school age and adolescent

School age Erikson

Industry vs. Inferiority

Wants to master skills, be competent

Too‑high expectations → inferiority

School age Piaget

Concrete Operations

Logical, literal thinking

Conservation, decentering, class inclusion

School age Kohlberg

Conventional Morality

Rules, fairness, approval matter

School age Freud

Latency

Same‑sex peer groups, clubs, secrets

School age growth

Growth spurts → temporary ↓ coordination

Girls taller than boys around age 12

BMI plotted annually

School age height

Height ↑ 2.5-3 in/year

School age weight

Weight ↑ 6.5-7.5 lb/year

School age concrete operational thinking

Conservation

Decentering

Accommodation

Class inclusion

Conservation

amount stays same despite shape

Decentering

sees others' perspectives

Accomodation

adjusts thinking

Class inclusion

objects belong to multiple groups

School age social and emotional

Best friend by age 7

Peer pressure increases

Same‑sex peer groups

Clubs with rules, passwords

Fears/anxiety normal → teach coping, not avoidance

School age health assessment

Direct questions to child first

Parent stays in room

Child sits on exam table (not lap)

Explain procedures literally

Head‑to‑toe sequence

School age screenings

Vision (Snellen)

Hearing

Blood pressure

Scoliosis

Dental

Hyperlipidemia at 11 years

BMI annually

Immunizations updated every visit

School age physical variants

Frontal sinuses fully developed at 7

Tonsillar hypertrophy common

Respiratory system fully developed at 10

PMI at 5th ICS MCL

Arms/legs grow faster → clumsiness

Acne may begin

Female puberty

Growth spurt occurs earlier than males

Asymmetrical breast development normal

Tender subareolar nodule = puberty onset

Irregular menses first 1-2 years

Female puberty onset

age 8-13

Female puberty first sign

Thelarche (breast budding)

Menarche

~2 years after thelarche (avg 12.8 yr)

Female puberty refer if

Puberty before age 8

Vulvar secretions causing irritation

Breast mass or severe asymmetry

Accessory nipples enlarging → reassure

Male puberty

Penis/scrotum enlarge

Hair distribution increases

Growth spurt occurs later than females

Male puberty onset

age 9-14

Male puberty first sign

Testicular enlargement

Male puberty refer if

Puberty before age 9

Gynecomastia with mass

Delayed puberty past 14

School age pain assessment

Ask about quality, not just intensity

Give child a "job" during procedures

Less than 7 pain assessment

FACES

7 and older pain assessment

numeric rating scale

School age sports safety

Protective gear

Hydration breaks

Match activity to size/skill

School age water safety

Never swim alone

Constant supervision

School age bike/pedestrian safety

Helmet always

Look both ways

Reflective clothing

School age home safety

Locked firearms

Fire safety plan

Secure meds/chemicals

School age vehicle safety

Booster seat until 4 ft 9 in AND 8-12 years

Lap belt low across thighs

Shoulder belt always

School age media safety

3-4 hours/day average

School age media risks

violence

obesity

risky behaviors

School age sleep

Needs 9-12 hours/night

Sleep deficit → irritability, inattention

No screens 2 hours before bed

Consistent routine

Bed only for sleep

School age nutrition

Teach caloric needs

Involve child in meal prep

Encourage family meals

Monitor calcium & vitamin D

Avoid sugary drinks

Energy drinks never

Promote 60 min/day activity

Avoid weight‑number goals → eating disorder risk

School refusal

Ages 5-7 and 12-14 peaks

Emotional distress, not defiance

Somatic symptoms disappear on weekends

Goal: return to school ASAP

Assess for bullying, learning issues, anxiety

Pharyngitis/Tonsillitis

Viral vs bacterial

Strep → sandpaper rash

Tonsillar hypertrophy → sleep apnea risk

Treat strep to prevent rheumatic fever

Complete full antibiotic course

Early adolescence

10-13

Concrete thinking

Body changes dominate

Same‑sex peers

Questions authority

Middle adolesence

14-17

Abstract reasoning

Strongest peer influence

Risk‑taking increases

Dating begins

Late adolesence

18-21

Identity stabilizes

Future planning

Individual relationships

Transition to adult roles

Adolescence Erikson

Identity vs. Role Confusion

Adolescence Piaget

Formal Operations

Abstract thought

Hypotheticals

Adolescent egocentrism ("everyone is watching me")

Adolescence Kohlberg

Postconventional Morality

Personal ethics may conflict with rules

Adolescence neuro development

Prefrontal cortex not fully developed until late adolescence

Judgment, impulse control, consequence anticipation immature

Explains risk‑taking

Adolescence health assessment

Privacy is essential

History taken without caregiver present

HEADSS assessment

Keep body covered

Sequential head‑to‑toe exam

Allow adolescent to choose who is present for physical exam

HEADSS

Home

Education/Employment

Activities

Drugs

Sexuality

Suicide/Depression

Adolescence physical variants

Wisdom teeth erupt

Growth plates close mid‑late adolescence

Skeletal growth precedes muscle → temporary awkwardness

Acne from androgen surge (NOT diet‑related)

Apocrine glands → adult body odor

Female adolescent growth

Growth spurt= 3-3.5 in/year

Growth stops at 16-17

Body fat ↑ in females

Male adolescent growth

Growth spurt= 3.5-4 in/year

Growth stops at 18-20

Muscle mass ↑ in males

Adolescent pain assessment

Numeric Rating Scale

Visual Analog Scale

Underreporting common

Validate pain; explain that pain control aids healing

Adolescent non pharm pain assessment

cognitive strategies

deep breathing