Chapter 20: Caring for the Developing Child (School-aged)

Question 1

School-Aged Child is What Age?

Answer 1

6 to 12 years

Question 2

Physical Development

Answer 2

• between ages 6 to 9, boys and girls follow similar growth patterns
• begin to grow taller; reducing their “baby fat” even more
• gain about 4 to 6 lbs
• grow 2 inches (5 cm) per year
• as abdominal muscles strengthen, their posture strengthens
• facial features become refined
• many variations in shape and size of children; influenced by familial and cultural genetics, and environmental factors (diet & exercise)
• begin to develop axillary sweating
• in girls, hips begin to broaden and the pelvis widens in preparation for childbearing
• breasts begin to enlarge and become tender
• vaginal pH changes from alkaline to acidic, and the vagina develops a thick mucoid lining
• pubic hair begins to develop between the ages of 8 and 14
• menarche can begin as early as 8 to 10 years of age, the average age is 12 years
• boys begin sexual development; bodies become more muscular. Between 10 and 12 years of age the testes become more sensitive to pressure, skin of the scrotum darkens, and pubic hair begins to develop
• boys often experience gynecomastia, a temporary enlargement of breasts as a result of hormonal shifts; can be embarrassing, child and family need reassurance of its transient nature

Question 3

How are Both Female and Males assessed at the well-child visits

Answer 3

• using the Tanner staging of development of secondary sex characteristics
• tanner staging is done to document evidence of normal pubertal development for the age of the child, and it is an important assessment to detect signs of sexual abuse and precocious puberty

Question 4

Privacy

Answer 4

• at this age, it is important to guard the child’s privacy
• as a nurse, be aware of self-conscious behavior r/t physical changes occurring in the body
• along with privacy, the nurse must be aware of other issues affecting the child and family r/t menstruation, secondary sexual characteristics, hormone imbalances, mood swings, and social needs, as well as other specific areas identified by the child and family

Question 5

Cognitive Development

Answer 5

• better able than the younger child to use logical thinking; this logic in thinking corresponds with Piaget’s Concrete Operational Stage of cognitive development
• while the child’s thinking is still concrete, he can begin to solve problems
• begins to replace the “why” questions with “how?” questions
• Mastery= focused on figuring out how things work
• school-aged child build on experience and begins to recognize consequences of actions
• In school, works on tasks requiring awareness of space (where things are relation to other things), causality (logical consequences), categories (how things fit together), conservation (physical quantity can remain constant even when state is altered), and numbers
• capable of metacognition, the ability to think about thinking; child is aware of his own thinking and is able to assess how he came to conclusions, a process that eventually leads to critical thinking
• memory deepens as child grows
• becomes more adept at processing and working through information
• memory improves because the brain retains more information
• better able to determine what is important to remember and what is not; helps filter out irrelevant data, leaving memory space available

Question 6

Language Development

Answer 6

• improves
• uses words more accurately, particularly verbs, metaphors, and similes
• able to elaborate on concepts that he wants to get across

Question 7

Psychosocial Development

Answer 7

• vast emotional growth during the middle child years
• Erikson’s stage Industry versus Inferiority
• unlike the younger -child who believes he can do almost anything, the 6 to 10 year old child begins to assess what he can and cannot accomplish
• school-age children need and seek praise
• have a more definite self-esteem or competence based on the ability or lack of ability to perform
• early in middle childhood period (age 6 to 9), the child is still self-focused
• school-aged child still exhibits magical thinking, in that he still may feel responsible for bad things that happen
• Later in the stage (ages 9 to 12), the child is increasingly independent, although wants approval and validation
• sorting, collecting, and board games are common activities
• competing and winning become important in the growing sense of self-competence
• friendships are exceptionally important at this stage
• school-age child looks more to friends than family, but family is still important
• best friends tend to be of the same gender, although mixed gender groups of school-age children become common as they reach the preteen and early teen years

Question 8

Moral Development

Answer 8

• for first several years, the school-age child is still operating within preconventional morality
• the younger child sees things as black and white and as self-referenced, rather than connected with more generalized rules and concepts
• by the age 10, the child enters Kohlberg’s conventional mortality stage
• the child has internalized rules and is intently gaining approval
• older child operates within a morality of cooperation that implies recognition of the interaction between the self and a “bigger” worldview
• motivated to adhere to laws as a way to keep order

Question 9

Discipline

Answer 9

• b/c the child in this stage is beginning to internalize rules, it is important to allow the child more independence and thus more awareness of the natural consequences of behavior
• parental technique: refrain from “rescuing” the child from the consequences of his behavior (e.g. rushing home to retrieve a forgotten piece of homework whenever the child calls rather than allowing him to learn a valuable lesson)
• while many school-aged children respond appropriately to natural consequences, some do not yet understand responsibility. In fact, most children opt at some time to ignore the natural consequences; parents may need to impose the previously discussed time-out strategy (e.g. grounded for a period of time or privileges restricted)

Question 10

Anticipatory Guidance

Answer 10

-the school-aged child experiences many physical changes that can be confusing and frightening; many parents are uncomfortable discussing, or unsure how to discuss, pubertal changes and need information to help them explain these changes to their child
>educating the parents and child about these changes before they occur is important
-many elementary and middle schools invite parents to view the materials taught in health classes regarding puberty and physical changes 
-nurses can encourage parents to review those materials and give permission for their child to receive that information in class and then reinforce it at home

Question 11

Anticipatory Guidance: Nutrition

Answer 11

• family meals
• provide 3 healthy meals and 2 to 3 nutritious snacks per day
• teach child how to make nutritious choices
• avoid high-fat, processed, and fast-foods
• manage weight through exercise and healthy nutrition

Question 12

Anticipatory Guidance: Health Promotion

Answer 12

• immunizations
• recommended CPR training and Heimlich maneuver
• oral health: brushing, routine cleanings
• be alert to mood changes, stress
• discus smoking and substance abuse avoidance
• discuss sexual feelings and how to say “no” to sex

Question 13

Anticipatory Guidance: Focus on Safety

Answer 13

• seat belt and car safety
• sunscreen
• safe home environment: secure matches, guns
• bike helmet
• water, sports, and playground safety
• check smoke detectors
• protective equipment for sports
• review rules for being home alone

Question 14

Anticipatory Guidance: Sleep-wake Patterns

Answer 14

• require 8 to 12 hours of sleep a night

- night terrors may occur

Question 15

Anticipatory Guidance: Physical Development

Answer 15

• discuss physical changes r/t secondary sex characteristics in later childhood
• body odor
• some girls may start menstruation in late childhood

Question 16

Anticipatory Guidance: Cognitive and Emotional Development

Answer 16

• stimulate thinking
• praise academic achievement
• provide regular time and space for homework
• teach organizational skills
• teach and encourage problem-solving skills
• implement goal-setting through calendars or charts
• assign regular chores
• provide for family-centered activities and trips
• assist child to recognize and handle new emotions
• teach social skills
• demonstrate acceptance, love, concern for the child
• support participation in hobbies, clubs, and extracurricular activities
• discuss ways to handle peer pressure
• encourage taking on new responsibilities: volunteering in the community

Question 17

Anticipatory Guidance: Motor Development

Answer 17

• daily regular exercise

- support participation in organzied sports

Question 18

Anticipatory Guidance: Discipline

Answer 18

• clearly defined limits

- restriction of privilege’s

Question 19

Developmental Milestones of the School-Aged Child (6-12 years)

Answer 19

> Physical Growth:
-Weight: 4-6 lbs /year
-Height: increases 2 inches (5 cm)/ year
Gross Motor Skills:
-gradual increase in dexterity and becomes limber, improves coordination, strength, balance and rhythm; climbs, bikes, skips, jumps rope, and swings; learns to swim, dance, do somersaults, and skate
Fine Motor Skills:
-good eye-hand coordination; balance improves; can sew, draw, make arts and crafts, build models, play video games; handwriting improves; prints and writes; likes activities that promote dexterity such as playing a musical instrument and building models
Cognitive, Sensory, and Language:
-increased logical thinking leads child to be able to solve problems; wants to know “how” things work; understands that actions have consequences; aware of own thinking and how conclusions were reached; 20/20 visual acuity; color discrimination fully developed; mature sense of smell; hearing deficits may be discovered as language develops; language: accelerated vocabulary expands to 8000 to 15000 words; as comprehension expands children engage in long conversations on a variety of topics; enjoy jokes; may experiment with profanity
Psychosocial:
-increases peer group involvement as peers influence values and beliefs; same-sex friends; masters skills; increases confidence and self-esteem
Play:
-cooperative play teaches children how to bargain, cooperate, and compromise to develop logical reasoning, which increases social skills; activities include: baseball, soccer, gymnastics, swimming, dodge ball, board games, simple card games, computer games, video games, puzzles, crosswords, and word search puzzles