Care of the

SCHOOLAGE CHILD

LEARNING OBJECTIVES:

On completion of this unit, you are

expected to demonstrate understanding
of the concepts related to the care of a
family with a school-age child.

Specifically, you are able to:

1. Describe the normal growth and

development of a school-age child
and associated parental concerns.

2. Distinguish each milestone achieved

by the school-age child and its
implication.

3. Use critical thinking to analyze

methods of a family-centered care of
a school-age child.
 GROWTH & DEVELOPMENT OF A
SCHOOL-AGE CHILD

LESSON 13

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to the care of a family with a school-age child. Specifically, students are
able to:

1. Identify key terms that are significant in the care of a school-age child and the family.
2. Discuss the school-age child’s biologic-proportional changes and their implications.
3. Evaluate the relationship among the motor, language, psychosocial, cognitive and
moral milestones of a school-age child.

INTRODUCTION

The middle years is also referred as the school-age or school years. In this period, the
school environment plays a vital role, giving a significant impact on the growth and develop-
ment of the child.
In terms of the physiologic changes, the school-age years begin with the shedding of the
deciduous teeth and would end with the transition into the teenage years. During this stage,
progress becomes evident as children are seen to have grown and developed into sturdy,
complicated individuals with the capacity to communicate, conceptualize in a limited way,
and become involved in complex social and motor behavior (Hockenberry, 2019).
In terms of biologic development, anthropometric measurements assumes a slower but
steady pace compared with the earlier years. In terms of proportional changes, this period
is characterized by more graceful movements as compared with the preschool years.
On the context of psychosocial and cognitive development, a leap of improvement can
be seen.
With these changes, our role as a nurse is important especially in guiding the family as
they go through caring for the child during this stage.
 ACTIVITY 13.1

INSTRUCTION: Fill-in the missing letters in the blank to complete the key terms. You can utilize
the presented definition to easily identify the needed key terms in each number.

1. Develops when a child does not receive rewards for accomplishment; implications later in life
will be difficulty in tackling new situations (can’t envision successful way of handling them).
ANSWER: _NF_RI_RI_Y

2. Ability to project one’s self into other people’s situation

ANSWER: D_CEN_ER_N_

3. Ability to adapt thought process to fir what is perceived

ANSWER: _CC_M_ _DA_ _ON

4. Ability to understand that objects can belong to more than one classification.
ANSWER: CL_SS I_CL_SI_N

5. Hypertrophy of the breast tissue can occur in prepubescent boys usually in obese children.
ANSWER: G_NE_OM_S_IA
 ACTIVITY 13.2

Instruction: Identify the specific development theory for each of the following statements.
Indicate ‘P’ for PSYCHOSOCIAL, ‘C’ for COGNITIVE and ‘M’ for MORAL.

_____ 1. Child needs a supportive/ loving environment to achieve sense of industry.

_____ 2. The school-age child begins to relate external events to mental representations and can
express those representations verbally and symbolically.

_____ 3. Can develop classification skills (sort objects according to object qualities).

_____ 4. Peer approval is a strong motivator.

_____ 5. Motivated by rewards and punishments.

_____ 6. Children with physical/ mental limitations may be at greater risk, but all children will have
some tasks that they cannot master.

_____ 7. Children know rules but do not understand reasons for them.

_____ 8. Do not tend to have personal judgement when it comes to “good” and “bad” but rather
judge these based on what they are told by others.

_____ 9. Can use memories of past experiences to evaluate and interpret the present.

_____ 10. A sense of independence grows, children want to complete tasks successfully on their
own.
 CONCEPT DISCUSSION

SCHOOL-AGE CHILD
• Age: 6 to 12 years of age
• Height increases from an average of 45.5 (115 cm) at 6 years to 59 (150 cm) at 12 years
• Weight increases from 46 lb (21 kg) to 88 lb (40 kg)
• By age 12, girls are taller and heavier than boys
• One of the healthiest periods of life
• Fear: displacement from school

Proportional Changes of School-age Children

Compared with preschoolers…
• Longer legs and lower center of gravity
• A lanky appearance up to 10 to 12 years
• Less body fat; greater percentage of muscle in body mass
• Improved posture and coordination
• Much greater strength (but muscles are still immature)
• Bone development that precedes muscular development
• A decreased ratio of head circumference and waist circumference compared with
height

EXPECTED GROWTH AND DEVELOPMENT(MATURATION OF SYSTEMS)

• Urinary System
 Girls have greater bladder capacity than boys

• Cardiopulmonary system
 Heart grows more slowly and is smaller compared with the body than at any other
period
 Heart rate and respiratory rate decreases
 Blood pressure increases
 Blood volume increases
 Frontal sinuses develop at about 6 years old (sinus headaches become possible)
 Maturation of respiratory system leads to increase gas exchange increasing exertion
ability and stamina
 TEMPERATURE PULSE RATE RESPIRATORY BLOOD
RATE PRESSURE RANGE
36.4 C– 37 C 70-110 bpm 16-22 Girls:
Systolic: 102-115
Diastolic: 60-74
Boys:
Systolic: 102-115
Diastolic: 61-75

* After 12 years of age, a boy’s pulse is 5 beats/min slower than a girl’s

• Immune System
 More competent in ability to localize infections and produce an antibody-antigen
response
 However, more infections increase in the first years of school because of exposure to
other children
 IgG and IgA reach adult levels and lymphatic tissue continues to grow in size until 9
years old
 Abundance of tonsillar and adenoid tissue in early school children
 Appendix is lined with lymphatic tissue

• Musculoskeletal System
 deciduous teeth are lost and permanent teeth erupt
 Average child gains 28 teeth between 6 & 12 years of age
 Central and lateral incisors first, second and third cuspids and first and second molars
 Refinement of coordination, balance and control
 Motor development is primary; necessary for competitive activity

• Sensory and Nervous System

 By 10 years old, brain growth is complete (refined fine motor coordination)
 Adult level vision is achieved

• Sexual Maturation
 Timing of onset of puberty varies widely between 8 and 14 years of age due to genetic
and cultural differences
 Both genders (10-12 years): pubescent changes begin to appear; earlier in females
than in males
 Androgen: Low in childhood (until 7-9 years)
 Estrogen: Low in childhood; In males, increasing gradually until maturity; In females,
increasing gradually until onset of ovarian function, then greatly increasing until
approximately 3 years after first menstruation
 Sexual and Physical Concerns

Concerns of Girls

- Prepubertal Girls: 2 in or 5 cm taller than preadolescent boys; earlier growth spurt for girls
- Change in pelvic contour: assure the child that it is part of an adult female profile
- Breast development not always symmetrical
- Early preparation for menstruation is important
for the following reasons:

a. to have a positive attitude towards the

occurrence of menstruation
b. girls need an explanation of proper
hygiene & reassurance they can bathe,
shower or swim during periods

- Girls need to know that vaginal secretions will

begin to be present
- 1st year or two after menarche: menstrual
irregularity is normal

PUBERTY
Sexual and Physical
Concerns
Concerns of Boys
- Boys become aware of increasing genital size
- Gynecomastia or hypertrophy of breast tissue can occur in prepubescent boys usually in
obese children
*** assure that this is a transitory phenomenon and will fade as soon as male hormones
become more mature and active
- Concerned about pubic hair growth but not yet able to grow a beard and o not have chest hair
yet
*** assure that pubic hair appears first and facial and chest hairs grow several years later
- Nocturnal emissions start (increased seminal fluid) and ejaculation during sleep
 DEVELOPMENTAL THEORIES
• Emotional Development
 Inferiority: develops when a child does not receive rewards for accomplishment;
implications later in life will be difficulty in tackling new situations (can’t envision successful
way of handling them)
 8-9 years old: spends less time with family and more time with peers
 Before engaging in competitive sports, they must learn how to avoid devastation when
losing
 The good time to teach children compassion and thoughtfulness
 Spite clubs or exclusion is evident especially at 9 years old
 Interest in opposite sex at 11 years old

MILESTONE

Psychosocial Development Theory: Sense of Industry

• Mastery of Erikson’s first three stages of psychosocial development is important to

healthy development
• Child needs a supportive/ loving environment to achieve sense of industry
• Stage of accomplishment (sense of industry) occurs sometime between 6 years and
adolescence; learning how to do things well
• Children wish to learn skills and participate in meaningful tasks; they have a desire
to contribute
• A sense of independence grows, children want to complete tasks successfully on
their own
• Children gain satisfaction from being able to do so independently
• Successful task completion may help children achieve status in social activities
• Recognition and rewards reinforce this desire
• Children develop ability to both cooperate and compete with others
• Peer approval is a strong motivator
• Sense of reward is often based on mastery of skills; Children needs reassurance
that they are doing things correctly immediately after the task is completed
• Potential difficulty in this stage is a situation that makes the child feel inferior
• Children with physical/ mental limitations may be at greater risk, but all children will
have some tasks that they cannot master
• Sense of industry is achieved when children have tasks that are necessary and that
they are able to complete well
• Adjusting and achieving in school are two vital tasks for this age group
• Give children small but frequent rewards (Merit badge system)
• Activities: reading books with short chapters, small chores that can be quickly com-
pleted, hobbies and projects that are small and can be finished within a short time
  Play
 Decline in imaginative play
 Interest in collecting items
 Boys and girls play separately
 Interest in rules and fairness

• Mental abilities of the school-age child

 Readiness for learning, especially in perceptual organization
 Understands rules and reasons for them
 Solves trial-and-error problem conceptually rather than through action
 Greater understanding and use of language

Cognitive Development: concrete operational thought

1. Decentering: ability to project one’s self into other people’s situation
2. Accommodation: ability to adapt thought process to fir what is perceived
3. Conservation
4. Class inclusion: ability to understand that objects can belong to more than one classification

MILESTONE
Cognitive Development Theory: Concrete Operations

• The school-age child begins to relate external events to mental representations and
can express those representations verbally and symbolically
• Can use thought to process events and actions
• Can understand outside/external viewpoints
• Develop an understanding of relationships between things and ideas
• Make judgements based on what can be reasoned (conceptual thinking)
• Can master symbols (eg, the alphabet representing sounds and words) and abstract
mathematical concepts, such as conservation
• Can use memories of past experiences to evaluate and interpret the present
• Is able to understand quantity remains the same even when appearance may
change (mass, weight, volume)
• Can develop classification skills (sort objects according to object qualities)
• Can enjoy arranging/ ordering the environment
• Can understand relative differences in concepts (eg, larger, smaller, darker, lighter,
etc)
• Understands reciprocity of familial relationships (eg, a mother must have a child; a
child has a mother)
• Begins to appreciate economics and finances
• Can follow several instructions at once

• Language Development
-Talks in full sentences
-Defines object by their use
-Can tell the time in hours, months, holidays and can add or subtract by 7 years old
-Discovers dirty jokes and uses swear words when angry by 9 years old
-Can carry adult conversation by 12 years old
 MILESTONE
Moral Development Theory

Level II: Conventional Orientation to interpersonal relations of mutuality

*SEEKS CONFORMITY & LOYALTY
* FOLLOWS RULES
*MAINTAINS SOCIAL ORDER

Ages 6-7 years

• Children know rules but do not understand reasons for them
• Motivated by rewards and punishments
• “Good” is something that obeys a rule and is rewarded
• “Bad” is something that breaks a rule and is punished
• May believe that something unfortunate was actually a punishment of something
bad
• Do not tend to have personal judgement when it comes to “good” and “bad” but
rather judge these based on what they are told by others

Ages 8-12 years

• Children begin to be aware of intentions as a factor in “good” and “bad”
• Rules are less absolute; children begin to understand that these may be based on
others’ preferences
• As they age, children start to consider context for any rule infractions
• Children are able to consider alternative points of view and temper their judge-
ments accordingly
 ASSIGNMENT 13.1

INSTRUCTION: Complete the Venn diagram by filling all the spaces inside the circle. Specify
the growth and development of the school-age child: boys and girls, based on the different
systems. Also provide the similar growth and development in the middle space.

BOYS GIRLS
 FEEDBACK
Let us look into how well you fared. If you answered all
questions correctly, congratulations! It shows that you are
already familiar with the topics discussed in lesson 13. If your
answers are quite not close to the discussion, you have some
ideas about the topics covered but need to learn more.
Now, you have a glimpse of the Growth and Development of
a School-age child. Read on and continue exploring this
topic.
Read further on your textbook pages _______ to _________
and on other Maternal and child health nursing references.

Quiz 13.1

Congratulations! You are done with Lesson 13. In order to see how much you have learned,
an online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your NDMU Academic Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 14 entitled Growth & Development of a
School-age Child.
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf
 WELLNESS PROMOTION & INJURY PREVENTION
FOR THE SCHOOL-AGE CHILD

LESSON 14

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to coping with school-age concerns, wellness promotion and injury
prevention. Specifically, students are able to:

1. Discuss various parental concerns related to a schooler’s growth and development .

2. Manage parental concerns related to schooler’s growth and development through
formulation of health teachings suited for each concern.
3. Recognize important safety issues for the schooler.
4. Formulate interventions and health teachings for the prevention of injury.

INTRODUCTION

The progression of skills and the evident growth among school-age children can also
bring out some concerns.
These concerns include the nutrition, daily activities, discipline , safety and common
,s

health problems that need to be attended to since it can have a significant impact on the
over-all growth and development of these children.
Our role as nurse usually would involve formulation of care plans that suits these con-
cerns. Interventions are being selected for implementation according to the identified needs
of the child and the family. One of the most important intervention for nurses to include is
the health teachings which are formulated with a sense of individuality. This entails that
these teachings are done in relation to the situation of the child and family.
Hence, our responsibility entails not only a clinical eye but also the ability to build effec-
tive communication in order to extract important cues which will be our basis for a care plan
that is patient and family centered.
 CONCEPT DISCUSSION

HEALTH PROMOTION

• Nutrition
 Caloric needs are decreased from earlier years
 Eating away from parent’s influence for the first time, though family patters still have influ-
ence
 Begin to try and develop tastes for new things
 Encourage eating of breakfast (parents must model this behavior)
 Eating habits during school age persists through adulthood
 Fostering Industry & Nutrition
***Allow children to help plan meals and assist during preparation
***Allow them to prepare simple meals
***Teach about proper etiquette
 Dietary Intake
***Boys need more calories than girls
***Both boys and girls require more iron
***Adequate calcium and fluoride
***Major deficit during this age is fiber

• Daily Activities
 Dress: Style is based on their friends’ or those that are popular to avoid exclusion
 Sleep : Younger school age: 10-12 hours; Older children: 8-10 hours
 Exercise: Encourage daily exercise to avoid obesity and osteoporosis later in life
 Hygiene: teach the importance of hygiene during menstruation and educate boys that are
uncircumcised to regularly wash genitals to avoid inflammation from secretions that lodges
under the foreskin
 Care of teeth: visit dentist twice a year

• Safety
 Avoid carrying heavy backpacks that weighs more than 10% of the child’s weight; causes
chronic back pain (Kistner, Fiebert & Roach, 2012)
 Teach about sexual maltreatment
• Limit-Setting and Discipline
 Intended to help children learn to control their own behavior
 Corporal punishment can have negative outcomes
 School-age child is old enough to understand basic reasoning
 Discipline should
 Define forbidden actions
 Provide an alternative (acceptable) course of action
 Provide reasoning regarding unacceptable and acceptable actions
 Teach child empathy (if her or she has wronged someone)

 Effective strategies may include withholding treats or privileges, requiring child to fix problem
(if possible), etc.

• Safety
 Avoid carrying heavy backpacks that weighs more than 10% of the child’s weight; causes
chronic back pain (Kistner, Fiebert & Roach, 2012)
 Teach about sexual maltreatment

• Promoting Health Family Functioning

 6 years old- teacher as the final authority in all subjects; friends are guides for their behavior
*** emphasize rule without criticizing the friend’s behavior
*** avoid negative remarks

COMMON HEALTH PROBLEMS

• Dental Caries
Caries: progressive, destructive lesions or decalcification of the tooth enamel & dentin
• Malocclusion: deviation of tooth position from the normal
• Problems with Language Development
 Articulation: difficulty pronouncing s,z,th,l,r & w or substitutes w for r or r for l
 Speech therapy is needed if it persists

COMMON FEARS AND ANXIETIES HOW TO DEAL WITH BULLIES

 Anxiety related to beginning school 1. Supervise recreation periods closely
 School refusal or phobia
 Homeschooling 2. Intervene immediately to stop bullying
 Children who spend time independently
3.Insist school and parents become
 Sex Education
 Stealing involved if it persists
 Violence or terrorism 4. Advise parents to discuss it with their
 Recreational drug use
 Obesity child and help them understand that it
 Bullying must be reported
INJURY PREVENTION

Source of Unintentional Injury Preventive Measure

Motor Vehicle  Encourage children to use seat belts and a booster

seat if needed; role model seat belt use

 Teach street-crossing safety; stress that streets are

no place for roughhousing, pushing or shoving

 Teach parking lot and school bus safety (eg, do not

walk in back of parked cars, wait for crossing guard)

Bicycle  Teach bicycle safety, including wearing a helmet and

not giving “passengers” rides

Community  Teach to avoid unsafe areas

 Stress to not go with strangers (parents can establish

a code word with child; child does not leave school
with anyone who does not know the word)

 Teach children to say “no” to anyone who touches

them if they do not wish it, including family members
(most sexual maltreatment is by a family member, not
a stranger)

 Teach children not to arrange a meeting with people

they meet on the internet
Source of Unintentional Injury Preventive Measure

Burns  Teach safety with candles, matches and campfires

and that fire is not fun. Also teach safety with begin-
ning cooking skills
 Teach safety with sun exposure; use sun block
 Teach to not climb electric poles

Falls  Educate that roughhousing on fences or climbing on

roofs is hazardous.
 Teach skateboard, scooter and skating safety.

Sports Injuries  Teach that wearing appropriate equipment for sports

is not babyish but smart management
 Stress not to play to a point of exhaustion or in a sport
beyond physical capability

Drowning  Teach how to swim; dares and roughhousing when

diving or swimming are not appropriate. Stress not to
swim beyond limits of capabilities.

Drugs  Help child to avoid all recreational drugs; prescription

medicine should only be taken as directed. Teach to
avoid tobacco and alcohol.
 Young school-age children may mistake drugs/
vitamins for candy

Firearms  Teach firearm safety. Keep firearms in locked cabinets

with bullets separate from gun.
Source of Unintentional Injury Preventive Measure

General  School-age children should keep adults informed as

to where they are and what they are doing; cell-
phones can help with this
 Be aware the frequency of unintentional injuries in-
creases when parents are under stress and therefore
less attentive. Special precautions must be taken at
these times.
 Caution that some children are more active, curious
and impulsive and therefore more vulnerable to unin-
tentional injuries than others.

SCHOOL-AGE
ame sex grouping
chool phobia & bullying
ix years: ties shoe laces with ease
ense of Industry
tart of articulation problem
 EXERCISE 13.1

INSTRUCTION: Write 'T' for 'true' and 'F' for 'false' for the following statements.

_____________a. Caloric needs are constant since early stages of the child development.

_____________b. The school-age children are recommended to avoid carrying heavy back-
packs that weighs more than 20% of their weight because it can cause
chronic back pain.
_____________c. One of the common health problem encountered during the school-age
stage is Malocclusion, which defines as the deviation of tooth position from
the normal.

_____________d. Intended to help children learn to control their own behavior.

_____________e. To promote healthy teeth to children, advise the family to allow their child
visit the dentist once a year only.

_____________f. Parents can establish a code word with child; child does not leave school with
anyone who does not know the word.

_____________g. School-age children should keep adults informed as to where they are and
what they are doing; cellphones can help with this.

_____________h. Caution that some children are more active, curious and impulsive and
therefore more vulnerable to unintentional injuries than others.

_____________i. Be aware the frequency of unintentional injuries increases when parents are
under stress and therefore less attentive. Special precautions are not neces-
sary.

______________j. Corporal punishment can have negative outcomes.

 EXERCISE 13.2

INSTRUCTION: Please list down at least 5 common fears and anxieties among school-age
children, and provide each related nursing interventions to overcome those common problems.

COMMON FEARS AND ANXIETIES NURSING INTERVENTION

3.

4.

5.
 FEEDBACK
Let us look into how well you fared. If you answered all
questions correctly, congratulations! It shows that you are
already familiar with the topics discussed in lesson 14. If your
answers are quite not close to the discussion, you have some
ideas about the topics covered but need to learn more.
Now, you have a glimpse of the Wellness promotion and
injury prevention of a School-age child. Read on and continue
exploring this topic.
Read further on your textbook pages _______ to _________
and on other Maternal and child health nursing references.

Quiz 14.1

Congratulations! You are done with Lesson 14. In order to see how much you have learned,
an online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your NDMU Academic Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 15 entitled Wellness promotion and Injury
prevention of a School-age Child.
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf