Unit 14 - School aged child

School-based interventions to promote nutrition education

(school nurse should have an active role in advocating for and implementing these) -have children collect pictures of healthy foods and make a poster for display in the cafeteria -make healthy foods available in vending machines and at sporting events -discourage use of high-fat foods like candy bars as part of school fundraising projects -avoid use of food as rewards for behavior -have teachers and school personnel model healthy eating habits -ask children to select foods from a fast-food menu and to ID foods high in fat, cholesterol, and sodium -ask each child to keep a diary to identify food cues for their eating behavior (stress, hunger, other people, social situations) -ask children to keep a diary of foods eaten in 1 day, and to use MyPlate to evaluate their choices -incorporate nutrition education into other classes -ask children to examine media to identify social influences on eating and physical activities -use role play to help students learn to cope with social/peer pressure to eat specific foods -have students ID environmental barriers to healthy eating -have students prepare nutritious foods, plan menus, and develop a recipe book of healthy foods -involve parents in nutrition education through homework assignments or by inviting them to attend student-led nutrition fairs

Risk taking behavior

-achieving social acceptance is primary objective for school-age children -often attempt dangerous acts or extreme behaviors to prove themselves worthy of acceptance or improve their status in a peer group -in process of moving from proportional to concrete operational thinking so can only begin to understand causal relationships, so may attempt risky activities without planning or evaluating the consequences -risk takers may have inadequate self-regulatory behavior and need to learn the motivation or incentives for such behavior and to visualize possible consequences if the behavior doesn't end well

Sleep resistance

-bedtime resistance can be due to a variety of things- fears or frightening dreams, unwillingness to give up a fun activity, or reluctance to leave the family social circle to go to bed. -when going to bed is used as a punishment or staying up late is a reward, children can view bedtime as punitive or status degrading -constant reassurance and limit setting resolves "multiple curtain calls" (getting up several times in the night for a drink of water, wanting to hear one more story, go to the bathroom, etc) -in school-age children, nighttime sleep is usually continuous, and children have developed tactics to help with occasional difficulties falling asleep (reading or playing quietly)

Sports- before puberty

-before puberty, girls and boys have basically the same structure and response to systematic exercise so fine for them to compete against each other, but after puberty when boys become stronger and larger, girls should only compete against girls and boys against boys

Sports- issues with

-controversial, but current view is that virtually every child is suited for some type of sport based on their abilities and physical and emotional constitutions -coaches should be skillful in managing children and not engage in abusive behavior -pressuring children to perform beyond their capabilities risks injury, developing a dislike for the activity, and a lowered self-image

Physical activity

-development of physical fitness is a goal for all children -essential for muscle development and tone, refinement of balance and coordination, gaining of strength and endurance, and stimulation of body functions and metabolic processes -parents should expect and encourage increased physical activity in school years -most children need little encouragement to engage in physical activities due to having so much energy -TV watching should be limited to encourage physical activities in children who may resist it more

Dental health

-first permanent (secondary) teeth come around age 6 starting with molars -pattern of losing baby teeth and eruption of secondary teeth can vary widely -good dental hygiene and regular attention to dental caries are vital parts of health supervision -60% of kids have cavities by age 5 -children tend to be careless about dental hygiene unless supervised -thoroughness of cleaning is more important than the technique used -flossing should follow brushing but kids can't usually do it themselves until about 8-9 yrs old

Bicycle injury

-many injuries related to violations of traffic laws by wrong-way riding (facing traffic), failure to yield right of way, and turning violations -other injuries related to hazards like bumps, potholes, and gravel -many injuries are due to school-age child's developmentally limited range of vision and inability to process situations quickly enough to safely ride in traffic -bicycles should be the right size, not something they can "grow into"

Motor vehicle injury

-most common cause of accidental injury and death in school-age children. -use of restraint systems, door-lock mechanisms, and appropriate passenger seating are simple but effective measures to help eliminate non crash injuries and reduce the severity of crash injuries

Nightmares

-nightmares are normal part of developmental process -repetitive or increased nightmares may indicate an underlying conflict or stressor -resolving worries or stress can often abate nightmares

Nutrition issues

-school-age children develop an eating style that is increasingly independent from parental influence/scrutiny -quality of their diet still depends largely on their family's pattern of eating -other interests and activities may compete with mealtime -easy for children to fill up on empty calories due to media influence and temptation of junk food -childhood obesity a common problem- 17% prevalence but higher among families in rural areas and in socioeconomic stress -low-cost or free meals available to children at school or after school programs (federal government established these, they must meet specific nutritional requirements and furnish 1/3 of daily recommended dietary allowance) These lunches often EXCEED recommended dietary guidelines for fat and saturated fat though, and children have the option of choosing only the items they want.

Sports- school-age appropriate

-school-aged children enjoy competition, but a safe and appropriate sport can be found for even an unskilled and uncompetitive child -sports activities should include practice sessions and unstructured play -actual game or event should stress mastery and enjoyment of the sport and enhancement of self-image rather than winning or pleasing others -all children should have equal opportunity to participate and ceremonies should recognize all participants rather than individuals

Sleep walking/talking

-sleepwalking and sleep talking may replace the preschool night terrors- best approach is to leave them alone unless they are in danger; gently redirect them back to bed without waking them, or wake them gently/softly and orient them to where they are, explain they were sleepwalking.

Bicycle helmets

-wearing a helmet is the single most important aspect of bicycle safety- 45% reduction in head injury, 33% reduction in brain injury, 27% reduction in facial injury, and 29% reduction for fatal injury -helmets should be hard-shelled with expanded polystyrene liner and should be adjusted to child's head, fit securely, and not interfere with vision or hearing.

Purposes of discipline:

1) To help the child interrupt or inhibit a forbidden action. 2) To point out a more acceptable form of behavior so that the child knows what is right in future settings. 3) To provide some reason, understandable to the child, that explains why one action is inappropriate and another action is more desirable. 4) To stimulate the child's ability to empathize with the victim of a misdeed.

Team play:

A more complex form of group play that develops from the need for peer interaction involves team games and sports. These contribute to children's social, intellectual and skill growth. Children learn to subordinate personal goals to group goals. Children learn that division of labor is an effective strategy for the attainment of a goal. It helps them learn about the nature of competition.

Play: Quiet games and activities

Although the play of school aged children can be highly active, they also enjoy many quiet and solitary activities. They become fascinated with complex board, computer, and video games - children play these alone or in groups. As in all games, the adherence to rules is fanatic.

School-Role of the teacher:

As a parental surrogate, teachers in the early grades perform many of the activities formerly assumed by parents, such as recognizing a child's personal needs, and helping develop their social behavior. Teachers share the parental influence in shaping a child's attitudes and values - they serve as models. Children's interest in school and learning, and much of their social interaction and self-concept are related to interactions with the teacher. Teacher sets the emotional tone of the classroom (good or bad)

Play:

As children enter the school years, their play takes on new dimensions that reflect a new state of development. Not only does play involve increased physical skill, intellectual ability, and fantasy but as children form groups or cliques, they begin to evolve a sense of belonging to a team or club. Belonging to a group is of vital importance.

Sex education:

Because parents can often repress or avoid their children's sexual curiosity, sexual info received in childhood is often acquired almost entirely by peers, and may contain considerable misinformation. Although middle childhood is an ideal time for formal sex education, this subject has created considerable controversy. Sex education programs have been successfully incorporated into a number of elementary school curricula. In many of these programs, sexuality is presented in the context of its central role as a biological mechanism for survival of the culture. Many programs also emphasize that sexual intimacy is part of a close, personal relationship and a means of conveying love, as well as means for ensuring the survival of the species.

(NCLEX) In terms of social development, the school-age child does which of the following?

Begins to explore the environment beyond the family, may actively participate in same-sex groups or clubs, and begins to form strong relationships with persons of the same gender.

Anticipatory socialization:

By the time they enter school, most children have a fairly realistic concept of what school involves. They receive information regarding the role of pupil from parents, playmates, and the media. In addition, most children have had experience with day care, preschool or kindergarten. Children's attitudes toward school and their adjustment are strongly influenced by their parents' attitudes.

Self-esteem:

Children's picture of their individual worth and consists of both positive and negative qualities. Children who have mastered the maturational crises of autonomy and initiative are able to face the world with feeling of pride rather than shame. Children depend almost entirely on external evidence of worth, such as grades, teacher comments, and parental and peer approval. Parents can help build self-esteem by being honest, by providing opportunities for creativity, by helping them succeed in activities, and by providing positive reinforcement. Nurses can help by fostering supportive relationships between the children and members of their families, and by emphasizing children's strengths and positive aspects of their behavior.

(NCLEX) A school nurse in middle school (grades 6-8) is preparing an outline for a sex education class. Which of these statements represent important concepts to be covered in discussing this topic with this age group?

Consider separating the boys and girls into same-sex groups with a leader of the same sex, answer questions matter-of-factly and honestly and appropriate to the children's level of understanding, discuss common myths and misconceptions associated with sex and reproduction.

Dishonest behavior:

During middle childhood, children engage in what is considered to be antisocial behavior. Lying, stealing and cheating may become manifest in previously well-behaved children. In many cases, this behavior is a natural part of growth, and will subside if dealt with in a proper manner, and if the behavior isn't being modeled by a parent.

Development of sexuality:

Evidence indicates that many children experience some form of sex play during or before preadolescence as a response to normal curiosity, not as a result of love or sexual urge. Adverse emotional consequences or guilt feelings depend on how the parents manage the behavior and whether children view their actions as wrong in the eyes of significant persons, particularly their parents.

School relationships and cooperation:

First, children learn to appreciate the numerous and varied points of view that are represented in the peer group. As children interact with peers who see the world in ways that are different from their own, they become aware of the limits of their own point of view. Second, children become increasingly sensitive to the social norms and pressure of their peer group. The peer group establishes standards for acceptance and rejection, and children may be willing to modify their behavior to be accepted by the group. Third, the interaction among peers leads to the formation of intimate friendships between same-sex peers. School-age is when children have "best friends" with whom they share secrets, private jokes and adventures; they come to one another's aid in times of trouble.

Identity, Reversibility, Reciprocity:

Identity: Because nothing has been added and nothing has been taken away, the pancake is still the same clay. Nothing has changed but the shape. Reversibility: The clay can be shaped into its original form. Reciprocity: Although the pancake appears larger in circumference, the ball is much thicker. In this instance the child demonstrates the ability to deal with two dimensions at once.

Erikson's stage?

Industry vs. Inferiority Lasting outcome: Competence and social engagement Important event: School Summary: The child must deal with demands to learn new skills or risk a sense of inferiority, failure and incompetence.

Conservation:

One of the major cognitive tasks if school-aged children is mastering the concept of conservation - that physical matter does not appear or disappear by magic.

Clubs and peer groups:

One of the outstanding characteristics of middle childhood is the formation of formalized groups or clubs. Conformity is the core of the group structure, with rigid rules imposed on the members. Membership in the group provides the children with a comfortable place in society. Children's strong desire to be different creates problems for those who are, for various reasons, unable to meet the accepted standards of the peer group (i.e. disabilities, physical defects, lack of money).

Relationships with families:

Parents are primary influences on shaping children's personalities, setting standards for behavior, and establishing value systems. Children need and want restrictions placed on their behavior; they are not prepared to cope with all of the problems of their expanding environment. Children need their parents to be adults, not pals. Children's relationship with siblings change - children view siblings as equal power and status.

School-Role of the parent:

Parents share responsibility with the schools for helping children achieve their maximum potential. Parents can supplement the school program in numerous ways. Cultivating responsibility is the goal of parental assistance. Being responsible for schoolwork helps children learn to keep promises, meet deadlines, and succeed at their jobs as adults. Responsible children may occasionally ask for help, but usually they like to work by themselves. Excessive pressure or lack of encouragement from parents may inhibit the development of these desirable traits.

School-age children are prone to accidental injury primarily because of:

Peer pressure and risk-taking behaviors.

Latency period:

Period of psychosexual development that Freud described - a time of tranquility between the oedipal phase of early childhood and the eroticism of adolescence. During this period children experience relationships with same-sex peers following the indifference of earlier years and preceding the heterosexual fascination that occurs for most boys and girls in puberty.

Play: Ego Mastery

Play also affords children the means to acquire representational mastery over themselves, their environment, and other persons. Through play, children can feel as big, as powerful, and as skillful as their imaginations will allow, and they can attain vicarious mastery and power over whomever and whatever they choose.

Bullying:

Poor relationships with peers and a lack of group identification can also contribute to bullying behavior. Bullying is infliction of repetitive physical, verbal or emotional abuse by one or more individuals to harm or bother another individual in order to establish power over someone who is perceived as being less physically or psychologically dominant than the aggressor(s). Appx 25% of elementary school students engage in bullying or cyberbullying as the bully or the victim.

Development of self-concept:

Refers to conscious awareness of a variety of self perceptions, such as one's physical characteristics, abilities, values, and self-ideals, and one's idea of self in relation to others.

School experience:

School serves as an agent for transmitting societal values to each succeeding generation of children and as a setting for many peer relationships. As a socializing agent, school exerts a profound influence on the social development of children.

Sense of industry:

Sense of industry, or stage of accomplishment, occurs somewhere between age 6 years and adolescence. The goal of this state of development is to achieve a sense of personal and interpersonal competence through the acquisition of technological and social skills. Failure to develop a sense of accomplishment may result in a sense of inferiority.

Fears (coping with stress):

Several anxiety symptoms, including fear of the dark, excessive worry about past behavior, self-consciousness, social withdrawal, and an excessive need for reassurance, are considered normal developmental events for children. Parents and other persons involved with children should discuss children's fears with them individually or through group activities. Their viewpoints must be respected, and their need to communicate their concerns should be recognized.

Play: Rules and Rituals

The need for conformity in the middle childhood is strongly manifested in the actives and games so important in the life of school age children. They begin to see the need for rules, and the games they play have fixed and unvarying rules that may be bizarre and extraordinarily rigid. Part of the enjoyment of the game is knowing the rules, because knowing means belonging.

Stress: Nursing Alert

The nurse who observes the following signs of stress in a child should explore the situation further: -Stomach pains of ache -Sleep problems -Bed-wetting -Change in eating habits -Aggressive or stubborn behavior -Reluctance to participate -Regression to earlier behaviors (e.g. thumb sucking)

(NCLEX) Characteristics of bullying include:

The infliction of repetitive physical, verbal, or emotional abuse upon another person with the intent to harm.

(NCLEX) A hallmark of cognitive development in the school-age child is in what Piaget describes as concrete operations. In this stage the child:

Uses thought processes to experience events and actions.

Latchkey children (coping with stress):

The term refers to children in elementary schools who are left to care for themselves before or after school without supervision of an adult. This can be a stress-provoking situation for many school-aged children. Leaving children unattended can lead to injury or delinquent behavior, and can cause children to feel lonely, isolated and fearful.

Body image:

What children think about their body. Children are aware of their bodies, the bodies of their peers, and those of adults. It is important that children know about body functions and that adults correct any misinformation children have about the body (e.g., what is fat). Children model themselves after their parents, and compare themselves to favored peers and images observed in the media. Children are aware of physical differences, and it is not unusual for them to think that their own bodies are in some way defective. Children need to be reassured about the uniqueness and sameness of their bodies. When children are criticized or teased about being different, that effect can last until adulthood.

Nurse's role in sex education:

When nurses present sexual information to children they should treat sex as a normal part of growth and development. Nurses should answer questions honestly, and matter-of-factly, and at the children's level of understanding. School aged children may be more comfortable when boys and girls are segregated for discussions; however, each group needs information about both sexes.

Cognitive development (Piaget):

When they enter the schools years, children begin to acquire the ability to relate a series of event and actions to mental representations that they can express both verbally and symbolically. This is the state that Piaget describes as concrete operations, when children are able to use their thought process to experience events and actions. Children become aware of a variety of perspectives and become more sensitive to that fact that others do not always perceive events as exactly as they do.