chapter 20

Here are detailed notes covering the topics you requested for your exam preparation:

Growth & Development, Biology, Genetics & Growth Expectations

• System Maturation: Between the ages of 5 and 12, a child's body systems reach adult-level function.

• Growth Expectations: Growth happens at a slower, steadier pace with alternating "spurts" and periods of minimal growth. Children typically grow about 5 cm (2 inches) and gain 2 to 3 kg (4.4 to 6.6 lbs) per year. These rates can vary by race, gender, and genetics. Preadolescent growth spurts and menarche (which is influenced by genetics and sufficient body fat) are occurring earlier in girls than in boys.

• Dentition: School-age children transition from deciduous (baby) teeth to permanent teeth, losing them in the same order they erupted at a rate of about 4 teeth per year. School sealant programs are highly effective, reducing dental caries by 60%.

• Lymphoid Tissue: This tissue grows rapidly, giving children a stronger immune system. It is normal for children to have enlarged tonsils, and they actually may have more lymphoid tissue than adults until it begins to decrease around age 10.

• Motor Skills & Bones: By age 7-8, the nervous system matures, and brain hemisphere articulation allows for more control and complex motor functions. Long bones lengthen and bone replaces cartilage (ossification), which can cause joint pain and an increased risk of fractures. It is important to avoid excessive weight in backpacks and ensure properly sized shoes and desks.

Stages of Development Theories & Developmental Tasks

• Piaget’s Theory (Cognitive Development): School-age children (approx. 7-11 years) are in the Concrete Operations Stage. They learn by manipulating concrete objects, lack abstract thinking, and become less egocentric, meaning they can consider the views of others. They develop an expanded conceptual understanding, including the conservation of substance and time, with major operations focused on classifying and ordering.

• Erikson’s Theory (Psychosocial Development): The major stage is Industry vs. Inferiority. The child's primary task is achieving mastery in whatever they are doing. This period is crucial for building self-concept and self-esteem (the belief that one is capable, significant, and successful), heavily influenced by family, peers, and school. They also develop a sense of internal versus external locus of control.

Nutrition, Metabolic Needs, and Allergies

• Nutritional Needs: Guidelines recommend a well-balanced diet of 1200-1800 kcal/day. Intake is often negatively influenced by mass media, contemporary busy lifestyles (skipping meals, eating out), and lack of access to nutritious food.

• Overweight & Obesity: Obesity is defined as a BMI >95th percentile or >30, while overweight is a BMI >85th but <95th percentile. Factors include genetics, environment, using food as a reward, and a lack of physical activity. Obesity increases the risk for cardiovascular disease, diabetes, sleep apnea, and psychosocial issues like ridicule. Management requires a multimodal approach involving caloric restriction, physical exercise, habit changes, and peer counseling.

• Allergies: The most common food allergies in this age group are peanuts, milk, eggs, and wheat.

Cognitive, Vision, Hearing & Sensory Perception

• Vision: Optimal visual function is achieved by age 6, as the eyes transition from being hyperopic (farsighted) to normal vision. However, vision problems affect 25% of school children, most notably myopia (nearsightedness) and astigmatism (uneven focusing).

• Hearing: Auditory acuity is almost fully complete by 7 years of age. The primary cause of hearing deficits is chronic serous otitis media.

• Sensory Perception: Children learn simultaneously through multiple senses, functioning as auditory, kinesthetic, and visual learners, with an increasing ability to differentiate specific details.

Immunization Schedules (Child to Adolescent)

• Catch-up Vaccinations: Key catch-up vaccines include Tetanus, diphtheria, and pertussis (Tdap), Hepatitis A and B, Polio (IPV), Measles, mumps, rubella (MMR), and Varicella (chickenpox).

• Pre-Adolescent/Adolescent: The schedule includes the Meningococcal vaccination (given at age 11-12) and the Human papillomavirus (HPV) vaccine.

Risk Factors, Safety, and Environmental Hazards

• Accidents: Drowning incidents decrease compared to preschool years, but water safety teaching remains crucial. Burn risks often stem from house fires (e.g., space heaters, Christmas trees).

• Mechanical Forces: Motor vehicle safety requires age-appropriate restraints, rear seat placement, and child locks. For bicycles, ATVs, and skateboards, safety helmets are mandatory. The AAP recommends children be at least 16 years of age to ride ATVs.

• Sports: Competitive sports increase the risk of musculoskeletal injuries; prevention includes hydration, conditioning, and protective devices.

• Chemical Agents: Risks include exposure to drugs, alcohol, tobacco, and food additives. Lead exposure from older homes, soil, clothes, and pipes is a significant pollution hazard that causes neurotoxic effects.

Biological Agents, Communicable Diseases & Poisoning

• General Immunity: School-age children experience fewer infections than preschool children. Common infections include viral upper respiratory infections, bacterial streptococcal infections and otitis media, and viral gastroenteritis.

• The Infectious Process: Consists of 4 stages:

  1. Incubation period: Time between entrance of the pathogen and the first symptoms.

  2. Prodromal stage: Interval from nonspecific signs to more specific symptoms.

  3. Illness stage: Patient manifests signs and symptoms specific to the infection.

  4. Convalescence: The recovery period.

Specific Infectious Diseases & Conditions

• Varicella Zoster Virus (Chickenpox): A mild, self-limited viral illness causing a red rash with fluid-filled blisters that eventually crust over. It causes itching, sensitivity to touch, and lethargy. Complications can include encephalitis, pneumonia, and secondary skin infections.

• Fifth’s Disease (Erythema Infectiosum): Caused by Parvovirus B19. Distinguishable by a red "slapped cheek" rash on the face that later spreads down the trunk and limbs, lasting 1 to 3 weeks. It is contagious before the rash appears and does not require isolation. There is no vaccine.

• Conjunctivitis (Pink Eye): Inflammation of the eye's outer membrane. Bacterial causes purulent drainage and crusting (treated with antibiotics). Viral causes clear drainage and tearing (no specific treatment). Allergic is treated with steroids or anti-allergy drops.

• Head Lice (Pediculosis Capitus): An infestation of tiny insects on the scalp spread through direct contact or sharing items. Symptoms include itching and visible lice/nits (eggs). Treated with medicated shampoos (though resistance is increasing) and patient combing to remove nits.

• Scabies: A highly contagious, intensely itchy condition caused by burrowing mites, spread through close physical contact. Treated with topical medications applied from the neck down and left on for eight hours, or with oral medications.

• Impetigo: A highly contagious bacterial skin infection common around the mouth and nose. It presents as red vesicular lesions that easily rupture, ooze, and form a yellow-brown crust. Treated with antibiotics.

• Pinworms (Enterobius Vermicularis): The most common worm infection in the US, caused by small, thin white roundworms in the colon and rectum. Spread via the fecal-oral route (scratching the anus and transferring eggs to the mouth or environment). Symptoms are intense anal itching and restlessness/sleep difficulty. Treatment: Requires 2 doses of medication spaced 2 weeks apart, and all family members must be treated. It also requires meticulous hand washing, keeping nails short, and laundering bedding and clothes in hot water.

• Community-Acquired MRSA (CA-MRSA): A staph skin infection acquired outside of a healthcare setting. If MRSA enters the bloodstream, it can cause major problems in the heart valves, lungs, bones, or joints. Athletes are at an increased risk. Prevention relies heavily on thorough hand washing, not sharing personal items, and carefully covering open sores.

Blood Pressure Screening

• Yearly Screening: Blood pressure should be screened annually during the school-age years. Early identification and treatment of hypertension helps prevent long-term cardiovascular disease and adult organ damage. Approximately 5 out of every 100 children have elevated blood pressure.

Piaget's Theory (Concrete Operational Stage) – Additional Concepts

• Conservation: Understands that the quantity of an object remains the same even when its appearance changes (e.g., the same amount of water in different shaped glasses).

• Classification: Able to group objects according to common characteristics.

• Seriation: Can arrange objects in order based on size, weight, or another measurable characteristic.

• Reversibility: Understands that actions can be mentally reversed to return to the original state.

• Decentration: Able to focus on more than one characteristic of a situation at the same time.

• Abstract Thinking: Not yet developed. School-age children think logically about concrete events, while abstract and hypothetical thinking develops during adolescence (Formal Operational Stage).

Depression in the School-Age Child

• Behavioral Changes: Depression in school-age children often presents differently than in adults. Instead of appearing sad, children may demonstrate aggressive or irritable behavior.

• Common Signs & Symptoms:

  • Withdrawal from previously enjoyed activities.

  • Frequent vague physical complaints (headaches, stomachaches).

  • Aggressive behavior or fighting.

  • Frequent crying or changes in mood.

  • Changes in appetite or sleep patterns.

  • Fatigue, lethargy, or decreased interest in school and friends.

• Nursing Role: Early recognition and referral for further evaluation are important to promote emotional well-being and prevent long-term mental health concerns.

Child Abuse & Neglect Indicators

• Assessment Findings: Nurses should recognize warning signs that may indicate abuse or neglect.

• Possible Indicators Include:

  • Delay in seeking medical treatment for injuries.

  • Conflicting explanations of how the injury occurred.

  • Injuries inconsistent with the child's developmental abilities.

  • Repeated injuries or frequent emergency department visits.

  • Inappropriate emotional response from either the caregiver or the child.

• Nursing Role: Nurses are mandatory reporters and are legally required to report suspected child abuse or neglect according to state laws.

Firearm Safety

• Safe Storage: Firearms should always be stored locked, unloaded, and with ammunition stored separately.

• Health Promotion: Parents should be educated that proper firearm storage significantly reduces the risk of accidental injury and death among school-age children.