Health Problems of the School Age Child

Obesity

Therapeutic and nursing management

• Use a family-centered plan with realistic goals.

• Encourage regular meals, balanced nutrition, enjoyable movement, and adequate sleep.

• Help the family identify barriers such as food cost or lack of safe recreation.

• Discuss weight respectfully and assess for bullying or disordered eating.

Dental Disorders

• Clinical Manifestations: Early decay may cause no symptoms. Later findings include visible spots or cavities, sensitivity, toothache, and difficulty chewing. Advanced infection may cause swelling.

• Nursing care

  • Assess oral hygiene, pain, diet, and access to dental care.

  • Teach brushing with fluoride toothpaste and cleaning between teeth.

  • Reduce frequent sugary snacks and drinks.

  • Encourage regular dental visits.

Enuresis

• repeated involuntary urination in a child old enough to be expected to have bladder control, generally at a developmental age of at least 5 years. Nocturnal enuresis occurs during sleep.

  • Primary: The child has never maintained nighttime dryness for at least six months.

  • Secondary: Bedwetting returns after at least six months of dryness.

Enuresis Factors

• delayed maturation of nighttime bladder control, family history, difficulty awakening to bladder signals, increased nighttime urine production, and constipation. Secondary enuresis may accompany stress or a medical condition (UTI, DM, trauma)

• Painful urination, fever, excessive thirst, or new daytime symptoms require evaluation for other causes.

Enuresis Nursing Management

• Use a bedwetting alarm when appropriate. It detects moisture and gradually helps the child respond to bladder signals, requires lots of patience as it awakens everyone

• Desmopressin reduces nighttime urine production but does not solve cause

• Anticholinergics may be prescribed for selected bladder problem however they can cause arrhythmias

• Protect privacy and reassure the family that wetting is not deliberate. Reward participation in the plan rather than outcomes the child cannot fully control.

Encopresis

• repeated involuntary defecation in a child who is old enough to have control over bowel movements, typically occurring after the age of 4.

• Etiology and pathophysiology

  A common cause is constipation with overflow soiling:

  1. A painful bowel movement makes the child avoid stooling.

  2. Retained stool becomes larger and harder.

  3. The rectum stretches, reducing awareness of the need to defecate.

  4. Softer stool leaks around the retained stool and soils the underwear.

  Not every case involves constipation; stress and behavioral factors may also contribute.

Encopresis Nursing Managment

• enemas, laxatives, fiber, hydration, bowel retraining

• instruct family to provide positive reinforcement and child to sit on toilet for 10-15 min after eating

ADHD

Attention Deficit Hyperactivity Disorder, a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity that interferes with functioning or development.

• Treatment may include behavioral interventions, medication such as stimulants or non-stimulants, and educational support to help manage symptoms and improve functioning.

• With stimulants they decrease appetite and cause sleep disturbances teach to take after breakfast

• Environmental management

  • Give short, clear directions.

  • Break assignments into manageable steps.

  • Use predictable routines and immediate positive reinforcement.

  • Reduce distractions.

  • Arrange school accommodations and planned movement breaks.

  • Help caregivers and teachers communicate about treatment response.

School Phobia

Definition

Persistent difficulty attending school because of significant anxiety or fear.

Etiology

Possible contributors include separation anxiety, bullying, academic difficulties, social fears, family stress, or a distressing school experience.

Clinical manifestations

• Abdominal pain, headaches, nausea, or dizziness around school time.

• Crying, clinging, or distress when separating from caregivers.

• Symptoms that improve when the child is allowed to remain home.

School Phobia Nursing Management

• Develop a supportive environment.

• Gradual exposure to school through short visits.

• Work with school personnel to create a supportive plan.

• Address underlying anxiety with counseling or therapy.

• Encourage open communication about fears.

Functional Abdominal Pain

• Clinical manifestations

  • Recurrent pain, often near the umbilicus.

  • Variable timing and duration.

  • Possible interference with school, sleep, or activities.

  Diagnostic evaluation

  Assess the pain pattern, bowel habits, growth, diet, and psychosocial stressors. Findings such as weight loss, poor growth, gastrointestinal bleeding, persistent vomiting, or fever suggest a need to investigate other causes.

Depression

• Clinical manifestations

  Children may show irritability as well as sadness.

  • Loss of interest in usual activities.

  • Withdrawal from friends or family.

  • Sleep, appetite, or energy changes.

  • Difficulty concentrating or declining school performance.

  • Feelings of worthlessness or hopelessness.

  • Repeated physical complaints.

  • Thoughts of death or self-harm

• nursing priority is safety assessment: ask directly about self-harm thoughts, plans, and access to means. Maintain a supportive approach and monitor treatment response. Antidepressants require close monitoring for increased suicidal thoughts or behavior, especially after initiation or dose changes.