Prep-u: Chapter 6: Growth and Development of the School-age Child

The nurse is caring for a hospitalized 5-year-old child. The child's mother has reported her child is becoming very "clingy." Which advice should the nurse provide?

• "Regression is normal during hospitalization." • "Allowing the child to have some input in the care may be helpful in managing these behaviors." • "The child may miss school and interaction with peers." -During hospitalization the school-aged child may exhibit increased clinging behaviors. The child may also demonstrate regression. It will be helpful to promote the child be able to make some decisions or have some age-appropriate sense of control. The school-age child may miss school and the interactions with his or her peers. Ignoring the behaviors may be counterproductive.

The school nurse asks a group of school-age children about pedestrian safety. Which comments by the children should the nurse address with either the child or parents of the child?

• My friends and I like to walk on the side of the road because our sidewalk is very uneven." • "I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." • "I think it is funny to hide behind my dad's car before he leaves for work and scare him."

When caring for hospitalized school-aged children, it is important to:

Consistently reinforce their worth. -Helping children experience satisfaction in projects they complete helps them gain a sense of industry.

The school nurse has completed an educational programs for parents at a local elementary school. Which statement by a parent would indicate the need for further education?

"It's okay for my 10-year-old to sit in the front seat of the car since he doesn't need a booster seat anymore." -Children under 12 should ride in the back seat of the car, even if they do not need a booster seat

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?

"Remind her in simple terms what will happen in the dentist's office."

A hospitalized 7-year-old is recovering from a head injury. Occupational therapy has been ordered to assist the child in regaining eye/hand coordination. If the child cannot master this skill, what feelings may arise?

A feeling of inferiority

An 11-year-old boy is significantly above the 100% percentile for height. The boy tells the school nurse that his parents expect so much out of him when he is playing basketball for the school team that he is thinking of quitting. What action should the nurse take?

Arrange a conference with the parents, son, and nurse to discuss the child's concerns.

The school nurse is speaking with a child who is a latch-key kid. Which statement by the child would need further investigation?

"I answered the door yesterday and the salesman wanted to come in even though my mom wasn't home." -When children are home alone after school they need to have an understanding of rules to promote safety. The child who answers the door when her parents are not at home has demonstrated a lapse in judgment. This needs further investigation and education. The remaining items are appropriate actions.

The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?

"Is there a family history of hypertension, heart disease, or diabetes?" -Parents would be more knowledgeable than the child regarding health problems within the family.

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse?

"It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?" -The school-age child needs reassurance that his or her fears are normal for this developmental age. Parents, teachers, and other caretakers should discuss the fears and answer questions posed by the child. However, the adult should not embellish the fear in any way. In addition, telling the child that she will "grow out of it" is not reassuring to the child

The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?

"My child sleeps between 11 and 12 hours a night."

A mother tells you her 6-year-old has been biting his fingernails since he began first grade. After analyzing the cause of this as increased stress, the advice you would give his mother regarding this problem would be to:

Allow some time every day for the child to talk about new experiences.

The nurse has just completed an assessment on a child who voices an interest in how things are made and who needs support when they are not successful. The child further reports he is involved in clubs and sports outside the home. The nurse is aware that this child is in which of Erikson's states of development?

Industry versus inferiority -Erikson defines industry versus inferiority in the school-aged child. Activities include interest in how things are made, needing support when they are not successful, and involvement in clubs and sports outside the home. Erikson defines initiative versus guilt as the preschool period, the toddler period as a time of autonomy versus shame and doubt, and trust versus mistrust as the infancy period.

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:

Make her child attend school every day. -School phobia may result from both a parent not wanting a child to attend school and a child not wanting to leave a parent. Helping them work together while keeping the child in school to resolve the issue is helpful

A 9-year-old child is feeling conflict from seeing other children in her class engaging in behaviors she senses are not appropriate. When making decisions about what actions are most appropriate, a child of this age will rely most heavily on which party of influence?

Parents

A nurse is caring for a hospitalized 10-year-old. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project

A 7-year-old has taken money from his brother's dresser on two occasions. When counseling his mother about this, you would advise her that:

She may need to remind him of property rights. -As children begin to be aware of the importance of money, they may fail to realize that property rights regarding money need to be respected.

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse?

Speak with the parents about the unusual increased number of respiratory infections -In the school-age child the respiratory system continues to mature with the development of the lungs and alveoli, resulting in fewer respiratory infections. Because the child is absent excessively for respiratory infections the nurse should speak with the parents to aid in determining if there is an underlying cause, or suggest the child visits the pediatrician to discuss the issue.

The parents of a 7-year-old tell the nurse that they are concerned that their child has attention deficit activity disorder (ADHD) because he can't seem to stay focused when playing in a baseball game. What questions/comments by the nurse are appropriate?

• "How is his attention span during school?" • "Do you notice him getting distracted in other activities, like bicycling?"

The nurse is caring for an 8-year-old girl. She is reviewing her nutritional requirements and describing interventions that promote healthy eating habits. Which response by the girl's mother indicates a need for further discussion?

"My daughter must stay at the table until she has cleaned her plate." -School-aged children understand the concept of satiety, of feeling full, and should not ignore this feeling by cleaning their plate. The nurse must encourage the mother not to force a child to eat as this may also lead to obesity.

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?

"Normal growth and development for this age results in an average weight gain of 7 pounds per year." -Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation

During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?

"Play helps children to develop cognitively, socially, physically, and emotionally." -It is important to recognize that the child is busy with other activities but that this does not replace the need to engage in play. Children need time to play because it helps them to develop cognitively, socially, physically, and emotionally. Play at this age embodies the needs for rules and structures.

The mother of two children ages 6 and 12 reports that her 6-year-old child seems to have "cold after cold" while her older child never seems to be ill. She questions if there is something wrong with her younger child. What is the best response by the nurse?

"The immune system of your younger child is less mature and may result in having more infections." -The immune system of the school-aged child is not fully mature. Lymphatic tissues continue to grow until the child is 9 years old; immunoglobulins A and G (IgA and IgG) reach adult levels at around 10 years of age.

The nurse is conducting teaching with families of school-age children. Which statement made by the nurse is most appropriate related to topics that would be covered with this group of individuals?

"The school-age child needs 10 to 12 hours of sleep per night."

A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?

"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school." -The 6-year-old needs 12 hours of sleep and should be provided with a quiet time after school to recharge after a busy day in the classroom.

An 8-year-old boy's foster mother is discussing her concerns about three recent cavities found in his permanent teeth. The mother reports that her child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. What would the nurse suggest to this mother is the most appropriate in regard to the child's dental health?

Ensure that the child brushes his teeth after each meal and snacks. -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.

An 8-year-old boy, who says he wants to be a doctor when he grows up, pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?

Industry -During the early school years, children attempt to master their new developmental step: learning a sense of industry or accomplishment.

A nurse overhears a 7-year-old calling her hospital roommate a vulgar name. What is the best action by the nurse?

Inform the child that talking to the roommate using that language is not acceptable behavior. -Judgment about acceptable and unacceptable behavior is not well developed in children of this age and can possibly result in name-calling and the use of vulgar words.

A mother calls the advance practice pediatric nurse practitioner about her 7-year-old daughter's dental hygiene. The daughter has had three cavities. She does not know what to do and asks the nurse for guidance. How should the nurse respond?

"Are you able to supervise her brushing?" -The number one dental problem in middle childhood is tooth decay. Until age 7, the child may need assistance brushing her teeth. 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 overlooked are brushed carefully.

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice?

"As parents, you need to be good role models."

The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important?

"Be sure to get the proper size bike."

The parents of a 10-year-old girl voice concern to the nurse because their daughter seems to "have a higher amount of body fat" than they expect based on the healthy eating habits and high activity level of the family. What is the best response by the nurse?

"Before adolescence the body fat composition of school-age children increases earlier and in greater amounts in girls than in boys." -Boys have more lean body mass per inch of height than girls during the late school-age years, in preparation for adolescence.

The nurse is working with a group of caregivers of 6-year-olds. One of the mothers states her son has been lying and making up stories; she asks for some advice about how to address the issue. What would be an appropriate response by the nurse?

"Children this age sometimes can't distinguish between fantasy and reality."