SCHOOL AGE GROWTH AND

DEVELOPMENT

PREPARED BY:
MS. AILEEN S. ADRALES, RN
1
School age 6-12 y.o
1. Physical growth and development
A. General growth parameters
1. During this period, girls usually grow
faster than boys and commonly surpass
them in height and weight.
 Height increases by 2 inches per year
 Weight increases by 2 to 3 kg per year
 Males and females differ little in size
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I. Physical growth and development
A. General growth parameters
2. During preadolescence (10 to 13) – commonly
experiences rapid growth.
3. the immune system more efficient, allowing
for more localization of infections and better
antibody-antigen response.

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I. Physical growth and development

B. NUTRITION
1. Nutritional requirements
 Caloric requirements diminish in relation
to body size.
 2,400 calories per day
 Stress the need for balanced diet.

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I. Physical growth and development

B. NUTRITION
2. Food pattern and preferences
a. A child is exposed to broader eating experiences
in the school lunchroom; he may still be a
―picky‖ eater but should be more willing to try
new food. Children may trade, sell, or throw
away home packed school lunches

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I. Physical growth and development
B. NUTRITION
2. Food pattern and preferences
b. At home the child should eat what the family eats, the
patterns that develop now stay with the child into
adulthood. The child’s eating patterns should reflect
family culture.
c. Many school-age children still dislike vegetables
casseroles, liver and spicy foods. They may go on
―food jags‖ eating only one type of food at a time, such
as peanut butter and jelly sandwiches for lunch
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I. Physical growth and development

B. NUTRITION
2. Food pattern and preferences
d. Family members play an important role in
the child food preferences; however, peers
and the media are also influences. Without
adult supervision, school-age children
typically make poor food choices.

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I. Physical growth and development

B. NUTRITION
3. Overweight and Obesity.
 More than 90% of obese children are
overweight due to overeating, with under
activity playing a significant role.

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I. Physical growth and development

C. SLEEP PATTERNS
1. Individual sleep requirements for school-age children
vary but typically range from 8-91/2 hours nightly.
Because growth rate slows, school-age children
actually need less sleep than they will during
adolescence.
2. The child’s bedtime can be later than during the pre-
school period but should be firmly established and
adhered on to school nights.
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I. Physical growth and development

C. SLEEP PATTERNS
3. Reading before bedtime may facilitate sleep
and set up a positive bedtime pattern.
4. Children may be unaware of fatigue, if allowed
to remain awake, they will be tired next day.

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I. Physical growth and development

D. DENTAL HEALTH
1. Beginning around age 6, permanent teeth erupt and
child begins with shedding of first deciduous teeth .
2. Regular dental visit are important.
3. Brush teeth after meal with soft nylon toothbrush
4. Floss teeth until child reaches age 8 or 9.
5. Caries, malocclusion and periodontal disease
evident

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I. Physical growth and development
E. ELIMINATION
1. By 6 years, 85% have full bowel and bladder
control.
2. Elimination patterns are similar to adult
patterns.
a. Bm occur on average 1 to 2 times per day.
b. Urination 6-8/day. Average urine volume 500-
1000 ml/day

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I. Physical growth and development
B. ELIMINATION
3. Common problems:
A. nocturnal enuresis – bed wetting
15% 6 yr olds; 3 % 12 yr olds;
1% 18yr olds.
b. Encopresis – persistent stool leakage
1.5% grade 2
c. Boys have more frequent problems with
soiling and constipation.
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 II. Motor development

A. GROSS MOTOR DEVELOPMENT

1. Bicycling
2. Roller skating, roller blading, and
skateboarding
3. Progressively improved running and
jumping.
4. swimming aileen s.adrales,rn 15
 II. Motor development
B. FINE MOTOR DEVELOPMENT
1. Printing in early years; script in later
years (by age 8)
2. Greater dexterity for crafts and video
games.
3. Computer competence (manual skills)

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 II. Motor development

C. RELATED SAFETY CONCERNS

1. Learn to accept more responsibility for
personal health care and injury
prevention.
2. Developing cognitive skills complement
their own judgments and assist them avoid
many types of injuries.
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 II. Motor development

C. RELATED SAFETY CONCERNS

3. Still prone to accidents:
a. Major sources of injuries:
Bicycles, Skateboards, and team
sports.

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 II. Motor development
C. RELATED SAFETY CONCERNS
3. Reduce the risk of injury by:
− Learning proper techniques.
− Using safe equipment.
− Good coaching
− Well-matched teams
− Fire saftey
− Use of seatbelts and bicycle helmets.
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 II. Motor development

C. RELATED SAFETY CONCERNS

4. Provide guidance for new situations
and threats to safety.
5. Should receive education about the
use and abuse of alcohol, tobacco and
other drugs.
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III. PSYCHOSOCIAL DEVELOPMENT
A. OVERVIEW (ERIKSON)
1. INDUSTRY VERSUS INFERIORITY.
a. Significant others expands to include
schoolmates and instructive adults.
b. Normally mastered the 1st three developmental
task ( task, autonomy, and initiative) and now
focuses on mastering industry.

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III. PSYCHOSOCIAL DEVELOPMENT
A. OVERVIEW (ERIKSON)
1. INDUSTRY VERSUS INFERIORITY.
c. A sense of industry springs from a desire for
achievement.
d. A sense of inferiority can stem from unrealistic
expectations or a sense of failing to meet
standards other set for the child. His self-
esteem declines.

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III.PSYCHOSOCIAL DEVELOPMENT
A. OVERVIEW (ERIKSON)
1. INDUSTRY VERSUS INFERIORITY.
2. Engages in tasks and activities that he can
carry through to completion.
3. Learn rules, competition, and cooperation to
achieve goals.
4. Social relationships become increasingly
important source of support.

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 Erikson:
Developing a Sense of Industry
• Eager to develop skills and participate in meaningful
and socially useful work
• Acquire sense of personal and interpersonal
competence
• Growing sense of independence
• Peer approval is strong motivator

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 Erikson: Inferiority

• Feelings may derive from self or social environment

• May occur if incapable or unprepared to assume the
responsibilities associated with developing a sense
of accomplishment
• All children feel some degree of inferiority
regarding skill(s) they cannot master

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III. PSYCHOSOCIAL DEVELOPMENT
A. FEARS AND STRESSORS
 Avoid being labeled ―Chicken‖ or a ―baby‖.
Common Fears
a. Failure at School
b. Bullies
c. Intimidating teachers
d. Bad happening to Parents

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III. PSYCHOSOCIAL DEVELOPMENT
A. FEARS AND STRESSORS
3. Common stressors: young
 Teasing
 Decision making
 Need for approval
 Loneliness
 Independence
 Opposite sex
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III. PSYCHOSOCIAL DEVELOPMENT
A. FEARS AND STRESSORS
3. Common stressors: older school
age
 Sexual maturation
 Shyness
 Health
 Competition
 Peer pressure
 Temptation to take drugs
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III. PSYCHOSOCIAL DEVELOPMENT
A. FEARS AND STRESSORS
4. Reduce client’s fears by communicating
empathy and concern without being
overprotective.
5. They must know that people will listen
and that they will be understood.

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 III. PSYCHOSOCIAL DEVELOPMENT
C. SOCIALIZATION
1. The period of dynamic change and maturation as
child becomes increasingly involved in more
complex activities, decision-making, and goal-
directed activities.
2. As a school-age child leans more about her body,
social development centers on the body and its
capabilities.

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III. PSYCHOSOCIAL DEVELOPMENT

C. SOCIALIZATION
3. Peer relationships gain new
importance.
4. Group activities, including team sports,
typically consume much time and energy.

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III. PSYCHOSOCIAL DEVELOPMENT
C. PLAY AND TOYS
1. Play becomes more competitive and complex
during the school-age period.
2. Characteristic activities include team sports,
secret clubs, ―gang‖ activities, scouting, or
other organizations, complex puzzles,
collections, quit board games, reading, and
hero worship.

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 III. PSYCHOSOCIAL DEVELOPMENT
C. PLAY AND TOYS
3. Rules and rituals are important aspects of play
and games.
4. Toys, games, and activities that encourage
growth development include:
a. increasingly complex board and card games
b. books and crafts
c. music and arts
d. athletic activities/ team activities
e. computer activities 36
III. PSYCHOSOCIAL DEVELOPMENT
D. DISCIPLINE
1. Begin to internalize their own controls and
need less outside direction.
2. Help them feel their importance.
3. Set reasonable, concrete limits and keep
rules to a minimum.

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IV. PSYCHOSEXUAL DEVELOPMENT
A. OVERVIEW (FREUD)
1. LATENCY PERIOD – 5-12 years
 Represents a stage of relative sexual
indifference
2. Development of self-esteem is closely
linked with developing sense of industry
to produce concept of one’s value and
worth.
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IV. PSYCHOSEXUAL DEVELOPMENT
2. Sexual development
A. OVERVIEW (FREUD)
a. Discrepancies in growth and maturation
between the sexes becomes apparent.
b. Acquire much knowledge of and many
attitudes toward sex at earlier stages.
c. Questions about sex require based on
child’s level of understanding.
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 V. COGNITIVE DEVELOPMENT

A. OVERVIEW (PIAGET )
1. Between 7 and 11- Concrete operations stage
 Marked by inductive reasoning, logical
operations and reversible concrete
thoughts.

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 V. COGNITIVE DEVELOPMENT
A. OVERVIEW (PIAGET )
• Characterized by the appropriate use of logic. Important
processes during this stage are:
1. Seriation—the ability to sort objects in an order according
to size, shape, or any other characteristic. For example, if
given different-shaded objects they may make a color
gradient.
2. Classification—the ability to name and identify sets of
objects according to appearance, size or other
characteristic, including the idea that one set of objects
can include another.
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V. COGNITIVE DEVELOPMENT
A. OVERVIEW (PIAGET )
3. Decentering—where the child takes into account multiple
aspects of a problem to solve it. For example, the child will
no longer perceive an exceptionally wide but short cup to
contain less than a normally-wide, taller cup.
4. Reversibility—where the child understands that numbers or
objects can be changed, then returned to their original
state. For this reason, a child will be able to rapidly
determine that if 4+4 equals 8, 8−4 will equal 4, the original
quantity.

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V. COGNITIVE DEVELOPMENT
A. OVERVIEW (PIAGET )
5. Conservation—understanding that quantity, length
or number of items is unrelated to the arrangement
or appearance of the object or items.
6. Elimination of Egocentrism—the ability to view
things from another's perspective (even if they
think incorrectly
• Children in this stage can, however, only solve
problems that apply to actual (concrete) objects or
events, and not abstract concepts or hypothetical 43
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tasks.
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V. COGNITIVE DEVELOPMENT
A. OVERVIEW (PIAGET )
3. Typical activities of child at this stage:
a.Collecting and sorting objects.
b.Ordering items according to size, shape,
weight, and other criteria.
c.Consider options and variables when
solving problems.

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V. COGNITIVE DEVELOPMENT
A. OVERVIEW (PIAGET )
B. LANGUAGE
1. Develops formal adult articulation
patterns by age 9.
2. Learns that words can be arranged in
terms of structure.
3. Ability to read is one of the most
significant skills that the child develops.
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 Kohlberg: Moral Development

• Development of conscience and moral standards

• Age 6 to 7: reward and punishment guide choices
• Older school age: able to judge an act by the
intentions that prompted it
• Rules and judgments become more founded on
needs and desires of others

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 VII. WELLNESS PROMOTION

A. GENERAL
 Follow guidelines for screening, child care visits,
immunizations and safety.
B. NUTRITION
1. Encourage healthy eating patterns.
2. Limit junk food.
3. Teach basics about food pyramid.

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 VII. WELLNESS PROMOTION
C. SLEEP
1. Agree on bedtime.
2. Allow flexibility on nonschool nights.
D. GROWTH AND DEVELOPMENT
1. Foster a sense of industry by encouraging
the child skill development.
2. Counsel families about safety measures
for latchkey children if needed.
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 VII. WELLNESS PROMOTION
E. FAMILY
1. Encourage open communication
2. Foster responsibility with chores and adherence
to rules and schedules.
3. Encourage decision making and individuality
4. Parents should know peer group.
F. HEALTH
1. Promote self-care and hygiene.
2. Monitor child for behavior problems.
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 VII. WELLNESS PROMOTION
G. ANTICIPATORY GUIDANCE
1. Teach child about:
 Puberty
 Physical and emotional changes
 Drugs
 Alcohol
 Tobacco and
 Sex education
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 VIII. ILLNESS AND HOSPITALIZATION
A. OVERVIEW
1. STRESSORS include immobilization, fear of
mutilation and death, and concerns over
modesty.
2. May have difficulty with force dependency.

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 VIII. ILLNESS AND HOSPITALIZATION
B. Reactions to illness
1. School-age children perceive external
forces as causes illness.
2. They are aware of the significance of
different illnesses. For example, they know
that cancer is more serious than a ―cold.‖

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 VIII. ILLNESS AND HOSPITALIZATION
C. Reactions to hospitalization
1. The primary defense mechanism of
school-age children is reaction formation,
an unconscious defense mechanism in
which the child assumes an attitude that is
opposite of the impulse that they harbor.
Typically, the child states he is brave
when he is really frightened.
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 VIII. ILLNESS AND HOSPITALIZATION
C. Reactions to hospitalization
• School-age children may react to separating by
demonstrating loneliness, boredom, isolation,
and depression. They may also show aggression,
irritability, and inability to relate to sibling and
peers.
• The sensed loss of control is related to enforced
dependency and altered family roles.
• Fear of bodily injury and pain results from fear
of illness, disability, and death.
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 VIII. ILLNESS AND HOSPITALIZATION
D. Nursing management
1. Provide general interventions.
a. Encourage verbalization.
b. Encourage self-care.
c. Encourage peer interactions.
d. Inform school-age children that it is ―OK‖ to cry.
e. Give factual information; use models to
demonstrate concepts or procedures.
f. Provide diversions.
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 VIII. ILLNESS AND HOSPITALIZATION
D. Nursing management
2. Provide physical comfort and safety interventions.
a. Allow the school-age child control over body functions.
b. Assist in developing fine motor skills. Encourage:
− construction toys, such as Lego sets
− drawing
− computer games
− drawing body pats
− ―taking notes‖ during patient education
c. Allow school-ageaileen
children to participate
s.adrales,rn
in treatment.
64
 VIII. ILLNESS AND HOSPITALIZATION
D. Nursing management
3. Provide cognitive interventions.
a. Assist in developing rational thinking (give scientific
explanations, rationales, and rules) and provide for
decision-making.
b. Assist the child with mastering concepts of
conversation, constancy and reversibility,
classification, and categorization.
− Allow the child to chart intake and output and vital signs.
− Encourage the child to tell the nurse when procedures are due.
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 VIII. ILLNESS AND HOSPITALIZATION
D. Nursing management
3. Provide cognitive interventions.
−Help the child create a scrapbook.
−Use concepts, such as cards and board games,
in teaching and games.
−Encourage the child to do schoolwork.

C. Provide time for, and encourage, verbalization

(talk time).aileen s.adrales,rn 66
 VIII. ILLNESS AND HOSPITALIZATION
D. Nursing management
4. Provide psychosocial and emotional interventions.
a. Provide the opportunity to channel drives.
− Encourage peer interaction, group education, and limit
setting.
− Avoid coid rooms.
b. Promote achievement of industry.
− Praise cooperative play.
− Assign tasks that the child can accomplish.
− Involve the child in care.
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END
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