Ch. 32

working with others

School-age children are sometimes so interested in tasks and in accomplishing physical projects that they forget they must work with people to achieve these goals. A good time to urge children to learn compassion and thoughtfulness toward others is during the early school years, when children are first exposed to large groups of other youngsters.

age 8 play

The movements of 8-year-olds are more graceful than those of younger children, although, as their arms and legs grow, they may appear awkward in their play and eating habits. They ride a bicycle well and enjoy sports such as gymnastics, soccer, and hockey.

how to help phobia

A particular child may be reacting to a situation such as a harsh teacher, having to shower in gym class, or facing a class bully every day. In these instances, counseling may help the child manage the situation better. School refusal may also occur if the child is overly dependent on the parents or may be reluctant to leave home because of worry that younger siblings will usurp the parents' affection. The anxiety of separation may also result because the parent is overprotective of the child or is the one having the most difficulty separating.

school aged

6-12 years Although these years represent a time of slow physical growth, the school-age child's cognitive growth and development continue to proceed at rapid rates. There are many differences among children at each year of this age group

age 7 play

A 7-year-old child appears quiet compared with the more active 6-year-old. Gender differences usually begin to manifest themselves in play: where girls may gravitate to more traditional female roles and activities and boys may gravitate to more traditional male roles and activities.

child of alcoholic

A feeling of guilt that they are the cause of the parent's drinking Constant worry that the alcoholic parent will become sick or die, leaving the child alone; at the same time, the child may fear the alcoholic parent and wish the parent would leave A feeling of shame that prevents the child from inviting friends home or asking for help Decreased ability to trust adults because the parent has been unreliable so many times Poor nutrition and decreasing grades in school because the alcoholic parent's behavior is so erratic that no regular schedule of bedtime or meals exists Anger at the alcoholic parent for drinking and at the nonalcoholic parent for not doing more to correct things Helplessness to change the situation

bullying

A frequent reason school-age children cite for feeling so unhappy that they turn guns on classmates or commit suicide is because they were ridiculed or bullied to the point they could no longer take such abuse

irregularity

A girl may fear that irregular periods indicate a hormone imbalance. She may worry about her future ability to conceive, or she may be ill informed about how conception occurs and may fear irregularity of her periods means that she is pregnant. Both malnourishment and obesity possibly influence menstrual regularity. Emotions can also affect consistent cycles. If irregularity continues beyond the first year, a careful history of the girl's nutrition; overall health; and school, social, and home adjustment should be taken.

breast development

A girl who develops ahead of her peers may tend to slouch or wear loose clothing to hide the size of her breasts. Another girl studies herself in a mirror and wonders whether her breasts are going to develop enough. Breast development is not always symmetrical, so it is not unusual for a girl to have breasts of slightly different sizes. Supernumerary (additional) nipples may darken or increase in size at puberty. Be sure girls understand that a supernumerary nipple is affected by the hormones in her body in the same way as other breast tissue, so she isn't concerned by the accessory nipple enlarging with puberty or in a future pregnancy.

independence

A major concern of children staying home alone is that they will experience an increased number of unintentional injuries, delinquent behavior, alcohol or substance abuse, or decreased school performance from a lack of adult supervision.

assessment

History and physical examination are used to assess growth and development of school-age children. History questions include school progress and extracurricular activities. School-age children are interested and able to contribute to their own health history. The school-age child may be interviewed with his or her parent and separately depending on the circumstances. provide privacy

friends

Children 8 or 9 years of age begin to spend more and more time with their peers and less time with their family. They forget to do household chores they once enjoyed, such as setting the table or mowing the lawn, or they may do the work sloppily so they have more time to spend with their friends. Although this may seem like a regression in behavior, it is actually a step of independence away from the parents and into the larger world, a developmental step toward helping them become emotionally mature.

In talking to parents of school-age children, good questions to ask to estimate the degree of interaction that occurs in the home and whether parents are strengthening a child's sense of accomplishment include:

How do they correct the child when he or she does something wrong? Do they display school projects? Does the child have chores that are his or hers to accomplish? Do they ask the child to participate in family decision making?

school

Adjusting to and achieving in school are two of the major tasks for this age group. Ideally, a child's teacher will think of learning as fun and will encourage a child to plunge into new experiences. Schools are increasingly assuming responsibility for education about sex, safety, avoidance of substances of abuse, and preparation for family living. These discussions are generally superficial, however, and, if the classes are large, may raise more questions than they answer. Although learning these skills with peers helps children learn other people's opinions in these areas, such classes should not replace parental teaching.

hygiene

Children 6 or 7 years of age still need help in regulating bath water temperature and in cleaning their ears and fingernails. By age 8 years, children are generally capable of bathing themselves but may not do it well because they are too busy to take the time or because they do not find bathing as important as do their parents.

Traits commonly associated with school-age bullies include:

Advanced physical size and strength for their age Aggressive temperament (both male and female) Parents who are indifferent to the problem or are permissive with an aggressive child Parents who typically resort to physical punishment There is the presence of a child who is a "natural victim" (e.g., small, insecure, with low self-esteem).

problem solving

An important part of developing a sense of industry is learning how to solve problems. Parents and teachers can help children develop this skill by encouraging practice. When a child asks, "Is this the right way to do this?" a parent can encourage problem solving by saying, "Let's talk about possible ways of doing it" rather than offering a quick solution.

preventing caries

As stated earlier, dental caries are largely preventable with proper brushing and use of fluoridated water or fluoride application. When caries do occur, it's important they be treated quickly and the child's dental hygiene practices be evaluated and improved if necessary. every 6 months dentist visit

violence and terrorism Common recommendations for parents to help children feel safe when they hear of these instances include:

Assure children they are safe; even if the violence is in their community, their parents are actively involved in being certain they are not in danger. Observe for signs of stress such as sleep disturbances, fatigue, lack of pleasure in activities, or signs of beginning substance abuse. Do not allow children or adolescents to view footage of traumatic events over and over because this decreases their ability to feel safe. Watch news programs with children so it can be explained that the situation portrayed is not near them and that their child is safe. Explain that there are bad people in the world, and bad people do bad things, but not all people in a particular group or who look a particular way are bad. Lashing out at people who resemble them only causes more harm. Prepare a family disaster plan, including such things as bottled water, blankets, toiletries, pet supplies, appropriate clothing, flashlights, and information such as what immunizations their children have had (particularly tetanus) and, if a child is ill, a history of medical needs or care so that such items are ready in an emergency. Designate a "rally point" where the family will meet if ever separated by a disaster or evacuation

age 11 play

At 11 years of age, many children feel awkward because of their growth spurt and drop out of sports activities rather than look ungainly attempting them. They may channel their energy into constant motion instead: drumming fingers and tapping pencils or feet. This fall in sports participation may bother parents who see sports as the key to popularity, self-esteem, fitness, and teamwork.

sexual maturation

At a set point in brain maturity, the hypothalamus transmits an enzyme to the anterior pituitary gland to begin production of gonadotropic hormones, which then activate changes in the testes and ovaries to cause puberty.

age 6 play

At the beginning of the school-age period (age 6 years), children endlessly jump, tumble, skip, and hop. They have enough coordination to walk a straight line, many can ride a bicycle, and they learn to skip rope with practice.

age 9 language

Because children discover "dirty" jokes at about age 9 years, they like to tell them to friends or try to understand those told by adults. They use swear words to express anger or just to show other children that they are growing up. They may have a short period of intense fascination with "bathroom language," as they did during the preschool years. As before, if parents want to discourage this, it should be made clear that they find such language unacceptable, and they refrain from using it themselves in their child's presence.

homeschooling

Because of religious or personal preference or because of disillusionment with the school system, a growing number of children are homeschooled today assess if children have peer experiences, perhaps through participation in community sports teams or clubs. Ask if they receive exposure to other cultures or families, so they can better adjust to people different from themselves later on at college or at a jo

12-13

Boys Pubic hair present across pubis. Penis lengthens. Dramatic linear growth spurt. Breast enlargement may occur. Girls Pubic hair grows darker; spreads over entire pubis. Breasts enlarge, still no protrusion of nipples. Axillary hair present. Menarche occurs.

11-12

Boys Sparse growth of straight, downy, slightly pigmented hair at base of penis. Scrotum becomes textured; growth of penis and testes begins. Sebaceous gland secretion increases. Perspiration increases. Girls Straight hair along the labia; vaginal epithelium becomes cornified. pH of vaginal secretions becomes acidic; slight mucous vaginal discharge is present. Sebaceous gland secretion increases. Perspiration increases. Dramatic growth spurt.

growth

By 10 years of age, brain growth is complete, so fine motor coordination becomes refined. As the eye globe reaches its final shape at about this same time, an adult vision level is achieved. If the eruption of permanent teeth and growth of the jaw do not correlate with final head growth, malocclusion with teeth malalignment may be present

age 7

By 7 years of age, children require more props for play than when they were younger. To be a police officer, for example, a 7-year-old may need a badge and gun, whereas before, a pointed finger sufficed. This is the start of a decline in imaginative play, which will continue unless a child receives adequate encouragement to use imagination. At age 7 years, children begin to prefer teenage dolls if they play with dolls, and their coordination is good enough that they can button the miniature dresses and pull on the tiny boots.

fine motor age 8

By 8 years of age, children's eyes are developed enough so they can read regular-size type. This can make reading a greater pleasure and school more enjoyable. Eight-year-olds are able to write script in addition to print. They enjoy showing off this new skill in cards, letters, or projects. By age 9 years, their writing begins to look mature and less awkward.

dental caries

Caries (cavities) are progressive, destructive lesions or decalcification of the tooth enamel and dentin. When the pH of the tooth surface drops to 5.6 or below (which happens after children eat readily fermented carbohydrates, such as table sugar), acid microorganisms (acidogenic lactobacilli and aciduric streptococci) found in dental plaque attack the cementing medium of teeth and destroy it.

11 and 12

Children age 11 and 12 years enjoy dancing and playing table games; they are accommodating enough again to be able to play with younger siblings who need the rules modified to their advantage. Time with friends is often spent just talking. Twelve-year-olds typically like to do jobs around the house or babysitting for money. State laws vary on when a child may care for younger children without adult supervision. Both boys and girls seem to feel they are on the verge of something great and anxiously wait to turn 13 years old and become teenagers.

healthy family functioning

Children also cite their friends as guides for behavior "There are all kinds of ways to do things, but in our house, the rule is this" shows no criticism of Carlos's or Mary Jane's family yet conveys a special and secure "our house" feeling.

Children can use concrete operational thought because they learn several new concepts during school age, such as:

Decentering, the ability to project one's self into other people's situations and see the world from their viewpoint rather than focusing only on their own view. Accommodation, the ability to adapt thought processes to fit what is perceived such as understanding that there can be more than one reason for other people's actions. A preschooler might expect to see the same nurse in the morning who was there the evening before, whereas a school-age child will understand that different nurses work different shifts. Conservation, the ability to appreciate that a change in shape does not necessarily mean a change in size. If you pour 30 ml of cough medicine from a thin glass to a wide one, the preschooler will say that one glass holds more than the other; a school-age child will know that both glasses hold an equal amount. Class inclusion, the ability to understand that objects can belong to more than one classification. A preschooler is able to categorize items in only one way, for example, stones and shells are found at the beach; a school-age child can categorize them in many ways such as by different materials or by a difference in sizes and shapes, not just that they are found at the beach.

teeth

Deciduous teeth are lost and permanent teeth erupt during the school-age period. Because of this, the average child gains 28 teeth between 6 and 12 years of age: the central and lateral incisors; first, second, and third cuspids; and first and second molars

home as a setting to learn industry

For the first time, they realize their child has begun to look to other role models than themselves. Parents who enjoyed fostering imagination in a preschooler may feel frustrated when a school-age child chooses to conform to rules and insists on the "right way" to do things. They may feel they have failed to encourage the child's creativity, but conformity is vital to children at this age. It is how they learn more about their world's rules

foods highest in calcium

Foods highest in calcium are green leafy vegetables such as spinach and turnip greens, enriched bread, and cereals.

girls and boys

Girls become increasingly interested in boys and vice versa by 11 years of age. Favorite activities are mixed-sex rather than single-sex ones. Children of this age are particularly insecure, however, and girls tend to dance with girls, whereas boys talk together in corners.

Common nursing diagnoses pertinent to growth and development during the school-age period include:

Health-seeking behaviors related to normal school-age growth and development Readiness for enhanced parenting related to improved family living conditions Anxiety related to slow growth pattern of child Risk for injury related to deficient parental knowledge about safety precautions for a school-age child

emotional development

Ideally, children enter the school-age period with the ability to trust others and with a sense of respect for their own worth. They can accomplish small tasks independently because they have gained a sense of autonomy. They should have practiced or mimicked adult roles, learned to share, discovered that learning is an adventure, and grasped the idea that doing things is more important and more rewarding than watching things being done (a sense of initiative).

exclusive clubs

If an excluded child does not react badly to being shut out, the club will probably disband after a few days because its purpose is lost. The next day, the excluded member may meet with two others and snub a different child. Parents need to use caution deciding whether to intervene with this type of play because loyalties shift quickly: The child who is club president today may be the excluded one tomorrow.

Industry vs. Inferiority

If gaining a sense of initiative can be defined as learning how to do things, then gaining a sense of industry is learning how to do things well. If children are prevented from achieving a sense of industry or do not receive rewards for accomplishment, they can develop a feeling of inferiority or become convinced they cannot do things they actually can do. These children can have difficulty tackling new situations later in life (e.g., new job, new school, new responsibility) because they cannot envision how they will be successful in handling them. This can result in frustration in school or work activities.

long term illness or physical cognitive challenge

One of the biggest problems facing school-age children with a long-term illness or physical challenges is time lost from school. This threatens not only their academic achievement but also their relationships with peers because it may make the child the "odd person out" with respect to making friends or joining clubs

malocclusion

Malocclusion (a deviation of tooth position from the normal) may be congenital due to conditions such as cleft palate, a small lower jaw, or familial traits tending toward malocclusion. The condition can result later on from constant mouth breathing or abnormal tongue position

types of malocclusion

Malocclusion may be either crossbite (sideways) or anterior or posterior. Children with a malocclusion should be evaluated by an orthodontist to see if orthodontic braces or other therapy is necessary

age 10

Many 10-year-olds spend most of their time playing screen games. Boys and girls play separately at age 10 years, although interest in the opposite sex is apparent. Boys show off as girls pass their group; girls talk loudly or giggle at the sight of a familiar boy. Girls become more interested in the way they look and dress. Slumber parties and campouts become increasingly popular.

language age 7

Most 7-year-olds can tell the time in hours, but they may have trouble with concepts such as "half past" and "quarter to," especially with the prevalence of digital clocks. They know the months of the year and can name the months in which holidays fall. They can add and subtract and make simple change (if they have had experience), so they can go with a parent to a store and make simple purchases. Much of children's talk is concerned with these concepts as they practice them and show them off for family or friends.

age 9 play

Nine-year-olds are on the go constantly, as if they always have a deadline to meet. They have enough eye-hand coordination to enjoy baseball, basketball, and volleyball. By 10 years of age, children are more interested in perfecting their athletic skills than they were previously.

age 9

Nine-year-olds play hard. They wake in the morning, squeeze in some activity before school, and plan something the moment they arrive home again. They may have difficulty going to bed at night because they want to play just one more game. Play is rough; children are not as interested in perfecting their skills as they will be in another year. Some parents or coaches expect children of this age to be more interested in perfecting their skills, so conflicts can arise.

fine motor older school age

Older school-age children begin to evaluate their teachers' ability and may perform at varying levels depending on each teacher's expectations. The middle school curriculum involves more challenging science and mathematics courses than previously and includes good literature. This may be a child's first exposure to reading as a fulfilling and worthwhile experience rather than just as an assignment and may be the time a child is "turned on" to reading

school anxiety

One of the biggest tasks of the first year of school is learning to read. It is best if parents have prepared children for this by reading to them since infancy, pointing to the words and pictures as they read. This helps children realize that sentences flow from left to right and that the words, not the pictures, tell the story. Urge parents to spend some time with the child after school or in the evening so the child continues to feel secure in the family and does not feel pushed out by being sent to school. If such behavior manifestations persist despite attempts to eliminate their cause, the family might benefit from formal counseling, cognitive behavioral therapy, and possibly pharmacology support for the child

Yearly health visits covering both physical and psychosocial development are important at this age. Examples of expected outcomes include:

Parent states that he permits the child to make his own age-related decisions. Child identifies books he has read together with parents in the past 2 weeks. Child states he understands the variations of growth as related to the growth chart. Child does not sustain injuries from sports activities.

implementation

School-age children are interested in learning about adult roles, so this means they will watch you to note your attitude as well as your actions in a given situation. When giving care, keep in mind that children this age feel more comfortable if they know the "hows" and "whys" of actions.

play age 6

Play continues to be active at age 6 years; however, when children discover reading as an enjoyable activity that opens doors to other worlds, they can begin to spend quiet time with books. Many children spend hours playing increasingly challenging video games, an activity that can either foster a healthy sense of competition or create isolation from others.

It's best if sex education is incorporated into health education classes throughout the school years in a manner that is appropriate to age and development. Topics to teach and discuss in a sex education course for both preadolescent boys and girls include:

Reproductive organ function and physiology of reproduction, so children understand what menstruation is and why it occurs Secondary sexual characteristics, so children will understand what is happening in their bodies Male sexual functioning, including why the production of increased amounts of seminal fluid leads to nocturnal emissions The physiology of pregnancy and the possibility for unintended pregnancies, which will come with sexual maturity Responsibilities of sexual maturity Reproductive life planning measures and the principles of safer sex if appropriate to the cultural setting (see Chapters 5 and 6). Sexual orientation questions and concerns may arise at this time, and questions should be addressed honestly and openly.

school phobia

School refusal is a fear of attending school. It is a type of "social phobia" similar to agoraphobia (fear of going outside the home) or separation anxiety disorder (SAD). Children who resist attending school this way develop physical signs of illness, such as vomiting, diarrhea, headache, or abdominal pain on school days. This lasts until after the school bus has left or the child is given permission to stay home for the day.

moral and spiritual development

School-age children begin to mature in terms of moral development as they enter a stage of preconventional reasoning, sometimes as early as 5 years of age They concentrate on "niceness" or "fairness" and cannot see yet that stealing hurts their neighbor, the highest level of moral reasoning. Because they are still limited in their ability to understand others' views, they may interpret something as being right because it is good for them, not because it is right for humanity as a whole.

exercise

School-age children need daily exercise. Although they go to school all day, they do not automatically receive much exercise because school is basically a sit-down activity. increasing time spent in exercise need not involve organized sports. It can come from neighborhood games, walking with parents or a dog, or bicycle riding

reassurance

School-age children need reassurance that they are doing things correctly, and this reassurance is best if it comes immediately after a task is completed.

nutrition

School-age children should be encouraged to eat a healthy breakfast to ensure the ability to concentrate during the school day. It is helpful if parents model this behavior. School-age children can help prepare a nutritious lunch to take to school. If they purchase lunch at school, healthy choices should be discussed with the child.

socialization

Six-year-old children play in groups, but when they are tired or under stress, they usually prefer one-to-one contact. Seven-year-olds are increasingly aware of family roles and responsibility. Eight-year-olds actively seek the company of other children. Nine-year-olds take the values of their peer group very seriously.

fine motor 6

Six-year-olds can easily tie their shoelaces. They can cut and paste well and draw a person with good detail. They can print, although they may routinely reverse letters. Seven-year-olds concentrate on fine motor skills even more than they did the year before. This has been called the "eraser year" because children are never quite content with what they have done. They set too high a standard for themselves and then have difficulty performing at that level.

language age 6

Six-year-olds talk in full sentences, using language easily and with meaning. They no longer sound as though talking is an experiment but appear to have incorporated language permanently. They still define objects by their use (e.g., a key is to unlock a door, a fork is to eat with).

snacks

Snacks are best limited to high-protein foods such as chicken and cheese rather than candy. Fruits, vegetables, and cereals fortified with minerals and vitamins (not empty calorie ones) can all be fun after-school snacks for school-age children.

tics

Some develop tics (irregular movements of isolated muscle groups), such as wrinkling the forehead, shrugging the shoulders, clearing the throat, or frequently blinking. Such movements may occasionally be confused with seizure activity. Tics, however, disappear during sleep and occur mainly when the child is subjected to stress or anxiety. Scolding, nagging, threatening, or punishing does not stop either tics or nail biting and invariably makes these problems worse

foods high in protein

Soybeans, legumes, grains, and immature seeds such as green beans, lima beans, and corn are relatively high in protein.

stealing

Stealing occurs because, although a child is gaining an appreciation for money, this appreciation is not yet balanced by strong moral principles or an understanding of ownership. Parents should explore the reason for the stealing, including: Do other children on the block receive an allowance and so have money for small items? Did their child make a bet that must be paid? Is a child buying a bully's friendship by purchasing gum or candy for that child? Does a child need more security and view money as security?

Bullying can be done face to face or through social media and/or texting. Suggestions for school personnel to deal with bullies include:

Supervise recreation periods closely. Intervene immediately to stop bullying. Insist if such behavior does not stop, both the school and parents will become involved. Advise parents to discuss bullying with their school-age child and help them understand that it should be reported to allow adults to intervene. Parents should monitor their child's social media and texting interactions.

structured activities

The Girl Scouts, the Boy Scouts, the Camp Fire Girls, and 4-H clubs are respected school-age activities. If the local chapters are well run by leaders who understand children's needs, they can provide hours of constructive activity and strengthen a sense of industry. Merit badge systems are geared to the needs of school-age children, offering small but frequent rewards. As with school activities, parents should determine the worth of each organization for their individual child.

weight and height

The average annual weight gain for a school-age child is approximately 3 to 5 lb (1.3 to 2.2 kg); the increase in height is 1 to 2 in. (2.5 to 5 cm). Children who did not lose a lordosis and knock-kneed appearance during the preschool period lose this now.

language development

The common speech problem of the preschool years is broken fluency; the most common problem of a school-age child is articulation. The child has difficulty pronouncing s, z, th, l, r, and w or substitutes w for r ("westroom" instead of "restroom") or r for l ("radies' room" instead of "ladies' room"). This is most noticeable during the first and second grades; it usually disappears by the third grade. Unless it persists, speech therapy for this normal developmental stage is not necessary.

immunity

The immune globulins IgG and IgA each reach adult levels, and lymphatic tissue continues to grow in size until about age 9 years. The resulting abundance of tonsillar and adenoid tissue in early school children is often mistaken for disease because the tonsils seem to fill the entire back of the throat. This may also result in temporary conduction deafness from eustachian tube obstruction until the tissue recedes normally. The appendix is also lined with lymphatic tissue, so swelling of this tissue in the narrow tube can lead to trapped fecal material and inflammation (appendicitis) in the early school-age child

age 8

These collections become structured as a child reaches 8 years of age; time is spent sorting and cataloging. Most girls and boys of this age also enjoy helping in the kitchen with jobs such as making cookies and salads or frosting cakes. They start to be more involved in simple science projects and experiments. Eight-year-olds also like table games but hate to lose, so they tend to avoid competitive games. They may change the rules in the middle of a game to keep from losing.

puberty onset

Timing of the onset of puberty varies widely, between 8 and 14 years of age, partly due to genetic and cultural differences, and is rated according to Tanner stages. The length of time it takes to pass through puberty until sexual maturity is complete also varies.

concerns for transgender children

Transgender children identify with the gender that is not their natal (sex assigned at birth) sex. Studies on the mental health of transgender children reported a higher incidence of psychosocial disorders such as depression and anxiety

age 12 play

Twelve-year-olds plunge into activities with intensity and concentration. They often enjoy participating in sports events for charities such as walkathons. They may be refreshingly cooperative around the house, able to handle a great deal of responsibility and complete given tasks.

care of teeth

With proper dental care, the average child today can expect to grow up cavity free. To ensure this happening, school-age children should visit a dentist at least twice yearly for a checkup, cleaning, and possibly a fluoride treatment to strengthen and harden the tooth enamel or sealants on secondary teeth

Cigarette smoking

With the sure knowledge that cigarette smoking plays a large part in the development of lung cancer and other serious respiratory illnesses, many parents assume their children will know better than to begin smoking. Smoking is viewed as an adult activity, however, so adopting the habit can be considered a giant step on the road to adulthood.

sleep

Younger school-age children typically require 10 to 12 hours of sleep each night, whereas older children require about 8 to 10 hours. Most 6-year-olds are too old for naps but do require a quiet time after school to get them through the remainder of the day. Nighttime terrors may continue during the early school years and may actually increase during the first-grade year as a child reacts to the stress of beginning school.

obsess child

as many as 50% of school-age children are obese by body mass index guidelines. Some of these children have been overweight since infancy, and the natural prepubertal weight gain makes them become obese. Children with an endomorphic build (a natural tendency to accumulate body fat) are more likely to be obese at any time in life than those with a mesomorphic (normal) or ectomorphic (slender) build.

Inhalants

asily available to school-age children for abuse, include airplane glue (toluene) and aerosolized cooking oil. Children do not become physically addicted to glue but do become psychologically dependent on it. To achieve the desired effect, they drop quantities of the glue into a paper bag and then sniff the fumes to experience a feeling of exhilaration or giddiness. This may seem like a harmless procedure, but, in high concentrations, glue fumes can cause extensive liver damage or enough pulmonary edema to be fatal. Cooking spray or computer keyboard cleaner gives this same effect. Because these products contain Freon, they can cause severe respiratory and cardiac irregularity

learning difficulties

attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs) are identified during the school-age years

boys

between 14 and 20 years.

9-11

boys Prepubertal weight gain occurs. girls Breasts: elevation of papilla with breast bud formation; areolar diameter enlarges.

concerns for boys

boys become aware of increasing genital size. If they do not know testicular development precedes penis growth, they can worry that their growth will be inadequate. Hypertrophy of breast tissue (gynecomastia) can occur in prepubescent boys, most often in those who are obese Some boys can also become concerned because although they have pubic hair, they cannot yet grow a beard or do not have chest hair, which are outward, easily recognized signs of maturity nocturnal emissions

sexual and physical concerns

can lead to concerns for both children and their parents. The school-age period is a time for parents to discuss with children the physical changes that will occur and the sexual responsibility these changes dictate. This is also a time to reinforce previous teaching with children that their body is their own, to be used only in the way they choose.

10

children become very interested in rules and fairness. Before this time, they gave younger children breaks in games, allowing extra turns or hints. Now, they strictly enforce rules (Fig. 32.4). Club activities become structured, with a president, a secretary, and rules of order.

intake

children begin to be separated into different categories for girls then for boys because boys require more calories and other nutrients at this time. Both girls and boys require more iron in prepuberty than they did between the ages of 7 and 10 years. Adequate calcium and fluoride intake remains important to ensure good teeth and bone growth. A major deficit may be fiber because school-age children typically dislike vegetables.

age 12 language

children can carry on an adult conversation, although stories are limited because of a lack of experience.

By preteen years, children who are obese begin to develop many of the same health problems as adults

hypertension, type 2 diabetes, and an elevated total cholesterol level, with possible atherosclerosis. They also may be ridiculed or bullied for their size and may be unable to participate on sports teams. This is strong evidence of the need for active measures to help preteens regulate their weight

handeling stealing

early childhood stealing is best handled without a great deal of emotion. A parent should tell the child the money is missing. The importance of property rights should be reviewed: Mother's and father's money is theirs, the child's money is the child's, and they are not interchangeable. Youngsters who continue to steal past 8 years of age may require counseling because they should have progressed beyond this normal developmental step by this age

Abuse of androgenic steroids or human growth hormone

enhance sports performance are yet other drugs that can be found in preteen children. Counsel children against this because abuse of steroids can lead to cardiovascular irregularities, uncontrollable aggressiveness, and possible cancer in later life

dressing

fully dress themselves, they are not skilled at taking care of their clothes until late in the school-age years. This is the right age, however (if not started already), to teach children the importance of caring for their own belongings. School-age children have definite opinions about clothing styles, often based on the likes of their friends, a popular sport, or a popular musician rather than the preferences of their parents

growth in girls

girls are usually taller by about 2 in. (5 cm) or more than preadolescent boys because their typical growth spurt begins earlier. Sometimes, a girl notices the change in her pelvic contour when she tries on a skirt or dress from the year before and realizes her hips are becoming broader. She may misinterpret this finding as a gain in weight and attempt a crash diet. You can assure her that broad bone structure of the hips is part of an adult female profile.

heart

he left ventricle of the heart enlarges to be strong enough to pump blood to the growing body. Innocent heart murmurs may become apparent due to this extra blood crossing heart valves. The pulse rate decreases to 70 to 80 beats/min; blood pressure rises to about 112/60 mmHg. Maturation of the respiratory system leads to increased oxygen-carbon dioxide exchange, which increases exertion ability and stamina. Scoliosis may become apparent for the first time in late childhood

recreational drug use

illegal drugs such as marijuana, cocaine, and amphetamines are now available to children as early as elementary school and certainly by the time they reach the seventh and eighth grades. Because they are available in so many homes, alcohol, inhalants, and prescription drugs have also become commonly abused by this age group

outcome identification

keep in mind that school-age children tend to enjoy small or short-term projects rather than long, involved ones. Behavior problems need to be well defined before outcomes are identified and interventions planned

The type of weight-reduction program that will probably work best is one that emphasizes long-term lifestyle changes and contains features such as:

n intake of about 1,200 calories a day (no more than 30% as fat), with lifestyle changes such as a structured family meal, eliminating eating or snacking in front of the television, decreasing portion sizes, and eliminating sugar-rich drinks. An active exercise program, including monitoring and limiting time spent in physical inactivity (e.g., watching television, playing computer and video games, surfing the Internet, texting). A counseling program to discuss aspects such as self-image and motivation to reduce weight.

teaching on menstration

normal function that occurs every month in all healthy women explanation of proper hygiene and reassurance they can bathe, shower, and swim during their periods. They can use either sanitary napkins or tampons; if they choose tampons, they must take precautions to avoid toxic shock syndrome vaginal secretions will begin to be present. If this is not explained, a girl may fear needlessly she has contracted an infection. Explain that any secretions that cause vulvar irritation should be evaluated by a healthcare provider because this does suggest infection. Most girls have some menstrual irregularity during the first year or two after menarche (the start of menstruation). This occurs primarily because a girl's cycles are at first anovulatory. With added maturity and the onset of ovulation, cycles become more regular.

both

puberty brings changes in the sebaceous glands. Under the influence of androgen, glands become more active, setting the stage for acne . Vasomotor instability commonly leads to blushing; perspiration also increases.

health problems

small health concerns such as head lice or ringworm lowest rates of death and serious illness of any age group. The two causes of death seen most frequently are from unintentional injury and cancer. Minor illnesses are largely due to dental caries, gastrointestinal disturbances, and upper respiratory infections

Sexual maturation in girls

usually occurs between the years of 12 and 18