Chapter 7: Health Promotion for the School-Age Child

Formal clubs

(Boy / girl scouts, camp fire USA, 4-H) Organized by adults, foster self esteem / competence, transmit societal values (service to others, duty to God, good citizenship)

Identify the 3 most pronounced physiologic changes that indicate increasing maturity in the school-aged child

1) A decrease in head circumference in relation to standing height 2) A decrease in waist circumference in relation to height 3) An increase in leg length in relation to height

Several factors have been identifies as contributing to childhood obesity. Name 3

1) Easy availability of fas tfood restaurants 2) Influence of mass media 3) Temptation to eat "junk food" (others: sedentary lifestyles, easy availability of high-calorie foods)

Identify 8 signs of stress in school-age children

1) Stomach pains of head aches 2) sleep problems 3) bed-wetting 4) changes in eating habits 5) Aggressive or stubborn behavior 6) Withdrawal or reluctance to participate in activities 7) Regression to earlier behaviors 8) Trouble concentrating or changes in academic performance

Identify 5 factors that influence the amount and manner of discipline and limit-setting imposed on school-age children

1) The psychosocial maturity of the parents 2) Childhood and childrearing experiences of the parents 3) Temperament of children 4) Context of children's misconduct 5) Response of the children to rewards and punishments

Identify 3 valuable lessons children learn from daily interactions with age-mates

1) To appreciate the various points of view found in the peer group 2) To become more sensitive to the social norms and pressures of the peer group 3) To form intimate friendships btw same-sex peers

When does the brain stop growing?

10 years old

Loves friends; talks incessantly about them at __________ years

12

What is the average age of puberty in girls?

12

What age does menarche typically occur?

12 years

What is the average age of puberty in boys?

14

How much should height increase per year in a school aged child?

2 inches per year

How long after breast buds appear does menarche generally start?

2 years

What is the definition of prepubescence?

2 years preceding puberty

How much should weight increase per year in a school-aged child?

2-3 kg/year

How much sleep should a school-aged child get per night?

2.5 hours may resist bedtime 8-11 12 and up are generally less resistant

Develops concept of numbers at __________ years

6

Likes simple card games at __________ years

6

What ages are considered school age?

6 - 11 years

What age do teeth begin falling out?

6 years

What is the definition of school-aged?

6-12 years

Enjoys group activities involving own sex but is beginning to mix with members of opposite sex at __________ years

9

Enjoys group sports and organizations as __________ years

9

How does the onset of the pubertal growth spurt compare in girls and boys? A. In girls, it occurs about 1 year before it appears in boys. B. In girls, it occurs about 3 years before it appears in boys. C. In boys, it occurs about 1 year before it appears in girls. D. It is about the same in both boys and girls.

A

Which is an important consideration in preventing injuries during middle childhood? A. Most injuries occur in or near school or home. B. Peer pressure is not strong enough to affect risk-taking behavior. C. Injuries from burns occur with the highest frequency at this age because of the fascination with fire. D. Lack of muscular coordination and control results in an increased incidence of injuries.

A

Children have a total of __________ primary (deciduous) teeth that they begin to lose when they are school age.

ANS: 20 twenty

Primary (deciduous) teeth are replaced by permanent teeth. By adulthood the child will have __________ permanent teeth.

ANS: 32 thirty-two

A nurse is planning a class for school-age children on obesity. Which percentile does the body mass index (BMI) need to exceed for a child to be assessed as obese?

ANS: 95 95th When intake of food exceeds expenditure, the excess is stored as fat. Obesity is an excessive accumulation of fat in the body and is assessed in children as a BMI that exceeds the 95th percentile for age.

A child has an evulsed (knocked-out) tooth. Which medium should the nurse instruct the parents to place the tooth in for transport to the dentist? a. In cold milk b. In cold water c. In warm salt water d. In a dry, clean jar

ANS: A An evulsed tooth should be placed in a suitable medium for transplant, either cold milk or saliva (under the child or parent's tongue). Cold milk is a more suitable medium for transport than cold water, warm salt water, or a dry, clean jar.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as: a. a belief common at this age. b. a belief that forms the basis for most religions. c. suggestive of excessive family pressure. d. suggestive of a failure to develop a conscience.

ANS: A Children at this age may view illness or injury as a punishment for a real or imagined misdeed. The belief in divine punishment is common for an 8-year-old child.

Which statement characterizes moral development in the older school-age child? a. They are able to judge an act by the intentions that prompted it rather than just by the consequences. b. Rules and judgments become more absolute and authoritarian. c. They view rule violations in an isolated context. d. They know the rules but cannot understand the reasons behind them.

ANS: A Older school-age children are able to judge an act by the intentions that prompted the behavior rather than just by the consequences. Rules and judgments become less absolute and authoritarian. Rule violation is likely to be viewed in relation to the total context in which it appears. The situation and the morality of the rule itself influence reactions.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her school work satisfactorily but lately has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as: a. signs of stress. b. developmental delay. c. physical problem causing emotional stress. d. lack of adjustment to school environment.

ANS: A Signs of stress include stomach pains or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. This child is exhibiting signs of stress.

Teasing can be common during the school-age years. The nurse should recognize that which applies to teasing? a. Can have a lasting effect on children b. Is not a significant threat to self-concept c. Is rarely based on anything that is concrete d. Is usually ignored by the child who is being teased

ANS: A Teasing in this age group is common and can have a long-lasting effect. Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable. Physical impairments such as hearing or visual defects, ears that "stick out," or birth marks assume great importance.

Which activity is most appropriate for developing fine motor skills in the school-age child? a. Drawing b. Singing c. Soccer d. Swimming

ANS: A Feedback A Activities such as drawing, building models, and playing a musical instrument increase the school-age child's fine motor skills. B Singing is an appropriate activity for the school-age child, but it does not increase fine motor skills. C The school-age child needs to participate in group activities to increase both gross motor skills and social skills, but group activities do not increase fine motor skills. D Swimming is an activity that also increases gross motor skills.

The ability to mentally understand that 1 + 3 = 4 and 4 - 1 = 3 occurs in which stage of cognitive development? a. Concrete operations b. Formal operations c. Intuitive thought d. Preoperations

ANS: A Feedback A By 7 to 8 years of age, the child is able to retrace a process (reversibility) and has the skills necessary for solving mathematical problems. This stage is called concrete operations. B The formal operations stage deals with abstract reasoning and does not occur until adolescence. C Thinking in the intuitive stage is based on immediate perceptions. A child in this stage often solves problems by random guessing. D In preoperational thinking, the child is usually able to add 1 + 3 = 4 but is unable to retrace the process.

An 8-year-old girl tells the nurse that she has cancer because God is punishing her for "being bad." She shares her concern that if she dies, she will go to hell. The nurse should interpret this as being a. A belief common at this age b. A belief that forms the basis for most religions c. Suggestive of excessive family pressure d. Suggestive of a failure to develop a conscience

ANS: A Feedback A Children at this age may view illness or injury as a punishment for a real or imagined mystique. B The belief in divine punishment is common at this age. C The belief in divine punishment is common at this age. D The belief in divine punishment is common at this age.

A school nurse is teaching a health class for 5th grade children. The nurse plans to include which statement to best describe growth in the early school-age period? a. Boys grow faster than girls. b. Puberty occurs earlier in boys than in girls. c. Puberty occurs at the same age for all races and ethnicities. d. It is a period of rapid physical growth.

ANS: A Feedback A During the school-age developmental period, boys are approximately 1 inch taller and 2 pounds heavier than girls. B Puberty occurs 1 1/2 to 2 years later in boys, which is developmentally later than puberty in girls (not unusual in 9- or 10-year-old girls). C Puberty occurs approximately 1 year earlier in African-American girls than in white girls. D Physical growth is slow and steady during the school-age years.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as a. Signs of stress b. Developmental delay c. Physical problem causing emotional stress d. Lack of adjustment to school environment

ANS: A Feedback A Signs of stress include stomach pains or headache, sleep problems, bedwetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, or regression to early behaviors. B This child is exhibiting signs of stress. C This child is exhibiting signs of stress. D This child is exhibiting signs of stress.

Peer victimization is becoming a significant problem for school-age children and adolescents in the United States. Parents should be educated regarding signs that a child is being bullied. These might include (select all that apply) a. The child spends an inordinate amount of time in the nurse's office. b. Belongings frequently go missing or are damaged. c. The child wants to be driven to school. d. School performance improves. e. The child freely talks about his day.

ANS: A, B, C Feedback Correct Signs that may indicate a child is being bullied are similar to signs of other types of stress and include nonspecific illness or complaints, withdrawal, depression, school refusal, and decreased school performance. Children express fear of going to school or riding the school bus. Very often, children will not talk about what is happening to them. Incorrect These are not indications of bullying.

Which demonstrates the school-age child's developing logic in the stage of concrete operations? Select all that apply. a. The school-age child is able to recognize that 1 lb of feathers is equal to 1 lb of metal. b. The school-age child is able to recognize that he can be a son, brother, or nephew at the same time. c. The school-age child understands the principles of adding, subtracting, and reversibility. d. The school-age child has thinking that is characterized by egocentrism, animism, and centration

ANS: A, B, C Feedback Correct The school-age child understands that the properties of objects do not change when their order, form, or appearance does. Conservation occurs in the concrete operations stage. Comprehension of class inclusion occurs as the school-age child's logic increases. The child begins to understand that a person can be in more than one class at the same time. This is characteristic of concrete thinking and logical reasoning. The school-age child is able to understand principles of adding and subtracting, as well as the process of reversibility, which occurs in the stage of concrete operations. Incorrect This type of thinking occurs in the intuitive thought stage, not the concrete operations stage of development.

A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis. Which activities should the nurse plan to bring from the playroom for the child? (Select all that apply.) a. Paper and some paints b. Board games c. Jack-in-the-box d. Stuffed animals e. Computer games

ANS: A, B, E School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Jack-in-the-box and stuffed animals would be appropriate for a toddler or preschool child.

Which interventions are appropriate for preventing childhood obesity? Select all that apply. a. Establish consistent times for meals and snacks. b. Eliminate all snacks. Eat three nutritious meals a day. c. Teach the family and child how to select foods and prepare foods. d. Encourage schools to provide snack machines with popcorn, cookies, and diet soda. e. Limit computer and television time.

ANS: A, C, E Feedback Correct Preventing obesity includes encouraging families to establish consistent times for meals and snacks and discouraging between-meal eating. Parents and children also need to be taught how to select and prepare healthful foods. Because snacks are an important aspect in childhood nutrition, nutritious snacks should be identified. School-age children usually require a healthful snack after school and in the evening. A child who spends time with social media has less interest in physical activity and going outdoors. Incorrect Snacks are an important aspect in childhood nutrition. Nutritious snacks should be identified, not eliminated. Healthy snack options include fruit, popcorn, nuts, and yogurt, not cookies and diet soda. In schools with snack machines, children may use their lunch money to purchase high-calorie snacks versus a nutritious lunch.

Which statement best describes fear in the school-age child? a. They are increasingly fearful for body safety. b. Most of the new fears that trouble them are related to school and family. c. They should be encouraged to hide their fears to prevent ridicule by peers. d. Those who have numerous fears need continuous protective behavior by parents to eliminate these fears.

ANS: B During the school-age years, children experience a wide variety of fears, but new fears relate predominantly to school and family. During the middle-school years, children become less fearful for body safety than they were as preschoolers. Parents and other persons involved with children should discuss children's fears with them individually or as a group activity. Sometimes school-age children hide their fears to avoid being teased. Hiding their fears does not end them and may lead to phobias.

A school nurse observes school-age children playing at recess. Which is descriptive of the play the nurse expects to observe? a. Individuality in play is better tolerated than at earlier ages. b. Knowing the rules of a game gives an important sense of belonging. c. They like to invent games, making up the rules as they go. d. Team play helps children learn the universal importance of competition and winning.

ANS: B Play involves increased physical skill, intellectual ability, and fantasy. Children form groups and cliques and develop a sense of belonging to a team or club. At this age, children begin to see the need for rules. Conformity and ritual permeate their play. Their games have fixed and unvarying rules, which may be bizarre and extraordinarily rigid. With team play, children learn about competition and the importance of winning, an attribute highly valued in the United States.

Parents of a twelve-year-old child ask the clinic nurse, "How many hours of sleep should our child get?' The nurse should respond that 12-year-old children need how many hours of sleep at night? a. 8 b. 9 c. 10 d. 11

ANS: B School-age children usually do not require naps, but they do need to sleep approximately 11 hours at age 5 years and 9 hours at age 12 years each night.

When teaching injury prevention during the school-age years, what should the nurse include? a. Teach children to fear strangers. b. Teach basic rules of water safety. c. Avoid letting child cook in microwave ovens. d. Caution child against engaging in competitive sports.

ANS: B Water safety instruction is an important source of injury prevention at this age. The child should be taught to swim, select safe and supervised places to swim, swim with a companion, check for sufficient water depth before diving, and use an approved flotation device. Teach stranger safety, not fear of strangers. This includes instructing children to not go with strangers, not wear personalized clothing in public places, tell parents if anyone makes child feel uncomfortable, and say "no" in uncomfortable situations. Teach child safe cooking. Caution against engaging in hazardous sports such as those involving trampolines.

An important consideration for the school nurse who is planning a class on bicycle safety is a. Most bicycle injuries involve collision with an automobile. b. Head injuries are the major causes of bicycle-related fatalities. c. Children should wear bicycle helmets if they ride on paved streets. d. Children should not ride double unless the bicycle has an extra-large seat.

ANS: B Feedback A Although motor vehicle collisions do cause injuries to bicyclists, most injuries result from falls. B The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. C The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission. D Children should not ride double.

Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry? a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures

ANS: B Feedback A Asking peers for feedback reinforces the child's feelings of failure. B The task of the caring teacher or parent is to identify areas in which a child is competent and to build on successful experiences to foster feelings of mastery and success. Structuring the environment to enhance self-confidence and to provide the opportunity to solve increasingly more complex problems will promote a sense of mastery. C When teachers or parents complete children's homework for them, it sends the message that you do not trust them to do a good job. Providing assistance and suggestions and praising their best efforts are more appropriate. D Decreasing expectations to eliminate failures will not promote a sense of achievement or mastery.

A nurse is assessing an older school-age child recently admitted to the hospital. Which assessment indicates that the child is in an appropriate stage of cognitive development? a. The child's addition and subtraction ability b. The child's ability to classify c. The child's vocabulary d. The child's play activity

ANS: B Feedback A Subtraction and addition are appropriate cognitive activities for the young school-age child. B The ability to classify things from simple to complex and the ability to identify differences and similarities are cognitive skills of the older school-age child; this demonstrates use of classification and logical thought processes. C Vocabulary is not as valid an assessment of cognitive ability as is the child's ability to classify. D Play activity is not as valid an assessment of cognitive function as is the child's ability to classify.

Which is an appropriate disciplinary intervention for the school-age child? a. Using time-out periods b. Using a consequence that is consistent with the inappropriate behavior c. Using physical punishment d. Using lengthy dialog about inappropriate behavior

ANS: B Feedback A Time-out periods are more appropriate for younger children. B A consequence that is related to the inappropriate behavior is the recommended discipline. C Physical intervention is an inappropriate form of discipline. It does not connect the discipline with the child's inappropriate behavior. D Lengthy discussions typically are not helpful.

A nurse teaches parents that team play is important for school-age children. Which can children develop by experiencing team play? (Select all that apply.) a. Achieve personal goals over group goals. b. Learn complex rules. c. Experience competition. d. Learn about division of labor.

ANS: B, C, D Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team. Team play can also contribute to children's social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal.

Which strategies can a nurse teach to parents of a child experiencing uncomplicated school refusal? Select all that apply. a. The child should be allowed to stay home until the anxiety about going to school is resolved. b. Parents should be empathetic yet firm in their insistence that the child attends school. c. A modified school attendance may be necessary. d. Parents need to pick the child up at school whenever the child wants to come home. e. Parents need to communicate with the teachers about the situation.

ANS: B, C, E Feedback Correct In uncomplicated cases of school refusal, the parent needs to return the child to school as soon as possible. If symptoms are severe, a limited period of part-time or modified school attendance may be necessary. For example, part of the day may be spent in the counselor's or school nurse's office, with assignments obtained from the teacher. Parents should be empathetic yet firm and consistent in their insistence that the child attend school. Incorrect Parents should not pick the child up at school once the child is there. The principal and teacher should be told about the situation so that they can cooperate with the treatment plan.

Which describes moral development in younger school-age children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave. c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.

ANS: C Children who are ages 6 and 7 years know the rules and behaviors expected of them but do not understand the reasons for these rules and behaviors. Young children do not believe that standards of behavior come from within themselves, but that rules are established and set down by others. Younger school-age children learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Misfortunes and accidents are viewed as punishment for bad acts.

19. A nurse is teaching parents of kindergarten children general guidelines to assist their children in school. Which statement by the parents indicates they understand the teaching? a. "We will only meet with the teacher if problems occur." b. "We will discourage hobbies so our child focuses on school work." c. "We will plan a trip to the library as often as possible." d. "We will expect our child to make all As in school."

ANS: C General guidelines for parents to help their child in school include sharing an interest in reading. The library should be used frequently and books the child is reading should be discussed. Hobbies should be encouraged. The parents should not expect all As. They should focus on growth more than grades.

A nurse planning care for a school-age child should take into account that which thought process is seen at this age? a. Animism b. Magical thinking c. Ability to conserve d. Thoughts are all-powerful

ANS: C One cognitive task of school-age children is mastering the concept of conservation. At an early age (5 to 7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 - 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. Animism, magical thinking, and believing that thoughts are all powerful are thought processes seen in preschool children.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as: a. behavior that encourages bullying and sexism. b. behavior that reinforces poor peer relationships. c. characteristic of social development at this age. d. characteristic of children who later are at risk for membership in gangs.

ANS: C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. A boys-only club does not have a direct correlation with later gang activity.

Generally, the earliest age at which puberty begins is _____ years in girls, _____ in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Puberty signals the beginning of the development of secondary sex characteristics. This begins earlier in girls than in boys. Usually a 2-year difference occurs in the age of onset. Girls and boys do not usually begin puberty at the same age. Girls generally begin puberty 2 years earlier than boys.

Which statement is the most accurate about moral development in the 9-year-old school-age child? a. Right and wrong are based on physical consequences of behavior. b. The child obeys parents because of fear of punishment. c. The school-age child conforms to rules to please others. d. Parents are the determiners of right and wrong for the school-age child.

ANS: C Feedback A Children 4 to 7 years of age base right and wrong on consequences. B Consequences are the most important consideration for the child between 4 and 7 years of age. C The 7- to 12-year-old child bases right and wrong on a good-boy or good-girl orientation in which the child conforms to rules to please others and avoid disapproval. D Parents determine right and wrong for the child younger than 4 years of age.

In general, the earliest age at which puberty begins is ____ years in girls and _____ years in boys. a. 13; 13 b. 11; 11 c. 10; 12 d. 12; 10

ANS: C Feedback A Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. B Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys. C Puberty signals the beginning of the development of secondary sex characteristics. This begins in girls earlier than in boys. Usually, there is a 2-year difference in the age at onset. D Girls and boys do not usually begin puberty at the same age; girls usually begin earlier than boys.

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as a. Behavior that encourages bullying and sexism b. Behavior that reinforces poor peer relationships c. Characteristic of social development of this age d. Characteristic of children who later are at risk for membership in gangs

ANS: C Feedback A Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. B Peer-group identification and association are essential to a child's socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. C One of the outstanding characteristics of middle childhood is the creation of formalized groups or clubs. D A boys-only club does not have a direct correlation with later gang activity.

The school nurse is conducting a class on bicycle safety. Which statement made by a participant indicates a need for further teaching? a. "Most bicycle injuries occur from a fall off the bicycle." b. "Head injuries are the major causes of bicycle-related fatalities." c. "I should replace my helmet every 5 years." d. "I can ride double with a friend if the bicycle has an extra large seat."

ANS: D Children should not ride double. Most injuries result from falls. The most important aspect of bicycle safety is to encourage the rider to use a protective helmet. Head injuries are the major cause of bicycle-related fatalities. The child should always wear a properly fitted helmet approved by the U.S. Consumer Product Safety Commission and should replace the helmet at least every 5 years.

Which describes the cognitive abilities of school-age children? a. Have developed the ability to reason abstractly b. Are capable of scientific reasoning and formal logic c. Progress from making judgments based on what they reason to making judgments based on what they see d. Are able to classify, to group and sort, and to hold a concept in their minds while making decisions based on that concept

ANS: D In Piaget's stage of concrete operations, children have the ability to group and sort and make conceptual decisions. Children cannot reason abstractly and logically until late adolescence. Making judgments based on what they reason to making judgments based on what they see is not a developmental skill.

Which is characteristic of dishonest behavior in children ages 8 to 10 years? a. Cheating during games is now more common. b. Lying results from the inability to distinguish between fact and fantasy. c. They may steal because their sense of property rights is limited. d. They may lie to meet expectations set by others that they have been unable to attain.

ANS: D Older school-age children may lie to meet expectations set by others to which they have been unable to measure up. Cheating usually becomes less frequent as the child matures. In this age group, children are able to distinguish between fact and fantasy. Young children may lack a sense of property rights; older children may steal to supplement an inadequate allowance, or it may be an indication of serious problems.

Parents ask the nurse whether it is common for their school-age child to spend a lot of time with peers. The nurse should respond, explaining that the role of the peer group in the life of school-age children provides: a. opportunity to become defiant. b. time to remain dependent on their parents for a longer time. c. time to establish a one-on-one relationship with the opposite sex. d. security as they gain independence from their parents.

ANS: D Peer-group identification is an important factor in gaining independence from parents. Children learn how to relate to people in positions of leadership and authority and how to explore ideas and the physical environment. Becoming defiant in a peer-group relationship may lead to bullying. Peer-group identification helps in gaining independence rather than remaining dependent. One-on-one opposite sex relationships do not occur until adolescence. School-age children form peer groups of the same sex.

A school nurse is teaching dental health practices to a group of sixth-grade children. How often should the nurse recommend the children brush their teeth? a. Twice a day b. Three times a day c. After meals d. After meals, snacks, and bedtime

ANS: D Teeth should be brushed after meals, after snacks, and at bedtime. Children who brush their teeth frequently and become accustomed to the feel of a clean mouth at an early age usually maintain the habit throughout life. Twice a day, three times a day or after meals would not be often enough.

The father of a 12-year-old child tells the nurse that he is concerned about his son getting "fat." His son is at the 50th percentile for height and the 75th percentile for weight on the growth chart. The most appropriate nursing action is to: a. reassure the father that his child is not fat. b. reassure the father that his child is just growing. c. suggest a low-calorie, low-fat diet. d. explain that this is typical of the growth pattern of boys at this age.

ANS: D This is a characteristic pattern of growth in preadolescent boys, where the growth in height has slowed in preparation for the pubertal growth spurt, but weight is still gained. The nurse should review this with both the father and the child and develop a plan to maintain physical exercise and a balanced diet. It is false reassurance to tell the father that his son is not fat. His weight is high for his height. The child needs to maintain his physical activity. The father is concerned, so an explanation is required. A nutritional diet with physical activity should be sufficient to maintain his balance.

The school nurse has been asked to begin teaching sex education in the fifth grade. The nurse should recognize that: a. children in fifth grade are too young for sex education. b. children should be discouraged from asking too many questions. c. correct terminology should be reserved for children who are older. d. sex can be presented as a normal part of growth and development.

ANS: D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development. Fifth-graders are usually 10 or 11 years old. This age is not too young to speak about physiologic changes in their bodies. They should be encouraged to ask questions. Preadolescents need precise and concrete information.

A school nurse is conducting a class on safety for a group of school-age children. Which statement indicates that the children may need further teaching? a. "My sister and I know two different ways to get out of the house." b. "I can dial 911 if there is a fire or a burglar in the house." c. "My mother has told us that if we have a fire, we have to meet at the neighbor's house." d. "If there is a fire I will have to go back in for my cat Fluffy because she will be scared."

ANS: D Feedback A All children should know two different escape routes from the house, in case one is blocked. B It is important for children to be taught how to call 911 in an emergency. C All families should have a predetermined meeting place away from the house. D Children should be taught never to return to a burning house, not even for a pet.

The school nurse has been asked to begin teaching sex education in the 5th grade. The nurse should recognize that a. Children in 5th grade are too young for sex education. b. Children should be discouraged from asking too many questions. c. Correct terminology should be reserved for children who are older. d. Sex can be presented as a normal part of growth and development.

ANS: D Feedback A Fifth graders are usually 10 to 11 years old. This age is not too young to speak about physiologic changes in their bodies. B They should be encouraged to ask questions. C Preadolescents need precise and concrete information. D When sexual information is presented to school-age children, sex should be treated as a normal part of growth and development.

Which comment is most developmentally typical of a 7-year-old boy? a. "I am a Power Ranger, so don't make me angry." b. "I don't know whether I like Mary or Joan better." c. "My mom is my favorite person in the world." d. "Jimmy is my best friend."

ANS: D Feedback A Magical thinking is developmentally appropriate for the preschooler. B Opposite-sex friendships are not typical for the 7-year-old child. C Seven-year-old children socialize with their peers, not their parents. D School-age children form friendships with peers of the same sex, those who live nearby, and other children who have toys that they enjoy.

Which behavior is not demonstrated in the 8-year-old child? a. Understands that his or her point of view is not the only one b. Enjoys telling riddles and silly jokes c. Understands that pouring liquid from a small to large container does not change the amount d. Engages in fantasy and magical thinking

ANS: D Feedback A School-age children enter the stage of concrete operations. They learn that their point of view is not the only one. B The school-age child has a sense of humor. The child's increased language mastery and increased logic allow for appreciation of plays on words, jokes, and incongruities. C The school-age child understands that properties of objects do not change when their order, form, or appearance does. D The preschool-age child engages in fantasy and magical thinking. The school-age child moves away from this type of thinking and becomes more skeptical and logical. Belief in Santa Claus or the Easter Bunny ends in this period of development.

Which statement made by a mother of a school-age boy indicates a need for further teaching? a. "My child is playing soccer this year." b. "He is always busy with his friends playing games. He is very active." c. "I limit his television watching to about 2 hours a day." d. "I am glad his coach is a good role model. He emphasizes the importance of winning in today's society. The kids really are disciplined."

ANS: D Feedback A Team sports such as soccer are appropriate for exercise and refinement of motor skills. B School-age children need to participate in physical activities, which contribute to their physical fitness skills and well-being. C Limiting television to 2 hours a day is an appropriate restriction. School-age children should be encouraged to participate in physical activities. D Team sports are important for the development of sportsmanship and teamwork and for exercise and refinement of motor skills. A coach who emphasizes winning and strict discipline is not appropriate for children in this age-group.

In providing anticipatory guidance to parents, which parental behavior is the most important in fostering moral development? a. Telling the child what is right and wrong b. Vigilantly monitoring the child and her peers c. Weekly family meetings to discuss behavior d. Living as the parents say they believe

ANS: D Feedback A Telling the child what is right and wrong is not effective unless the child has experienced what she hears. Parents need to live according to the values they are teaching to their children. B Vigilant monitoring of the child and her peers is an inappropriate action for the parent to initiate. It does not foster moral development and reasoning in the child. C Weekly family meetings to discuss behaviors may or may not be helpful in the development of moral reasoning. D Parents living what they believe gives nonambivalent messages and fosters the child's moral development and reasoning.

The number of hours spent sleeping decreases as the child grows older. Children ages 6 and 7 years require approximately 9 or 10 hours of sleep per night. Is this statement true or false?

ANS: F Children ages 6 and 7 actually need approximately 12 hours of sleep per night. Some children also continue to need an afternoon nap or quiet time to restore energy levels. The 12-year-old needs approximately 9 to 10 hours of sleep at night. Adequate sleep is important for school performance and physical growth. Inadequate sleep can cause irritability, inability to concentrate, and poor school performance.

____________________ is the leading cause of death in children of every age-group beyond 1 year of age.

ANS: Unintentional injury

Immunizations for a school age child.

Ages 11 - 12 Tada - Tdap Human - HPV Men - Meningococcal

Car safety for the school age child

At 4 ft 9 inches and 8-11 years old can use vehicle seat belt instead of car seat / booster seat, shoulder belt needs to cross middle of chest, lap belt rides on thighs, children should sit in back seat away from air bags

A 12-year-old child being seen in the clinic has not received the vaccine for the hepatitis B virus (HBV). What recommendation should the nurse make? A. One dose of HBV vaccine is needed at age 14 years. B. The three-dose series of HBV vaccine should be started. C. Only one dose of HBV vaccine will be needed sometime during adolescence. D. The three-dose series of HBV vaccine should be started at age 16 years or sooner if the adolescent becomes sexually active.

B

Which is descriptive of the social development of school-age children? A. Identification with peers is minimal. B. Children frequently have "best friends." C. Boys and girls play equally well with children of either gender. D. Peer approval is not yet an influence toward conformity.

B

Which of the following best describes the older (11-12 y/o) school-age child's perception of rules and judgement of actions? A) Does not understand the reason for rules B) Takes into account different points of view to make a judgement C) Judges an act by its consequences D) Believes that rules and judgements are absolute

B) Takes into account different points of view to make a judgement

The nurse is reviewing with a group of school age parents about what to expect regarding their school-aged children. What information should the nurse include? (Select all that apply.) A. The average weight gain is 7 lbs per year. B. The average increase in height is 2 inches per year. C. Children this age like to collect groups of things like coins. D. They really want to please their parents and teachers. E. The developmental task for this age is initiative. F. Children this age are able to understand sports and social rules.

B,C,D,F

What are the sex education topics appropriate for a school age child?

Basic anatomy and Physiology, body functions, expected puberty changes, menstruation / nocturnal emissions, reproduction, teenage pregnancy, HIV infection, STD's

The school age child and peer groups

Becomes major socializing influence, child begins to prefer activities with friends over family, child becomes more independent, peer approval is strong motivating force (child risks disapproval of parent), formal / informal clubs, learn interpersonal skills (sharing / cooperation / tolerance),

Poor relationships with peers and a lack of group identification can contribute to __________

Bullying

Where does bullying most frequently occur?

Bullying occurs most frequently at school where supervision is minimal, such as school hallways or on the playground

How do school age children react to stress?

By being unhappy, moody, irritable, aggressive, fatigued, hyperactive, complains of physical discomfort (headaches / stomach ache), poor performance in school

Parents of a 10-year-old child are concerned that their child has been recently showing signs of low self-esteem. Which developmental information should the nurse consider when discussing this issue with the parents? A. Changing self-esteem is difficult after about age 5 years. B. Self-esteem is the objective judgment of one's worthiness. C. Transitory periods of lowered self-esteem are expected developmentally. D. High self-esteem develops when parents show adequate love for the child.

C

The parents of an 8-year-old girl tell the nurse that their daughter wants to join a soccer team. What guidance would be appropriate for the nurse to share with the parents? A. Organized sports, such as soccer, are not appropriate at this age. B. Competition is detrimental to the establishment of a positive self-image. C. Sports participation is encouraged if the sport is appropriate to the child's abilities. D. Girls should compete only against girls because at this age boys are larger and have more muscle mass.

C

The school nurse is discussing dental health with children in first grade. Which information should the nurse include in the presentation? A. Teach the children how to floss teeth properly. B. Recommend using a toothbrush with hard nylon bristles. C. Emphasize the importance of brushing before bedtime. D. Recommend using nonfluoridated toothpaste approved by the American Dental Association.

C

What nursing intervention to promote health during middle childhood would be appropriate? A. Stress the need for increased calorie intake to meet increased demands. B. Instruct parents to defer questions about sex until the child reaches adolescence. C. Reinforce the need for good dental hygiene because these are the years in which permanent teeth erupt. D. Advise parents that the child will need decreasing amounts of rest toward the end of this period.

C

According to Piaget, the school child is in which stage? A) Sensorimotor B) Pre operational C) Concrete operational D) Formal operational

C) Concrete operational

Safety and the school aged child

Car safety, fire safety, gun safety, bicycle safety, playground safety, pedestrian safety, water safety, sin protection, good / bad touch safety, exposure to contact allergens, sports safety, home / stranger safety, reason to contact 911

According to Piaget, what occurs when children can recognize that changing the shape of a substance, such as a lump of clay, does not alter its total mass?

Conservation

The school nurse is asked to speak with the parents of a 10-year-old boy who has been bullying other children. What response by the nurse is based on what knowledge about children this age? A. Bullying at this age is considered normal. B. Children who bully others usually join gangs. C. Children who bully others usually have low self-esteem. D. Bullies often have difficulties developing and maintaining relationships.

D

Which is an important consideration related to childhood stress? A. Children do not have coping strategies. B. Children should be protected from stress. C. Parents cannot prepare children for stress. D. Some children are more vulnerable to stress than others.

D

According to Erikson, the development task of middle childhood is acquiring a sense of which of the following? A) Trust B) Autonomy C) Initiative D) Industry

D) Industry

Which of the following best describes the younger (6 to 7 y/o) school-age child's perception of rules and judgement actions? A) Judges an act by its intentions rather than by the consequences alone B) Believes that rules and judgements are not absolute C) Understands the reason behind rules D) Interprets accidents and misfortunes as punishment for misdeeds

D) Interprets accidents and misfortunes as punishment for misdeeds

According to Freud, the school-aged child is in which of the following periods? A) Oral B) Anal C) Oedipal D) Latency

D) Latency

Physiologically, the middle years begin with the shedding of the first __________ and end at puberty, with the acquisition of the __________

Deciduous teeth; permanent teeth

Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that __________ is an effective strategy for attaining a goal

Division of labor

Water safety and school age child

Do not swim with out adult there to watch,

What do you teach parents of school age children about nutrition?

Do not use food as reward, establish consistent times of meals / snacks, offer healthy foods, be role model (eat healthy / exercise)

How often should school age children see a dentist?

Every 6 months

T/F: During the school-age years, a child will grow approx. 5 cm (2 in) per year and will almost triple in wt

F. Children grow an average of 5 cm (2 in) per year and almost double in their weight

T/F: The most common cause of severe accidental injury and death in school-age children in poisoning

False - Most common cause of severe accidental injury and death in school-age children is motor vehicle accidents

Who runs the risk of early puberty?

Females who are significantly over weight

What is the average age of puberty for girls and boys?

Girls: 10 Boys: 12

What would the nurse teach the parents of school age children to promote self esteem?

Give household responsibilities, set reasonable rules, allow to solve problems and make responsible choices, praise what is done well / right, Encourage to do better (but don't be critical), allow children to make mistakes / encourage responsibility of mistakes (accept consequences), emphasize strengths, help improve weaknesses, allow them to do their homework (you can help but do not do it for them), set good example of behavior toward others, show consistent love

What does the school age child need to do to be successful in achieving industry?

Have secure sense of self (separate from loved ones), learn to trust others, have previously developed sense of autonomy and initiative, replace fantasy play with work (homework, crafts, chores, hobbies, athletics), be satisfied after achieving skill and external rewards (good grades, trophies, allowance), enjoy taking on and completing new tasks, develop sense of worth / competence (learn to do things and do them well)

What does health screening of the school aged child include?

Hearing / vision screening, speech assessment, hemoglobin / Hematocrit, urine (for sugars / protein), blood pressure, fasting lipid screening, TB screening, scoliosis screening

Bike safety and school age child

Helmet / knee / elbow pads necessary, rules of road

Gross motor development of the school ager

Improved muscle mass, coordination, participates in variety of sports and games

School age children shift their interests and focus from home and family to what?

Independence, peers, sharing, exploring.

Ericksons stage of development for a school age child

Industry vs inferiority

According to Erikson, failure to develop a sense of accomplishment results in a sense of __________

Inferiority

What opportunities does the school age nurse have regarding sexual development?

Introduction of sex education, Resource person for parents, teachers, and children (available to answer questions)

What would you teach a parent of a school ager in regards to dental care?

Keep tooth moist by placing it in saline, water, milk, or commercial tooth preservative, do not clean or scrub tooth, take child and tooth to dental emergency facility immediately, reinforce need to adhere to discharge instructions and follow up with health care provider

Children who spend some amount of time before or after school w/out supervision of an adult are termed __________

Latchkey children

Informal clubs for 6 - 8 year olds

Loosely organized, membership changes frequently, based on mutual interests (playing ball, riding bikes, playing with dolls),

Dental Development of the school ager

Lose 20 baby teeth and replaced by 28 permanent teeth

What teeth are generally lost first?

Lower incisors

What develops fully during school age years?

Lungs and alveoli (results in fewer respiratory infections)

Therapeutic management for school age dental problems

Mainly done by specialists / dentists, but nurse can check to see if teeth are loose, and must watch for aspiration of the child comes in with dental injury and the tooth is not in the socket or brought in with child.

A condition in which the teeth are crowded, crooked, or out of alignment is known as ________________.

Malocclusion

What years are pivotal in development of conscience and internalization of values?

Middle school years

clubs in children 9 - 11 years of age

More structured, characterized by secret codes / rituals / rigid rules, may be formed for purpose of exclusion

What leads to more coordination?

Musculoskeletal growth

Treatment for Lice includes...

Nix - kills with 1 application but should be re- treated in 7 - 10 days, use fine tooth comb 4x or more over 2 weeks, wash all clothing / bedding / stuffed toys in hot water / hot dryer, if items can not be washed wrap in plastic bag for 2 - 3 weeks, vacuum home thoroughly

Is fluoride supplementation recommended for children who are not at risk for tooth decay?

No, not any more

Do you treat everyone in the house hold if one child gets lice?

No, only treat those infested

Are there immunizations aside from annual flu vaccine to be administered between the ages of 6 and 11?

Not unless child is behind on immunizations

There is a developmental sequence in children's capacity to conserve matter. Conservation of __________ is usually grasped before conservation of __________

Numbers; substance

Dental emergencies of the school age children

Occur more often in school age children because of injury from sports or on the play ground.

Sexual development of a school age child

Onset of puberty can occur as young as 8 years

What is important for a child between ages of 6 and 11 years of age to be successful in school?

Parents take active interest in child'e progress, parents encourage child to do their best, reinforcement for honest efforts not just good grades, adequate sleep, reward organization and meeting deadlines, parent encourages child to take responsibility for their learning, foster skills important for success later in life, Parents communicate with teachers, stay informed of child's progress, visit classroom / parent - teacher conferences / school activities, show respect for teachers

One of the most important socializing agents in the school-age years is the __________ group.

Peer

What has a strong influence on the child's attainment of independence form parents?

Peer group identification

Developmental milestones for the school age child

Positive self esteem, peer group becomes primary socializing force, become outgoing, develops the know it all attitude, becomes more reflective and quiet by 8 yrs, love new ideas / places, sense of humor / crude jokes, may be argumentative, likes to make things (but usually doesn't finish them), loves family (worries about them), strong sense of fairness / justice, use rules to define cooperative relationships with others

What are common stress factors in the school age child?

Pressure to succeed, physical violence, bullying, media influences, sports, over scheduling (events or activities), family issues

Fire safety with the school age child

Routine fire drills practiced, know 2 escape routes, know how / when to dial 911, crawl under smoke to leave burning building, predetermined meeting place outside of house, never return to burning building

When is a persons fundamental attitude about work established?

School age years

The term __________ refers to a conscious awareness of self-perceptions, such as one's physical characteristics, abilities, values, ideals, and expectations, as well as an idea of self in relation to others. It also includes one's body image, sexuality, and self-esteem.

Self-concept

What does a child learn in this stage of development? (industry vs inferiority)

Skills needed to function in society

What happens during the school age years?

Slow, steady physical growth, rapid cognitive and social development

How is safety education best accomplished for school age children?

Stating and providing reinforcement through projects and immediate rewards

Nutrition of the school age child

Teach child how to keep track of servings and to give input on meal prep, avoid fast food, eat healthy breakfast, monitor calcium and iron intake, Vitamin D supplementation, Overweight / obesity, increase intake of fruits / vegetables / calcium . who grains, decrease saturated fats / sugars / sodium

__________ serve as role models with whom children identify and whom they try to emulate

Teachers

Define the term classification

The ability to group and sort objects according to the attributes they share, place things in a sensible and logical order, and hold a concept in mind while making decisions based on that concept

School age children look more ____________ than preschool children?

Thin

What teeth do not erupt during school age years?

Third molars

Fine motor development for the school ager

Ties shoe laces, buttons and zips clothes, dresses / undresses without help, can print / draw / color well, model clay cut with scissors, visual acuity fully developed

T/F: An important component of ongoing sex education is effective communication with parents

True

T/F: Children with physical or mental limitations may be at a disadvantage for skill acquisition and are therefore at risk of feeling inferior

True

T/F: School nurses are vital to the development, implementation, and evaluation of health care plans for chronically ill or disabled children

True

T/F: The appearance of permanent teeth in the school-age child begins with the eruption of the 6-month molar

True

T/F: The most significant and valuable tool acquired during school-age years is the ability to read

True

T/F: school-age children are not prepared to abandon all parental control

True

What is the leading cause of death in children older than 1 year?

Unintentional injury

Health Promotions for School aged children

Visit health care provider at least every 2 years for screening

Are visits from the tooth fairy an important part of growing up?

Yes

What is self-concept?

a conscious awareness of a variety of self-perceptions

The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years. Which statement made by a participant, indicates the correct understanding of the teaching?

a. "My body weight will be almost triple in the next few years." b. "I will grow an average of 2 inches per year from this point on." c. "There are not that many physical differences among school-age children." d. "I will have a gradual increase in fat, which may contribute to a heavier appearance." ANS: B In middle childhood, growth in height and weight occurs at a slower pace. Between the ages of 6 and 12 years, children grow 2 inches per year. In middle childhood, children's weight will almost double; they gain 3 kg/year. At the end of middle childhood, girls grow taller and gain more weight than boys. Children take on a slimmer look with longer legs in middle childhood.

What happens to body image as a child ages?

children like physical selves less as they grow older

Play and the school age child

complicated board games, card games, crafts, electronic / science games, encourage reading, limit TV (no more than 2 hrs / day), Planned moderate to vigorous physical activity for 1 hour / day

What is the stage of cognitive development in a school-aged child?

concrete operations uses though processes to experience events and actions able to make judgments based on reason

How are lice transmitted?

direct contact with infested objects (they can not jump)

When does "school-age" physiologically end?

ends at puberty with acquisition of final permanent teeth

When might inferiority occur in a school-aged child?

incapable or unprepared to assume the responsibilities associated with developng a sense of accomplishment

What is the psychosocial stage of school-aged children?

industry vs inferiority

When is the ideal time for sex education?

middle school

What are some characteristics of relationships with families of school-aged children?

parents are primary influence in personality, behavior, value system increasing independence from parents children not ready to abandon parental control yet

What are some social development characteristics of school-aged children?

peer group identification with peers promotes independence sex roles strongly influenced by peer relationships

What does play mostly involve in a school-aged child?

physical skill, intellectual ability, fantasy sports, clubs, teams

When does "school-age" physiologically begin?

shedding of the first deciduous teeth

Lice infestation can lead to what?

subsequent secondary skin infections

Language / cognitive development for the school ager

vocabulary expands (properties of language / play on words / puns / mnemonics / jokes / adapts well to changing physical properties of objects), long term memory improves, organizes concepts / classifies several ways, uses various memory strategies for improvement in school, learns to tell time