Teeth Development: Loss of primary teeth begins around age 6; four permanent teeth erupt per year.
GI Tract Maturity: Gastrointestinal tract matures during this stage.
Caloric Needs: Decrease in caloric needs as children grow.
Vital Signs: Vital signs approach adult levels by ages 11-12 (see Appendix A for ranges).
Emotional Maturity: Size is not always correlated with emotional maturity, challenging expectations placed on taller/heavier children.
GENDER IDENTITY
Influences: Gender role development influenced by parents, teachers, and school environment.
Gender Identity Differences: Children may feel their assigned sex at birth differs from their gender identity, leading to social anxiety.
Age of Awareness: Awareness of gender differences may occur between ages 6 to 7.
Support: Health care providers can help families accept children's gender identity.
SEX EDUCATION (1 of 2)
Importance: Knowledge enhances a child’s sexual health.
Communication: Questions should be answered simply, using correct anatomical terms for genitalia.
Topics: May cover consent, internet safety, and sexting; timing varies by school systems.
Context: Information provided should encapsulate healthy processes and functions of the human body.
SEX EDUCATION (2 of 2)
Preparation:
Boys should be prepared for erections and nocturnal emissions.
Girls should be prepared for menarche and educated on how to use feminine hygiene supplies.
NURSING TIP
Discussing Sexuality: When talking about sexuality with children, review slang or street terms, as children may hear these but be unclear about their meanings.
SCHOOL
Success Factors: Success in school requires cognitive, receptive, and language skills.
Impact of Failure: Academic failure can impair a child's self-image.
Parental Involvement: Parents and children should set realistic academic goals.
Awareness of Issues: Parents should be mindful of attendance, tardiness, loneliness, and potential signs of depression.
PLAY
Involvement: Engages increased physical and intellectual skills and elements of fantasy.
Social Dynamics: The culture of school-age children involves group membership.
Team Sports: Participation in team sports fosters a sense of control and capability.
Balancing Activities: Necessary to balance physical activity and limit non-educational screen time.
BULLYING
Definition: Bullying characterized by recurrent and targeted aggression meant to harm, either physically or psychologically.
Significance: The impacts of bullying are profound; school personnel can help implement antibullying interventions.
Forms of Bullying: Includes traditional bullying and cyberbullying.
Empowerment: Children need strategies to empower them to seek peer support in bullying situations.
EMOTIONAL AND BEHAVIOURAL SIGNS OF BEING BULLIED
Afraid to attend school or partake in activities.
Appears anxious or fearful.
Low self-esteem, makes negative comments about oneself.
Frequently complains of feeling unwell (e.g., headaches, stomachaches).
Decreased interest in activities and lower academic performance.
Loses belongings, needs money, reports hunger after school.
Displays injuries, bruises, or damaged clothing.
Seems unhappy, irritable, or withdrawn.
Has trouble sleeping, experiences nightmares.
Makes threats to harm themselves or others.
Appears isolated from peer groups.
SAFETY
Critical Learning: Children must learn rules related to:
Road safety.
Car seat safety.
Safe play practices.
Concussion prevention.
Safe technology usage.
THE 5-YEAR-OLD
Vocabulary: Over 2000 words; can play games with rules.
Motor Skills: Encourage activities to develop motor skills.
Adaptation: Needs time and support to adjust to school; observe for fatigue and stress.
Health Considerations: Increased exposure to infections; nurses must emphasize immunization importance.
THE 6-YEAR-OLD
Coordination Activities: Can engage in activities requiring muscle coordination.
Attention Span: Often has a short attention span and difficulty making decisions.
Sleep Needs: Requires 9 to 12 hours of sleep.
Social Dynamics: Enjoys collecting things; begins to prefer same-sex play.
THE 7-YEAR-OLD
Self-Expectations: Sets high personal standards and is increasingly modest.
Cognitive Development: Understands seasonal cycles and the basic concepts of math.
Motor Skills: Demonstrates steadier hands; active play remains essential.
Independence: Becoming more self-reliant.
THE 8-YEAR-OLD
Alone Play: Can play independently for extended periods.
Creativity and Group Activities: More creative and enjoys group activities; interested in group fads.
Physical Development: Muscles are better developed; enjoys competitive sports.
Social Dynamics: Starts secret clubs; adheres to peer-enforced rules.
THE 9-YEAR-OLD
Responsibility: More dependable and willing to take on more responsibility.
Task Completion: More likely to complete tasks and able to accept criticism.
Coordination: Good hand/eye coordination develops.
Sleep Requirements: Continues to require 9 to 12 hours of sleep.
Physical Activity: Engaged in competitive sports; importance of teaching proper techniques and safety measures in these activities.
THE 10-YEAR-OLD
Pre-Adolescence: Marks beginning of preadolescence; girls often more physically mature than boys.
Self-Direction: Begins to exhibit self-direction and clear thinking about social issues and prejudices.
Independence and Peer Influence: A strong desire for independence and valuing group opinions over individual thoughts.
Sexual Curiosity: Continues, alongside increased interest in personal appearance.
11- AND 12-YEAR OLDS
Variability of Maturity: Onset and rate of physical maturity vary widely.
Peer Participation: Group participation remains important; increased body awareness.
Emerging Adult Concerns: Starting to notice physical changes (e.g., needing a bra, menstruation).
Need for Autonomy: Requires freedom within limits; important to explain decision-making to children rather than dictating rules without explanation.
HEALTH PROMOTION (1 of 2)
Health Assessments: Physical examinations typically conducted prior to school admission.
Vaccinations: Immunizations are administered as necessary.
Nutrition Counseling: Nutrition is assessed and counseled accordingly.
Screening: If inattentive, screening for vision or hearing impairments, language or learning disabilities is advised (consult Table 17.4, Leifer’s).
HEALTH PROMOTION (2 of 2)
Active Play: Promotes health; may be dependent on geographic location or neighborhood.
Illness Awareness: When ill, school-age children can grasp simple explanations of their condition, often attributing illness to bad behavior, needing clear communication.
Study Routine: Necessary time and space for studying; providing an allowance can help children learn the value of money.
TIPS TO PREVENT OBESITY
Eliminate sugary beverages (soda, juice).
Ensure daily breakfast consumption.
Promote family meal times.
Encourage children to serve themselves based on hunger cues and preferences.
Parents should model healthy eating and physical activities.
Aim for at least 1 hour of physical activity every day.
Limit screen time to no more than 2 hours per day.
BOWEL AND BLADDER DYSFUNCTION: ENURESIS
Diurnal Enuresis: Daytime wetting occurs after achieving toilet independence.
Nocturnal Enuresis: Nighttime bedwetting, more common in boys.
Types of Enuresis:
Primary Enuresis: Bedwetting occurs in a child who has never been dry.
Secondary Enuresis: Recurrence in a child who has been dry for 6 months or more.
Contributing Factors: Often related to delayed maturation, generally improves with age and is developmentally normal until age 8.
ORGANIC CAUSES OF NOCTURNAL ENURESIS
Possible medical influences include:
Urinary tract infections.
Diabetes mellitus.
Diabetes insipidus.
Seizure disorders.
Obstructive uropathy.
Anomalies of the urinary tract.
Sleep disorders.
Stressful events.
ENURESIS: TREATMENT AND NURSING CARE
Assessment: Detailed physical and psychological history; assess for constipation; consider the social impact of enuresis on the child.
Support: Crucial to support both the family and child through the process; if enuresis is not distressing, treatment may not be required.
Emotional Focus: The aim of treatment should be to minimize the emotional fallout for the child, using a nonpunitive, matter-of-fact attitude.
TREATMENT FOR ENURESIS
Goal Clarification: Goal is to assist the child in getting up at night to use the toilet.
** toilet access**: Ensure easy access to the toilet during the night.
Dietary Restrictions: Avoid caffeine-containing foods and excessive fluids before bedtime.
Pre-Bedtime Actions: Encourage the child to empty their bladder before sleeping.
Use of Training Pants: Only utilize training pants instead of diapers.
Morning Cleanup: Involve the child in cleanup efforts in a nonpunitive manner to preserve self-esteem.
Alarm Systems: Consider using a conditioning alarm system, which may be effective.
Pharmacological Support: In certain cases, pharmacological therapy may be prescribed.