1. The School-Age Child and Family
Chapter 34
The School-Age Child and Family
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2. 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
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3. 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
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4. 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”
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5. Biologic Development (Cont.)
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6. 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
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7. 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
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8. 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
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9. 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
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10. Psychosocial Development (Cont.)
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11. 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
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12. 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
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13. Cognitive Development (Cont.)
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14. 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
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15. 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
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16. 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
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17. Social Development (Cont.)
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18. 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
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19. Play Rules and rituals Team play Quiet games and activities
Ego mastery
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20. Play (Cont.)
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21. Play (Cont.)
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22. 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
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23. 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)
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24. 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
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25. 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
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26. 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
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27. 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
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28. 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
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29. Exercise and Activity (Cont.)
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30. Dental Health Eruption of permanent teeth Good dental hygiene
Prevention of dental caries
Periodontal disease
Malocclusion
Dental injury
Dental avulsion: replacement/reattachment
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31. Dental Health (Cont.)
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32. 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
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33. 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
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34. School Health
Responsibilities of parents, schools, and health departments
Routine services
Health appraisal
Education
Communicable disease control
Counseling
Follow-up care and referral
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35. 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
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36. Injury Prevention (Cont.)
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37. 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
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38. 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
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