School-Age and Teen Development

Growth of the School-Age Child

Slow progressive physical growth. Growth depends upon genetics, nutrition, and activity level. School-age children appear thinner and graceful.

School-Age Child Grow

2.5 inches per year.

School-Age Child Gain

4-7 pounds a year.

preadolescence

The time when prepubescence changes are occurring and early secondary sexual characteristics are appearing. It occurs in the late school years, the time between middle childhood and the 13th birthday. Normally occurs two years before puberty.

School-Age Child Neurologic system

brain and skull grow very slowly; shape of head is longer; growth of facial bones changes facial proportions.

School-Age Child Respiratory system

continues to mature with development of lungs and alveoli; respiratory rates decrease; respirations diaphragmatic in nature

School-Age Child Cardiovascular system

blood pressure increases and pulse rate decreases.

School-Age Child Immune system

matures to an adult level around 6-8 years old; fewer infections are experienced.

School-Age Child Gi GU

Increased stomach capacity. Increased bladder capacity. Greater coordination and strength in the musculoskeletal system. Be cautious with heavy backpacks.

School-Age Child The loss of deciduous teeth

(baby teeth) and the eruption of permanent teeth begin at about 6 years of age.

School-Age Child Development of Fine

Work with hands more efficiently. Eye–hand coordination. Balance. Write, print words, sew, or build models. Takes pride in activities requiring dexterity

School-Age Child Gross Motor Skills They can learn to bicycle, skate, swim, and play sports.

School-Age Child Sensory Development

A child typically has 20/20 visual acuity. Screening for vision via the Snellen chart.

Amblyopia

Lazy Eye

Strabismus

Cross Eye (Eyes do not move together as a pair.)

Amblyopia and Strabismus treatment

patching the good eye

Hearing screening is recommended in

kindergarten, first, second, and third grade. via tympanometry or audiometry).

Lead screening is done about

every 4 years.

Scoliosis screening

(Recommended at 10 and 12 years for females and 13-14 years for males during sports physicals)

School-Age Child Screenings

Dental Screening. BMI Screening.

At 6-12 years (school age) Motor

Encourage extra curricular physical activities, Learning a musical instrument

At 6-12 years (school age) Cognitive (Piaget)

Concrete Operations Conceptual thinking, Learns to tell time, Able to see perspective of others, Problem solving. Anticipates consequences, Stores memories

At 6-12 years (school age) Language

Reading and language improving, Understanding metaphors

Social (Erikson) Industry vs Inferiority

Development of skills, Sense of accomplishment, Challenge with tasks, Peer groups, Conformity

At 6-12 years (school age) Moral

Develop Judgement, different points of view The Golden Rule

At 6-12 years (school age) Language and Communication

Vocabulary expands to 8,000 to 14,000 words., Uses all parts of the language., Should be reading by age 5-6.

Psychological and Social Development of the School-Age Child Erikson

Industry vs Inferiority. (We want them to succeed in something.) Friendship and school are important to the child. , The teacher is a big influence, second to the parent. The child is developing a sense of morality. They can assimilate and coordinate information about the world from different dimensions.

Emotional and social development issues School-Age Child

Temperament will vary based on the child and personality., Self-esteem development Promote healthy body image School-age fears are normal Help navigate complicated family dynamics.

Discipline for school age children

Children should learn the natural and logical consequences of discipline., Discipline should focus on the development of the child. Examples include time out, grounding, taking away something the child likes.

Promoting good Sleep and rest

Bedtime expectations and wake-up times, 9-12 hours sleep time , Night terrors and sleepwalking may occur but should resolve by age 8 to 10 years

Obesity and Exercise

Unhealthy eating habits developed in childhood have a greater risk of continuing into adulthood.

Benefits of physical activity

Cardiovascular benefits, Weight control, Emotional tension release, reducing anxiety and depression, Development of leadership skills, Boosts academic performance, Improves memory and attention

Growth of the Adolescent

adolescence

spans the years of transition from childhood to adulthood, which is usually between the ages of 11 & 20 years. Rapid changes in growth Secondary sexual characteristics appear.

Female Puberty initiates

8 - 13 years

Male puberty

9 - 14 years.

Puberty onset

is influenced by genetics, nutrition, physical activity, and environment.

The brain releases GnRH (gonadotropin-releasing hormone)

, which is critical for sexual maturity. This leads to increased estrogen in girls and testosterone in boys, causing the body changes of adolescence and preparing the body for reproduction.

The first sign of pubertal changes in boys is

testicular enlargement in response to testosterone secretion.

Males Sexual maturation order

Testicular enlargement- Pubic hair growth- Penile enlargement- Growth of axillary hair- Facial hair growth-Vocal changes.

Girls-Sexual maturation order

Breast development- Pubic hair growth- Axillary hair growth- Menstruation

Tanner stages

Sexual maturity rating scale.

Girls experience changes in secondary sexual characteristics

before males! They also have their height spurt earlier than males! Males grow taller because they grow about 2 years more than females. Males stop growing age 15-16.

Teens

They are exploring who they are as a person and developing a sense of identity.

In most states teens can be

treated for STI’s, given birth control, and treated for pregnancy without parental knowledge and consent. As parental notification mandates increase, the number of teens who independently seek medical treatment decreases.

Teens may participate in risky behaviors.

Promote safety especially in regards to MVC accidents (leading cause of death) and firearm safety.

HEADSSS assessment screening tool may be given to teens upon admission to the hospital.

Nutritional assessment may be done in teens but

should be done with caution in regards to self-esteem and body-image. Promote and educate regarding proper hygiene and the treatment of acne.

Sex

Sex assigned at birth based on anatomy and chromosomes

Gender

A person’s fundamental sense of being a man, woman, or indeterminant

Gender dysphoria

The distress and unease experienced if gender identity and sex are not congruent.

Sex and gender identity are considered

independent of one another in health care practice.

Transgender

Identification with the desire to live and be accepted as a member of the gender opposite to that assigned at birth

Transition

Process of physical and social change

Sex reassignment

Medical treatment for those who want to adapt their body to the desired sex.

Transgender diagnostic criteria

Post pubertal, Present for at least 2 years, Not a symptom of another mental disorder or genetic, intersex, or chromosomal abnormality, Persistent, consistent, insistent

Nursing Care Concepts for Transgender patients

Ask for their pronouns and name to use instead of assuming Be a support and connect them with resources Be aware that this population is at increased risk for depression and suicide

Sex reassignment surgery (Gender affirmation surgery)

only the surgical part of this treatment

Adolescents 12-20 years Motor and Language

Fully developed

Adolescents 12-20 years Cognitive (Piaget) Formal Operations

Longer attention span, Highly imaginative and idealistic, Formal logic to make decisions, Understand how personal actions influence others, Abstract thought and hypothetical situations.

Adolescents 12-20 years Social (Erikson)

Identity vs Role Confusion Try different roles and experiences to develop a sense of personal identity. Group identity

Adolescents and their PEERS

Peers play an essential role in identity of the adolescent Opportunities to learn negotiation of differences, Recreation, companionship, and a confidant, Peer loyalty, Provide stability in times of stress or transition, Peers are considered credible sources of information and social reinforcement, Can have positive or negative influences on each other

Teen Communication

In hospital setting, seek to have conversations without parental presence. Use open-ended questions. Talk to them like an adult. Let them make their own choices.Don’t be afraid to ask the difficult questions E

Teen Safety concerns

Unintentional injuries ( think they are invincible.) Motor vehicle safety Firearm safety Water safety, Suicide

The nurse should always be on the lookout for signs of

abuse when performing pediatric assessments. Any suspicion should be discussed with the charge nurse for further evaluation and reporting.

HEEADSSS assessment screening tool

Home, Education, Employment, Activities, Drugs, Sexuality, Suicide, Safety - Violence and access to firearms

S/S of Child Abuse

Bruising, Multiple fractures, Child is afraid of parent or caregiver, Missed medical appointments, Anxious, Lacks social skills and has few friends, Poor hygiene, Dressed inappropriately for social situation, Retinal hemorrhages and skull fractures (infants)

Caring for the Hospitalized Teenager

Provide opportunities for adolescent to maintain independence., Allow teen to participate in decisions., Encourage socialization with friends through phone, e-mail, and visits when possible., Always ask open-ended questions!, Always respect their body privacy!

Risk factors for suicide

Mental health changes or depression or other mental illness, Vocalizing thoughts of suicide, Wanting to give clothing or belongings away, Family history of suicide, Sudden decline in school performance, Prior suicide attempt, Substance abuse, LGBTQ, “Being a loner” or “having no friends”, incarceration, Sudden change in behavior, Understand nurse’s role in being a mandatory reporter if you suspect suicide in a pediatric patient.

Common Substances Abused by Children and Teens

Alcohol and prescribed medications, Hallucinogens, sedatives, analgesics, Anxiolytics, Steroid, Inhalants (inhaling fumes of common household products), Stimulants, opiates , Various club drugs such as ecstasy, GHB, and LSD

Nationally Notifiable STIs

Chancroid, Chlamydia. Gonorrhea, Syphilis