NURSING CARE OF A

FAMILY WITH A
SCHOOL-AGE CHILD
 The term “school age” refers to children between the ages of 6 to 12 years.
Although these years represent a time of slow physical growth, the school-aged
child’s cognitive growth and development continue to proceed at rapid rates.
 Always assess children as individuals to understand the particular developmental
needs of each child based on what developmental status has been achieved, not
on what stage you think the child should have reached (Lowe, Godoy, Rhodes, et
al., 2013)
 Unlike the infant or toddler periods, when progress is marked by obvious new
abilities and skills such as the ability to sit up or roll over or the ability to speak
a full sentence, the development of a school-age child is much more subtle. In
addition, the child may demonstrate contradictory responses.
 Parents who don’t understand this normal aspect of development may engage in
excessive conflicts with their child. The school-age period is the initiation of
independent decision making.
 For Healthy Development of a School-age
Child
ASSESSMENT
 History and physical examination are used to assess growth and development of
school-age children. History questions include school progress and extracurricular
activities
 School-age children are interested and able to contribute to their own health
history, and they can be interviewed with his or her parent and separately
depending on the circumstances.
 Parents of school-age children often mention behavioral issues or conflicts during
yearly health visits, this is a time period where children begin to express their
own opinions and beliefs.
 School personnel may be involved in a child’s health care as optimal school
functioning has the greatest potential when a child is healthy physically,
emotionally, and socially.
NURSING DIAGNOSIS
Common nursing diagnoses pertinent to growth and development
during the school-age period include:

 Health seeking behaviors related to normal school-age growth &

development
 Readiness for enhanced parenting related to improved family living
conditions
 Anxiety related to slow growth pattern to child
 Risk for injury related to deficient parental knowledge about safety
precautions for a school-age child
 Growth and Development of a School-Age Child
 The school-age period is a relatively long time span, and even though growth is slow, children grow and develop
extensively during this time.

PHYSICAL GROWTH
the average annual weight gain for a school-age child is approximately 3 to 5 lb (1.3 to
2.2 kg); the increase in height is 1 to 2 in. (2.5 to 5 cm). Children who did not lose a
lordosis and knock-kneed appearance during the preschool period lose this now.
frontal sinuses develop at about 6 years, so sinus headaches become a possibility
(before then, headache in children is rarely caused by a sinus infection).
the left ventricle of the heart enlarges to be strong enough to pump blood to the
growing body, thus, innocent heart murmurs may become apparent due to this extra blood
crossing heart valves. The pulse rate decreases to 70 to 80 beats/min, blood pressure rises
to about 112/60 mmHg.
maturation of the respiratory system leads to increased oxygen-carbon dioxide
exchange, which increases exertion ability and stamina.
all school-age children older than 8 years old should be screened for this at all health
appraisals.
SEXUAL MATURATION
 At a set point in brain maturity, the hypothalamus transmits an enzyme to the anterior pituitary gland
to begin production of gonadotropic hormones, which then activate changes in the testes and ovaries
to cause puberty.
 Timing of the onset of puberty varies widely, between 8 to 14 years of age, partly due to genetic and
cultural difference.
 Sexual maturation in girls usually occurs between the years of 12 and 18; in boys, between 14 to 20
years. Puberty is occurring increasingly earlier, however, and in class of 11 year old sixth graders, it is
not usual to discover more than half of the girls are already menstruating.

SEXUAL AND PHYSICAL CONCERNS

 The changes in physical appearance that come with puberty can lead to concerns for both children and
parents, the school-aged period is a time for parents to discuss with children the physical changes that will
occur and the sexual responsibility these changes dictate.
 This is the time to reinforce previous teaching with children that their body is their own, to be used only in
the way they choose.
 In both sexes, puberty brings changes in the sebaceous glands, under the influence of androgen, glands
become more active, setting the stage for acne. Vasomotor instability commonly leads to blushing;
perspiration also increases.
CONCERNS OF GIRLS
 Prepubertal girls are usually taller by about 2 in. (5cm) or more than preadolescent boys because
their typical growth spurt begins earlier. Girls are usually conscious of breast development,
breast development is not always symmetrical, so it is not usual for a girl to have breast of
slightly different sizes
 Supernumerary nipples may darken or increase in size at puberty, be sure girls understand that a
supernumerary nipple is affected by hormones in her body in the same way as other breast
tissue, so she isn’t concerned by the accessory nipple enlarging with puberty or in future
pregnancy.
 Early preparation for menstruation is an important preparation for future childbearing and for a
girl’s concept of herself as a woman. In addition, girls need an explanation of proper hygiene and
reassurance they can bathe, shower, and swim during their periods.
 Most girls have some menstrual irregularity during the first year or two after menarche (the start
of menstruation). These occurs primarily because a girls cycles are at first an ovulatory. With
added maturity and the onset of ovulation, cycles become more regular.
 Irregular periods can cause concern because girls need to know when their periods will occur so
they can get use to this new phenomena and learn to trust their bodies.
CONCERNS OF BOYS
 Boys become aware of increasing genital size, if they do not know testicular
development precedes penis growth, they can worry that their growth will be
inadequate.
 Hypertrophy of breast tissue (gynecomastia) can occur in prepubescent boys,
most often in those who are obese. A youth with this condition may be
concerned a breast tumor is present or may feel embarrassed about his growing
breast
 Some boys can also become concerned because although they have pubic hair,
they cannot yet grow a beard or do not have chest hair, which are outward,
easily recognized signs of maturity.
 As increased seminal fluid begins to be produced, boys begin to notice
ejaculation during sleep, termed “nocturnal emission”
 DEVELOPMENTAL MILESTONES
GROSS MOTOR DEVELOPMET
 A 7-year old child appears quiet compared with the more active 6 year old. Gender
differences usually begin to manifest themselves in play: where girls may gravitate to more
traditional female roles and activities and boys may gravitate to more traditional male roles
and activities.
 The movements of 8 year old are more graceful than those of younger children, although, as
their arms and legs grow, they may appear awkward in their play and eating habits.
 Nine year old are on the go constantly, as if they always have a deadline to meet. 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 and drop out of
sports activities rather than look ungainly attempting them. They may channel their energy
into constant motion instead: drumming fingers, and tapping pencils or feet.
 Twelve-year old plunge into activities with intensity and concentration. They often enjoy
participating in sports events for charities such as walkathons, they maybe refreshingly
cooperative around the house, able to handle a great deal of responsibility and complete
given task.
FINE MOTOR DEVELOPMENT
 Six year olds can easily tie their shoelaces. They can cut and paste well and draw
a person with good detail. Seven years old concentrate on fine motor skills even
more than they did the year before. This has been called “eraser year” because
children are never quite content with what they have done, and they set too
high standard for themselves and then have difficulty performing that level.
 By eight years of age, children’s eyes are developed enough so they can read
regular-size type, thus, they are able to write script in addition to print and they
are enjoy showing off this new skills in cards, letters and projects. 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 teachers expectations.
 The middle school curriculum involves more challenging science and
mathematics courses than previously and includes good literature.
LANGUAGE DEVELOPMENT
 Six year old talk in full sentences, using language easily and with meaning. They no
longer sound as though talking is an experiment but appear to have incorporated
language permanently.
 Most 7 year olds, can tell the time in hours, but they may have trouble with concepts
such as “half past” and “quarter to”, especially with the prevalence of digital clocks and
they know the months of the year and can name the months in which holidays fall.
 Age 9 years old, children discover “dirty jokes”, they like to tell them to friends or try
to understand those told by adults. They use swear words to express anger or just to
show other children that they are growing up. As before, if parents want to discourage
this, it should be made clear that they find such language unacceptable, and they
refrain from using themselves in their child’s presence.
 By 12 years old, children can carry on an adult conversation, although stories are
limited because of a lack of experience.
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, thus, they can accomplish small tasks
independently because they have gained a sense of autonomy.
 They must have practiced or mimicked adult roles, learned to share, discovered that
learning is an adventure, and grasped the idea that doing things is more important
and rewarding than watching things being done (a sense of initiative).
COGNITIVE DEVELOPMENT
 The age 5 to 11 years is transitional stage where children undergo a shift from the
preoperational thought they used as preschoolers to concrete operational thought or the ability
to reason through any problem they can actually visualize .
 Children can use concrete operational thought because they learn several new concepts during
school age, such as:
Decentering- the ability to project one’s self into other people’s situations and see the world
from their viewpoint rather than focusing only on their own view.
Accommodation- the ability to adapt thought processes to fit what is perceived such as
understanding that there can be more than one reason for other people’s actions.
Conservation- the ability to appreciate that a change in shape does not necessarily mean a
change in size
Class Inclusion- the ability to understand that objects can belong to more than one
classification.

 These cognitive developments lead to some of the typical changes and characteristics of the
school-age period.
MORAL AND SPIRITUAL DEVELOPMENT
 School-aged children begin to mature in terms of moral development as they
enter a stage of “preconventional reasoning”, sometimes as early as 5 years of
age.
 They concentrate on “niceness” or “fairness” and cannot see yet that stealing
hurts their neighbor, the highest level of moral reasoning.
 Remember that school-age children are rule oriented: when they ask for
something, because they were good, they expect to receive what they are
asking.
 HEALTH PROMOTION FOR A FAMILY SCHOOL-AGE CHILD
AND FAMILY
PROMOTING SCHOOL-AGE SAFETY
 School-age 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.
 School age is not too early for parents to look at the effect of carrying heavy backpacks on children’s
posture. A backpack that weighs more than 10% of the child’s body weight is enough to cause a child
to have lean forward chronically to bear the weight.

PROMOTING NUTRITIONAL HEALTH OF A SCHOOL AGE CHILD

 Most school-age children have good appetites, although meals may be influenced by the day’s
activity. If children have had a full day of active play, they may come to the dinner table ready to eat
anything.
Establishing healthy eating patterns- school age children should be encourage to eat a healthy
breakfast to ensure the ability to concentrate during the school day, it is helpful if parents model this
behavior.
Fostering Industry and Nutrition- school age children usually enjoy helping to plan meals, they can prepare
simple meals with healthy ingredients, they can assist with the preparation of more complex meals and learn
the safe use of kitchen appliances such as the microwave and stove.
-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.
A Vegetarian Diet- school age children who are vegetarians or vegans need to learn how to obtain essential
nutrients whether they pack their lunch or purchase it at school. The consumption of adequate protein and
calcium is important for muscle, bone and dental development.

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 of
living later in life. Along with nutritional needs, areas of concern for a school age child and family include dressing,
sleep needs, exercise, hygiene and dental care.

DRESS- although school age children can fully dress themselves, they are not skilled at taking care of their
clothes thus, 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.
- In schools with gang or bullying culture, children may not be able to wear certain color or style lest they be
mistaken for a gang member or become a bully’s victim.
SLEEP
 Sleeps need vary among individual children. Younger school age children typically require 10 to 12
hours of sleep each night, whereas older children require about 8 to 10 hours. Nighttime terrors may
continue during the early school years and may actually increase during the first grade year as a child
reacts to the stress of beginning school.
 During early school years, many children enjoy a quiet talk or a reading time at bedtime, at about 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.
 Children with television sets, electronic games, or smartphones in their bedrooms not only have
shorter sleep times at night but also are more likely to be obese (Chalal, Fung, Kuhle, et al., 2013)

Exercise
 School age children need daily exercise, although they go to school all day, they do not
automatically receive much exercise because school is basically a sit-down activity. Increasing
time spent in exercise need not to involve organized sports.
 As children enter preadolescence, those with poor coordination may become reluctant to
exercise, urge them to participate in some form of daily exercise, however, or obesity or
osteoporosis can result later in life ( Eagle, Sheetz, Gurm, et al., 2012; Gunter, Almstedt, &Janz,
2012).
HYGIENE
 Children 6 to 7 years of age still need help in regulating bath water temperature and in cleaning their eras and
fingernails. By 8 years of age, children are generally capable of bathing themselves but may not do it well.
 Both boys and girls become interested in showering as they approach 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 fore skin from increased secretions if they do
not wash regularly ( Meng & Tanagho., 2013)

CARE OF TEETH