Ch. 28 School-Age children
The nurse is providing anticipatory guidance to a parent of an 8-year-old girl whose weight is 65 lb (29.5 kg) and height is 50.5 in (128.3 cm). Which statement by the parent demonstrates the need for further teaching?
"Based on my child's weight and height, I should be concerned my child is overweight." An 8-year-old girl needs between 1400 and 1600 calories per day. Based on the child's weight and height, the child has a body mass index (BMI) of 17.9 (around 75th percentile). To calculate BMI use [wt in lb/{ht in inches}x{ht in inches}] x703. This child is not in the overweight or obese category (>85th percentile is classified as overweight). An 8-year-old needs 1000 mg calcium per day. Children should be encouraged to make half of their of plate fruits and vegetables, to make half of their grains whole grains, and to choose lean proteins and calcium-rich foods. Chapter 28: Growth and Development of the School-Age Child - Page 1021-1023, 1134
The nurse is caring for a 6-year-old child. During the course of a routine wellness examination, the parent proudly reports that the child eats whatever the parent puts on the plate. The nurse wants to emphasize the importance of allowing the child to make some choices regarding the types of foods eaten. How should the nurse communicate this to the parent?
"Now is the time to let your child choose some of the meals." Diet preferences are established in the preschool years and continue to develop as the child ages. The diet is influenced by family, peers, and media. Because of these influences and the child striving for independence, it is important to involve the child in helping select the food choices and guiding the child to healthy food choices. With parents, as well as children, it is more effective and less a matter of personal opinion to say "now is the time" rather than "you need," "I want you to," or "you must" do something. The nurse can emphasize the importance of the child participating in meal selection while encouraging the child's independence in a gentle manner. Chapter 28: Growth and Development of the School-Age Child - Page 1022
A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time, even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?
"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Sleep needs for children change according to their ages. A 6- to 8-year-old child needs 12 hours of sleep per night. The 8- to 10-year-old child needs 10 to 12 hours of sleep per night. The 10- to 12-year-old child needs between 9 and 10 hours of sleep per night. Many younger children need a nap or to be provided with quiet time after school to recharge after a busy day in the classroom. Increasing the child's sleeping hours should be attempted before asking for medical intervention. Chapter 28: Growth and Development of the School-Age Child - Page 1023
Children at risk for bullying?
-Different from majority -Acts different from majority -Has low self-esteem -Mental or psychological problem p. 1066
How to help parents deal w/ their child who is the bully?
-Educate why its important to stop behavior -Discuss ways for child to release anger -Help parents try to get child to understand what its like to be bullied -Do not fight at home -Reward solving conflicts w/ out violence p. 1067
Erickson's developmental stage for industry vs. inferiority?
-Interested in how things work/made -Success in personal or social tasks -Increased activities outside home-clubs, sports -Increased interactions w/ peers -Increased interest in knowledge -Needs support and encouragement from important people in childs life -Needs support when child is not successful -Inferiority occurs w/ repeated failures w/ little support or trust from those who are important to the child p. 1052
Paiget "concrete operational" activities?
-Learns by manipulating concrete objects -Lacks ability to think abstractly -Learns objects remains constant -Understands concepts of time -Engages in serial ordering, addition and subtraction -Classifies/groups objects -Understand relationships amongst objects -Starts collecting items -Can reverse thought process p. 1052
Latchkey kid rules?
-Not answering phone, door -No friends in house when parents are not home -No playing w/ fire -Teach about finding a trusted neighbor for 911 emergency -Post important numbers should as schools, police, hospitals -Enroll in afterschool program w -Discuss limitations of outside play -Limitations of tv -Teach first aid, water shut off valves, circuit breaker p. 1066
Kohlberg Conventional stage 4: "law and order," age 10-12y.o.?
-Practices "golden rule" -Acts are judged in terms of intention not just punishment p. 1052
How to promote reading in school age children?
-Read to and with child -Ask teachers and librarians for advice on books appropriate for your child -Choose stories that a child can relate to if the child has difficulty reading -Choose books w/ movement for children w/ short attention span -Take advantage of reading opportunities (cereal boxes, road signs) -Provide choices for the child to select a book of interest -Talk about the text and asking questions -Keep a record of what the child is reading -Visit a library, get a library card, and check out books -Demonstrate role modeling through reading books p. 1058
Kohlberg Conventional stage 3:interpersonal conforming, "good child, bad child," age 7-10y.o.?
-Realizes an act is wrong and brings punishment -Behavior is completely wrong or right -Does not understand reason behind rules -If child and adult differ in opinions then the adult is right -Can empathize p. 1052
What to do when child refuses school?
-Return to school -Investigate cause of fear -Support child -Collaborate w/ teacher -Praise success in school attendance p. 1066
Ways to deal w/ bullying?
-Role-play, scenarios -Impress that they do not cause the bullying -Try to increase self esteem -Discuss situation w/ teacher p. 1067
Freud Latency activities?
-Time of tranquility between Oedipal phase of early childhood and adolescence-focuses on activities that develop social and cognitive skills -Develops social skills in relating to same sex friends through joining clubs like Brownies, Girl Scouts, Boy Scouts p. 1052
How much should electronics be limited per day?
1-2hr/day p. 1066
Brain growth is complete by what age?
10 y.o. p. 1051
8-10y.o. requires how much sleep a night?
10-12h p. 1064
6-8 y.o. requires how much sleep a night?
12h p. 1064
13y.o. needs how many mg of calcium?
1300 mg p. 1063
Moderately active children ages 4-8 usually need how many cal/day?
1400-1600 cal/day p. 1063
Girls age 9-13 need how many cal per day?
1600-2000 cal/day p. 1063
Boys age 9-13 need how many cal per day?
1800-2000cal/day p. 1063
Teeth expectations in school age child?
20 primary deciduous teeth are lost and replaced by 28-32 permanent teeth p. 1051
Typical school age acuity?
20/20 p. 1054
Weight increase expectation?
3-3.5kg (7lb) per year p. 1050
Toothbrush should be replaced how often?
3-4m p. 1064
School age children ages?
6-12y.o. p. 1050
Avg growth per year for 6-12y.o.?
6-7cm (2.5in) per year p. 1050
Children will need help brushing teeth until what age?
7-10y p. 1064
Frontal sinuses develop by what age?
7y.o. p. 1051
Night terrors in 6-8 y.o. should resolve by?
8-10y.o. p. 1064
Avg age for child to be left alone in the house?
8-10y.o. if mature and 11-12y.o. or older p. 1068
When are children most commonly lieing?
8-12y.o. p. 1068
4-8y.o. needs how many mg of calcium?
800-1000mg p. 1063
10-12y.o. needs how much sleep at night?
9-10h p. 1064
Lymphatic tissues continue to grow until how long?
9y.o. p. 1051
A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?
A feeling of inferiority Children who are unsuccessful in completing activities during the school-age phase, whether from physical, social, or cognitive disadvantages, develop a feeling of inferiority. Chapter 28: Growth and Development of the School-Age Child - Page 1010
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 Lack of the ability to think abstractly The principle of conservation The conventional stage of development
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. Chapter 28: Growth and Development of the School-Age Child - Page 1009
Formula for bladder capacity?
Age in years plus 2oz p. 1051
What is a natural consequence?
Allowing child to learn from their own mistakes p. 1065
Frequent problems w/ eyes?
Amblyopia (most common, it is lazy eye), uncorrected refractive errors or other eye defects, strabismus p. 1054
How should a seat belt fit on a school aged child?
Booster seat should be used at all times, lap belt should lie low and flat on hips and shoulder belt on shoulder not on neck or face, should be fastened when car is started, children under 13 should sit in back seat, use childproof locks p. 1059`
All-terrain vehicle safety?
Child should be 16y.o. to operate vehicle, helmets should be worn, no nighttime riding, do not go on public roads, never standup in vehicle or ride on someones lap p. 1060
The nurse is about to see a 9-year-old girl for a well-child checkup. Knowing that the child is in Piaget's period of concrete operational thought, which characteristic should the child display? Consider an action and its consequences. View the world in terms of her own experience. Make generalized assumptions about groups of things. Know lying is bad because she gets sent to her room for it.
Consider an action and its consequences. The child will be able to consider an action and its consequences in Piaget's period of concrete operational thought. However, she is now able to empathize with others. She is more adept at classifying and dividing things into sets. Defining lying as bad because she gets punished for it is a Kohlberg characteristic. Chapter 28: Growth and Development of the School-Age Child - Page 1010
Logical consequence?
Discipline for example is child does not put toy away they cannot play w/ it for the rest of the day p. 1065
How is amblyopia fixed?
Eye glasses or patching forcing to use the weak eye p. 1054
Self esteem is impacted by whom in the childs life?
Family, teachers, and authority figures p. 1055
Bruxism?
Grinding teeth p. 1065
Which immunoglobulins reach adult levels at age 10?
Immunoglobulin A and G (IgA &. IgG) p. 1051
An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?
Industry During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment. Accommodation is the ability to adapt thought processes to fit what is perceived, such as understanding there can be more than one reason for other people's actions. Conservation is the ability to appreciate that a change in shape does not necessarily mean a change in size. Perfectionism is the desire to do something perfectly. The boy's desire to apply the band-aid "the right way" is a hallmark of the development of industry. The other answers are not as pertinent. Chapter 28: Growth and Development of the School-Age Child - Page 1025
Pedestrian child safety?
Instruct to look left or right when crossing, older children should supervise, walking should be done on sidewalks, children should be taught to be aware of cars backing up in parking lots, have signs outside to notify drivers of children playing outisde p. 1059
The 12-year-old child speaks with the school nurse about the stomachaches he has been having lately. He tells the nurse that he is upset because his best friend stole something and he knows this isn't acceptable behavior. The nurse identifies that this child is demonstrating which stage of moral development?
Kohlberg's Conventional Stage 4 Kohlberg's Conventional Stage 4 describes the child as recognizing that acts are judged in terms of intention, not just punishment as in Kohlberg's Stage 3. Piaget's theory focuses on view of objects and abstract thoughts, Erikson's theory focuses on relationships, and Freud's theory focuses on tranquility between the Oedipal phase of early childhood and adolescence. Chapter 28: Growth and Development of the School-Age Child - Page 1010-1011
The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child?
Needs 10 to 12 hours of sleep per night The school-aged child needs 10 to 12 hours of sleep per night. They need to brush their teeth after every meal and at bedtime. A routine physical exam once a year is all that is necessary. Children are screened around the age of 10 or 11 for scoliosis. Chapter 28: Growth and Development of the School-Age Child - Page 1023
Water safety?
Never run near pool, drains should be covered, life jackets should be worn on boats, make sure water is deep enough to support diving p. 1060
Bike safety in traffic?
Observe all traffic signs, lights and reflectors at night, child should ride on side of road, learn to watch and listen for cars, headphones should not be used, do not hitch rides on back cars p. 1059
What activities would a nurse recommend to the families of school-aged children to promote attainment of Erikson's developmental stage of industry vs. inferiority? Select all that apply.
Participating on the school soccer team Praising the child for their academic efforts Allowing the child to assist her teacher in straightening up the classroom School-age children need support in order to achieve attainment of the developmental stage of industry vs. inferiority; parents can play a large role in the child accomplishing this. Encouraging participation in group sports, allowing children to assist their teacher and praising their academic efforts, even though they may not have made the best grade, are all ways to help the child accomplish this task. Expressing doubts about the child's abilities or defending them when they are not successful in accomplishing a skill only increases the chance the child will develop a sense of inferiority. Chapter 28: Growth and Development of the School-Age Child - Page 1009
Prepubescense?
Period before puberty, usually 2yrs before secondary sexual characteristics develop p. 1051
The nurse is working with a group of 8-year-olds who are learning about the concept of conservation of numbers. Which activity will help teach this concept to these school-aged children?
Rearranging a group of coins first into a circle, then a triangle and then a square In understanding the concept of conservation of numbers, the child understands that the number of objects does not change even though they may be rearranged. Conservation of weight can be accomplished by weighing different objects. Conversation of mass is demonstrated by forming vases out of clay. Chapter 28: Growth and Development of the School-Age Child - Page 987
Fire safety?
Smoke detectors, fire-escape plan, smoking in home should be prohibited especially in bed, stove should be under supervision, flammable liquids should be stored safely, fireplaces should have protective gratings, children should avoid wires p. 1060
Sports safety?
Sports should match ability and desire, should have warm up procedure, coaches should be trained in CPR and first aid, appropriate protection p. 1059
Malocclusion?
Teeth become crowded, crooked, or misaligned p. 1065
Parents of an 11-year-old child are bewildered that their child was caught stealing. The nurse best supports the parent by explaining which?
The child had a strong desire to have the item with little other way of obtaining it. The nurse must consider the age of the child and compare with stages in moral development. The nurse would point out that the desire to have an item may have overcome the child's 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. Chapter 28: Growth and Development of the School-Age Child - Page 1026
How often should school age children brush their teeth?
They should brush their teeth 2-3x per day w/ 2-3min each time w/ fluorinated toothpaste p. 1064
Bike safety?
Wear a proper helmet: sit level, not tilted, have strong Y shaped straps, should not be worn over hat or scarf, establish safe areas for bike riding, do not ride barefoot, wear proper shoes, do not have someone ride on bike , basket should help carry heavy things p. 1059
Skateboarding and inline skating safety?
Wear helmet, protective padding on knees, elbows, and wrists, should not skate in traffic or on streets or highways, homemade ramps should be assessed for hazards before skating p. 1059
The nurse is conducting a support group for parents of 9- and 10-year-olds. The parents express concern about the amount of time their children want to spend with friends outside the home. What should the nurse teach the parents that peer groups provide?
a sense of security as children gain independence Nine-year-olds take their peer group seriously. They are more interested in how other children dress than what their parents want them to wear. This is the age where groups are formed and others are excluded from the club. This age group is imitating their peers as they develop their own identity and separate from their parents. Groups are fluid as they change regularly due to many reasons: each member lives on the same street, each member plays on the same ball team, or one member has fewer material things than the others, etc. Security is gained through these clubs because it helps the school-age child develop independence away from the family. Most of the time in the school-age child, peer group relationships are with same-sex friends. Children do not become self-sufficient through these clubs. They remain dependent on their families for their physical needs. Chapter 28: Growth and Development of the School-Age Child - Page 1014
At a routine health checkup, a nurse assesses a child who has just turned 8 years of age. The nurse determines that the child is meeting developmental milestones for this age based on which finding(s)? Select all that apply.
able to move gracefully demonstrates symmetrical balance An 8-year-old child can typically put one's thoughts in chronological order, but the child is not yet able to group things in descending order or look at others' points of view. Grouping things in descending order and considering others' points of view are more commonly achieved by age 9. This age group also has symmetric balance and has graceful movements.
The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. What understanding has this child developed? conservation decentration classification reversibility
conservation Piaget described concrete operational thought occurring in the child ages 7 to 10 years. During this time the child develops various skills to see objects and the world. The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass. Using reversibility, the child can understand that processes can be reversed or canceled out by other things. Decentration is developed when the child can pay attention to multiple attributes of an object or situation instead of only one. In classification, the child is able to put objects together by shared qualities or characteristics. Chapter 28: Growth and Development of the School-Age Child - Page 1010
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 to Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned?
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. Chapter 28: Growth and Development of the School-Age Child - Page 1010
The developmental task of the school-aged period, according to Erikson, is gaining a sense of:
industry versus inferiority. The school-age years, according to Erickson, are the stage of industry versus inferiority. The developmental stage helps increase the child's sense of self worth. Industry is associated with the child's increased interest in knowledge and the development of social skills. Autonomy versus shame is the developmental tasks of 1 to 3 year old children. Erickson's stages do not include the developmental tasks of independence versus dependence nor identity versus failure. Chapter 28: Growth and Development of the School-Age Child - Page 1009
