Chapter 28Growth and Development of the School-Age Child

An 11-year-old child is continually late for the bus, resulting in asking if it's okay to stay home that day from school. The parents ask the school nurse for advice on what they should do. What is the best response by the nurse? "Is there anything happening at home that is making him want to stay there instead of school?" "It is best if you make him get on the bus whether he is ready or not in order to let him know you are in control." "I am sure he has school phobia. We will need to speak with the school counselor." "Could both of you and your child come in for a conference so we can discuss this situation?"

"Could both of you and your child come in for a conference so we can discuss this situation?" While the child is demonstrating a sign of school phobia, it is not possible to determine this without talking with the child and the parents. Forcing him to get on the bus does not address the situation.

A 12-year-old child tells the school nurse about not understanding why the parents don't allow the child to go to concerts without chaperones like some of the friends' parents. "I feel like a baby compared to my friends." How should the nurse respond? "I'm sure your parents are just very worried that you could get into trouble attending concerts at a young age." "You are so young that you have plenty of time to go to concerts alone. Your parents just care about you." "Your parents are right. Twelve years old is too young to be attending concerts without a chaperone." "Have you given any thought to why they don't let you go without a chaperone? Let's talk about some of the reasons they feel this way."

"Have you given any thought to why they don't let you go without a chaperone? Let's talk about some of the reasons they feel this way." Keeping dialogue open with the child and encouraging exploration of feelings is beneficial. This therapeutic communication will allow the child to identify reasons without being told why the parents have this rule. Peer pressure can be difficult for children to manage. Helping them identify reasons for the parents' actions can help.

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse? "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?" "Are you afraid that something is going to happen to you or that something or someone may be outside that you can't see?" "I was afraid of the dark at your age. You will grow out of that fear soon." "That is so horrible that you are afraid of the dark. Can you sleep at night at all?"

"It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"

During a well-child visit, an 11-year-old child reports to the nurse looking different from friends who are wearing bras. What is an appropriate response? "It is normal for there to be differences in the time and rate children your age develop." "It is common for children your age to worry about being different." "Remember the methods you have been taught to manage peer pressure." "You are doing well in school. Be happy with this success."

"It is normal for there to be differences in the time and rate children your age develop." Letting the child know that differences are normal and that development occurs at different times and rates among children the child's age is reassuring. Focusing on strengths is positive but talks around the child's concern. Telling the child that the worry is common minimizes the child's report and provides no information. Concern about breast development does not equate to peer pressure.

The parents of a 10-year-old child report they are having problems with their child. The child's parent reports the child is not a talented athlete but the spouse continues to encourage the child to play and try to excel. The spouse reports sports will help the child build character. What response by the nurse is most appropriate? "Although your child is not a talented athlete, continue to encourage the child to try." "Perhaps another pursuit would be better suited for your child." "It is important not to let your child quit without trying." "Encouraging involvement in sports can build valuable skills for a child."

"Perhaps another pursuit would be better suited for your child." Children should be encouraged to try new things but, when they are faced with things they are not good at, the pressures can ultimately be counterproductive if they feel they are disappointing their parents or others of importance to them.

During an annual visit of a 6-year-old child, the nurse observes dental caries on two of the child's primary teeth. Which response by the parents suggests more education is needed regarding the importance of primary teeth? "These are only baby teeth so we are not worried." "I guess we will need to supervise our child while brushing." "I guess we better look for a pediatric dentist for our child." "I see now we need to use a fluoride toothpaste for our child."

"These are only baby teeth so we are not worried." Parents need to understand the value of the primary teeth and not see them only as temporary and soon-to-be replaced. Referral to a pediatric dentist and parental supervision of tooth brushing both lead to dental health and may be better appreciated once parents understand the importance of the primary teeth. Fluoride supplementation is not necessary if fluoride is part of the local water supply.

The nurse is caring for a 9-year-old child who is being seen for a well-child care visit. During the visit, the child's parent reports the child is one of the shorter children in class. The parent asks how much more the child will grow in the next few years. Which response by the nurse is most appropriate? "Children in this age range can expect to grow about 1 in (2.5 cm) per year until they are about 15 years old." "Your child will likely remain one of the shorter children in class." Unanswered option"It is hard to tell at this point." "Your child should grow approximately 10 in (25 cm) over the next 4 years."

"Your child should grow approximately 10 in (25 cm) over the next 4 years." From 6 to 12 years of age, children grow an average of 2.5 in (6 to 7 cm) per year, increasing their height by at least 1 ft (30.5 cm).

Amblyopia

(Also called "lazy eye") is the term to describe the condition when one eye can focus better than the other.

Safety Issues for the School-Age Child

-Car safety -Pedestrian safety -Bicycle and sport safety -Fire safety -Water safety -Abuse in children

Benefits of Physical Activity for the School-Age Child

-Cardiovascular fitness -Weight control -Emotional tension release -Development of leadership and social skills

Assessing Nutrition in School-Age Child

-Check height and weight compared to previous measurements; assess BMI for age. -Nutrition history including a 24-hour recall of what was consumed. -Inquire about family meals and the social aspects of eating including who prepares the meals. -Solicit from both parent and child. -Identify any knowledge gaps relating to nutrition.

Promoting Appropriate Discipline (School-Age Child)

-Children learn the natural and logical consequences of discipline. -Parents should teach children rules established by the family, values, and social rules of conduct. -Discipline should be consistent, applied fairly and focus on the development of the child. -Positive acknowledgment of positive behaviors are more likely to encourage those positive behaviors and promote development.

Kohlberg school age

-Conventionality MORALITY -rules are created for benefit of all -adhering to rules is right thing to do (7-11)

Gross Motor skills (School-Age Child)

-Coordination, balance, and rhythm improve. -May become awkward as bodies growing faster than able to compensate.

Factors Determining Type and Amount of Discipline

-Developmental level of both the child and the parents -Severity of the misbehavior -Established rules of the family -Temperament of the child -Response of the child to rewards

Signs of Vision Problems in School-Age Children

-Eye rubbing, squinting -Avoiding reading -Frequent headaches -Holding reading materials close -Problems with depth perception or hand-eye coordination -Sports-related eye injuries and eye protection are important in this age group.

Fine Motor skills (School-Age Child)

-Hand usage improves -Eye-hand coordination and balance improve -Can write, print words, sew, or build models -Takes pride in activities requiring dexterity and fine motor skills, such as playing musical instruments.

Developmental Concerns (School-Age Child)

-Television and video games (setting limits on both the content and amount of time). -School refusal (school phobia) -Latchkey children and safety -Stealing, lying, cheating, bullying (whether as the perpetrator or the victim). -Fitting in with peer groups -Tobacco and alcohol education

Emotional and Social Developmental Issues (School-Age Child)

-Temperament -Self-esteem development -Body image -School-age fears -Peer relationships -Teacher and school influences -Family influences

Causes of Amblyopia:

-Uncorrected refractive errors or other eye defects in one eye (near-sighted, far-sighted, or astigmatism). -Malalignment of the eye muscles (strabismus). -Deprivation due to cataract formation in one eye (rare)

Language and Communication Skills (School-Age Child)

-Vocabulary expands to 8,000 to 14,000 words -Culturally specific words are used -Reading efficiency improves language skills -More complex grammatical forms are used -Development of metalinguistic awareness occurs -Metaphors are beginning to be understood

Calcium/Day for 9-13yr old

1,300mg

Cals/day for 4-8yrs old

1,400-1,600

Cals/day for 9-13yr old GIRL

1,600-2,000

Cals/day for 9-13yr old BOY

1,800-2,000

How many hours of sleep are required for the school aged child?

10-12hrs

Iron/Day for 4-8yrs old

10mg

Brain growth is complete by the time the child is

10yrs.

Fiber needs

25g for 4‐8yrs 26 to 31g for 9‐13yrs

Night terrors and sleepwalking may occur but should resolve by what age?

8 to 10 years

Calcium/Day for 4-8yrs old

800-1,000mg

Iron/Day for 9-13yr old

8mg

The nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. What is part of this stage of Erikson's theory? A sense of competence, mastery, and worth. The principle of conservation. The conventional stage of development. Lack of the ability to think abstractly.

A sense of competence, mastery, and worth. Erikson states that school-agers receive satisfaction from developing new skills and successfully using them to accomplish goals (industry). Failing (without adult support) or being unable to meet expectations that are set too high can result in feelings of inferiority. Lacking the ability for abstract thought is a cognitive skill and part of Piaget's theory, as is the principle of conservation. The conventional stage belongs to Kohlberg's theory of moral development.

The parents of a 10-year-old child tell the nurse that they don't understand how their child falls into the obesity category. They state that they are consistent with good nutrition and their child is very active in sports and clubs. What would be appropriate questions for the nurse to ask? (Select all that apply.) A. "Given your busy schedules does your family eat a lot of meals late in the evening?" B. "Can you give me an idea of a typical day for you and your child?" C. "A lot of children of this age commonly have thyroid issues. Does this run in your family?" D. "Could you keep a food diary over a 2 to 3 days time for us to review?" E. "Does your child consume soda and other fluids high in sugars?"

A, B, D, E Determining eating patterns and types of foods and beverages is helpful when assisting the family to identify areas that may be contributing to weight gain in their child. Thyroid issues are not common in children

The nurse is providing information to the parents of a 6-year-old child who has been caught lying at home and at school. Which would the nurse share with the parents? (Select all that apply.) A. Suggest reading a story with the child about the consequences of lying. B. Explain that children this age typically lie to avoid punishment. C. Indicate that the child is probably lying to impress friends. D. Notify the healthcare provider to check for underlying problems. E. Recommend the use of immediate and firm punishment.

A,B Parents need to know that lying is common at this age and that it is usually done to avoid punishment. Reading the story would address the unacceptable behavior and reinforce the value of reading. Immediate and firm punishment precludes a calm, measured approach to the issue and may damage self-worth. An older child between 8 and 12 years is more likely to lie to impress friends. If lying persists in older school-age children, parents should discuss the matter with the healthcare provider because the lying may be evidence of underlying problems.

A nurse is assisting with a seat belt clinic at a local community center. Which parents should the nurse speak with after inspecting their seat belt use? (Select all that apply.) A. The parents of a 10-year-old whose child is sitting in the front seat with the seat belt properly fastened B. The parents who ask their 9-year-old child to fasten the seat belt before starting the car C. The parents of a 6-year-old who has the shoulder belt behind the back due to the strap lying across the face D. The parents of a 8-year-old who check to see if the lap belt portion of the seat belt is lying low on the hips E. The parents of a 12-year-old who still uses child-proof locks in the back seats

A,C Children under 12 years of age should sit in the back seat of the vehicle. Shoulder belts should not be behind the child; the shoulder belt should lie on the shoulder, not the neck or face. If the child is too short for the belt to lie on the shoulder, a booster seat or belt clip should be used.

The nurse is discussing nutrition choices with a group of parents of 10- to 12-year-old children. The nurse determines that the discussion was successful based on which statements by a parent? (Select all that apply.) A. "My 12-year-old child, who plays soccer, needs to consume around 2,000 calories a day to maintain good health." B. "It's convenient that my 8-year-old and 12-year-old children need to consume the same amount of calories, because they're both active." C. "The highest percentage of my child's diet should come from carbohydrates." D. "Meats, poultry, and fish are good sources of calcium for my child." E. "We will make sure that our child consumes at least 900 mg of calcium through various sources."

A,C Rationale: Children 9- to 13-years-old need 1,300 mg of calcium for maintenance of growth and good nutrition. Boys 9 to 13 years old who are moderately active need about 1,800 to 2,200 calories a day. Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories a day, and girls 9 to 13 years old who are moderately active need about 1,600 to 2,000 calories a day. For this age group 45% to 65% of calories should come from carbohydrates. Milk, yogurt, and cheese provide protein, vitamins, and minerals and are excellent sources of calcium.

The formula for bladder capacity is

Age in years plus 2 oz.

The nurse is assessing the moral developmental level of children being seen in the clinic according to the Kohlberg's conventional stage of moral development. Which children does the nurse determine have met this stage of development? (Select all that apply.) A. The 8-year-old child who frequently asks the teacher if he is doing his math correctly. B. The 10-year-old who states, "I sure wouldn't want to be my friend taking that bad report card home." C. The 9-year-old child who tells his friends that they shouldn't throw rocks because they will "get in trouble." D. The 10-year-old child who visits his elderly neighbor three times per week. E. The 7-year-old child who yells at his parent, "I don't understand why I can't go to the park!"

All. In the conventional stage of moral development according to Kohlberg, the 7- to 10-year-old usually follows rules out of a sense of being a "good" person. He or she wants to be a good person to parents, friends, and teachers and to himself or herself. The adult is viewed as being right. The child believes an act is wrong only if it brings punishment, not because of the outcome of an act. The child in this phase also doesn't understand the reason behind rules, but can put self in another person's position.

Malocclusion

Any deviation from the normal positioning of the upper teeth against the lower teeth.

While treating a minor playground injury for an 8-year-old child, the school nurse discovers that the injury was the result of bullying. What should be the nurse's first action? Question those responsible for the bullying. Determine if there have been other playground bullying incidents. Assess the situation with the help of the school staff and parents. Immediately call the bullied child's parents.

Assess the situation with the help of the school staff and parents. Assessing the situation and following the school's bullying protocol will be an important first step. Immediately calling the bullied child's parents may be premature. Questioning those responsible for the bullying and determining if there have been other playground incidents of bullying may be part of the overall assessment, but would not be the first action taken

School-Age Child Growth

Average of 2.5 in per year.

School-Age Child Weight

Average of 7 lb per year.

The parents of a 12 year-old child voice concern to the nurse that their child wants to dress like peers and not the way they prefer. Which responses by the nurse are appropriate? (Select all that apply.) A. "If the way your child's friends are dressing is not against school dress code, is it worth it to argue about his clothes?" B. "Peer acceptance is an important part of development for children, especially at this age. Maybe talking about it with your child lead to an agreement." C. "Have you spoken with your child about the concerns and about your concerns? Open dialogue often helps in resolving these issues." D. "Children at this age often want to connect with their peers. You should probably allow your child to dress like friends." E. "Peer pressure is hard enough for children of this age without pressure from their parents. You need to seek family counseling immediately."

B,C It is important for late school-age children to feel accepted by peers. Lifelong effects can occur if they feel different and are teased. Dialogue is always a good way to resolve conflict so suggesting the parents talk and listen to their child is acceptable guidance by the nurse. Telling the parent what they should do is not in the nurse's scope of practice. The situation does not warrant immediate counseling. If further problems occur counseling is always a good option.

The parent of an 11-year-old child is worried that the child spends too much time watching TV. What information should the nurse share with this parent? (Select all that apply.) A. Limit TV time by using it as a reward. B. Establish guidelines on when a child can watch TV. C. Watch programs together and discuss subject matter with the child. D. The American Academy of Pediatrics recommends 2 hours or less of TV daily. E. Use video games that are more active to offset sedentary TV viewing.

B,C,D The American Academy of Pediatrics recommendation is correct. The parents should establish guidelines on when the child can watch TV, such as after chores are completed. Using TV as a reward elevates its importance and may not decrease viewing time. Certain TV programs and video games have merit, yet both represent screen time with little activity difference between the two. The parents should watch TV with the child and use the opportunity to discuss the subject matter with the child.

The nurse is preparing a care plan for a 7-year-old child on the pediatric unit newly diagnosed with asthma. One of the child's parents is employed as a family practice physician and the other as a lawyer. The child has two older siblings and two younger siblings. Which nursing diagnoses would apply to this situation? (Select all that apply.) A. Impaired mobility B. Risk for infection C. Risk for caregiver role strain D. Knowledge deficit regarding disease process E. Knowledge deficit regarding use of inhaler medication for asthma

B,C,D,E Regardless of their careers, the parents are at risk for caregiver role strain given the new diagnosis, having jobs, and having four other children. Any chronic illness and hospitalization puts the child at risk for infection. The disease is new so the child needs to learn about the disease and inhaler use according to developmental status.

GU system Maturation (School-Age Child)

Bladder capacity increases (age in years + 2 oz); prepubescence occurs.

Cardiovascular system Maturation (School-Age Child)

Blood pressure increases and pulse rate decreases.

Neurologic system Maturation (School-Age Child)

Brain and skull grow very slowly; cognitive processes mature.

The school nurse is monitoring children as they arrive at school riding their bicycles. Which children should the nurse speak with about their riding habits? (Select all that apply.) A. The child who is wearing a helmet that states "Snell approved" on it. B. The child who is wearing a helmet with Y-shaped straps mouth should pull down when the child opens their mouth. C. The child who wears a stocking cap under the helmet during cold weather. D. The child who is wearing a book bag hanging off one shoulder E. The child who is wearing flip flops when riding the bicycle to school.

C,D,E

Piaget school age

CONCRETE OPERATIONS -Can concentrate on more than one aspect of a situation at a time. -Becomes capable of abstract reasoning-->thought is still limited to their own experience. -Understands cause & effect.

GI system Maturation (School-Age Child)

Deciduous teeth replaced by permanent teeth; fewer gastrointestinal upsets; stomach capacity increases; caloric needs are lower but appetite may increase.

When considering the psychosocial development of a school-aged child, which is the primary developmental task? Planning for future events. Reflecting on recent activities of accomplishment. Establishing a social network. Establishing trust in friends outside the home family unit.

Establishing a social network. Erikson (1963) describes the task of the school-age years as industry versus inferiority. During this period, the child is developing his or her sense of self-worth by becoming involved in multiple activities at home, at school, and in the community, which develops his or her cognitive and social skills.

Is the following statement true or false? The school nurse conducting a vision screening program identifies a child with amblyopia. Both eyes were noted to have visual acuity less than expected for the child's age.

False. Amblyopia, or lazy eye, occurs when one eye is more nearsighted, farsighted, or astigmatic than the other eye causing an imbalance in vision. Rationale: Malalignment of both eyes is referred to as strabismus.

Liver, spleen, kidneys, and digestive tract

Fully develop during school age.

Increased body fat occurs earlier in

Girls.

Musculoskeletal system Maturation (School-Age Child)

Greater coordination and strength; muscle still immature and can easily be injured.

Erickson school age

Industry vs inferiority

Freud School Age

Latency: focusing on peer relations; learning to live in groups & to achieve knowledge

Immune system Maturation (School-Age Child)

Matures to adult level around *10 years old*; fewer infections experienced.

The school nurse is performing a vision screening for a 7-year-old child. Which finding should trigger a referral? Slight misalignment of the eyes Peripheral vision similar to that of the school nurse Visual acuity of 20/20 in both eyes Ability to color discriminate

Misalignment of the eyes (strabismus) interferes with vision and eye development. Amblyopia (vision loss) can result. Lack of alignment of the eyes needs referral and treatment. The rest represent normal visual findings in a 7-year-old.

The nurse is taking a health history for a 12-year-old child who is seriously overweight. Which general question would the nurse direct to the child's parents? "What beverages are preferred?" "Is there a family history of hypertension, heart disease, or diabetes?" "How important is exercise?" "Is breakfast eaten regularly?"

Parents would be more knowledgeable than the child regarding health problems within the family.

Respiratory system Maturation (School-Age Child)

Respiratory rates decrease; respirations are diaphragmatic in nature.

The nurse is talking with a school-aged child about interests. In which interest do most school-aged children place the most focus? School Pets Church Family

School The school-age child typically values school attendance and school activities. During school-age, the focus expands from family to teachers, peers, and other outside influences.

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse? Ask the child if he really has had respiratory infections during these absences. Continue to monitor the child's absences. Discuss with the child's teacher to determine if the number of absences has effected academic performance. Speak with the parents about the unusual increased number of respiratory infections.

Speak with the parents about the unusual increased number of respiratory infections. In the school-age child the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visits the pediatrician to discuss the issue.

While observing a group of 9-year-old children at school the nurse is concerned that one of the children is not cognitively developing according the Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned? Enjoys math instruction and decides to join the math club. Believed that not turning in homework on time was acceptable, but has since decided it is not acceptable. The child does not understand the phrase "slow as molasses" when used by the teacher. Arrives to class late from recess and apologizes to the teacher.

The child does not understand the phrase "slow as molasses" when used by the teacher. Piaget's stage of cognitive development for the 7- to 11-year-old is the period of concrete-operational thoughts. In developing concrete operations, the child is able to assimilate and coordinate information about his or her world from different dimensions. Abstract thinking, such as understanding the meaning of the phrase "slow as molasses" is expected at this stage of cognitive development.

Parents of an 11-year-old child are bewildered that their child was caught stealing. Which reason for this behavior would the nurse suggest? The child has not attained the ability to understand ownership and property rights. This is one way for the child to increase self-esteem. The child was attempting to escape punishment. The child had a strong desire to own the item.

The child had a strong desire to own the item. The nurse would point out that the desire to own the item may have overcome the sense of right and wrong. Lying, not stealing, is used to escape punishment. Stealing is not a way to build self-esteem, although it may help the child gain a certain status among peers. The lack of understanding of ownership and property rights are typical of children between 6 and 8 years.

Bruxism

The involuntary grinding or clenching of the teeth that usually occurs during sleep and is associated with tension or stress.

Prepubescence

Typically occurs in the 2 years before the beginning of puberty and is characterized by the development of secondary sexual characteristics, a period of rapid growth for girls, and a period of continued growth for boys.

The nurse obtains a nutrition history for a school-age child. The parent indicates the child's favorite beverage is apple juice and consumes three large glasses per day. The mother asks if this is a good thing. Which of the following would be the best response for the nurse to reply to the mother? a. Apple juice is very healthy. Keep up the good work! b. Apple juice has quite a bit of sugar and no fiber. Could you substitute an apple for one of those servings? c. As long as your child drinks plenty of fluids, she will be fine.

b. An 8-oz serving of apple juice has about 24 g of sugar—the equivalent of 3 teaspoons of sugar, with none of the fruit fiber that would be available in a whole apple. Rationale: Children need both fruit and fiber daily as part of a healthy diet. Apple juice, while made from apples, concentrates the sugar and takes out the fiber. Water and milk are good alternatives for beverages.