Health Promotion School Age
Health Promotion-immunizations
11-12 yr Boosters and new vaccines: - Tdap - MMR - Meningococcal Vaccine - *HPV- for girls, and boys - *Hep A - Yearly Flu shots....every year
Adolescents and Health
Adolescents are seen sporadically for health care. - Visits are still recommended yearly. Usually healthy Do not require immunizations as often Typical reasons for visit to healthcare provider: - Minor illness - Birth control - Sports examination
Adolescents and Parents
Adolescents are trying to gain independence. Teens still need parents for guidance and reassurance. Adolescents may: - Strike out at parents. - Test limits. - Have conflicts with parents.
Strategies for School-Age Children
Allow child to answer some questions directly. Discuss immunizations, physical activity, and nutrition habits. Emphasize importance of hand hygiene in preventing disease. Discuss injury prevention. - Example: use of helmets
Biological Development
Anterior pituitary stimulates gonadal development - 20-25% of height occurs in puberty Female: estrogen and progesterone - Breast buds-pubic hair-menstruation - 2 ½ years after menarche Males testosterone: - Increased scrotal size-pubic hair-genital growth- facial hair-voice change Males peak ht at 18-20
Injury Prevention - Motor- Vehicle Injuries
Approved car restraint system - Most common cause of severe injury and death is MVA Appropriate seat belt use - Promote use of seatbelt Safest area is still back seat 1. It is recommended that children use an approved car restraint system until they achieve a height of 145 cm (4 feet, 9 inches). 2. Teach children appropriate seat belt use when no longer using a car restraint system or booster seat. 3. Safest area for children is the backseat of the car. 4. Never let child ride in the bed of a pickup truck. 5. Reinforce safe pedestrian behaviors Never ride in back of pick up Reinforce safe pedestrian behaviors
Assessing Mental Health Status
Ask what the teen is proud of? - Proud of the work I've done in social studies, etc. Ask what the teen is disappointed in? - Wanted to gymnastics and never happened. Are you ok with it now? Ask about body image. - What do they like what don't they like? Ask about sexual activity. - Ask directly if they have had intercourse. - Focus on birth control, prevention of sexually transmitted infections (STIs).
Communication Strategies for Teens and Parents
Assist parents in understanding that adolescent is striving for independence. Reassure adolescent that parent is trying to provide guidance. Encourage parents to reward positive behaviors. - The good child tends to get ignored because the bad child is always praised when done good. Encourage adolescent to discuss specific issues rather than global subjects. - May start talking about other people instead of themselves and then bring it back to them. Model respectful communication. - Want to know that you value them and are open to hearing their points of view. Be honest because they do understand more. Others? - If they think you are not being honest than they will not trust you and it will be the end of the relationship. - Be direct (ask them if their grandparents are dead or alive) (not "passed")
Dental Health
Average age of first tooth loss: 6 years Eruption of permanent teeth Dental visits every 6 months Brushing and flossing Braces - Braces or other orthodontic treatment need extra care when brushing and flossing. Your child should also skip hard and sticky foods, and not chew on pencils, pens, or fingernails. Most common dental issues for school age children are: - Dental caries - Periodontal disease - Malocclusion (need to be addressed later)
Mental and Spiritual Health
Basics for a child's good mental health: 1. Unconditional love from family 2. Self-confidence and high self-esteem 3. The opportunity to play with other children 4. Encouraging teachers and supportive caretakers 5. Safe and secure surroundings 6. Appropriate guidance and discipline As children enter the school-age years, they begin to show signs of a budding independence. This period of growth is also marked by the active pursuit of, and genuine appreciation for, new relationships. Parents, or primary caregivers, continue to be the most important people in their child's life, but relationships with peers become increasingly important. In fact, the appearance of a "best friend" is considered a universal feature of the school-age years. Other significant, and often defining, characteristics of this phase of development are a child's capacity to control their urges and conform to an appropriate standard of behavior without direct supervision. Collectively, this is known as Self-regulation.
Vision Screening
Because vision may change frequently during the school years, regular eye and vision care is important. 25% of school aged children will exhibit vision problems Most common: 1. Myopia (nearsightedness) 2. Astigmatism - Astigmatism is a common vision condition that causes blurred vision. It occurs when the cornea (the clear front cover of the eye) is irregularly shaped or sometimes because of the curvature of the lens inside the eye.
Cognitive - Piaget's Concrete Operation Stage
Child enter concrete-operational stage around age 7 - The process is divided by Piaget into two stages, the Concrete Operations, and the Formal Operations stage, which is normally undergone by adolescents. In the Concrete Operational stage, the child has the ability to develop logical thought about an object, if they are able to manipulate it. Concrete-operational thought is reversible and flexible - Maters the concept of conservation, they can distinguish between weight of an item regardless of size - Learns to tell time Children can reverse mathematical operations (2+3=5 can be reversed to 5-3=2) Masters conservation - Develop ability to see things from another's point of view
Age-Appropriate Activities
Competitive and cooperative play is predominant For children ages 6-9: - Board and numbers games - Hopscotch - Jump rope - Collecting - Build simple models - Join organized sports for skill development For Children aged 9-12 years: - Make crafts - Build models - Engage in collection hobbies - Board and card games - Join organized sports for competition
Hormones
Estrogen "Feminizing hormone" Low production during childhood, rapid increase at puberty In males, there is some production throughout maturation In females, levels increase until about 3 years after menarche; estrogen then remains at this maximum level throughout reproductive life Androgens - "Masculinizing hormones" Testosterone - Secreted in small and gradually increasing amounts up to 7 to 9 years; then rapid increase in both sexes until 15 years - Responsible for rapid growth of the early teenager
Injury Prevention -Poisoning/ Substance Abuse
Data from the last decade shows rates of middle school substance abuse and addiction in kids as young as 11 or 12 years old have swelled across the United States. In 2015, more than 8% of 8th graders reported using illicit drugs. In 2015, the most commonly used drugs among 8th graders were: Alcohol - More adolescents drink alcohol than smoke cigarettes or use marijuana Marijuana Inhalants - Inhalants are household fixtures like gasoline, keyboard cleaner, paint thinner, markers and glue that give off noxious fumes that get people high. These drugs are extremely dangerous, but also readily available to younger children, which is perhaps why 11% of 8th graders surveyed said they have abused inhalants in their lifetime. Cough medicine - Children who abuse over-the-counter drugs like cough syrups and pills take the substances in high doses to get high. Around 48% of ER visits related to cough medicine abuse involve people aged 12-20. Tranquilizers
Self Concept
Develop awareness themselves in relationship to others Components of self-concept - Self-esteem and sense of accomplishment - Body image - Sexuality Confidence is gained through establishing a positive self-image Before eight years old children see themselves and others in all-or-none ways. While children at this age are able to understand the concept of opposites, they believe it is impossible to be both antonyms at the same time. Their logic tells them "I'm good, therefore I can't be bad." Parents continue to influence the school-age child's self-ideals - but by middle-school the opinion of peers and teachers have become more valuable
Disease Prevention Assessments
Discuss: - Smoking (tell them all bad things) - Depression (s/s, do you seek help?) - Stress (high stress?, relaxation techniques) - Alcohol or other substance use - Immunization status (current) - Testicular, breast exams Prevention of skin cancer - Sunscreen use - Limiting exposure - Avoiding tanning beds
Moral Development
Early School-age - Does not understand reasoning behind rules and expectations - Believe what they think is wrong and what others tell them is right - Judgement is guided by rewards and punishment - May interpret accidents as punishment Later School-age - Able to judge the intension of the act, rather than just its consequences - Understand different points of view instead of just whether or not an act is right or wrong - Conceptualizes treating others as they would like to be treated
Body image is large and in charge!
Experts have determined that the body image established during adolescence is the one retained for life. The idea of "self-concept" becomes more differentiated as adolescents understand their own special characteristics
Family and Social Relationships
Family still important, but peers and school also important. Learning how to make and maintain friendships Teamwork skills developed. See Outcome 9-6 for details.
Self-Esteem and Sense of Accomplishment
Feelings and beliefs about competence Worth as an individual - Want them to feel like they are worth a lot. Ability to meet challenges - Do they feel like they are able to meet these challenges. Learn from success and failure - Just because you fail doesn't't mean you didn't't learn something important. Sense of accomplishment - What is child good at doing? - Physical activities - School performance
Injury Prevention - Burns
Fire Safety - Children should be taught fire safety and potential burn hazards. Working smoke detectors - Working smoke detectors should be kept in the home Sunscreen - Children should use sunscreen when outside. Cooking safety - Teach child safety precautions to take while cooking. Also: avoid high-tension wires Practice proper behavior in the event of fire
Injury Prevention- Bodily harm
Firearms - should be kept in locked cabinets or boxes. Safe play areas - areas should be identified. Stranger safety - should be taught. Reinforce helmets and padding - and/or pads when roller skating, skateboarding, bicycling, riding scooters, skiing, and snowboarding. ATVs are unstable and dangerous for school age children - NO BODY DRIVING UNDER AGE 16
Promoting Healthy Nutrition
Five fruits and vegetables daily Whole grain products Three meals a day - Do not skip breakfast! - Kick start metabolism. How to plan menus - Need to know how to make certain foods not freezer foods. Limiting high-fat, high-calorie foods
Other Sources of Injury
Four-wheelers Watercraft - Boats, jet skis Power tools Firearms Fires Sports Abuse
Nutrition
Goal - Independence and healthy food choices Have strong likes and dislikes - Food choices now, good and bad, influence nutrition habits for years to come Prepare own snacks - During the visit, talk to the child and family about access to fresh fruits and vegetables, ask about family gardens or local farmers markets - Provide information about healthy snacks and limiting soft drinks Access to vending machines - Children need to learn to eat snacks only when hungry, and not when bored or inactive
Growth and Development During Adolescence
Growth spurt occurs during adolescence. - We don't always know when they will happen - Generally girls begin maturing earlier than boys - Boys will have a more significant growth spurt. Plot height, weight, and BMI on growth chart. Look for trends, changes in percentiles. - Might see them normal up until 12 then it might flatten off because of diet changes. Developmental tasks and milestones - Separating from family (nature) - Establishing positive relationships with peers (if they have no friends what is going on?)
Physical Activity
Habits developed in childhood influence exercise preferences later in life. - During these years, children continue to refine skills such as hand-eye coordination, muscular strength and speed. Find something they like to do and are good at. - Some will enjoy team sports, while others may prefer skateboarding, skiing, horseback riding. Still developing motor skills - When the school-age child is involved in a physical activity, they experience socialization, positive sense of accomplishment, weight control and increased physical ability.
Injury Prevention During Adolescence
Injury is greatest health hazard for adolescents. Teach more likely to go over speed limit and underestimate situations. Driving and motor vehicle collisions - Easily distracted - Little experience with maneuvering a car - Drinking and driving - Driving while tired - Use of restraint devices
Normal Growth & Development Concerns
Latchkey children- children who are left to care for themselves before or after school. It can be stressful for the child. - Talk about how they feel about being alone after school - What do you do? what about incase of emergency? Etc. Limit Setting and Discipline - with advancing cognitive skills, they can benefit from more complex disciplinary strategies such as withholding privileges, requiring compensation or contracting. - You stayed out till 2 oclock and you were supposed to be home at 10 so we are making a contract that this wont happen again. Dishonest behavior- Previously well-behaved children may engage in lying, stealing and cheating. - Not unusual for it to happen but must not continue.
Growth and Development: School-Age Children
Measure height and weight; plot on growth chart. - Rapid growth of toddler and preschool years slows, slow, steady growth is the norm. - They have a slimmer appearance than a preschooler. Their legs are longer as compared to the rest of the body - Weight- gain 4-7 kg/year - Height - grow about 2 inches/year Calculate body mass index (BMI) to assess for obesity. Physical assessment - Pay special attention to systems and skills that influence performance at school - vision, hearing coordination Developmental milestones
Adolescents and Mental Health
Mental health linked to: - Gaining independence. - Forming close relationships. (first boyfriend, first girlfriend, best friend) - Becoming confident in accomplishments. (they will know what they are good at) -Setting goals for the future. (play basketball forever?)
Health Promotion During Adolescence
Most adolescents are generally healthy. Screening tests during adolescence include: - Scoliosis. - Anemia. - Sexually transmitted infections. - Vision and hearing. The major causes of morbidity and mortality at this age are due to health-damaging behavior (stupid behavior) Screening tests during adolescence include: - Blood pressure. - Urinalysis. - Pap smear, breast exam. - Screening tests for sexually active teens.
Nutrition and the Adolescent
Need well-balanced diet to support growth and immune function Teens often do not eat well. - Lead busy lives - Like high-fat, high-calorie foods May diet to achieve weight loss (sometimes good or bad like bilemia or anorexia) Family may not have financial resources to buy healthy foods. - Help them brainstorm other ways.
Cognitive Development-Piaget's Formal Operational
No longer restricted to the real and actual Now they are also concerned with the possible They are able to imagine the thoughts of others Teach me some cool new language....last year I learned YOLO...
The Adolescent and the Family
Nurse should encourage adolescent to answer questions as well as parent. Adolescent has increasing independence for managing disease and illness. Adolescent has increased understanding of illness and how the body works. - May be more likely to tell the doctor that they have burning while peeing, etc. May or may not want family to be present during exam
General Observations During the Health Promotion Visit—Adolescents
Observe if parents or friends are present or if teen is alone. - Sometimes they bring their friends. (confidentiality issue) Parent may or may not come into examination room with adolescent. Reassure parent that he or she will be able to talk with healthcare provider at end of visit. Assess comfort level of teen. - Sometimes have different ideas than we would imagine. Ex.) a young man wanted a female provider instead because he was worried a male provider might be gay.
Social Development
Peer groups are important! - peer pressure becomes more powerful Clubs and best friends are popular Bullying actions may occur - in attempt to control others Same gender companions are preferred - but they begin to develop interest in the opposite sex Conformity becomes evident - Obvious to them
Prepubescence
Period of about 2 years prior to puberty. Also called early adolescence. - A period of about 2 years that begins at the end of middle childhood and ends at 13 - Pre-pubescence - 1-2 years prior to puberty. Variability in physical growth and physiological changes evident by age 10-11 years
Sexuality
School-age children - Have many misconceptions about the bodies of men and women, sexual intercourse, and reproduction May begin to ask questions - Make it comfortable for them to ask the questions. Parents out of the room they are more likely to answer truthfully. Questions should be answered truthfully and fully. It is suggested parents have sexual education books in the house by the time the child is in the 3rd grade.
Physical Activity and the Adolescent
Physical activity levels decrease during adolescence, especially among girls. - Less than half of teens report daily vigorous activity. - Only 22% of 12th graders regularly attend PE class at school. (drop in time set aside for physical activity) (dance, yoga) something they can use for the rest of their life as an outlet for physical activity. Assess physical activity levels and favorite activities during health visits. - Sports - Other activities (to get a sense of how active they are)
Play - Cooperative
Play involves increased physical skills, intellectual abilities and fantasy Rules and rituals are important because knowing the rules because knowing means belonging Team play teaches children to modify or exchange personal goals for the goals of the group Through play, children can feel as big, as powerful and as skillful as their imagination will allow. This is called ego mastery Cooperative play - when a child is interested both in the people playing and in the activity they are doing. In cooperative play, the activity is organized, and participants have assigned roles. There is also increased self-identification with a group, and a group identity may emerge
Nutritional Assessment
Plot height, weight, and BMI on growth chart. Ask if they have concerns about weight. Discuss usual meal routines and favorite foods.
Peer Pressure
Pressure to fit in and do what others encourage Becomes more significant during adolescence, but starts in school-age years Discuss smoking, drug and alcohol use, and gun safety. Bullying All should be discussed over and over so they get the message.
Erikson's Psychosocial Stage- Industry vs. Inferiority
Psychosocial Conflict: Industry versus Inferiority Major Question: "How can I be good?" Basic Virtue: Competence Important Event(s): School 1. A sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society. 2. A sense of accomplishment is gained through the ability to cooperate and compete with others. 3. Children should be challenged with tasks that need to be accomplished, and be allowed to work through individual differences in order to complete the tasks. 4. Creating systems that reward successful mastery of skills and tasks can create a sense of inferiority in children unable to complete the tasks or acquire the skills. 5. Children should be taught that not everyone will master every skill.
Puberty
Puberty - point that sexual maturity is achieved. Also called middle adolescence. Post-pubescence - 1-2 years after puberty when skeletal grow is complete. Also called late adolescence Maturational growth process that occurs when reproductive organs begin to function and secondary sex characteristics develop Puberty complete when period begins. Once you hit puberty you don't grow any taller (girls)
Sleep and Rest
Required hours of sleep are variable and is dependent on: 1. Age 2. Level of activity 3. Health status - Some with a cardiac defect/body working harder = more rest. Approximately 9 hours of sleep is needed each night by age 12 years. Help children and families plan for healthy sleep hygiene, or behaviors to foster a regular and sufficient sleep pattern.
Major Health Concerns of Adolescents
School performance Sexual issues Body image issues Need for independence - While parents are struggling with the need to let them be independent.
Health Screenings
Scoliosis - - School-age children should be screened for scoliosis by examining for a lateral curvature of the spine before and during growth spurts. Screening may take place at schools or at a healthcare facilities
Body Image
Solidification of body image occurs - Only expose the part you need to look at and cover it back up. Curiosity about sexuality - should be addressed with education regarding sexual development and reproductive process School-agers are more modest than preschoolers - And place more emphasis on privacy The idea that one forms about one's body Look at child's appearance and dress Clean and neat? Appears secure/insecure? Posture? Dressed appropriately for age? Ask parents if they have concerns about child's body image
General Observations
Speak to the child first, welcome child. Establish positive rapport with child will enhance health teaching efforts. Family-centered care is important for school-age children. Notice if parents and children are interacting, tones of speech, mutual respect, and so on. Be alert for family dynamics that influence mental health; family history.
Promoting Physical Activity
Suggest one thing they can do every day that increases activity levels. - Walking the dog - Take the stairs instead of the elevator - Ride bicycle to school Suggesting peer group activities is helpful. - Karate, helps them to stick with it.
Nursing Interventions for the School-Age Child and Adolescent
Summarize strengths and needs identified during visit; ask child and family if they agree. Plan together with them to provide the needed information for topics developed during the visit. Emphasize the areas where the family excels. - e.g., using protective sports gear, current with immunizations (praise the parents for this) Summarize the child's next developmental tasks. - To the parents Provide guidance to assist with the child's growing independence. - If you don't want to go to your parents who else can you go to? Focus some discussion on maintaining healthy relationships. Provide reading materials, websites for later exploration. Insert appropriate health promotion/health maintenance topics. - Ex.) if sun tanning a lot talk to them about dangers of this.
Injury Prevention - Drowning
Supervised swimming - Children should be supervised when swimming or when near a body of water. Swimming lessons - Children should be taught to swim. Check diving depth - Check depth of water before allowing child to dive. Encourage breaks - Encourage breaks to prevent child from becoming over-tired.
Family and Social Relationships
The school aged child: 1. Is learning how to make and maintain friendships 2. Since peers are important, children may feel pressure to appear like others, to fit in. 3. Although these pressures are often associated with the teen years, they actually begin earlier, by age 8-9 years. Teamwork skills are well developed. School age is the often the time children will first experience violence in relationships with others. When parents are out of the room, ask about things their friends try to get them to do things that they know they are not supposed to do. Ask the child what they do in these situations. Some children are bullied, while others may be the bully. Ask child to describe when they last had a disagreement with someone and the problem was solved. Suggest people who could help like school nurse, teachers or counselors.
Health Promotion for School-agers and Adolescents- Immunizations
school age child (11 -12 years) Tdap (tetanus and diphtheria toxoids and pertussis vaccine); meningococcal vaccine (MCV4); and human papillomavirus vaccine (HPV2) in 3 doses for females; HVP4 may be given to males. If not given between 4 and 5 years of age, children should receive the following vaccines by 6 years of age - DTaP, IPV, MMR, and Varicella and yearly seasonal flu vaccine For ages 11 -12: Tdap, HPV2 or HPV4 in three doses for females, HPV4 for males; and MCV4. Meningococcal (MPSV4/MCV4)
