school-age

SCHOOL-AGE YEARS (AGES 6–12) OVERVIEW OF THE SCHOOL-AGE YEARS

• The school-age years include children ages 6 to 12 years.

• This stage is characterized by:

  • Great physical growth

  • Great social development

• Children in this age group begin formal school attendance, leading to:

  • Increased exposure to people outside the family structure.

• Key social developments during this stage include:

  • Friends becoming more important

  • Increased peer influence

  • Development of a greater need to understand their own individual roles in the world.

• Importance for nursing:

  • Understanding normal growth and development during this age.

  • Managing unexpected findings to support children in thriving within their environments.

• Components of the module include:

  • Biological development of school-age children

  • Behaviors of school-age children

  • Health concerns

  • Disease prevention

  • Health promotion strategies

  • Unexpected findings for this population

BIOLOGICAL DEVELOPMENT

PHYSICAL DEVELOPMENT

• School-age children continue to:

  • Grow

  • Develop

• Growth and development occur at varied paces influenced by:

  • Genetics

  • Nutrition

  • Activity levels

General Growth Pattern

• School-age children typically grow at a steady pace:

  • Approximately 2 to 2.5 inches per year.

  • Gain about 4 to 7 pounds per year.

Monitoring Growth

• Essential factors to monitor include:

  • Height

  • Weight

  • Body mass index (BMI)

• Monitoring should be conducted using:

  • Centers for Disease Control and Prevention (CDC) growth charts

Average Height

• At age 6, the average height is:

  • Approximately 115 cm (45 inches)

• By age 12, the average height is:

  • Approximately 150 to 152 cm (59 to 60 inches)

  • Females tend to be slightly taller than males at this stage.

Average Weight

• At age 6, the average weight is:

  • Approximately 20 kg (44 pounds)

• By age 12, the average weight is:

  • Approximately 40 kg (88 pounds)

  • Average child doubles their weight during this period.

TEETH DEVELOPMENT

• Loss of deciduous teeth begins around age:

  • 6 years of age.

• Deciduous teeth, also known as baby teeth, begin to be replaced by permanent teeth.

• Tooth loss typically starts:

  • Earlier in females than in males

PUBERTY / SECONDARY SEX CHARACTERISTICS

• During school-age years, children become more aware of:

  • Their bodies

  • May begin developing secondary sex characteristics, with puberty usually starting around:

  • Age 10

• Changes observed include:

  • Growth of underarm hair and pubic hair in both sexes

  • Specific male changes:

  • Growth of chest hair

  • Testicular growth

  • Growth of the penis

  • Specific female changes:

  • Breast development

  • Menstruation typically occurs:

    • About 2 to 3 years after breast budding

BODY AWARENESS AND PHYSICAL COMPLAINTS

• Increased body awareness can lead to:

  • More physical complaints such as stomach aches and limb pain.

• Nurses should inform parents that these complaints should:

  • Be investigated

  • Purpose: Ensure no underlying medical issues exist and reassure the child of parental care for health and safety.

MOTOR SKILL DEVELOPMENT

GROSS MOTOR SKILLS

• School-age children show improved:

  • Smoothness and strength in gross motor skills, refined over time.

• Gross motor abilities encompass:

  • Coordination

  • Endurance

  • Balance

• Children as young as age 6 can engage in physical activities such as:

  • Running

  • Jumping rope

Physical Activity Recommendation

• Children in this age group should engage in at least:

  • 1 hour of physical activity each day.

• Common activity preferences include:

  • Physical activities and team sports.

KEY TERM: Gross Motor Skills

• Definition:

  • Gross motor skills are generalized motor skills such as walking, running, and jumping.

FINE MOTOR SKILLS

• School-age children continue to develop and refine fine motor skills, vital for:

  • Writing

  • Dressing

  • Household tasks, such as:

  • Cleaning

  • Making a bed

• Milestones in fine motor skills:

  • By age 6: Ability to tie shoelaces

  • By age 9: Most can dress and groom themselves independently

  • Continues to improve writing, drawing, and painting skills.

KEY TERM: Fine Motor Skills

• Definition:

  • Fine motor skills are specialized skills like writing, cutting with scissors, and tying shoes

MILESTONES

• Nurses must recognize common developmental milestones for this age group for:

  • Educating parents

  • Promoting health

• If milestones are not met or concerns arise from:

  • Parents, teachers, or caregivers,

  • Parents should be encouraged to discuss these concerns with the child’s healthcare provider.

• Important note about milestones:

  • Milestones are guidelines indicating that earlier development often results in better outcomes.

  • Each child should be observed and evaluated for timely intervention if needed.

PSYCHOSOCIAL DEVELOPMENT

SOCIAL DEVELOPMENT

• The psychosocial development during school-age years typically focuses on:

  • New involvement with school

  • Friendships become increasingly important

  • Greater need for peer acceptance and recognition of behavior similarities

• Friend groups often consist of:

  • Same-sex members

  • Acceptance of opposite sex peers increases towards adolescence

Modern Influences

• Exposure to various societal factors may include:

  • Violence

  • Sexuality

  • Illicit drugs from:

  • Social media

  • Peer interactions

• Nurses play a crucial role in:

  • Providing open discussions on concerns and feelings, helping children manage their emotions, and clarifying misinformation

COGNITIVE DEVELOPMENT

• Most children begin basic learning in a school setting before age 6, focusing on:

  • Fundamentals and routine integration for classroom adjustment.

• By third grade, children can grasp increasingly complex concepts, including:

  • Fractions and an understanding of the cosmos

LANGUAGE DEVELOPMENT

• Language development continues through these years:

  • Early school-age language reflects simplicity in phrases, usually 5 to 7 words in length.

  • By age 10, children can follow five commands in a row.

• With growth, language becomes more complex, and children enjoy engaging in conversations.

LANGUAGE DELAYS

• Language delays can be frustrating for both child and family, leading to:

  • Negative behaviors or acting out.

  • Nurses should evaluate language abilities by observing and asking about:

  • Understanding spoken language

  • Self-expression issues

• Anticipation of referral to:

  • Speech-language pathologists (speech therapists), who can collaboratively work with clients and families to create effective treatment plans.

READING DEVELOPMENT

• Most children start reading around age 5.

• Their reading enjoyment and frequency increase through school.

• By third grade, reading complexity advances, transitioning from letter recognition to:

  • Content understanding and comprehension.

• By ages 10 to 12, children are expected to:

  • Read well independently

ATTENTION / TASK COMPLETION

• The ability to pay attention is critical for:

  • Success and information retention.

• As children mature, they can follow more complex directions.

• Expected attention span/task focus:

  • At age 6: Should maintain focus for 15 minutes.

  • By age 9: Should sustain attention for about 1 hour.

PLAY

• School-age children typically enjoy structured group play.

• Around age 6, children may still engage in solitary or fantasy play, often with same-sex peers.

• As children develop, they prefer competitive games that involve rules and begin mixing with peers of different sexes.

ACTIVITY LEVEL

• School-age children are generally highly active with:

  • Unstructured activities like running, swimming, or bike riding and structured activities like organized sports.

• Benefits of unstructured activities include:

  • Promoting physical activity, encouraging fun, and facilitating peer socialization.

• Structured sports help children learn rules, teamwork, and build friendships.

BEST PRACTICE

• A balanced mix of unstructured and structured activities supports optimal growth and development.

HIGH-YIELD SUMMARY

General School-Age Overview

• Ages 6–12 represent a crucial period for physical and social growth, with peer relationships being central.

• Physical growth typically includes:

  • Height increases of about 2–2.5 inches/year

  • Weight gains of about 4–7 pounds/year

Teeth and Puberty

• Baby teeth begin falling out around age 6, giving way to permanent teeth as puberty generally starts around age 10.

Motor Development

• Gross motor skills become smoother, stronger, and more coordinated, with fine motor skills improving for activities such as dressing, and chores.

Milestones in Development

• By age 6, children should be able to tie their shoes, and by age 9, they typically dress and groom independently.

Psychosocial Development

• Peer acceptance becomes very important, with same-sex friendships predominating early on.

• Acceptance of the opposite sex increases as children approach adolescence.

Cognitive and Language Development

• Academic routines evolve from basic skills to more complex concepts by third grade, emphasizing language complexity in communication.

Reading and Attention

• Reading typically begins around age 5, progressing to independent reading by ages 10–12. Attention spans increase from 15 minutes at age 6 to approximately 1 hour by age 9.

Play

• School-age children gravitate towards structured, competitive play, emphasizing the need for both types of play to foster development.

PSYCHOSOCIAL DEVELOPMENT AND BEHAVIORS — SCHOOL-AGE CHILD BULLYING

OVERVIEW

• Bullying presents a significant issue for school-age children, with:

  • 1 in 3 children reporting experiences of being bullied globally.

  • In the U.S., 14% of public schools cite bullying as a recurring disciplinary challenge that occurs daily or weekly, predominantly occurring in middle schools.

Bullying Behaviors

• Types of bullying behaviors include:

  • Physical attacks

  • Verbal attacks

  • Social exclusion and gossip

  • Property damage

Effects of Bullying

• Consequences include:

  • Harm and distress to the targeted individuals

  • Inclusion of sexual bullying (harassment) and cyberbullying.

Importance of Prevention

• Factors contributing to children's aggression include:

  • Mental health concerns and behavioral problems affecting both the target and the bully.

• Preventing bullying necessitates identifying risk factors and developing interventions.

KEY TERMS

• Bullying: Repeated aggressive behavior, often stemming from power imbalances, resulting in both physical and psychological harm.

• Cyberbullying: Bullying perpetrated through the internet, social media, or other technological mediums

POPULATIONS VULNERABLE TO BULLYING

• Higher incidence of bullying reported among:

  • Lesbian, Gay, and Bisexual students

  • Female students experience higher bullying rates compared to male counterparts.

• Children in low- and middle-income neighborhoods tend to face a higher prevalence of physical and sexual bullying.

EFFECTS OF BULLYING

• Children affected by bullying may manifest:

  • Physical injuries

  • Mental health issues, including depression and anxiety

  • Disruptions in academic performance and school attendance

Psychosomatic Manifestations

• Children may report diverse physical symptoms linked to psychological stress:

  • Fatigue

  • Poor appetite

  • Stomach pain

  • Sleep difficulties

  • Headaches

  • Back pain

  • Dizziness

KEY TERM: Psychosomatic

• Definition:

  • Psychosomatic: Physical complaints arising from psychological factors.

BULLYING PREVENTION PROGRAMS

• Effective programs aim at:

  • Identifying and preventing bullying to increase awareness and mitigate its impact.

• Comprehensive programs may involve:

  • School and community collaborations providing education, advocacy, and strategies to foster positive peer relations.

Reporting and Intervening

• Establishing clear reporting mechanisms whereby community members can recognize and act against bullying behaviors is crucial.

• Notify school officials for school-related incidents and law enforcement when involved in serious bullying incidents involving firearms, advanced harassment behavior, or injuries.

• Counseling and health practitioner referrals are important steps for supportive treatment for bullying effects.

SELF-ESTEEM

Definition and Importance

• Self-esteem: The subjective perception of one's own worth.

• High self-esteem is associated with:

  • Enhanced adaptability

  • Fulfilling relationships

  • Improved academic performance

  • Better mental and physical health

Development of Self-Esteem

• Develops during childhood, linked to:

  • Academic achievement

  • Parental trust and support.

• Critical for school-age children experiencing:

  • Social relationship formations and academic challenges.

BODY IMAGE

Importance in School-Age Children

• Significance during physical and psychological developmental changes, making body image crucial for overall well-being.

• Children as young as age 6 begin to develop body image concerns and questions related to bodily changes, necessitating nursing involvement for healthy communication about physical changes.

KEY TERM: Body Image

• Definition:

  • Body image refers to the individual's perception and feelings towards their physique.

Body Dissatisfaction

• Affects:

  • 40% to 50% of school-age children report body dissatisfaction concerning body shapes, sizes, and parts.

• Influenced by comments from peers, family, and adults.

• Importance of assessing the child's self-perception and promoting positive body attitudes.

Influencing Factors

• Factors impacting body image include:

  • Physical changes, body composition, culture, media influence, and societal norms.

Supportive Strategies

• Encouraging a warm and supportive environment while role modeling positive body image practices.

• Promoting trust in relationships and addressing societal beauty norms detrimentally impacting children's self-image.

• Include growth and development changes in the health curriculum, encourage physical activity, and counteract negative stereotypes associated with body size or appearance.

SEXUALITY

Definition/Overview

• Sexuality encompasses:

  • Sexual orientation, gender identity, ideals about relationships, and intimacy.

• By school-age, many children develop a foundational understanding of:

  • Puberty, sex, pregnancy, and childbirth.

Influences on Sexuality

• Children may receive information from peers, media, and the internet, necessitating careful management to prevent misinformation.

• Understanding sexual development involves:

  • Physiological changes alongside social components, including desire and intimacy.

Knowledge in School-Age Children

• Recognition of gender identity may arise as early as 18 months, while sexual orientation can become identifiable between ages 10 and 17.

Nursing Care Related to Sexuality

• Aim to decrease negative health outcomes related to issues of sexuality by:

  • Acknowledging identities, providing safe learning spaces, and opening discussions on related questions.

• Communicate sensitively about gender identity and sexual orientation using child-friendly language.

DISCIPLINE

Importance

• Discipline is essential for fostering positive behaviors, accountability, and character development.

• WHO reports indicate that corporal punishment correlates with:

  • Impaired cognitive and socio-emotional development, affecting emotion regulation and conflict resolution roles.

  • Long-term negative behavioral outcomes.

Effective Discipline Techniques

• Advocating for non-violent discipline alternatives helps children develop coping strategies for emotional responses involving feelings.

STRESS AND FEARS

General Overview

• School-age children often encounter stress from various sources:

  • Internal (self-generated) and external (parents, teachers, peers, societal pressures).

Causes of Stress

• Stress can arise from both positive and negative experiences, such as:

  • Positive changes (like new activities) and negative changes (worried about academic performance).

Common Manifestations

• Children may exhibit stress through:

  • Physical signs such as trouble sleeping and vague stomach pain, and behavioral signs like anxiety and irritability.

IMPACT OF SOCIAL DETERMINANTS OF HEALTH (SDH)

Overview

• Early-life stress related to environmental factors and socioeconomic status can detrimentally influence health and educational outcomes.

• Five domains of SDH include:

  • Economic stability

  • Educational access

  • Health care access

  • Built environment

  • Social community

Nursing Importance

• Nurses are responsible for evaluating SDH to implement effective public health strategies and interventions that support holistic child development.

School Setting and Development

• School-age children spend about 6 hours per day in school, a pivotal setting for social, psychological, physical, and intellectual growth.

HEALTHY SCHOOL PROGRAMS

Overview

• CDC Healthy Schools and Whole School, Whole Community, Whole Child (WSCC) model aims to promote health through school systems, addressing health education, health promotion, and chronic disease prevention.

Goals of Health Programs

• Address healthy nutrition, physical activity, chronic condition support, health education, literacy, and social-emotional learning.

• Childhood health behavior development is more effective than modifying adult habits.

Role of School Nurse

• Key responsibilities of school nurses include healthcare access facilitation, immunization support, chronic condition management, and promoting safety and well-being for students and staff.

SAFETY PROMOTION AND INJURY PREVENTION

Overview

• Children in environments with high violence rates or lacking infrastructure are often at risk for negative health outcomes.

BICYCLES

• Importance of bicycle safety, which includes:

  • Wearing helmets, daytime visibility with fluorescent clothing, and nighttime reflective materials.

BUS SAFETY

• School buses serve as crucial transportation, and proper safety education for students is vital.

SOCIAL MEDIA AND INTERNET USE

• In 2023, reports indicate social media can negatively affect mental health.

• Parents should educate children on online dangers, maintaining confidentiality, and responsible internet use.

FIREARMS

• Firearms pose significant risks, with recommendations from the AAP for safest homes being those without guns.

HEALTH PROMOTION AND DISEASE PREVENTION

NUTRITION

• Strong emphasis on healthy habits from early childhood, recognizing that unhealthy habits formed during childhood increase the likelihood of persistence into adulthood.

Physical Activity

• Physical activity is essential at least 60 minutes a day to support health, reducing obesity risks.

SLEEP

• Importance of adequate sleep (9-12 hours) and strategies to promote restful sleeping patterns are crucial for development.

SUBSTANCE USE

Overview

• Substance use education is vital, as early engagement with alcohol, tobacco, or illicit drugs can begin as young as age 10.

• Engagement in substance abuse correlates negatively with mental and behavioral health outcomes.

Family Influence

• Family-centered approaches alongside positive role modeling help mitigate children's likelihood of substance use.

Community Approach

• Community-based strategies, alongside health education, are pivotal in decreasing overall access to substances for children.

HIGH-YIELD SUMMARY

• Nutrition: A focus on building healthy habits in childhood that persist into adulthood, emphasizing balanced meals and physical activity.

• Physical Activity: Critical to mental and physical health, supporting the reduction of obesity and improving overall quality of life.

• Sleep: Children need 9-12 hours of restful sleep for optimal health outcomes.

• Substance Use Prevention: Targeting education and community engagement to prevent substance use from an early age.

LEARNING DISABILITY (LD)

Overview

• Includes various disorders affecting how individuals:

  • Acquire, organize, retain, comprehend, and apply verbal and nonverbal information.

• Individuals often have average or above-average IQ.

• The discrepancy between academic struggle and expected potential defines LD's core concept.

Prevalence

• LDs affect approximately 5% of school-aged children globally, with about 10% in the U.S.

Common Learning Disabilities

• Dyslexia: Affects reading and language processing, comprising at least 80% of LD cases.

• Oppositional Defiant Disorder, ADHD, Dysgraphia, Dyscalculia are frequently comorbid with LDs.

IMPORTANT NOTE: Early Identification

• Early identification through screenings and collaborative strategies can lead to efficient interventions addressing specific learning challenges.

ADHD

• Symptoms include hyperactivity, impulsivity, and inattention, with a diagnosis necessitating persistence across settings and time.

• Common treatments involve medication, behavioral therapy, counseling, and educational services, fostering management and support.

OBESITY

• Considered a significant public health challenge affecting health and well-being, with inherent risks for chronic conditions.

• Prevalence rates are concerning among school-age populations, leading to examination and intervention strategies focused on lifestyle changes.

FOOD INSECURITY

• Reported to affect about 10.3% of school-age children, leading to adverse health and developmental outcomes, highlighting the need for dietary education and community resources.

DENTAL CARE

• Ensuring dental health is critical, with an emphasis on cavity prevention strategies, including fluoride use and regular dental checkups.

NOCTURNAL ENURESIS

• A prevalent issue among school-age children that often resolves naturally but can require supportive measures when problematic.

ENCOPRESIS

• Often relates to constipation and requires appropriate dietary and routine guidelines to prevent and manage occurrences effectively.

PTSD

• Stressful events, unresolved trauma may lead to the development of PTSD, impacting children’s functioning and necessitating professional intervention.

OTHER BEHAVIORAL CONCERNS

• Include anxiety, depression, and conduct problems, evidenced through various manifestations as children develop emotionally and socially through this age.

IMPORTANCE OF EARLY INTERVENTION

• Vital for these health concerns to mitigate against long-term impairments and promote positive health outcomes.