood, children may engage in lying, stealing, and cheating.
Such behaviors are disturbing and challenging to parents.
 LYING
 Lying can occur for a number of reasons. By the time children enter school, they
still “tell stories,” often exaggerating a story or situation as a means of impressing
their family or friends. However, during middle childhood, children become
able to distinguish between fact and fantasy.
 Young children may lie to escape punishment or to get out of some difficulty
even when their misbehavior is evident.
 Older children may lie to meet expectations set by others to which they have
been unable to measure up.
 Most children know that lying and cheating are wrong, and they are
concerned when it is observed in their friends. They are quick to tell on others
when they detect cheating.
 Parents need to be reassured that all children lie occasionally and that
sometimes children may have difficulty separating fantasy from reality.
 Parents should be helped to understand the importance of being truthful in
their relationships with children.
 CHEATING
 Cheating is most common in young children 5 to 6 years of age.
 They find it difficult to lose at a game or contest, so they may cheat to win.
 They have not yet realized that this behavior is wrong, and they do it almost
automatically.
 This behavior usually disappears as they mature.
 However, because 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.
 STEALING
 Between 5 and 8 years of age, children’s sense of property rights is limited, and
they tend to take things simply because they are attracted to them or to take
money for what it will buy.
 When young children are caught and punished, they are penitent— they
“didn’t mean to” and “promise to never do it again”—but they are likely to
repeat the performance the following day.
 Often they not only steal but also lie about their behavior or attempt to justify it
with excuses.
 It is seldom helpful to trap children into admission by asking directly if they
committed the offense.
 Children do not take responsibility for these behaviors until the end of middle
childhood.
 Stealing can be an indication that something is seriously wrong or lacking in
the child’s life.
 For example, children may steal to make up for love or another satisfaction
that they feel is lacking.
 In most situations, it is wise not to attempt to attach 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,
takes care of 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.
 STRESS AND FEAR
 Children today experience significant amounts of stress, which can cause long-
term adjustment and health problems.
 Stress in childhood comes from a variety of sources such as conflict within the
family, interpersonal relationships, and poverty. The school environment and
participation in multiple organized activities can be additional sources of stress.
 To help children cope with stress, parents, teachers, and health care providers
need to frequently reassure children that they are safe, have honest and open
communication, encourage children to express their feelings, and provide time for
unstructured play.
 Adults must recognize signs that indicate a child is undergoing stress, identify the
source of the stress promptly, and refer those children who need specialized
treatment.
 Children 7 to 12 years of age are capable of identifying their own physiologic
responses to stress. Common physiologic signs of stress include tight muscles, hot or
red in the face, jittery, fast heartbeat, breathing difficulties, headache, neck pain,
and abdominal pain
 Children should be taught to recognize these signs as indicators of stress and
to use techniques to manage their stress.
 Children can learn relaxation techniques such as deep-breathing exercises,
progressive relaxation of muscle groups, and positive imagery to immediately
reduce stress.
 When an effective strategy has been developed for one situation, parents
can show the child how to transfer the coping strategy or technique to other
situations.
 School-age children experience a wide variety of fears, including fear of the
dark, excessive worry about past behavior, self-consciousness, social
withdrawal, and an excessive need for reassurance. These fears are
considered normal for children this age.
 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 the 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
 SCHOOL REFUSAL OR PHOBIA
 School refusal is a fear of attending school.
 It is a type of “social phobia” similar to agoraphobia (fear of going outside the
home) or separation anxiety disorder (SAD).
 Children who resist attending school this way develop physical signs of illness,
such as vomiting, diarrhea, headache, or abdominal pain on school days. This
lasts until after the school bus has left or the child is given permission to stay
home for the day.
 A particular child may be reacting to a situation such as a harsh teacher,
having to shower in gym class, or facing a class bully every day. In these
instances, counseling may help the child manage the situation better.
 Because the problem of school refusal is usually only partly the child’s, the
entire family generally requires counseling to resolve the issue.
 As a rule, once it has been established that the child is free of any illness and
the resistance stems from separation anxiety or phobia, the child should be
made to attend school.
 Reinforcement by parents to go to school this way helps to prevent problems
such as school failure, peer ridicule, or a pattern of avoiding difficulties.
 BULLYING
 A frequent reason school-age children cite for feeling so unhappy that they
turn guns on classmates or commit suicide is because they were ridiculed or
bullied to the point they could no longer take such abuse.
 Alert parents that Internet or texting bullying are both also possible and that a
bully does not have to be in fact-to-face contact with their child to be harmful.
 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, both the school and parents will become
involved. Advise parents to discuss bullying with their school-age 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.
 If bullying behavior is ingrained, therapy may be needed to correct the
behavior. Stopping bullying helps not only the victim but also the bully because
statistics show that children with this type of aggressive behavior in grade
school are more apt to be incarcerated as adults than others.
PROMOTION OF HEALTH
DURING SCHOOL-AGE
PERIOD
NUTRITION
 Although parents may have less to say about what a school-age child eats, it
is important that the increasing energy requirements that come with this age
(often in spurts) are met daily with foods of high nutritional value.
 Both girls and boys require more iron in prepuberty than they did between the
ages of 7 and 10 years.
 Adequate calcium and fluoride intake remains important to ensure good
teeth and bone growth. A major deficit may be fiber because school-age
children typically dislike vegetables.
 Parents and children need to be aware of the value of a balanced diet to
promote growth because children usually eat what their family members eat.
 School-age children should be encouraged to eat a healthy breakfast to
ensure the ability to concentrate during the school day. It is helpful if parents
model this behavior.
 The development of proper etiquette is important in the school-age years.
Parents can model this behavior for their child and encourage meals to be
eaten at the table rather than while watching television.
 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
the mass media, and the temptation of “junk food” make it
easy for children to fill up on empty calories. The easy
availability of high-calorie foods, combined with the tendency
toward more sedentary activities, has also contributed to an
epidemic of childhood obesity.
 Parents are unable to monitor what their children eat when
they are away from home. A parent may pack a lunch for
school but is unaware of how much is eaten, traded, sold, or
thrown away. Nutrition education can and should be
integrated in the curriculum throughout the school years.
 School nurses can take an active role in nutrition education by
working with teachers to plan and implement units on nutrition
instruction and by working with parents and children to give
nutritional guidance.
SLEEP AND REST
 School-age children usually do not require naps, but they do need to sleep
approximately 11 hours at age 5 years and 9 hours at age 12 years each night.
 Usually children 6 or 7 years old exhibit few bedtime problems, and
encouraging quiet activity before bedtime, such as coloring or reading,
facilitates the task of going to bed.
 At about age 9 years, when friends become important, children generally are
ready to give up bedtime talks with parents in preference to phoning or text
messaging a friend.
 Most children in middle childhood must be reminded frequently to go to bed;
8- to 9-year-old children and 11-year-old children are particularly resistant.
Often these children are unaware that they are tired; if they are allowed to
remain up later than usual, they are fatigued the following day.
 Sometimes bedtime resistance can be resolved by allowing a later bedtime as
the child gets older.
 Twelve year-old children usually offer no resistance at bedtime; some even
retire early to read a book or listen to music.
EXERCISE AND ACTIVITY
 All growing children need regular exercise and opportunities for satisfying
experiences consistent with individual likes and dislikes.
 Appropriate activities during the school-age years include running, jumping
rope, swimming, roller skating, ice skating, dancing, and bicycle riding.
 Exercise is essential for muscle development and tone, refinement of
balance and coordination, increased strength and endurance, and
stimulation of body functions and metabolic processes.
 Although children go to school all day, they do not automatically receive
much exercise because school is basically a sit-down activity.
 Most children have abundant energy and need little encouragement to
engage in physical activity.
 Children with disabling conditions or those who hesitate to become
involved in active play (e.g., obese children) require special assessment and
help so that activities appeal to them and are compatible with their
limitations while also meeting their developmental needs.
HYGIENE
 Children 6 or 7 years of age still need help in cleaning their ears and
fingernails.
 By age 8 years, children are generally capable of bathing themselves
but may not do it well because they are too busy to take the time or
because they do not find bathing as important as do their parents.
 Both boys and girls become interested in showering as they approach
their teen years.
 This can be encouraged because 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 their period if they have heard this is not safe. They
need information that both of these practices are safe during their
menses.
 Boys who are uncircumcised may develop inflammation under the
foreskin from increased secretions if they do not wash regularly.
DRESSING

 Although school-age children can fully dress themselves, they are not skilled
at taking care of their clothes until late in the school-age years.
 This is the right age, however (if not started already), 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, a popular sport, or a popular musician
rather than the preferences of their parents.
 Help parents be aware that a child who wears different clothing than others
may become the object of exclusion from a school club or group.
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.
 With the appearance of the second permanent (12-year) molar, most
permanent teeth are present.
 Because the permanent teeth erupt during the school-age years, dental
hygiene and regular attention to dental caries are important parts of
health supervision during this period.
 It is important to be alert to possible malocclusion problems that may result
from irregular eruption of permanent teeth and that may impair function.
 Regular dental supervision and continued fluoride supplementation are
integral parts of the health maintenance program.
 The most effective means of preventing dental caries is proper oral
hygiene.
 Children should be taught to perform their own dental care with the
supervision and guidance of the parents.
 Parents should learn the correct brushing technique with their children,
and they should monitor their child’s efforts until the child can assume full
responsibility.
 Teeth should be brushed after meals, after snacks, and at bedtime.
 Children who brush their teeth frequently and become accustomed to
the feel of a clean mouth at an early age usually maintain the habit
throughout life.
 For school-age children with mixed and permanent dentition, the best
toothbrush is one with soft nylon bristles and an overall length of about 21
cm (6 inches).
 Flossing follows brushing. Parents should perform the flossing until children
acquire the manual dexterity required (usually at about 8 or 9 years of
age).
SEX EDUCATION

 Middle childhood is an ideal time for formal sex education, and many
authorities believe that the topic is best presented from a life span approach.
 Information about sexual maturation and the process of reproduction minimizes
children’s uncertainty, embarrassment, and feelings of isolation that often
accompany puberty.
 An important component 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

 No matter where nurses practice, they can provide information on human

sexuality to both parents and children.
 To discuss the topic adequately, nurses must have an understanding of the
physiologic aspects of sexuality; knowledge of the cultural and societal
values; and an awareness of their own attitudes, feelings, and biases about
sexuality.
 When presenting sexual information to school-age children, nurses should
treat sex as a normal part of growth and development.
 Questions should be answered honestly, matter of factly, and to the same
extent as questions about other topics. Answers should be at the child’s level
of understanding.
 Children need explanations of sexual information that is provided via the
media or jokes. Information concerning pregnancy; contraceptives; and
sexually transmitted diseases, including human immunodeficiency virus and
human papillomavirus, should be presented in simple, accurate terms.
 Preadolescents need precise and concrete information that will allow them to
answer questions such as, “What if I start my period in the middle of class?” or
“How can I keep people from telling I have an erection?” It is important to tell
children what they want to know and what they can expect to happen as
they become mature sexually.
 Nurses can be open and available for questions and discussion. They can set
an example by the language they use in discussing body parts and their
function and by the way in which they deal with problems that have
emotional overtones.
 Parents need help to understand normal behaviors and to view sexual curiosity
in their children as a part of the developmental process.
 Assessing the parents’ level of knowledge and understanding of sexuality
provides cues to their need for supplemental information that will prepare
them for the increasingly complex explanations they will need to provide as
their children grow older.
PREVENTION OF INJURY
 the number of injuries in middle childhood is diminished
compared with the number in early childhood
 the most common cause of severe injury and death in school-
age children is motor vehicle crashes
 Most injuries occur in or near the home or school. The most
effective means of prevention is education of the child and
family regarding the hazards of risk taking and the improper
use of equipment.
Anticipatory
Guidance
during
School
Years