THE SCHOOL AGE CHILD KATHRYN KUSHTO-REESE, MS.RN.
Growth and Development • Spans age 6-12 years • Begins with shedding of first deciduous tooth ends with puberty and final permanent teeth. • Height and weight, slower but steady pace • Caloric needs decrease • Organ growth slows
GROWTH AND DEVELOPMENT• Body systems mature• Average school age child grows• 5 cm or 2”/year and 2-3 kg or 4-6 lbs/year• Prepubescence occurs 2 years• before Puberty• Puberty (avg age)• Girls 12, Boys 14
Nutrition• Caloric needs diminish• Need well balanced diet• Food preferences set• Pattern based largely upon family’s• “Junk food” / Peer influenceTEACHING/PREVENTION• Nutrition education/ School Nurse• Oral health ( dentition, cavities) http://www.youtube.com/watch?v=08HVcfx Rg-k&feature=related
OBESITY RISK FACTORS1. Genetic factors/predisposition2. Dietary intake3. Physical activity4. Family Patterns/habits5. Sedentary life style
Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 1999 2008No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Prevalence of Obesity* Among U.S. Children and Adolescents (Aged 2 –19 Years) National Health and Nutrition Examination Surveys*Sex-and age-specific BMI > 95th percentile based on the CDC growth charts.
View and reflecthttp://www.youtube.com/watch?v=6nM6NDe3hQM&feature=related What do you think?
CostIn 2000, obesity-related health care costs totaled anestimated $117 billion.From 1979-1981 to 1997-1999, annual hospital costs relatedto obesity in children and adolescents increased, from $35million to $127 million.
OBESITY PREVENTION1. Diet Nutrition/School based programs limit sugared/sweetened drinks eliminate foods of low nutritional value2. Change old habits: food as a reward, children forced to eat all of meal3. Water freely available4. Increase physical activity: limit, screen time, required # minutes spent in physical activity5. Policy and environmental changes
Implications for Nursinghttp://www.youtube.com/watch?v=BXvDI3Lh9xQ&feature=fvw
Major TheoristsDevelopmental Tasks/Milestones for this period ● Erickson (Psychosocial development) ● Piaget ( Cognitive development) ● Kohlberg ( Moral development)
Erikson – Industry vs. Inferiority• Goal is to achieve a sense of competence• Intrinsic motivation increases with competence in mastering new skills• Children with mental/physical limitations at risk
Piaget – Concrete Operations• 7-11 years progress from what they see(perceptual thinking) to what they reason(conceptual thinking)• Decrease in egocentricity• Reversibility• Conservation of matter• Classification of objects
Kohlberg –Moral development• Young children 6-7: rewards and punishment guide their actions • Older school age children 9 + Rules of conduct are seen more as mutual agreements based upon cooperation and mutual respect for others• Spiritual Development become important
Gross motor skills/ Fine Motor SkillsGross Motor: Fine MotorBike riding WritingJumping rope MusicalSwimming InstrumentsBall game skills Constructing models 17
Language• Diction is adult, clear.• Opposites.• Word definitions.• Building vocabulary.• Can learn grammar, parts of speech, rules and exceptions to rules 18
Social Development • Explore environment beyond family • Parent’s influence still primary • Peer approval • Same sex friendships • Question parent’s values • Formalized groups or “Clubs” • Bullying, Gang Violence ● Follow rules, judge those who do not
Play/Peers• Cooperative Play/ Team Play• Sports, Debate Team, Spelling Bee• Importance of group goals• Dividing tasks• Nature of Competition• Stimulation of cognitive growth• Complex board games, computer games and reading for pleasure
Self Concept/Body Image • Self esteem often based upon grades, teacher comments, peer approval etc.. • Small successes- increase child’s self- image. • Sexuality- Ideal time for formal sex education
School Age Child’sConcept of Illness • Perceive illness as having an external cause • May view pain and illness as punishment for wrong doing • Fear bodily harm, pain, and death
Reaction To Hospitalization • Fear loss of control, abandonment, injury and death. • Fear procedures, pain, and outcomes, as opposed to the preschooler’s fear of equipment and surroundings.
Pre-admission Preparation • School Age- ideal age for advanced preparation • Tours • Classes • Booklets • Discussion with honest answers
Interventions To Promote Coping• Encourage questions /discussion• Use diagrams, models, and equipment to supplement explanations• Encourage participation in care• Encourage parent involvement/stay
Interventions To Promote Coping• Use books, games, role play to work through feelings and to prepare child for procedures.• Promote contact with family, friends school
Pain Assessment• Subjective “self report” is best1. Assess using Pain scale Faces 0-52. Visual analog Pain Scale 0-10• Behavioral scales and observations important for child with cognitive impairment