School Age Growth And Development

SCHOOL AGE GROWTH AND DEVELOPMENT PREPARED BY: MS. AILEEN S. ADRALES, RN 1

School age 6-12 y.o 1. Physical growth and development A. General growth parameters

1. During this period, girls usually grow faster than boys and commonly surpass them in height and weight.  Height increases by 2 inches per year  Weight increases by 2 to 3 kg per year  Males and females differ little in size aileen s.adrales,rn

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Physical growth and development A. General growth parameters 2. During preadolescence (10 to 13) – commonly

experiences rapid growth. 3. the immune system more efficient, allowing for more localization of infections and better antibody-antigen response.

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I. Physical growth and development

B. NUTRITION 1. Nutritional requirements  Caloric requirements diminish in relation to body size.  2,400 calories per day  Stress the need for balanced diet. aileen s.adrales,rn

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I. Physical growth and development B. NUTRITION 2. Food pattern and preferences a. A child is exposed to broader eating experiences in the school lunchroom; he may still be a ―picky‖ eater but should be more willing to try new food. Children may trade, sell, or throw away home packed school lunches

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I. Physical growth and development B. NUTRITION 2. Food pattern and preferences b. At home the child should eat what the family eats, the patterns that develop now stay with the child into adulthood. The child’s eating patterns should reflect family culture. c. Many school-age children still dislike vegetables casseroles, liver and spicy foods. They may go on ―food jags‖ eating only one type of food at a time, such as peanut butter and jelly sandwiches for lunch aileen s.adrales,rn

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I. Physical growth and development B. NUTRITION 2. Food pattern and preferences d. Family members play an important role in the child food preferences; however, peers and the media are also influences. Without adult supervision, school-age children typically make poor food choices. aileen s.adrales,rn

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I. Physical growth and development B. NUTRITION 3. Overweight and Obesity.  More than 90% of obese children are overweight due to overeating, with under activity playing a significant role.

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I. Physical growth and development C. SLEEP PATTERNS 1.

Individual sleep requirements for school-age children vary but typically range from 8-91/2 hours nightly. Because growth rate slows, school-age children actually need less sleep than they will during adolescence. 2. The child’s bedtime can be later than during the preschool period but should be firmly established and adhered on to school nights. aileen s.adrales,rn

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I. Physical growth and development C. SLEEP PATTERNS 3. Reading before bedtime may facilitate sleep and set up a positive bedtime pattern. 4. Children may be unaware of fatigue, if allowed to remain awake, they will be tired next day.

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I. Physical growth and development D. DENTAL HEALTH 1. Beginning around age 6, permanent teeth erupt and child begins with shedding of first deciduous teeth . 2. Regular dental visit are important. 3. Brush teeth after meal with soft nylon toothbrush 4. Floss teeth until child reaches age 8 or 9. 5. Caries, malocclusion and periodontal disease evident aileen s.adrales,rn

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I. Physical growth and development E. ELIMINATION 1. By 6 years, 85% have full bowel and bladder control. 2. Elimination patterns are similar to adult patterns. a. Bm occur on average 1 to 2 times per day. b. Urination 6-8/day. Average urine volume 5001000 ml/day

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I. Physical growth and development B. ELIMINATION 3. Common problems: A. nocturnal enuresis – bed wetting 15% 6 yr olds; 3 % 12 yr olds; 1% 18yr olds. b. Encopresis – persistent stool leakage 1.5% grade 2 c. Boys have more frequent problems with soiling and constipation. aileen s.adrales,rn

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II. Motor development A. GROSS MOTOR DEVELOPMENT 1. Bicycling 2. Roller skating, roller blading, and skateboarding 3. Progressively improved running and jumping. 4. swimming aileen s.adrales,rn

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II. Motor development B. FINE MOTOR DEVELOPMENT 1. Printing in early years; script in later years (by age 8) 2. Greater dexterity for crafts and video games. 3. Computer competence (manual skills) aileen s.adrales,rn

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II. Motor development C. RELATED SAFETY CONCERNS 1. Learn to accept more responsibility for personal health care and injury prevention. 2. Developing cognitive skills complement their own judgments and assist them avoid many types of injuries. aileen s.adrales,rn

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II. Motor development

C. RELATED SAFETY CONCERNS 3. Still prone to accidents: a. Major sources of injuries: Bicycles, Skateboards, and team sports. aileen s.adrales,rn

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II. Motor development C. RELATED SAFETY CONCERNS 3. Reduce the risk of injury by: − − − − − −

Learning proper techniques. Using safe equipment. Good coaching Well-matched teams Fire saftey Use of seatbelts and bicycle helmets. aileen s.adrales,rn

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II. Motor development C. RELATED SAFETY CONCERNS 4. Provide guidance for new situations and threats to safety. 5. Should receive education about the use and abuse of alcohol, tobacco and other drugs. aileen s.adrales,rn

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III. PSYCHOSOCIAL DEVELOPMENT A. OVERVIEW (ERIKSON) 1. INDUSTRY VERSUS INFERIORITY. a. Significant others expands to include schoolmates and instructive adults. b. Normally mastered the 1st three developmental task ( task, autonomy, and initiative) and now focuses on mastering industry.

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III. PSYCHOSOCIAL DEVELOPMENT A. OVERVIEW (ERIKSON) 1. INDUSTRY VERSUS INFERIORITY. c. A sense of industry springs from a desire for achievement. d. A sense of inferiority can stem from unrealistic expectations or a sense of failing to meet standards other set for the child. His selfesteem declines.

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III.PSYCHOSOCIAL DEVELOPMENT A. OVERVIEW (ERIKSON) 1. INDUSTRY VERSUS INFERIORITY. 2. Engages in tasks and activities that he can carry through to completion. 3. Learn rules, competition, and cooperation to achieve goals. 4. Social relationships become increasingly important source of support. aileen s.adrales,rn

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Erikson: Developing a Sense of Industry • Eager to develop skills and participate in meaningful and socially useful work • Acquire sense of personal and interpersonal competence • Growing sense of independence • Peer approval is strong motivator

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Erikson: Inferiority • Feelings may derive from self or social environment • May occur if incapable 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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III. PSYCHOSOCIAL DEVELOPMENT A. FEARS AND STRESSORS  Avoid being labeled ―Chicken‖ or a ―baby‖.

Common Fears a. Failure at School b. Bullies c. Intimidating teachers d. Bad happening to Parents aileen s.adrales,rn

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III. PSYCHOSOCIAL DEVELOPMENT A. FEARS AND STRESSORS 3. Common stressors: young      

Teasing Decision making Need for approval Loneliness Independence Opposite sex aileen s.adrales,rn

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III. PSYCHOSOCIAL DEVELOPMENT A. FEARS AND STRESSORS

3. Common stressors: older school age      

Sexual maturation Shyness Health Competition Peer pressure Temptation to take drugs aileen s.adrales,rn

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III. PSYCHOSOCIAL DEVELOPMENT A. FEARS AND STRESSORS 4. Reduce client’s fears by communicating empathy and concern without being overprotective. 5. They must know that people will listen and that they will be understood.

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III. PSYCHOSOCIAL DEVELOPMENT C. SOCIALIZATION 1. The period of dynamic change and maturation as child becomes increasingly involved in more complex activities, decision-making, and goaldirected activities. 2. As a school-age child leans more about her body, social development centers on the body and its capabilities. aileen s.adrales,rn

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III. PSYCHOSOCIAL DEVELOPMENT

C. SOCIALIZATION 3. Peer relationships gain new importance. 4. Group activities, including team sports, typically consume much time and energy.

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III. PSYCHOSOCIAL DEVELOPMENT C. PLAY AND TOYS 1. Play becomes more competitive and complex during the school-age period. 2. Characteristic activities include team sports, secret clubs, ―gang‖ activities, scouting, or other organizations, complex puzzles, collections, quit board games, reading, and hero worship. aileen s.adrales,rn

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III. PSYCHOSOCIAL DEVELOPMENT

C. PLAY AND TOYS 3. Rules and rituals are important aspects of play and games. 4. Toys, games, and activities that encourage growth development include: a. increasingly complex board and card games b. books and crafts c. music and arts d. athletic activities/ team activities 36 e. computer activities

III. PSYCHOSOCIAL DEVELOPMENT D. DISCIPLINE 1. Begin to internalize their own controls and need less outside direction. 2. Help them feel their importance. 3. Set reasonable, concrete limits and keep rules to a minimum. aileen s.adrales,rn

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IV. PSYCHOSEXUAL DEVELOPMENT A. OVERVIEW (FREUD) 1. LATENCY PERIOD – 5-12 years  Represents a stage of relative sexual indifference 2. Development of self-esteem is closely linked with developing sense of industry to produce concept of one’s value and worth. aileen s.adrales,rn

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IV. PSYCHOSEXUAL DEVELOPMENT 2. Sexual development A. OVERVIEW (FREUD) a. Discrepancies in growth and maturation between the sexes becomes apparent. b. Acquire much knowledge of and many attitudes toward sex at earlier stages. c. Questions about sex require based on child’s level of understanding. aileen s.adrales,rn

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V. COGNITIVE DEVELOPMENT A. OVERVIEW (PIAGET ) 1. Between 7 and 11- Concrete operations stage  Marked by inductive reasoning, logical operations and reversible concrete thoughts.

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V. COGNITIVE DEVELOPMENT A. OVERVIEW (PIAGET ) • Characterized by the appropriate use of logic. Important processes during this stage are: 1. Seriation—the ability to sort objects in an order according to size, shape, or any other characteristic. For example, if given different-shaded objects they may make a color gradient. 2. Classification—the ability to name and identify sets of objects according to appearance, size or other characteristic, including the idea that one set of objects can include another. aileen s.adrales,rn

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V. COGNITIVE DEVELOPMENT A. OVERVIEW (PIAGET ) 3. Decentering—where the child takes into account multiple aspects of a problem to solve it. For example, the child will no longer perceive an exceptionally wide but short cup to contain less than a normally-wide, taller cup. 4. Reversibility—where the child understands that numbers or objects can be changed, then returned to their original state. For this reason, a child will be able to rapidly determine that if 4+4 equals 8, 8−4 will equal 4, the original quantity. aileen s.adrales,rn

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V. COGNITIVE DEVELOPMENT A. OVERVIEW (PIAGET ) 5. Conservation—understanding that quantity, length

or number of items is unrelated to the arrangement or appearance of the object or items. 6. Elimination of Egocentrism—the ability to view things from another's perspective (even if they think incorrectly • Children in this stage can, however, only solve problems that apply to actual (concrete) objects or events, and not abstract concepts or hypothetical 43 aileen s.adrales,rn tasks.

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V. COGNITIVE DEVELOPMENT A. OVERVIEW (PIAGET )

3. Typical activities of child at this stage: a.Collecting and sorting objects. b.Ordering items according to size, shape, weight, and other criteria. c.Consider options and variables when solving problems. aileen s.adrales,rn

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V. COGNITIVE DEVELOPMENT A. OVERVIEW (PIAGET ) B. LANGUAGE 1. Develops formal adult articulation patterns by age 9. 2. Learns that words can be arranged in terms of structure. 3. Ability to read is one of the most significant skills that the child develops. aileen s.adrales,rn

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Kohlberg: Moral Development • Development of conscience and moral standards • Age 6 to 7: reward and punishment guide choices • Older school age: 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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VII. WELLNESS PROMOTION A. GENERAL  Follow guidelines for screening, child care visits, immunizations and safety. B. NUTRITION 1. Encourage healthy eating patterns. 2. Limit junk food. 3. Teach basics about food pyramid.

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VII. WELLNESS PROMOTION C. SLEEP

1. Agree on bedtime. 2. Allow flexibility on nonschool nights.

D. GROWTH AND DEVELOPMENT 1. Foster a sense of industry by encouraging the child skill development. 2. Counsel families about safety measures for latchkey children if needed. aileen s.adrales,rn

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VII. WELLNESS PROMOTION E. FAMILY 1. Encourage open communication 2. Foster responsibility with chores and adherence to rules and schedules. 3. Encourage decision making and individuality 4. Parents should know peer group.

F. HEALTH 1. Promote self-care and hygiene. 2. Monitor child for behavior problems. aileen s.adrales,rn

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VII. WELLNESS PROMOTION G. ANTICIPATORY GUIDANCE 1. Teach child about:      

Puberty Physical and emotional changes Drugs Alcohol Tobacco and Sex education aileen s.adrales,rn

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VIII. ILLNESS AND HOSPITALIZATION A. OVERVIEW 1. STRESSORS include immobilization, fear of mutilation and death, and concerns over modesty. 2. May have difficulty with force dependency.

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VIII. ILLNESS AND HOSPITALIZATION B. Reactions to illness 1. School-age children perceive external forces as causes illness. 2. They are aware of the significance of different illnesses. For example, they know that cancer is more serious than a ―cold.‖

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VIII. ILLNESS AND HOSPITALIZATION C. Reactions to hospitalization 1. The primary defense mechanism of school-age children is reaction formation, an unconscious defense mechanism in which the child assumes an attitude that is opposite of the impulse that they harbor. Typically, the child states he is brave when he is really frightened. aileen s.adrales,rn

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VIII. ILLNESS AND HOSPITALIZATION C. Reactions to hospitalization • School-age children may react to separating by demonstrating loneliness, boredom, isolation, and depression. They may also show aggression, irritability, and inability to relate to sibling and peers. • The sensed loss of control is related to enforced dependency and altered family roles. • Fear of bodily injury and pain results from fear of illness, disability, and death. aileen s.adrales,rn 62

VIII. ILLNESS AND HOSPITALIZATION D. Nursing management 1. Provide general interventions. a. b. c. d. e.

Encourage verbalization. Encourage self-care. Encourage peer interactions. Inform school-age children that it is ―OK‖ to cry. Give factual information; use models to demonstrate concepts or procedures. aileen s.adrales,rn 63 f. Provide diversions.

VIII. ILLNESS AND HOSPITALIZATION D. Nursing management 2. Provide physical comfort and safety interventions. a. Allow the school-age child control over body functions. b. Assist in developing fine motor skills. Encourage: − construction toys, such as Lego sets − drawing − computer games − drawing body pats − ―taking notes‖ during patient education

c. Allow school-ageaileen children to participate in treatment. s.adrales,rn 64

VIII. ILLNESS AND HOSPITALIZATION D. Nursing management 3. Provide cognitive interventions. a. Assist in developing rational thinking (give scientific explanations, rationales, and rules) and provide for decision-making. b. Assist the child with mastering concepts of conversation, constancy and reversibility, classification, and categorization. − Allow the child to chart intake and output and vital signs. − Encourage the child to tell the nurse when procedures are due. aileen s.adrales,rn

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VIII. ILLNESS AND HOSPITALIZATION D. Nursing management 3. Provide cognitive interventions. −Help the child create a scrapbook. −Use concepts, such as cards and board games, in teaching and games. −Encourage the child to do schoolwork.

C. Provide time for, and encourage, verbalization 66 (talk time).aileen s.adrales,rn

VIII. ILLNESS AND HOSPITALIZATION D. Nursing management 4. Provide psychosocial and emotional interventions. a. Provide the opportunity to channel drives. − Encourage peer interaction, group education, and limit setting. − Avoid coid rooms.

b. Promote achievement of industry. − Praise cooperative play. − Assign tasks that the child can accomplish. − Involve the child in care. aileen s.adrales,rn

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