The School-Age Child and Family Chapter 34 The School-Age Child and Family All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimal Growth and Development “School age” generally defined as ages 6 to 12 years Physiologically begins with shedding of first deciduous teeth; ends at puberty with acquisition of final permanent teeth Gradual growth and development Progress with physical and emotional maturity All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Biologic Development Middle childhood Height increases by 2 inches/year Total height gain is 1-2 feet Weight increases by 2-3 kg/year Weight almost doubles Boys and girls differ little in size All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Biologic Development (Cont.) Proportional changes Movements more graceful than those of preschoolers Skeletal lengthening and fat diminution Increased muscle tissue Decrease in head circumference related to height Change in facial proportions The age of “loose teeth” All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Biologic Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Biologic Development (Cont.) Maturation of Systems Bladder capacity increases Heart is smaller in relation to rest of body Immune system is increasingly effective Bones continue to ossify Physical maturity is not necessarily correlated with emotional and social maturity All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Biologic Development (Cont.) Prepubescence Preadolescence is the period of 2 years before age 13 Prepubescence typically occurs during preadolescence Age at prepubescence varies from 9 to 12 (girls about 2 years earlier than boys) Puberty begins at approximately age 10 in girls and age 12 in boys All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Psychosocial Development Latency period (Freud) Precedes heterosexual fascination that occurs in puberty A time of tranquility Relationships revolve around same-sex peers This time is the “latency” period of psychosexual development All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Psychosocial Development (Cont.) A sense of industry (Erikson) Stage of accomplishment Eagerness to develop skills and participate in meaningful and socially useful work Acquisition of sense of personal and interpersonal competence Growing sense of independence Peer approval: a strong motivator All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Psychosocial Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Psychosocial Development (Cont.) Sense of inferiority (Erikson) Feelings may derive from self or social environment Feelings may occur if child is unable or unprepared to assume the responsibilities associated with developing a sense of accomplishment All children feel some degree of inferiority regarding skill(s) they cannot master All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cognitive Development Concrete operations (Piaget) Uses thought processes to experience events and actions Develops understanding of relationships between things and ideas Is able to make judgments on the basis of reason (“conceptual thinking”) Masters the concept of conservation Develops classification skills All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cognitive Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Moral Development Development of conscience and moral standards (Kohlberg) Ages 6-7: reward and punishment guide choices Older school age: child is able to judge an act by the intentions that prompted it Rules and judgments become more founded on needs and desires of others All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Spiritual Development Children think in very concrete terms Children are avid learners with a desire to know their God Children expect punishment for misbehavior Children may view illness or injury as punishment for a real or imagined misdeed All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Social Development The peer group is extremely important Identification with peers is a strong influence in achieving independence from parents Sex roles are strongly influenced by peer relationships All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Social Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Social Relationships and Cooperation Clubs and peer groups Formation of formalized groups Bullying Relationships with families Parents are primary influence in shaping child’s personality, behavior, and value system Increasing independence from parents is primary goal of middle childhood Parents need to be adults, not friends All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Play Rules and rituals Team play Quiet games and activities Ego mastery All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Play (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Play (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Developing a Self-Concept Children develop conscious awareness of a variety of self-perceptions (abilities, values, appearance) Significant adults can help children experience success Positive self-concept leads to feelings of self-respect, self-confidence, and happiness All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Developing a Body Image In general, children like their physical selves less as they grow older The head is the most important part of the body (hair and eye color) Body image is influenced by significant others Increased awareness of “differences” may influence feelings of inferiority (e.g., hearing or visual defects) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Coping with Concerns Related to Normal Growth and Development School experience Entrance to school is a sharp break in the structure of the child’s world School is second only to the family as socializing agent Values of the society are transmitted in school Peer relationships become increasingly important All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Coping with Concerns Related to Normal Growth and Development (Cont.) School experience Teachers Parents “Latchkey children” Limit setting and discipline Dishonest behavior Stress and fear All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimal Health During the School Years Nutrition Importance of balanced diet to promote growth Quality of diet related to family’s pattern of eating Developing a taste for a variety of foods “Fast food” concerns MyPlate All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimal Health During the School Years (Cont.) Sleep and rest Sleep averages 9-11 hours/night during school age but is highly individualized Children may resist going to bed at ages 8-11 Children aged 12 years and up are generally less resistant to bedtimes All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Exercise and Activity Sports Acquisition of skills Controversy regarding early participation in competitive sports Concerns with physical and emotional maturity in competitive environment Acquisition of skills Children generally like competition All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Exercise and Activity (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Dental Health Eruption of permanent teeth Good dental hygiene Prevention of dental caries Periodontal disease Malocclusion Dental injury Dental avulsion: replacement/reattachment All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Dental Health (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Sex Education Sex play is part of normal curiosity during preadolescence Middle childhood is ideal time for formal sex education Lifespan approach Information on sexual maturity and process of reproduction Effective communication with parents All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nurse’s Role in Sex Education Treating sex as normal part of growth and development Questions and answers Differentiation between “sex” and “sexuality” Values, problem-solving skills Open communication with parents All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

School Health Responsibilities of parents, schools, and health departments Routine services Health appraisal Education Communicable disease control Counseling Follow-up care and referral All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Injury Prevention Most common cause of severe injury and death in school-age children is motor vehicle crashes: pedestrian and passenger Bicycle injuries: benefits of bike helmets Appropriate safety equipment for all sports All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Injury Prevention (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Anticipatory Guidance: Care of Families Parents adjust to child’s increasing independence Parents provide support as unobtrusively as possible Child moves from narrow family relationships to broader world of relationships All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question A child has an avulsed (knocked-out) tooth. The parents are reluctant to try to reimplant the tooth. Where should the tooth be placed for transport to the dentist? A. In cold milk B. In cold water C. In warm salt water D. In a dry, clean jar All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.