Growth and Development of the School-Aged Child: 6 to 10 Years Chapter 26

Family with School-Aged Child: 6 to 12 Years

-JAYSON KING CRUZ1OBJECTIVESState the major developmental task of the school-aged group according to Erikson.Discuss the physical growth patterns during the school-aged years.Describe dentition in school-aged children.Discuss the psychosocial development of the school-aged child.Explain the cognitive development seen in the school-aged children regarding (a) conservation, (b) decentration, (c) reversibility, and (d) classification. Identify nutritional influences on the school-aged child, including (a) family attitudes, (b) mealtime atmosphere, (c) snacks, and (d) schools role.List three factors that contribute to obesity in the school-aged child.State two appropriate ways to help an obese child control weight.

Discuss recommended health promotion and maintenance for the school-aged child, including: (a) scoliosis screening, (b) vision and hearing screening, (c) dental hygiene, (d) exercise, and (e) sleep.Discuss the need for sex education in the school-aged group and describe the role of the family, school, and others in this education. Describe principles that a family caregiver can use to teach children about substance abuse. Identify common inhalant products that children may use as deliriants.Describe safety education appropriate for the school-aged group.Discuss the effects of the progression in the 6- to 10-year-old childs concept of biology, including the concepts of (a) birth, (b) death, (c) human body, (d) health, and (e) illness.Identify factors that may influence the school-aged child in the health care facility.

Growth and Development of the School-Age ChildAreas of dramatic change between 6 and 10 yearsFirst day of schoolThinking processSocial skillsActivitiesAttitudesUse of languageIndustry vs. inferiority -if unsuccessful in completing activities during this stage, children develop a feeling of inferiority -success with completing the activities in this stage provides the child with self-confidence

4Growth and Development of the School-Age Child (cont.)Health becomes community concernStarting schoolPhysical examImmunizationsUsually healthy time of childs lifeAccidents still pose serious hazard5Physical DevelopmentWeight and heightGrowth is slow and steady Gains about 5 lbs. annuallyAnnual height increase about 2.5 (6 cm)Period ends in the preadolescent growth spurt Changes in dentition Starts to lose deciduous (baby) teeth at about 6 yearsEruption of permanent teeth, 6 year molars (directly behind the deciduous molars)These are important: key or pivot teeth-help shape the jaw and affect the alignment of the permanent teeth6ERUPTION OF PERMANENT TEETH

Physical Development (cont.)Changes in skeletal growthSpine is straighterAbdomen is flatterBody is generally more slender and long-leggedBone growth in long bonesCartilage is being replaced by bone at the epiphyses(growth centers at the end of long bones and at wrists)Skeletal maturation is more rapid in girls than in boys

8SKELETAL GROWTH

6 YEAR OLD10 YEAR OLDQuestionTell whether the following statement is true or false.

Eriksons developmental task for this age group is industry versus inferiority.

10AnswerTrue

Rationale: Eriksons developmental task for this age group is industry versus inferiority.

Q#1

11Psychosocial DevelopmentDisplays a sense of duty and accomplishment Engages in meaningful projects and sees them through to completionApplies the energies earlier put into play to accomplishing tasks Refines motor, cognitive, and social skills Develops a positive sense of self12Psychosocial Development (cont.)Not all children are ready for this stage due to environmental deprivation, a dysfunctional family, insecure attachment to parents, and immaturityUnrealistic or excessive goals can cause problems later in lifeWhen environmental support is adequate child should complete several personality development tasks at this age:Developing coping mechanismsDeveloping a sense of right and wrongAccomplishing a feeling of self-esteemDisplaying ability to care for oneself

13Psychosocial Development (cont.)School age thought processes7 years Piagets concrete operational stage beginsSkills of conservation (the ability to recognize that a change in shape does not necessarily mean a change in mass or amount) significantConservation of numbers, number of cookies does not change when rearrangedConservation of mass, amount of cookie dough is the same whether in ball form or flattenedConservation of weight, a pound is a pound whether plastic or brickConservation of volume, half a glass of water is the same regardless of shape of the container (11-12 yrs.)14Psychosocial Development (cont.)Each child is product ofPersonal heredityEnvironmentCognitive abilityPhysical healthEvery child needs love and acceptanceUnderstanding, support and concern when mistakes are madeThrive on praise and recognition

Psychosocial Development (cont.)Factors affecting self-confidenceConsistent rulesPositive attentionClear expectations16Psychosocial Development (cont.)Development from ages 6 to 7Still employs magical thinkingCan sit still for short periods of time Understands taking turnsEnjoys group activitiesBegins to enjoy participating in real-life activities17Psychosocial Development (cont.)Development from ages 7 to 10Questions parental standards as the ultimate authority Becomes more impressed by the behavior of peersIs increasingly interested in group activitiesMoves from preoperational, egocentric thinking to concrete, operational, decentered thought 18Psychosocial Development (cont.)Development from ages 7 to 10Concepts displayed by the 7- to 10-year-old childDecentration Being able to see several aspects of a problem at the same time and to understand the relation of various parts to the whole situationCause-and-effect relations become clearMagical thinking begins to disappear19Psychosocial Development (cont.)Concepts displayed by the 7- to 10-year-old child (cont.)ReversibilityConservation of continuous quantityThe ability to think in either direction ClassificationThe ability to group objects into a hierarchical arrangementCollections

20QuestionA school-age child aged 7-10 years moves from preoperational, egocentric thinking to what?a. Concrete, operational, centered thoughtb. Concrete, operational, decentered thought c. Cognitive, operational, centered thought d. Cognitive, operational, decentered thought 21Answerb. Concrete, operational, decentered thought

Rationale: Important changes occur in a childs thinking processes at about age 7 when there is movement from preoperational, egocentric thinking to concrete, operational, decentered thought.

Q#222NutritionAs coordination improves, the child becomes increasingly active Requires more food to supply necessary energyThe nutritional needs of the school-age child should be met by choosing foods from all the food groups Increased appetite and a tendency to go on food jags are typical Offer choices Supervise snacking habitsMatter-of-fact attitude about food by caregiversProvide a positive mealtime atmosphere23Nutrition (cont.)Obesity can be a concernCauses Genetic, environmental, or sedentary lifestyle factorsInterventionsAppropriate physical activity (moderately active for 60 minutes every day, or most days)Limiting fat intake (no more than 35% of total calories)Positive caregiver support -avoid nagging -avoid clean your plate rule-limit fast food meals

24Nutrition (cont.)Health teaching at schoolReinforce proper dietSubsidized breakfast and lunch programsProvide well-balanced meals (often children only eat part)Old enough to be partially responsible for packing own lunchPost school lunch menusQ#3

25Health Promotion and Maintenance Routine checkups Annual physicalsBooster of tetanusdiphtheria vaccine every 10 years throughout life (Appendix J)Visit to the dentist at least twice a year10-11 years: first exam for scoliosisVision and hearing screening-before entrance to school and on a periodic basis (annual, biannual)-often conducted by the school nurse

26Health Promotion and Maintenance (cont.)Family teachingProper dental hygiene-particularly 6 yr. molarsExercise and sufficient rest (6 yr. old-12 hrs./night & quiet time after school to recharge; 7-10 yr. old/)Health educationCaregivers should teach child aboutBasic hygieneSexual functioningSubstance abuseAccident preventionSchool should include same topics in curriculum27Health Promotion and Maintenance (cont.)Health education (cont.)Sex education-time and place for formal education remains controversialIncludes Helping children develop positive attitudes about their own bodiesTheir own sexTheir own sexual role to achieve optimum satisfaction in being a boy or a girl

28Health Promotion and Maintenance (cont.)Sex education (cont.)At various places in curriculum-often limited to 1 class, usually 5th gradeCovers different topics in different school systems-watch films about menstruation and developing bodies; separate classes for boys and girlsCaregivers may want to use printed materialsTeach about HIV29Health Promotion and Maintenance (cont.)Health education (cont.)Substance abuse educationJust say no programsTeach unhealthy aspects of tobacco, alcohol and drug useChildren may experiment with inhalantsMay contain deliriantsCan cause death

30HEALTH PROMOTION AND MAINTANENCE CONTDCommon Products Inhaled as DeliriantsModel glueVarnishRubber cementShellacCleaning fluidsHair SprayKerosene vaporsNail polish removerGasoline vaporsLiquid typing correction fluidButane lighter fluidPropellant (whipped cream)Paint spraysAerosol paint cansPaint thinnerSolventsHealth Promotion and Maintenance (cont.)Substance abuse educationFamily caregivers shouldTeach familys valuesTeach difference between right and wrongSet and enforce rules of acceptable behaviorLearn facts about drugs and alcoholActively listen to the children in the family

Q#432Health Promotion and Maintenance (cont.)Accident prevention-remains leading cause of deathChildren must learn safety rules and practice them until they are routineChildren should know Their full nameCaregivers namesHome addressTelephone numberHow to call 91133Health Promotion and Maintenance (cont.)Safety topics for school-age group-page 598Traffic signals and safe pedestrian practicesSafety belt use for car passengersBicycle safetySkateboard and skating safetySwimming safetyDanger of projectile toysDanger of all terrain vehiclesUse of life jacket when boatingQuestionHealth promotion and maintenance is important in this age group. What is one topic that is important for the caregiver to teach the child?a. Positive body imageb. How to use the stovec. How to call the health care providerd. Basic hygiene 35Answerd. Basic hygiene

Rationale: Caregivers have a responsibility to teach the child about basic hygiene, sexual functioning, substance abuse, and accident prevention.

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The School-Age Child in the Health Care FacilityMore accepting of experience than younger childrenThese children have changing concepts ofBirthDeathThe human bodyHealth and illness37The School-Age Child in the Health Care FacilityCONCEPT6-8 YEARS8-10 YEARSIMPLICATIONS FOR NURSINGBirthSee babies as a result of 3 factors: social and sexual intercourse and biological fusionBegin to put 3 components together; sperm and egg come together not sure whyCultural & educational factors play a part in development of where babies come fromTend to see baby as emerging from female only; from outside force- created wholeFewer discrepancies in knowledge based on sex differencesNurse should assess childs idea about birth; can they understand where babies come from and how before teachingBoys know less than girls about baby informationExplain roles of both parents, but the idea of sperm and egg union may not be understood until 8 or 9 years oldThe School-Age Child in the Health Care FacilityCONCEPT6-8 YEARS8-10 YEARSIMPLICATIONS FOR NURSINGDeathMay be viewed as reversibleConsidered irreversibleChange from vague view of death as reversible and caused by external forces to awareness of irreversibility and bodily causesAnimism (attribution of life) may be seen in some children; death is viewed as result of outside forceIdeas about what happens after death unclear; related to concreteness of thinking and socio-religious upbringingFears about death more common @ 8; adults should alert to thisExperiences with death facilitate concept developmentExplanations about death, the fact their thoughts will not cause a death, they will not die (if illness is not fatal) are neededThe School-Age Child in the Health Care FacilityCONCEPT6-8 YEARS8-10 YEARSIMPLICATIONS FOR NURSINGHuman BodyKnow body holds everything insideCan understand physiologyCultural factors may play a part in ability and willingness to discuss bodily functionsUse outside world to explainUse general principles to explain body functionsEducational programs can be very effective because of natural interestAware of major organsInterested in invisible functions of the bodyAssess knowledge of body by using diagrams before teachingInterested in visible functions of body40The School-Age Child in the Health Care FacilityCONCEPT6-8 YEARS8-10 YEARSIMPLICATIONS FOR NURSINGHealthSee heath as doing desired activitiesSee health as doing desired activitiesNeed assistance in seeing cause and effectList concrete practices as components of healthUnderstand cause and effectCapitalize on positiveness of concept; health lets you do what you really want to doMany do not see sickness as related to health; may not consider cause and effectBelieve it is possible to be part healthy and part not at the same time; can reverse from health to sickness and back to healthYoung children who are sick may feel they will never get well againThe School-Age Child in the Health Care FacilityCONCEPT6-8 YEARS8-10 YEARSIMPLICATIONS FOR NURSINGIllnessSick children may see illness as punishment; evidence suggests that healthy children do not see illness as punishmentSame as 6-8 years of age; can identify illness states, report bodily discomfort, recognize that illness is caused by specific factorsSocial factors play a part in illness conceptHighly anxious children more likely to view illness as disruptiveRecognize that some see illness as punishmentSickness is a diffuse state; rely on others to tell them when they are illEncourage self-care and self-help behavior, especially in older childrenThe School-Age Child in the Health Care Facility (cont.)Anxious about looking different than others their ageMay be uncomfortable with nurse of the opposite sexInform families and children of rules as part of admission process

43Nursing Care for the School-Age Child in a Health Care Facility Explain all procedures to children and their familiesShow equipment and material to be usedOutline realistic expectations of procedures and treatmentsAnswer childrens questions truthfullyGive children an opportunity to verbalize anxietiesRespect desire for privacy44Childrens Understanding of Health and IllnessDevelopmental AspectsSchool ageLoss of control/ privacyAdolescentAware of the physiologic, psychologic and behavioral causes of illnessConcerned with appearanceSeparation from peer groupChildrens Understanding of Health And IllnessPsychological AspectsInfantIssues with attachmentToddlerDisruption of routine/ separation from parentsPreschoolerLoss of self-control Fear of dark InjuryChildrens Understanding of Health and IllnessPsychological AspectsSchool-aged childrenPain Bodily Injury DeathAdolescentsLoss of control/ privacyFear of altered body image

The Effects of Hospitalization on the Child and FamilyChildrens understanding of health and illness is primarily based on their cognitive ability at their developmental levelPrevious experiences with healthcare professionals The Effects of Hospitalizaiton on the Child and theFamilyParentsDisrupt usual routineFears/ anxietyCoping abilities (made more difficult if lack of financial, community or family support)SiblingsFearsBehavioral Disruption

Adaptation to HospitalizationParentsTailor nursing care to familys needs and preferencesMaintain positive communication with familyAsk for parents participation in careExplain all aspects of treatment, keep family in the loopProvide information to family (ie teaching materials etc.)Adaptation to HospitalizationSiblingsInform siblings about their brother/ sisters condition (using age-appropriate language and concepts at their developmental level)Encourage siblings to visit (as appropriate)Discuss what to expect before the visit w/ the child, then f/u on how they are feeling after.Adaptation to HospitalizationScheduled AdmissionChild/ parentPreparationToursPlayWritten visual materialChild LifeTalking with peers with similar experience (adolescents)

Adaptation to Hospitalization Nursing Considerations in Preparing Parents and Child for Planned Short-Stay AdmissionAdaptations to HospitalizationNurses can assist the parents in preparing the child for hospitalization byRead stories about the experienceTalk about going to the hospitalEncourage child to ask questions/ draw picturesVisit hospital beforehandPlan hospital stay/routine as much as possibleBe honestFIGURE 172 The childs anxiety and fear often will be reduced if the nurse explains what is going to happen and demonstrates how the procedure will be done by using a doll. Based on your experience, can you list five actions you can take to prepare a school-age child for hospitalization? Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

55FIGURE 173 Jasmines parents are taking the time to prepare her for hospitalization by reading a book recommended by the nurse. Such material should be appropriate to the childs age and culture. Why do you think that having the parents read this material is valuable? Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

56Adaptation to HospitalizationUnanticipated admissionOrientation to unit/environmentExplain all of the proceduresOpportunities for parents/ child to express fearsStress-reduction methodsAdaptation to HospitalizationSpecial units and types of care:Short-stay unitOutpatient unitAmbulatory surgical unitGeneral pediatric unitEmergency DepartmentsNICU/ PICUAcute care or long-term rehabilitative unitAdaptation to HospitalizationNursing care focuses on providing family-centered carePromoting the childs and familys coping strategies to deal w/ hospitalizationPromoting optimal development and safetyMinimizing disruption of the childs usual routine Nursing strategies to Improve the Illness/ HospitalizationExperience of Parents/ ChildrenVarious Practice SettingsEmergency DepartmentPsychological considerationsSame day surgeryThorough discharge teaching instructionsFIGURE 176 This child has just undergone surgery and is in the post anesthesia care unit (PACU). Although the childs physical care is immediate and important, remember that both the child and the family have strong psychosocial needs that must be addressed concurrently. It is important to reunite the family as soon as possible after surgery.Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

61Nursing strategies to Improve the Illness/ HospitalizationExperience of Parents/ ChildrenPractice SettingsICUPsychological considerationsParental decision making/ involvement in careHospital Care Mediation administrationDevelopmental considerationsVariations in Med AdministrationOralRectalOphthalmic and oticTopicalIntramuscularIntravenous Nursing strategies to Improve the Illness/ HospitalizationExperience of Parents/ ChildrenHospital (cont)Educational needsIndividual education plan (IEP)TeachingPartnering w/ parentsAdaptation to HospitalizationPreparation for ProceduresPsychological preparationUsing language the child understandsPhysical preparationSigned consent, pre-medicatePerforming the procedureTreatment roomAssisting Children through proceduresRefer to Table 17-7:Infant ToddlerPreschool childSchool-age childAdolescentStrategies to Promote Coping and Normal Development of the Hospitalized ChildThese strategies help to meet the psychosocial needs of the hospitalized childRooming inChild Life ProgramsChild life specialistTherapeutic PlayAssessing the child and family in preparation for dischargeAssess the familys ability to manage the childs care ? Any special adaptation to home environment/ or other facilityCollaborate w/ parents to teach them treatment procedures and proper equipment useHave family member demonstrate proper care of equipment, and any procedures necessaryProfessional Practice Standards for Pediatric Nursing PracticeCollecting health dataAnalyzing the assessment data in determining diagnosesIdentifying expected outcomes individualized to the child and familyDeveloping a plan of care that prescribes interventions to attain expected outcomesImplementing the interventions identified in the plan of care70THANK YOU!

When families do better- kids do better.

Families dont care about how much you know until they know how much you care. Marian Wright EdelmanPlease complete an evaluation of the training!

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