The document discusses growth and development in school age children ages 6-12. Key points include: - Physical growth slows but continues steadily, with average gains of 2 inches and 4-6 pounds per year. - Nutritional needs decrease but well-balanced diets and prevention of "junk food" are important. - Cognitive, social, and language skills continue to mature, with children able to think more conceptually and cooperate with peers. - Hospitalization can be scary due to fears of injury, pain, and separation from parents, so preparation and explanation are important.

1. THE SCHOOL AGE CHILD
KATHRYN KUSHTO-REESE, MS.RN.

2. 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

3. 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

4. Nutrition
• Caloric needs diminish
• Need well balanced diet
• Food preferences set
• Pattern based largely upon family’s
• “Junk food” / Peer influence
TEACHING/PREVENTION
• Nutrition education/ School Nurse
• Oral health ( dentition, cavities)
http://www.youtube.com/watch?v=08HVcfx
Rg-k&feature=related

5. OBESITY RISK FACTORS
1. Genetic factors/predisposition
2. Dietary intake
3. Physical activity
4. Family Patterns/habits
5. Sedentary life style

6. Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2008
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1990 1999
2008
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

7. 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.

8. View and reflect
http://www.youtube.com/watch?v=6nM6NDe3hQM&feature=related
What do you think?

9. Cost
In 2000, obesity-related health care costs totaled an
estimated $117 billion.
From 1979-1981 to 1997-1999, annual hospital costs related
to obesity in children and adolescents increased, from $35
million to $127 million.

10. OBESITY PREVENTION
1. Diet Nutrition/School based programs
limit sugared/sweetened drinks
eliminate foods of low nutritional value
2. Change old habits: food as a reward,
children forced to eat all of meal
3. Water freely available
4. Increase physical activity: limit, screen
time, required # minutes spent in
physical activity
5. Policy and environmental changes

12. Implications for Nursing
http://www.youtube.com/watch?v=BXvDI3Lh9xQ&feature=fvw

13. Major Theorists
Developmental Tasks/Milestones for this period
● Erickson
(Psychosocial development)
● Piaget
( Cognitive development)
● Kohlberg
( Moral development)

14. 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

15. 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

16. 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

17. Gross motor skills/ Fine Motor Skills
Gross Motor: Fine Motor
Bike riding Writing
Jumping rope Musical
Swimming Instruments
Ball game skills Constructing
models
17

18. Language
• Diction is adult, clear.
• Opposites.
• Word definitions.
• Building vocabulary.
• Can learn grammar, parts of speech,
rules and exceptions to rules
18

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. 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

21. Play and Peers

22. 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

23. School Age Child’s
Concept 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

24. 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.

25. Pre-admission Preparation
• School Age- ideal
age for advanced
preparation
• Tours
• Classes
• Booklets
• Discussion with
honest answers

26. Interventions To Promote Coping
• Encourage questions /discussion
• Use diagrams, models, and equipment to
supplement explanations
• Encourage participation in care
• Encourage parent involvement/stay

27. 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

28. HOSPITALIZED CHILD

29. Pain Assessment
• Subjective “self report” is best
1. Assess using Pain scale
Faces 0-5
2. Visual analog Pain Scale 0-10
• Behavioral scales and observations important for
child with cognitive impairment

30. Faces Scale

31. Visual Analog Pain Scale

32. Pain Management
PCA ( patient controlled analgesia) pump
Basal/Bolus rates
• Oral pain meds
Opioids/NSAID’s
• Comfort/Diversional measures ( computer, video
games, game boy) etc….

35. Special Problems
• Limit Setting – Discipline
• Withholding privileges
• Contracting
• Problem solving with child
• Dishonest Behavior
• Lying
• Stealing
• Cheating

36. 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

37. Anticipatory Guidance
• Injury Prevention/Safety
• Health Care Visits
• Stress Reduction
• Nutrition
• Rest /Activity/Exercise
• Communicable Diseases
• Substance Abuse Education
• Developmental changes