School-Age Child

1. School-Age Child
Fall 2018
Jacey Mitchell, RDH, MS
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2. Biology and Genetics
 5-12 years: “Calm before the storm”
 Body systems reach adult level function
 Screen for childhood elevated blood pressure yearly
 ID and tx prevents adult organ damage
 Prevalence: 5 out of 100 children
 Growth
 Slower, steadier pace
 Alternating “spurts” and minimal growth
 Height: 5 cm (2 in) per year; weight: 2-3 kg (4.4-6.6 lb) per year
 Differ by race, gender, genetics
 Preadolescent growth spurt: earlier in girls than boys
 Menarche: occurring earlier; related to genetics, sufficient body fat
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3. Biology and Genetics (Cont.)
 Teeth
 Transition from deciduous to permanent teeth
 Lost in same order they initially erupted; 4 teeth/year
 Potential for dental caries, periodontal disease, malocclusion
(dental and orthodontia implications)
 School sealant programs reduce caries by 60%
 Lymphoid tissue
 Grows rapidly; stronger immune system
 Enlarged tonsils are normal
 Lymphoid tissue increases to 10 years then decrease
 Children may have more lymphoid tissue than adults
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4. Motor Skills Development
 Maturated nervous system by age 7-8: brain hemisphere
articulation → more control
 Lengthening long bones → risk fx, joint pain )
 Muscle mass increase: potential for more complex fine and
gross motor functions
 Ossification—bone replaces cartilage
 Occurs throughout childhood; completed in adulthood
 Avoid excessive weight, e.g., backpacks
 Proper-sized shoes, desks, and chairs
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5. Gordon’s Functional
Health Patterns
 Health perception–health management pattern
 Nutritional-metabolic pattern
 Elimination pattern
 Activity-exercise pattern
 Sleep-rest pattern
 Cognitive-perceptual pattern
 Self-perception–self-concept pattern
 Roles-relationships pattern
 Sexuality-reproductive pattern
 Coping–stress tolerance pattern
 Values-beliefs pattern
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6. Health Perception–
Health Management Pattern
 Health perception:
 Correlated with cognitive development
 Stage is concrete operation; can grasp germ theory
 Illness often viewed as punishment
 Cultural influences: karma, “evil eye” use of talismans
 Facilitating health promotion
 Monitor/reinforce preventative practices
 Parents to model health promoting behaviors
 Teach healthy behaviors at home and school
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7. Nutritional-Metabolic Pattern
 Nutritional guidelines
 Well-balanced diet: 1200-1800 kcal/day
 Factors influencing food intake
 Access to food: lack of nutritious food, make own snacks
 Mass media influence: billboards, TV
 Contemporary busy lifestyles: skip meals, eat out
 Nutritional education
 School programs
 Dietary guidelines
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8. Nutritional-Metabolic Pattern
 Overweight/obesity definition
 Obesity: BMI >95th percentile for age/gender or BMI >30
 Overweight: BMI >85th but <95th percentile
 Factors
 Genetic
 Environmental: use of food as reward; lack of physical activity,
living conditions, financial constraints
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9. Nutritional-Metabolic Pattern
 Risk
 Increase risk for cardiovascular diseases, diabetes, sleep apnea
 Psychosocial: ridicule, discrimination
 Management of obesity: multimodal intervention
 Reasonable caloric restriction
 Physical exercise
 Peer counseling
 Habit changes
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10. Elimination Pattern
 Physical ability
 Most have achieved full bowel/bladder control
 Enuresis
 Primary vs secondary
 Nocturnal vs diurnal enuresis
 Behavior management strategies; drug therapy
 Encopresis
 Common complication of chronic constipation
 Psychosocial component
 Bowel management program and counseling recommended
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11. Activity-Exercise Pattern
 Critical time to acquire and foster activity behaviors
 Types of activities
 Group: little league baseball, soccer
 Individual: gymnastics, ballet
 Unorganized play: bike riding, rollerblading
 Play activities
 Promote social, personal, cognitive development
 Focus on fun, connections to peers and family
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12. Sleep-Rest Pattern
 8-12 hours of sleep/night
 Fewer difficulties with going to bed
 Sleeping arrangements
 Culturally influenced: own bed vs bed sharing
 Sleep disturbances: sleepwalking and sleep talking
 Disorders of arousal: immaturity of nervous system; most outgrow
with CNS maturation
 Consider safety, relaxation techniques, sleep preparation
consistency
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13. Cognitive-Perceptual Pattern
 Piaget: concrete operations stage
 Learn by manipulating concrete objects
 Lack of abstract thinking
 Less egocentric—consider others’ views
 Expanded conceptual understanding
 Conservation of substance
 Time
 Major operations: classifying and ordering
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14. Cognitive-Perceptual Pattern
 Vision—optimal function by age 6
 Eye changes
 Δ from hyperopic (farsighted) to normal vision
 Vision screening needed to detect abnormalities
 Vision problems:
 Affects 25% of school children
 Myopia (nearsightedness)
 Astigmatism (uneven focusing)
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15. Cognitive-Perceptual Pattern
 Hearing
 Auditory acuity nearly complete by 7 years
 Hearing deficit cause: chronic serous otitis media
 Periodic earing evaluations
 Education on hearing protection
 Sensory perception
 Learn simultaneously through many senses
 Auditory learners
 Kinesthetic learners
 Auditory, kinesthetic, and visual learners
 Increasing ability to differentiate detail
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16. Cognitive-Perceptual Pattern
 Language—rapid development
 Capacity to imitate sounds
 Complex sentences; multiple meanings
 Reading
 Skills: letter and sound recognition, combinations to form words
 Handwriting skills
 Hand-eye coordination, motor control, perceptual abilities
 Dyslexia: reversal of letters and numbers in writing
 Memory—improved ability
 Organizing, classifying, labeling facilitates retention
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17. Cognitive-Perceptual Pattern
 Intelligence
 Debate
 Inherent cognitive capacity vs achieved level of performance vs
immeasurable
 Traditional intelligence test shortcomings
 Do not test all forms of intelligence
 Culturally insensitive
 May measure achievement, not ability
 Environmental factors affect achievement (e.g., SES, nutrition,
sociocultural environmental stimuli)
 Achievement test results vs intelligence test results
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18. Cognitive-Perceptual Pattern
Learning Disabilities
 Affects 5%-10% of children
 Attention-deficit/hyperactivity disorder (ADHD)
 Difficult to assess: varying symptoms
 Treatment controversial: behavior management, counseling,
nutrition, medication
 Nurse’s role varies
 Includes detection, referral, collaboration on plan, counseling,
liaison with family
 Legislation
 Individuals with Disabilities Education Act of 1997
 Section 504 of Rehabilitation Act of 1973
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19. Self-Perception–Self-Concept
Pattern
 Erikson: industry vs inferiority
 Major task: mastery of whatever the child is doing
 Self-concept
 Self-esteem
 Belief that one is capable, significant, successful, worthy
 Family, peer, school influence
 Sense of control
 Internal vs external locus of control
 Cultural and gender differences
 Body concept
 Develop understanding of internal body
 Physical differences (freckles, deformity, chronic illness) can cause anxiety,
feelings of being threatened
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20. Roles-Relationships Pattern
 Family environment
 Provides sense of security
 Increasing independence and maturity
 Begin to reduce parental authority/structure
 Broaden interests outside home
 Clubs, sports, gangs
 More responsibility in home and community
 Pets, chores, earn allowances
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21. Roles-Relationships Pattern
 Learn socially accepted behaviors
 Limit setting
 Nonviolent resolutions for conflict
 Behavioral contracts
 Positive reinforcement vs punishment
 Child abuse
 Victims: increased risk of repeating cycle
 May occur with/without recognized risk factors
 Consider cultural factors in detecting abuse
 Sexual abuse
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22. Sexuality-Reproductive Pattern
 Strong identification with parent of same gender
 Affects concepts of role and self-concept
 Desire for knowledge of sexual function (puberty)
 Exploration of others’ sexual organs
 Desire for privacy
 Discuss sexuality with peers
 Sex education resources
 Health care agency short programs
 Age-appropriate books
 Nurse's role in school setting
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23. Coping–Stress Tolerance Pattern
 Childhood stresses: multiple new stressors
 School expectations
 Peer relationships
 Cultural differences
 Bullying
 May respond to stress with negative behavior
 Coping strategies: buffer stressful events
 Very stressful situations may need referral, counseling
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24. Coping–Stress Tolerance
Pattern (Cont.)
 Divorce
 Stressful—after-effects may result in juvenile behavior
problems or require counseling
 School: role of advocate for child
 Depression-somatization
 Somatization: Transfer of feelings to physical
problems
 Depression: symptoms include anorexia,
sleeplessness, lethargy, changed affect, aggressive
behavior, crying, withdrawal
 Treatment: individual/family counseling; medication
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25. Values-Beliefs Pattern
 Kohlberg’s theory
 Younger school-age: preconventional
 Moral behavior based on self-interest
 Older school-age: conventional
 Concern about group interests/values
 Moral behavior problems
 Lying, stealing, cheating
 Common developmental behaviors
 Guidance needed to choose more socially acceptable ways to
cope with stressors
 Consequences should be congruent with developmental
understanding of the event
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26. Environmental Processes:
Accidents
 Environmental factors
 Seasonal influence
 SES (physical environment, access dangers)
 Social environment—family stress, playmates
 Drowning
 Fewer incidents than younger children; racial differences
 Prevention: water safety teaching
 Burns
 House fires (Christmas trees, space heaters)
 Prevention: smoke detectors; fire safety practices
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27. Environmental Processes:
Accidents
 Firearms
 Gun accidents; adolescent shootings
 Prevention: locked guns, gun safety
 Sports and recreation
 Risk: musculoskeletal injuries with competitive sports
 Playground equipment safety
 Prevention: protective devices, hydration, conditioning exercises,
match child to activity
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28. Mechanical Forces
 Motor vehicles
 Car safety: age-appropriate restraints and seats, child locks,
rear seat placement
 No requirement for seat belts in buses
 Pedestrian-car accidents
 Bicycles, motorized skateboards, and all terrain vehicles
(ATVs)—safety helmets needed
 Rollerblades, skateboards, skate scooters—more severe than
pedestrian injuries
 More boys than girls injured
 AAP recommends at least 16 years of age to ride ATVs
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29. Biological Agents
 Fewer infections than preschool child
 Common infections
 Upper respiratory infections (viral)
 Streptococcal infection, otitis media (bacterial)
 Gastroenteritis (viral)
 Scabies/lice (skin infestations)
 AIDS
 Lower risk; education starting at age 8 recommended
 Immunization
 Meningococcal vaccination (age 11-12)
 Hepatitis B series, if not completed in early childhood
 Human papilloma virus (HPV)
 Varicella (if no history of chickenpox)
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30. Chemical Agents
 Food additives
 Drugs
 Alcohol, glue inhalants
 Tobacco exposure/smoking
 Experimentation with illicit drugs
 Pollution
 Lead exposure: clothes, soil, pipes, older homes
 Neurotoxic effects
 Chemicals for insect/weed control
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31. Radiological Agents
 X-ray exposure
 Natural and human-made ionizing radiation
 Risk of breast and thyroid cancer, leukemia
 Cancer
 Most common types: leukemia, cancers of brain/nervous system,
lymphomas
 May be cured; potential for later health effects
 Nurse’s role: psychological/emotional support; assist in meeting
developmental goals
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32. Determinants of Health:
Social Factors and Environment
 Community and work
 Peers—strongest relationship outside family
 Other adults—influential role models (e.g., teachers)
 Working parents—issues with after-school care
 Culture and ethnicity
 Attitude toward racial differences develop
 TV, video, computer
 Potential harms: violent images, sedentary nature of activity, influence on
buying choices, Internet dangers
 Challenges: access to positive programming, discuss TV images vs reality,
limit amount of TV time
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33. Determinants of Health:
Social Factors and Environment
 Legislation
 Public Law 94-142 Education for All Handicapped Children Act:
Individualized educational plan (IEP)
 No Child Left Behind (2001)
 Economics
 Poverty—22% of children live below poverty level
 Homeless, depression, developmental delay, more disease
 Affluence—“latchkey children”
 Less supervision, risk-taking behavior
 Health care delivery system
 Well-child care—recommended every 2 years
 State Children’s Health Insurance Program (SCHIP)
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