Prepu: Chapter 6: Growth and Development of the School-age Child
A parent calls the health care provider about the 7-year-old child's dental hygiene. The child has had three cavities. The parent does not know what to do and asks the nurse for guidance. How should the nurse respond? "Did you teach your child how to brush the teeth?" "Are you able to supervise your child's brushing?" "What type of toothbrush does your child use?" "Is there fluoride toothpaste available for use?"
"Are you able to supervise your child's brushing?" Explanation: Dental caries is the leading chronic disease in the United States. Children need help with toothbrushing until they are between 7 and 10 years of age. The parent should monitor the toothbrushing to make sure it is thorough, observe for any abnormal tooth alignment, and schedule cleanings every 6 months. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those teeth are brushed carefully. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Pedestrian Safety, p. 154. Chapter 6: Growth and Development of the School-age Child - Page 154
The nurse is presenting information about school-aged children at a community event. Which statement from the group should the nurse prioritize to address with further teaching and more information? "I make sure they have good teeth by giving them calcium and phosphorus." "Sometimes we have to be firm, but our children wash their hands before eating." "Even if the weather is cool and cloudy, our children play outside every day." "Food is so expensive, we always make our children eat everything on their plates."
"Food is so expensive, we always make our children eat everything on their plates." Explanation: Obesity can be an issue in the school-aged child, especially if they are urged to clean their plates even if they have more food than they want or need on the plate. The parents should be encouraged to use smaller plates for the children so they will still appear to have a full plate but smaller portions. Firm guidance and direction is important with the school-aged child. Calcium and phosphorus are important to healthy teeth. Exercise each day is important, especially outdoor exercise. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, TEACHING GUIDELINES 6.1 Safety Issues and Interventions of the School-Age Child, p. 155. Chapter 6: Growth and Development of the School-age Child - Page 155
During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress? "Does your son speak in complete sentences all the time?" "Would you say your son has a vocabulary of about 900 words?" "How well does your son communicate or follow instructions?" "Is your son's speech clear enough that anyone can understand it?"
"How well does your son communicate or follow instructions?" Explanation: Asking how well the boy communicates and follows instructions is the best trigger question because it is open-ended. Asking if the child uses complete sentences or speaks clearly will elicit a yes or no answer about only those specific areas of development. The parents would have no way of judging the size of their child's vocabulary. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Promoting Growth and Development through Play, p. 153. Chapter 6: Growth and Development of the School-age Child - Page 153
The nurse is teaching a group of school-age children about physical development. Which statement made by one of the children indicates the correct understanding of the teaching? "I will have improved gross motor skills." "I will appear heavier due to an increase in fat production." "I will grow an average of 2.5 in (6.5 cm) per year." "There are not many physical differences among school age boys."
"I will grow an average of 2.5 in (6.5 cm) per year." Explanation: During the school-age years, the child will grow an average of 2.5 in (6.5 cm). As puberty approaches, there will be significant differences in development between boys and girls. As development occurs, weight does increase, but it is not directly related to fat production. This is an area where much education needs to occur with young girls because "dieting" can be detrimental to the child's health and increased size is tied to the child's body image and self-esteem. By 10 years of age, brain growth is complete, and fine motor coordination is refined. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, INTRODUCTION, p. 144. Chapter 6: Growth and Development of the School-age Child - Page 144
The nurse is educating a group of parents about childhood nutrition, specifically caloric needs. Which statement, when made by a parent, indicates teaching was successful? "My 12-year-old child, who plays soccer, needs to consume no more than 2,000 calories a day to maintain good health." "We will make sure that our 11-year-old child consumes at least 900 calories, primarily through protein sources." "I will assure that at least 75% of calories for my 10-year-old child's diet come from simple carbohydrate sources." "It is convenient that my 8-year-old and 12-year-old children both need to consume the same amount of calories."
"My 12-year-old child, who plays soccer, needs to consume no more than 2,000 calories a day to maintain good health." Explanation: Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories per day. Boys 9 to 13 years old who are moderately active need about 1,800 to 2,000 calories a day and girls 9 to 13 years old who are moderately active need about 1,600 to 2,000 calories a day. Approximately 45% to 65% of calories should come from carbohydrates. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Promoting Nutrition, p. 157. Chapter 6: Growth and Development of the School-age Child - Page 157
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? "I want you to give your child choices about the food eaten." "You need to make sure your child has input regarding the food eaten." "Now is the time to let your child choose some of the meals." "You must let your child make some choices for oneself."
"Now is the time to let your child choose some of the meals." Explanation: 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. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Nursing Process, p. 151. Chapter 6: Growth and Development of the School-age Child - Page 151
An overly tired school-aged child enters the school clinic. The nurse asks the child to state the times he/she usually goes to bed at night and wakes up in the morning. The child answers 11:00 PM and 6:00 AM. Which is the best response made by the nurse? "That should be enough sleep. Let's talk about your eating habits." "That is not enough sleep. You should get at least 9 to 12 hours of sleep each night." "Why do you go to bed so late at night?" "Do your parents always let you stay up so late at night?"
"That is not enough sleep. You should get at least 9 to 12 hours of sleep each night." Explanation: The school-aged child needs 9 to 12 hours of sleep per night. Seven hours of sleep is not enough sleep for this child. It is not appropriate to ask judgmental questions concerning parenting skills nor why the child goes to bed at 11:00 PM. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Promoting Healthy Sleep and Rest, p. 159. Chapter 6: Growth and Development of the School-age Child - Page 159
The parents of a 9-year-old child voice concern that the child seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased weight by 6 or 7 lb (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated? "Your child does seem to be rapidly gaining weight." "On the contrary, your child's annual weight gain is somewhat low for this age." "Children in this age range on average gain about 5 lb (2.3 kg) per year." "Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range."
"Weight gains of about 7 lb (3.2 kg) per year are normal for children in this age range." Explanation: Children who are between the ages of 6 and 12 years usually gain about 7 lb (3.2 kg) per year. The child in the scenario is gaining weight at a normal rate. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Abuse in Children, p. 157. Chapter 6: Growth and Development of the School-age Child - Page 157
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? "We should ask the health care provider to run some tests; with that much sleep, the child should not be tired." "Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." "Your child should be getting 8 to 9 hours of sleep per night." "Your child should be getting at least 9 hours of sleep per night."
"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." Explanation: 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. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Promoting Healthy Sleep and Rest, p. 159. Chapter 6: Growth and Development of the School-age Child - Page 159
The nurse is caring for a 11-year-old girl who has been identified as weighing 10% more than recommended for her age and height. When developing the plan of care, which intervention is of the highest initial priority? Review the BMI for other children in the family for familial tendencies. Discuss keeping a food journal with the child and parents. Assess readiness to learn in the child and parents. Assess the child's activity level for the past week.
Assess readiness to learn in the child and parents. Explanation: When a plan of care is initiated cooperation and understanding of the participants is key. It is most important that the nurse determine readiness to learn of the parents and child. The other interventions are appropriate for inclusion but are not of the highest priority. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Latchkey Children, p. 163. Chapter 6: Growth and Development of the School-age Child - Page 163
An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health? Have the child's teeth professionally cleaned every 3 months. Encourage the child to abstain from eating sugary snacks at school. Accept that the child is genetically predisposed to having more cavities than most children. Ensure that the child brushes his teeth after each meal and snacks.
Ensure that the child brushes his teeth after each meal and snacks. Explanation: Proper dental hygiene includes a routine inspection and conscientious brushing after meals. A well-balanced diet with plenty of calcium and phosphorus and minimal sugar is important to healthy teeth. Foods containing sugar should be eaten only at mealtimes and should be followed immediately by proper brushing. The school-aged child should visit the dentist at least twice a year for a cleaning and application of fluoride. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Gastrointestinal System, p. 145. Chapter 6: Growth and Development of the School-age Child - Page 145
A 9-year-old boy has arrived for a health maintenance visit. Which milestone of physical growth should the nurse expect to observe? All deciduous teeth are replaced by 32 permanent teeth. Brain growth is complete and the shape of the head is longer. Frontal sinuses are developed while tonsils have decreased in size. Lymphatic tissue growth is complete, providing greater resistance to infections.
Lymphatic tissue growth is complete, providing greater resistance to infections. Explanation: Lymphatic tissue growth is complete by age 9, better helping to localize infections and produce antibody-antigen responses. Brain growth will be complete by age 10. Frontal sinuses are developed at age 7. Third molars do not erupt until the teen years. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Immune System, p. 145. Chapter 6: Growth and Development of the School-age Child - Page 145
A nurse is caring for a hospitalized 10-year-old child. What would be an appropriate activity for this child to meet the developmental tasks of this age group? Participating in a craft project Writing letters to friends Playing with a jack-in-the-box Playing with blocks
Participating in a craft project Explanation: During this stage, the child is interested in how things are made and run. The child learns to manipulate concrete objects. The child likes engaging in meaningful projects and seeing them through to completion. Playing jack-in-the-box and blocks are for much younger children. If anything, the child would be texting back and forth with friends, not writing a letter. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Fine Motor Skills, p. 148. Chapter 6: Growth and Development of the School-age Child - Page 148
On physical examination, the nurse discovers that a 6-year-old child's palatine tonsils are somewhat enlarged in the back of the throat. What would be the nurse's best action? Record this as a normal finding in an early school-age child. Suggest the health care provider examine the child for breathing difficulty. Give the child something for pain. Take the child's temperature; this must be tonsillitis.
Record this as a normal finding in an early school-age child. Explanation: Lymphoid tissue reaches maximum growth in early school-aged children. The tonsils may decrease in size somewhat from the preschool years but they remain larger than those of adolescents. The tonsils and adenoids may appear larger than normal even in the absence of infection. The nurse would be correct to document this as a normal finding. The child would not need pain medication nor an examination for respiratory problems if this a normal finding. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Respiratory System, p. 145. Chapter 6: Growth and Development of the School-age Child - Page 145
The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely? The child has a leaner body mass than a girl at this age. The child's body fat has decreased since last year. The child has different diet preferences than his parents. The child described a somewhat reduced appetite.
The child has a leaner body mass than a girl at this age. Explanation: The nurse would have found that the child still has a leaner body mass than girls at this age. Both boys and girls increase body fat at this age. Food preferences will be highly influenced by those of her parents. Although caloric intake may diminish, appetite will increase. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, INTRODUCTION, p. 144. Chapter 6: Growth and Development of the School-age Child - Page 144
The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely? The child's body fat has decreased since last year. The child has different diet preferences than his parents. The child described a somewhat reduced appetite. The child has a leaner body mass than a girl at this age.
The child has a leaner body mass than a girl at this age. Explanation: The nurse would have found that the child still has a leaner body mass than girls at this age. Both boys and girls increase body fat at this age. Food preferences will be highly influenced by those of her parents. Although caloric intake may diminish, appetite will increase. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, INTRODUCTION, p. 144. Chapter 6: Growth and Development of the School-age Child - Page 144
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 time to establish relationships with the opposite sex time to remain dependent on their parents an opportunity for children to become self sufficient
a sense of security as children gain independence Explanation: 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. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Peer Relationships, p. 150. Chapter 6: Growth and Development of the School-age Child - Page 150
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? an opportunity for children to become self sufficient time to establish relationships with the opposite sex time to remain dependent on their parents a sense of security as children gain independence
a sense of security as children gain independence Explanation: 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. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Peer Relationships, p. 150. Chapter 6: Growth and Development of the School-age Child - Page 150
The family who are vegetarian voice concern that their child is not growing well. The nurse should suggest which food to increase the calcium intake for adequate bone growth? quinoa oatmeal kale sweet potato
kale Explanation: The consumption of adequate protein and calcium is important for muscle, bone, and dental development. Foods highest in calcium are green leafy vegetables, enriched breads, and cereals. Soybeans, legumes, grains, and immature seeds are high in protein. Oatmeal and quinoa are both high in protein. Sweet potatoes are high in fiber, vitamin A, and potassium. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 6: Growth and Development of the School-age Child, Nutritional Needs, p. 158. Chapter 6: Growth and Development of the School-age Child - Page 158