NURSING CARE OF A FAMILY WITH A SCHOOL AGE - Over one in ten women experienced her first

menstruation before age 12

School Age
Concerns for Girls
- Refers to children between the ages of 6 and 12
- Slow physical growth, cognitive growth, and - Early preparation for menstruation for future
development continue to proceed at rapid rates childbearing and for the girl’s concept of herself
- The development of a school-age child is subtler as a woman
and may be marked by mood swings - A preadolescent who is experiencing consistent
- More influenced by the attitudes by their irregularities in her period should be assessed
friends for malnourishment and obesity as possible
- The first time begin to make truly independent influences; an explanation of good hygiene
judgements - Explain that any secretions that cause vulvar
irritation should be evaluated at a health care
GROWTH & DEVELOPMENT
facility, because this does suggest infection
Physical Growth - Inform them that breast development is not
always symmetrical (usually left is bigger than
- Yearly average wt gain 3 to 5 lb (1.3 to 2.2 kg) the right)
- Increase in ht is 1 -2 in (2.5 to 5 cm)
- Posture becomes more erect Concerns for Boys
- Fine motor coordination becomes refined (brain
- If they do not know testicular development
growth is completed at 10 years old)
precedes penis growth, they can worry that
- Abundance of tonsillar and adenoid tissue in the
their growth will be inadequate
early school years (because the lymphatic
- Assure them that pubic hair normally appears
system grows rapidly)
first and that chest and facial hair may not grow
- The left ventricle of the heart enlarges to be
until several years later
strong enough to pump blood to the growing
- Nocturnal emissions – ejaculations during sleep
body that can result to innocent heart murmurs
auscultated coz of the extra blood Teeth
- PR decreases to 70 to 80 bpm; BP rises to about
- Deciduous teeth are lost and permanent teeth
112/60 mmHg
erupt
- Increased oxygen-carbon dioxide exchange
- The average child gains 28 teeth between 6 and
because of the maturation of the respiratory
12 years of age: the central and lateral incisors;
system
first, second, and third cuspids; and first and
- Scoliosis may become more apparent for the
second molars
first time in late childhood (10- 12 yo)

Sexual Maturation

- Usually occurs between 12 and 18 years in girls;

in boys, between 14 and 20 years
- The changes in the physical appearance that
come with puberty can lead to concerns for
both children and their parents, this is the time
where parents will discuss to the children the
physical changes that will occur
- According to the Philippine National

Demographic and health Survey, in 2013, the

mean age at menarche among women ages 15
to 49 is 13.1 years
Developmental Milestones Structured Activities

- Urge parents to evaluate competitive sports

programs
- Consider with organized contact sports the
possibility of athletic injuries

Problem Solving

- Help children develop this skill by encouraging

practice
- Encourage problem solving by saying, “Let’s talk
about possible ways of doing it”

Language Development Learning to Live with Others

- Six-year-olds talk in full sentences - Children may show empathy toward others as
- Most 7-year-olds can tell the time in hours, but early as 20 months, but cognitively they cannot
difficulty with “half past” and “quarter to” relate others’ experiences to their own until
- Children discover “dirty” jokes and “bathroom about 6 years of age
language,” at about age 9
- By 12, a sense of humor is apparent and can Socialization
carry on an adult conversation
- Six-year-old children play in groups, but when
Emotional Development they are tired or under added stress, they prefer
one-to-one contact
Developmental Task: Industry VS Inferiority - Seven-year-olds are increasingly aware of
- The ability to trust others and with of respect family roles and responsibility (they view
for their own worth promises as firm commitments, diri
- Gain a sense of industry by learning how to do nangangalimot and they have a strong sense of
things well justice, they tattle because they think that’s the
- If prevented, they can develop a feeling of right thing to do)
inferiority or become convinced they cannot do - Eight-year-olds actively seek the company of
things they actually can do other children
- They need reassurance they are doing things - Nine-year-olds take the values of their peer
correctly and this reassurance is best if it comes group very seriously and are ready for activities
frequently away from home (they are interested in how
- Hobbies and projects also are enjoyed best if other children dress)
they are small and can be finished within a - Although 10-year-olds enjoy groups, they also
short time enjoy privacy
- Girls become increasingly interested in boys and
Home as a Setting to Learn Industry vice versa by 11 years of age (children start to
- Parents should realize that their child looks to become insecure)
other role models than themselves - 12-year-olds feel more comfortable in social
- Eight-or 9-year-olds begin to spend more and situations than they did the year before (boys
more time with their peers and less time with experience erections on small provocations)
their family Cognitive Development
School as a Setting to Learn Industry - 5 -7 y.o is a transition stage from preoperational
- Adjusting to and achieving in school are two of thought to operational thought or it’s the ability
the major tasks for this age group to reason to any problem they can visualize
- Parents must monitor teachers and school Children can use concrete operational thought with
activities to make sure their children are being these concepts:
led this way while not being pushed too hard
- Schools are increasingly assuming responsibility 1. Decentering
for education about sex, safety, avoidance of - Ability to project oneself into other people’s
substances of abuse, and preparation for family situation and see the world from their POV
living rather than focusing only on their own way
(they start to feel pity)
2. Accommodation 2. Adequate calcium and fluoride intake remain
- Ability to adapt thought processes to fit what is important to ensure good teeth and bone
perceived such as understanding that their can growth
be more than one reason for other people’s
Promoting Development of a School-Age Child in Daily
action
Activities
3. Conservation
- Ability to appreciate that a change in shape Dress
does not necessarily mean a change in size
4. Class Inclusion 1. Teach children the importance of caring for
- Ability to understand that objects can belong to their own belongings
more than one classification (helps in math, 2. Their clothing styles are often based on the likes
categorizing, numbers) of their friends or a popular sports or rock star
rather than the preferences of their parents
Moral and Spiritual Development
Sleep
Preconventional Reasoning
1. Younger school-age children typically require 10
- Can be as early as 5 years of age to 12 hours of sleep each night, the older ones
- A stage of “The police say it’s wrong” require about 8 to 10 hours
- A child’s sense of morality is externally
controlled. Children accept and believe the Exercise
rules of authority figures, such as parents and 1. Urge them to participate in some daily exercise,
teachers, and they can judge an action based on or else obesity, or osteoporosis later in life, ca
its consequences result
HEALTH PROMOTION FOR A SCHOOL-AGE CHILD AND Hygiene
FAMILY
1. By age 8, children are generally capable of
Promoting School Age Safety bathing themselves
- They are ready for time on their own without 2. Both boys and girls become interested in
direct adult supervision (if they can reliably showering as they approach their teens
follow instructions) Care of Teeth
- Parents should look at the effect of carrying
heavy backpacks on children’s posture (>10% 1. Should visit the dentist at least twice yearly for
body wt) a checkup, cleaning, and possibly a fluoride
- Teaching points to help children avoid sexual treatment to strengthen and harden the tooth
abuse enamel
2. School-age children have to be reminded to
Promoting Nutritional Health of a School-Age Child brush their teeth daily
Establishing Healthy Eating Patterns Promoting Healthy Family Functioning
1. School-age children need breakfast to provide
enough energy to get them through active
mornings at school
2. If children take a packed lunch to school, urge
parents to allow child some say in the meal
3. Urge parents to make the after-school snack
nutritious
4. Teach parents to make every attempt to make
mealtime a happy and enjoyable part of the day
for everyone COMMON HEALTH PROBLEMS OF THE SCHOOL-AGE
PERIOD
Fostering Industry
 The two leading causes of death are accidents
1. They enjoy helping to plan meals and cancer
2. Most parents would like children to develop  Minor illnesses are largely because of dental
better table manners caries, gastrointestinal disturbances, and
Recommended Dietary Reference Intakes upper respiratory infections
 Health maintenance pattern or schedule for a
1. Both girls and boys require more iron in school-age child is available to maintain health
prepuberty than they did between the ages of 7 of a child (look it up at Pillitteri book at table
and 10 32.4 p. 874)
Dental Caries - The most common problem is articulation
- Difficulty pronouncing s, z, th, l, r, and w or
- Progressive, destructive lesions or
substitutes for r (“westroom” instead of
decalcification of the tooth enamel and dentin
“restroom”) or r for l (“radies’ room” instead of
- When pH of the tooth drops to 5.6 or below,
“ladies’ room”)
acid microorganisms found in dental plaque
- Most noticeable during the first and second
attack the cementing medium of the teeth and
grades; it usually disappears by the third grade
destroy it
- If it persists, speech therapy may be needed for
- The enamel on primary teeth is thinner than on
the child
permanent teeth, so they are more susceptible
to destruction than permanent teeth Common Fears and Anxieties of the School-Age Child

1. Anxiety Related to Beginning School

- A health assessment should include an inquiry
about progress in school
- One of the biggest tasks is learning to read so it
is best for parents to prepare their child as early
as infancy, pointing to the words and pictures as
they read
- This helps children that sentences flow from left
Malocclusion to right, and that the words, not the pictures,
tell the story
- Sometimes children may develop “pseudo
sophistication”, they might present a mature
behavior at school but when they return home
they start biting their nails, suck their thumb or
baby talk
- This stops when the underlying stress is
alleviated
2. School refusal or Phobia
- Fear of attending school
- Similar to agoraphobia (fear of going outside
- The upper jaw in children matures rapidly than the home)
the lower jaw so sometimes it forces the teeth - Children resist attending school and they
to make a prolonged series of changes until develop physical signs of illness such as
they reach their final adult alignment and vomiting, diarrhea, headache, or abdominal
position pain on school days
- Malocclusion is a deviation of tooth position - This fear may occur from fear of separation
from the normal from parents, the child may be overly
- May be crossbite (sideways) or anterior or dependent to the parents or reluctant to leave
posterior home because of worry that younger sibling will
- Children should be evaluated by an orthodontist usurp the parent’s affection, it can also be that
to see if orthodontic braces or other therapy is the parents are overly protective of the child
necessary - Requires coordination between the parent,
- Some children develop mild, shallow ulcerations school nurse and the healthcare provider who
on the buccal membrane from the friction of identifies the problem
metal wires, rubbing the wire with dental wax 3. Home Schooling
can give relief - When discussing homeschooling with parents,
- Oral acetaminophen or an agent such as Orajel assess if children have peer experiences, ask if
rubbed on the ulceration may also offer relief they have exposure to other culture of families,
so they can better adjust to people different
Concerns and Problems of the School-Age Period from themselves later on at college or at a job
- One of the most important disorders of the 4. Latchkey Children
school-age period is attention- - Children without adult supervision for a part of
deficit/hyperactivity disorder because it each weekdays
interferes so dramatically with school progress - The major concern is that of they are alone is
- Other problems concern language, fears and that they will experience an increased number
responsibility of unintentional injuries, delinquent behavior,
alcohol or substance abuse or decreased school
Problems Associated with Language Development performance due to lack of adult supervision
 5. Sex Education - Help children to plan ways they could be
- It is important to be educated about sexual comfortable in social food-based settings such
changes during puberty as bringing a party snack that is easily eaten and
6. Stealing appropriate for the child, or politely declining
- Most children go through a period during which particular foods
they steal loose change from their mother’s - Help children to select a diet that is enjoyable as
purse of father’s dresser well as nutritious
- Usually happens at 7 or 8 years old
7. Violence or Terrorism
- Children view the world as safe so they get
shocked if they see any kind of violence
- Parents should assure children they are safe,
observe for signs of stress, do not let children
watch footage of traumatic events
- Watch news programs with children so it can be
explained what the situation portrays
- Explain that there are bad people in the world,
and bad people do bad things, but not all
people in a particular group or who look a
particular way are bad
- Prepare a family disaster plan
- Designate a rally point where the family will
meet if ever separated
8. Bullying
- A frequent reason for a child to so unhappy
because they experience bullying to the point
they could no longer take such abuse
9. Recreational Drug use
- Once considered as a college or high school
problem, but now illegal drugs are available to
children as early as elementary school because
they are available in so many homes, alcohol,
inhalants and prescription drugs have also
become commonly abused by this age group
10. Children of Alcoholic Parents
- Children feel guilty that they might be the
reason their parents are alcoholic
- Constant worry that their parents will become
sick or die
- A feeling of shame that prevents the child from
inviting friends’ home or asking for help
- Poor nutrition or decreased grades in school
- Anger at the alcoholic parent
- Helplessness to change the situation
11. Obesity
- 50% of school-age children are obese
- Some children gave been obese since infancy
- Obese children may be ridiculed and it may
develop poor self-image

Concerns of the Physically Challenged or Chronically Ill

School-Age Child

- Time lost from school that threatens not only

academic achievement but also children’s
relationships with peers
- Urge parents to assign them household chores
just like other children their age and to allow
them to participate in activities

Nutrition and the Challenged School-Age Child