THE SCHOOL AGE CHILD   KATHRYN KUSHTO-REESE, MS.RN.
Growth and Development       Overview        • Spans age 6-12 years        • Begins with shedding of first          decidu...
PHYSICAL GROWTH• Body systems mature• Average school age child grows• 2.5 inches ( 6-7cm.) per year  and 7 lbs (3-3.5 kg) ...
Prepubescence/Preadolescence• Late school age years• Occurs 2 years before puberty• Characterized by the development of 2n...
Nutrition•   Caloric needs diminish•   Need well balanced diet•   Food preferences set•   Pattern based largely upon famil...
OBESITY RISK FACTORS1.Genetic factors/predisposition2.Dietary intake3.Physical activity4.Family Patterns/habits5.Sedentary...
Obesity Trends* Among U.S. Adults                     BRFSS, 1990, 1999, 2008          (*BMI ≥30, or about 30 lbs. overwei...
Prevalence of Obesity* Among U.S. Children and Adolescents                        (Aged 2 –19 Years)       National Health...
View and reflecthttp://www.youtube.com/watch?v=6nM6NDe3hQM&feature=related                    What do you think?
OBESITY PREVENTION     Healthy People 20201.   Diet Nutrition/School based programs     limit sugared/sweetened drinks    ...
Implications for Nursinghttp://www.youtube.com/watch?v=BXvDI3Lh9xQ&feature=fvw
Major TheoristsDevelopmental Tasks/Milestones for this period                     ● Erickson                     (Psychoso...
Erikson – Industry vs. Inferiority• Goal is to achieve a sense of  competence, mastery and success• Intrinsic motivation i...
Piaget – Concrete Operations• 7-11 years progress from what they see(perceptual thinking) to what they reason(conceptual t...
Kohlberg –Moral development• The school age child is at the conventional  stage of moral development. 7-10 year olds  are ...
Kohlberg –Moral development• • 10-12 year olds progress to the “law and   order stage” actions are good or bad, based  upo...
Gross motor skills/ Fine Motor SkillsGross Motor:               Fine MotorBike riding                 WritingJumping rope ...
Language• Vocabulary expands. Reading skills  improve.• Bilingual children may speak English  at school, primary/secondary...
Social Development        • Explore environment          beyond family        • Parent’s influence still primary        • ...
Play/Peers• Cooperative Play/ Team Play/Skill  development• Sports, Debate Team, Spelling Bee• Importance of group goals, ...
Play and Peers
Self Concept/Body Image            • School-age children              -knowledgeable              about human body        ...
Reaction To Hospitalization              • Fear loss of control,                abandonment and                death.     ...
Pre-admission Preparation             • School Age- ideal               age for advanced               preparation        ...
Interventions To Promote Coping• Encourage questions /discussion• Use diagrams, models, and equipment to  supplement expla...
Interventions To Promote Coping• Use books, games, role play to work  through feelings and to prepare child for  procedure...
HOSPITALIZED CHILD
Pain Assessment• Subjective “self report” is best1. Assess using Pain scale   Faces 0-52. Visual analog Pain Scale 0-10• B...
Faces Scale
Visual Analog Pain Scale
Pain ManagementPCA ( patient controlled analgesia) pump  Basal/Bolus rates• Oral pain meds  Opioids/NSAID’s• Comfort/Diver...
Special Problems• Limit Setting – Discipline     • Withholding privileges     • Contracting     • Problem solving with chi...
Special Problems• Stress – Over programming      • “ Hurried Child” ( Elkind)      • “ Latch Key” Children• Fears/Worries ...
Anticipatory Guidance      • Injury Prevention/Safety      Independence → self confidence      → accidents and injuries.  ...
Anticipatory Guidance      •   Health Care Visits      •   Stress Reduction      •   Nutrition      •   Rest /Activity/Exe...
School age lecture ppp summer 2012 new text
School age lecture ppp summer 2012 new text
School age lecture ppp summer 2012 new text
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School age lecture ppp summer 2012 new text

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  • These 3 maps of the US representing 1990, 1999, and 2008 show the tremendous increase in the prevalence of obesity. It is estimated that 1/3 of adults in the US – and 16% of children are obese. The rate of obesity since 1980 has doubled in adults and tripled in children.
  • The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. The survey examines a nationally representative sample of about 5,000 persons each year. These persons are located in counties across the country, 15 of which are visited each year. Another source of data, is the Youth Risk Behavior Survey (YRBSS) which is conducted every 2 years and it monitors 6 categories of priority health-risk behaviors among youth; two of which are unhealthy dietary behaviors, and physical inactivity. There are state specific info r/t the results of this survey on the CDC website. According to YRBSS (2007), only 53.6% of students had PE classes, 35.4% watched TV for > 3hrs per day, 13% were obese, 15.8% were overweight, 21.4% had eaten fruits and vegetables 5 or more times a day, and 33.8% had drank soda at least once a day.
  • Know the facts . Health promotion : Educate children and their families. Be culturally and socially sensitive . Be aware of resources in the area you practice.
  • Policy affects a much larger group therefore, it’s a more efficient way of making change. There are many examples of important public health victories in the US: Reduction in lead exposure Motor Vehicle safety Tabacco regulations: reduction in rates of smoking Increased vaccination rates Some examples of policies in different states: Minnesota: state graduation standards include physical activity. Maine: a significant portion of the tobacco settlement funds are being used to support “healthy Maine Partnerships”. The state employs school health coordinators to promote physical activity, nutrition,…. In Los Angeles , CA: Sale of soft drinks are banned in all school districts. In Michigan: “Building Healthy Communities” project was designed to improve the environment and change policies to make it easier for residents to be healthy. Some of the achievements were, conducting 129 community fitness classes, providing residents with walking maps, coupons to low-income families to redeem for fruits and veggies, and creating community and school gardens. sliding scale fees for gyms/parks and rec classes, schools offering their gym spaces to the community) and good nutrition (corner stores stock healthier foods, incentives/grants for stores to make infrastructure changes to offer healthier foods)
  • Referral for speech problems. Definitions, in the sense of dictionary definitions
  • School age lecture ppp summer 2012 new text

    1. 1. THE SCHOOL AGE CHILD KATHRYN KUSHTO-REESE, MS.RN.
    2. 2. Growth and Development Overview • 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 matures
    3. 3. PHYSICAL GROWTH• Body systems mature• Average school age child grows• 2.5 inches ( 6-7cm.) per year and 7 lbs (3-3.5 kg) per yearIn early school-age, boys and girlsheight and weight are similar. In later school age years, most girls surpass boys in height and weight
    4. 4. Prepubescence/Preadolescence• Late school age years• Occurs 2 years before puberty• Characterized by the development of 2nd sex characteristics, a period of rapid growth for girls and continued growth for boys.• Early development vs. delayed development
    5. 5. 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=08HVcfxRg-k&feature=related
    6. 6. OBESITY RISK FACTORS1.Genetic factors/predisposition2.Dietary intake3.Physical activity4.Family Patterns/habits5.Sedentary life style
    7. 7. 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%
    8. 8. 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.
    9. 9. View and reflecthttp://www.youtube.com/watch?v=6nM6NDe3hQM&feature=related What do you think?
    10. 10. OBESITY PREVENTION Healthy People 20201. Diet Nutrition/School based programs limit sugared/sweetened drinks eliminate foods of low nutritional value, free water available.2. Increase physical activity: limit, screen (TV, computer) time, set a required # minutes spent in physical activity. Screen all children for development of overweight as indicated by BMI for their age.3. Policy and environmental changes
    11. 11. Implications for Nursinghttp://www.youtube.com/watch?v=BXvDI3Lh9xQ&feature=fvw
    12. 12. Major TheoristsDevelopmental Tasks/Milestones for this period ● Erickson (Psychosocial development) ● Piaget ( Cognitive development) ● Kohlberg ( Moral development)
    13. 13. Erikson – Industry vs. Inferiority• Goal is to achieve a sense of competence, mastery and success• Intrinsic motivation increases with competence in mastering new skills• Expectations of adults too high, child will develop a sense of inferiority and incompetence.• Children with mental/physical limitations at risk
    14. 14. Piaget – Concrete Operations• 7-11 years progress from what they see(perceptual thinking) to what they reason(conceptual thinking)• Decrease in egocentricity• Reversibility• Principles of Conservation• Classification of objects
    15. 15. Kohlberg –Moral development• The school age child is at the conventional stage of moral development. 7-10 year olds are in stage 3, Interpersonal Conformity “Good Child/bad Child) Adults are Right.
    16. 16. Kohlberg –Moral development• • 10-12 year olds progress to the “law and order stage” actions are good or bad, based upon the reason not just consequences. Actions are guided by cooperation and respect for others• Spiritual Development becomes more important
    17. 17. Gross motor skills/ Fine Motor SkillsGross Motor: Fine MotorBike riding WritingJumping rope MusicalSwimming InstrumentsBall game skills Constructing Refinement of motor skills occur models 18
    18. 18. Language• Vocabulary expands. Reading skills improve.• Bilingual children may speak English at school, primary/secondary language at home.• Experiment with profanity, role modeling important 19
    19. 19. 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
    20. 20. Play/Peers• Cooperative Play/ Team Play/Skill development• 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
    21. 21. Play and Peers
    22. 22. Self Concept/Body Image • School-age children -knowledgeable about human body • Acceptance of body parts, changes? • Successes impact self esteem • Sexuality- Ideal time for formal sex education
    23. 23. Reaction To Hospitalization • Fear loss of control, abandonment and death. • Fear procedures, pain, and outcomes, as opposed to the preschooler’s fear of equipment and surroundings.
    24. 24. Pre-admission Preparation • School Age- ideal age for advanced preparation • Tours • Classes • Booklets • Discussion with honest answers
    25. 25. Interventions To Promote Coping• Encourage questions /discussion• Use diagrams, models, and equipment to supplement explanations• Encourage participation in care• Encourage parent involvement/stay
    26. 26. 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
    27. 27. HOSPITALIZED CHILD
    28. 28. 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
    29. 29. Faces Scale
    30. 30. Visual Analog Pain Scale
    31. 31. Pain ManagementPCA ( patient controlled analgesia) pump Basal/Bolus rates• Oral pain meds Opioids/NSAID’s• Comfort/Diversional measures ( computer, video games, game boy) etc….
    32. 32. Special Problems• Limit Setting – Discipline • Withholding privileges • Contracting • Problem solving with child• Dishonest Behavior • Lying • Stealing • Cheating
    33. 33. Special Problems• Stress – Over programming • “ Hurried Child” ( Elkind) • “ Latch Key” Children• Fears/Worries – school/peers/family • Violence • Failing feeling “stupid” • Not being accepted by peers • Changes in family structure • Too many adult responsibilities • http://www.guardian.co.uk/society/video/2009/feb/18/worried -smoking-children
    34. 34. Anticipatory Guidance • Injury Prevention/Safety Independence → self confidence → accidents and injuries. Exposure to danger Bike safety/helmet safety Seat belts/rear seat Pedestrian safety Sports safety Fire safety Water safety Firearms safety
    35. 35. Anticipatory Guidance • Health Care Visits • Stress Reduction • Nutrition • Rest /Activity/Exercise • Communicable Diseases • Substance Abuse Education • Developmental changes

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