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Objectives

• Discuss the physical growth changes during school period.

• Discuss the developmental millstones of school age.
• Recognize nursing role in provide education about safety of school
age.
• Discuss the most common problems of school age.

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 Growth and Development of a School-
Age Child

• The term “school age” commonly refers to

children between the ages of 6 and 12.

• Although these years represent a time of slow

physical growth, cognitive growth and development
continue to proceed at rapid rates.

• Children of school age may also be more

influenced by the attitudes of their friends than
previously.
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 Physical growth

 General growth is slow until puberty. The child

show progressive lower in growth in height and
rapid gain in weight.

 School -age children's annual average weight

gain is approximately 1.3 to 2.2 kg. The
increase in height is 2.5 to 5 cm.

 By 10 years of age, brain growth is complete,

so fine motor coordination becomes refined.

 As the eye globe reaches its final shape at

about this same time, an adult vision level is
achieved. 4
• If the eruption of permanent teeth and growth of
the jaw do not correlate with final head growth,
malocclusion with teeth malalignment may be
present.

• The immune globulins IgG and IgA each reach

adult levels, and lymphatic tissue continues to
grow in size until about age 9 years.

• The appendix is also lined with lymphatic tissue,

so swelling of this tissue in the narrow tube can
lead to trapped fecal material and inflammation
(appendicitis).
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• Frontal sinuses develop at about 6 years, so
sinus headaches become a possibility

• Posture becomes more erect. lordosis and knock-

knee appearance disappear.

• The left ventricle of the heart enlarges to be

strong enough to pump blood to the growing body.

• Innocent heart murmurs may become apparent

due to this extra blood crossing heart valves

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Vital signs T: 37 degree Pulse 70-80 B/m,
Bp:112/60 Respiration 20Breath/m
Maturation of the respiratory system leads to

increased oxygen–carbon dioxide exchange, which

increases exertion ability and stamina.
Scoliosis may become apparent for the first

time in late childhood

All school-age children older than 8 years should

be screened for this at all health appraisals

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 Sexual Maturation

 Puberty is provoked in this period in

response to gonadotropine hormones.

 Sexual maturation in girls occurs between

12 and 18 years; in boys, between 14 and
20.

 Prepubertal girls are usually taller, by

about 2 inches (5 cm) or more, than
preadolescent boys because their typical
growth spurt begins earlier.
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 Teeth

• Deciduous teeth are lost and permanent teeth erupt

during the school -age period at 6 years of age.

• The average child gains 28 teeth between 6 and 12 years

of age: the central and lateral incisors; first , second, and
third cuspids; and first and second molars

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 Developmental
Milestones
Gross Motor
Development
• At age 6, children are energetic and enjoy physical
activities like jumping, tumbling, and skipping. They begin
to develop coordination, ride bicycles, and learn to skip
rope.

• By age 7, children may become quieter compared to the

previous year. Gender differences in play start to emerge,
with girls and boys gravitating towards traditional gender
roles.

• At age 8, children's movements more graceful than those

of younger children, although, as their arms and legs
grow, they may appear awkward in their play and eating
habits. They ride a bicycle well and enjoy sports such as
gymnastics, soccer, and hockey. 10
• Nine-year-olds are constantly active and show good
eye-hand coordination, enjoying sports like baseball,
basketball, and volleyball.

• At age 10, children focus more on refining their athletic

skills.

• By age 11, some children may feel awkward due to

growth spurts and may withdraw from sports activities,
preferring constant motion instead (drumming fingers
and tapping
• pencils or feet).

• Twelve-year-olds plunge into activities with intensity

and concentration, participating in events like
walkathons for charity. Able to handle a great deal of 11
responsibility and complete given tasks.
 Fine Motor Development

• Six-year-olds can tie shoelaces, cut and

paste well, and draw with good detail.

• Seven-year-olds focus on fine motor skills

and may set high standards for
themselves. This has been called the
“eraser year” because children are never
quite content with what they have done.
They set too high a standard for
themselves and then have difficulty
performing at that level.

• By age 8, children's eyes are developed

enough for reading regular-sized type,
making reading more enjoyable.
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• Eight-year-olds can write in script and enjoy
demonstrating this skill in cards or letters.

• At age 9, children's writing becomes more mature and

less awkward, and reading and writing become
enjoyable activities.

• Older school-age children begin to evaluate their

teachers’ ability and may perform at varying levels
depending on each teacher’s expectations.
• Middle school introduces more challenging science,
mathematics, and literature courses, turning reading
into a fulfilling experience for some children.
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 Play
• At age 6, play remains active, but children start to discover
reading as an enjoyable activity. Many children spend hours
playing challenging video games, which can foster healthy
competition or lead to isolation.

• By age 7, children require more props for imaginative play

and begin to show preferences for specific toys and interests.
Interest in collecting items, and children start to enjoy helping
in the kitchen and engaging in simple science projects.

• At 8 years old, children become more structured in their

collections and enjoy participating in table games but may
dislike losing.

• 9 year-olds play vigorously and may have difficulty adhering

to bedtime due to their desire for more playtime. 14
• At age 10, children spend much of their
time playing screen games. Boys and girls
play separately at age 10 years, although
interest in the opposite sex is apparent.
Children become interested in rules and
fairness at 10 years old and may enforce
rules strictly in games and club activities.

• At 11 and 12 years old, children enjoy

dancing, playing table games, and
spending time with friends, often
engaging in conversation.
• Twelve-year-olds may take on household
chores or babysitting for money, eagerly
anticipating the transition to teenage
years at 13.
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 Language Development

• Six-year-olds talk in full sentences, using

language easily and with meaning. They no
longer sound as though talking is an experiment
but appear to have incorporated language
permanently.
• Most 7-year-olds can tell the time in hours, but
they may have trouble with concepts such as
“half past” and “quarter to,” especially with the
prevalence of digital clocks
Seven-year-olds know the months of the year
and can perform simple addition, subtraction,
and make basic purchases.

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• Nine-year-olds discover "dirty" jokes and may
use swear words to express anger or show
maturity.
• By 12 years of age, children can carry on an
adult conversation, although stories are limited
because of a lack of experience.

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 Emotional Development

• Ideally, children enter the school-

age period with the ability to trust
others and with a sense of respect
for their own worth. They can
accomplish small tasks
independently because they have
gained a sense of autonomy. Also a
sense of initiative by learning how
to do things

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•Developmental Task: Industry Versus Inferiority - During
early school years, children strive to master a sense of
industry or accomplishment.
• Gaining a sense of industry is learning how to do things
well.

• If do not receive rewards for accomplishment, they can

develop a feeling of inferiority or become convinced they
cannot do things they actually can do.

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• School-age children focus their questions on how tasks
are done, seeking reassurance about their
performance.
• School-age children need reassurance that they are
doing things correctly, and this reassurance is best if it
comes immediately after a task is completed.
• The books preferred by school-age children have many
short chapters; children experience a sense of
accomplishment as they finish each chapter.
• Hobbies and projects are more enjoyable if they can be
finished quickly, within a short time.

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 Socialization
• Six-year-old children play in groups, but when they are
tired or under stress, they usually prefer one-to-one
contact.
• Seven-year-olds become more aware of family roles
and responsibilities, viewing promises as firm
commitments and often engaging in tattling due to a
strong sense of justice.
• Eight-year-olds actively seek the company of other
children, forming close friendships with same-sex peers
and engaging in secretive behaviors like whispering
and sharing secrets.
• Nine-year-olds take the values of their peer group very
seriously, over parental preferences, This is typically
the friend or club age because children form groups,
usually “spite clubs.” This means if there are four girls
on the block, three form a club and exclude the fourth.
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• Ten-year-olds enjoy groups, they also enjoy privacy.
They like having their own bedroom or at least their
own dresser. One of the best gifts for a 10-year-old
is a box that locks.

• Eleven-year-olds, Girls become increasingly

interested in boys and vice versa, Favorite activities
are mixed-sex rather than single-sex ones.
11-year-olds must attempt many uncomfortable
social experiences before they become comfortable
forming relationships with the opposite sex.

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• Twelve-year-olds feel more at ease in social
situations but may experience physical changes
like erections in boys, leading to discomfort in
boy-girl interactions.
• Because some children develop faster than
others, every group has some members who are
almost adolescent and some who are still
children, making social interactions sometimes
difficult.

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 Cognitive Development

• Children aged 5 to 11 undergo a transition from

preoperational thought to concrete operational thought,
marked by the ability to reason through visualized problems.

• Cognitive developments during this stage include:

• Decentering: the ability to project one’s self into other
people’s situations and see the world from their viewpoint
rather than focusing only on their own view
• Accommodation: the ability to adapt thought processes to
fit what is perceived such as understanding that there can be
more than one reason for other people’s actions.
• Conservation: the ability to appreciate that a change in
shape does not necessarily mean a change in size.
(recognizing equal amounts in differently shaped containers).
• Class inclusion: the ability to understand that objects can
belong to more than one classification.
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 Cognitive Development
• These cognitive advancements
foster characteristics of the school-
age period, such as:
• Decentering enables a school-age
child to feel compassion for others.
• Understanding the principle of
conservation is possible, a school-
age child is not fooled by
perceptions as often as before.
• The ability to classify objects leads
to the collecting activities of the
school-age period.
• Class inclusion is also necessary for
learning mathematics and reading,
systems that categorize numbers
and words.
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 MORAL AND SPIRITUAL
DEVELOPMENT
• School-age children begin to mature in terms of moral
development as they enter a stage of preconventional
reasoning, sometimes as early as 5 years of age.
• During this stage, if asked, “Why is it wrong to steal
from your neighbor?” school-age children will answer;
”The police say it’s wrong,” or “Because if you do, you’ll
go to jail.
• They concentrate on “niceness” or “fairness” and
cannot see yet that stealing hurts their neighbor, (the
highest level of moral reasoning). Because they are still
limited in their ability to understand others’ views.
• They may interpret something as being right because it
is good for them, not because it is right for humanity as
a whole.
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 Health Promotion for a
School-Age Child and
Family
• School-age children need guidelines on safety,
nutrition, and daily care, making these topics important
for discussion during healthcare visits.
• Children at this age may spend time unsupervised, so
they require education on safety practices to prevent
unintentional injuries. See BOX 32.3
• Heavy backpacks can lead to chronic back pain,
emphasizing the need to monitor their weight relative
to the child's body.
• Sexual maltreatment is a common hazard, and children
should be taught strategies to avoid it.
• BOX 32.4 TEACHING POINTS TO HELP CHILDREN AVOID SEXUAL MALTREATMENT

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 PROMOTING NUTRITIONAL
HEALTH OF A SCHOOL-AGE
CHILD
• Establishing Healthy Eating Patterns
• Encouraging healthy eating patterns is crucial,
including having a nutritious breakfast and
preparing balanced lunches.
• School lunches should provide essential nutrients
and cater to children with food allergies.
• After-school snacks should also be nutritious to
support overall health and well-being.
• Poor eating habits developed in the school-age
years may last through adulthood and lead to an
increased risk of health-related diseases, such as
type 2 diabetes, hypertension, cardiovascular
disease, and obesity.
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• Fostering Industry and Nutrition
• Involving children in meal planning and
preparation fosters industry and helps them
develop proper etiquette.
• Meals eaten while watching television or
performing another activity is a risk factor for
obesity.
• essential nutrients like protein, calcium, and iron
from their diet, with possible supplementation if
needed.

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• Recommended dietary intakes
• should be met, with attention to the increasing
energy requirements during the school-age
years; boys require more calories
• Both girls and boys require more iron in
Prepuberty
• Adequate calcium and fluoride intake remains
important to ensure good teeth and bone
growth.
• A major deficit may be fiber because school-age
children typically dislike vegetables.
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• A Vegetarian Diet
• vegetarians or vegan children need to ensure
they obtain essential nutrients like protein,
calcium, and iron from their diet, with possible
supplementation if needed.

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 PROMOTING DEVELOPMENT
OF A SCHOOL-AGE CHILD IN
DAILY ACTIVITIES
• School-age children still need parental guidance for
daily activities, as the habits formed during this period
influence their future lifestyle.
• Areas of concern include dressing, sleep, exercise,
hygiene, and dental care.
• Dress
• Children should be taught to care for their clothes and
may develop preferences based on peer influence.
• Sleep
• needs vary, with younger children requiring 10-12
hours and older children needing 8-10 hours per night.
• Exercise
• Daily exercise is essential for school-age children, even
if they spend much of their day sitting at school.

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• Children should engage in physical activities
such as walking, biking, or neighborhood games
to meet their exercise needs.
• Hygiene
• Children 6 or 7 years of age still need help in
regulating bath water temperature and in
cleaning their ears and fingernails. By age 8
years, children are generally capable of bathing
themselves but may not do it well
• Both boys and girls become interested in
showering as they approach adolescence, and
proper hygiene practices should be encouraged.
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• Care of Teeth
• Dental care is crucial, school-age children should
visit a dentist at least twice yearly for a checkup,
cleaning, and possibly a fluoride treatment.
• Children should be reminded to brush their teeth
daily with fluoride-based toothpaste and use
dental floss.

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 PROMOTING HEALTH
FAMILY FUNCTIONING
• Many 6-year-olds quote their teacher or friends as
authorities, sometimes surpassing their parents in their
eyes, which can be challenging for parents to accept.
• Parents should understand that such behavior is normal
and can use statements like "There are all kinds of
ways to do things, but in our house, the rule is
this" to convey family rules without criticizing others.
• Parents need to remember that children require
repeated practice to master tasks and should provide
constructive feedback rather than criticism.
• Asking open-ended questions like "Tell me about it"
rather than "What is it?" helps children feel valued
and encourages their creativity.

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• Displaying and using children's gifts, such as
artwork, is important for fostering their sense of
accomplishment.
• To gauge the level of interaction and support in
the home, parents can ask questions about how
they correct their child's behavior, display school
projects, assign chores, and involve the child in
family decision-making.

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 COMMON HEALTH PROBLEMS
OF THE SCHOOL-AGE PERIOD

• Common health concerns for school-age children

include minor issues like head lice or ringworm,
• At the same time, they have one of the lowest rates of
death and serious illness of any age group.
• The two causes of death seen most frequently are from
unintentional injury and cancer.
• Minor illnesses are largely due to dental caries,
gastrointestinal disturbances, and upper respiratory
infections
• Learning difficulties likes attention deficit hyperactivity
disorder (ADHD) and autism spectrum disorders ASDs
are often identified during this period and are
significant parental concerns.

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• Dental caries (cavities) are progressive,
destructive lesions or decalcification caused by
acid microorganisms attacking tooth enamel,
often due to poor dental hygiene and diet.
• Malocclusion, or abnormal tooth alignment,
can result from various factors including
genetics, thumbsucking, or mouth breathing.
Evaluation by an orthodontist may be
necessary for correction.

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• Children with malocclusion may require
orthodontic braces, which can cause initial
discomfort and may lead to shallow ulcerations
in the mouth. Proper oral hygiene, including
brushing and flossing, is essential for children
with braces.

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• After braces are removed, retainers may be
necessary to maintain tooth alignment. Loss of
retainers can be a problem, so children should
be reminded to keep track of them, especially
during meals.
• While braces were once stigmatized, they are
now common among schoolchildren, and many
children find comfort in knowing they are not
alone in wearing them.
• Some even view them as a mark of pride or
status symbol.

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 CONCERNS AND PROBLEMS OF
THE SCHOOL-AGE PERIOD

• Problems Associated With Language

Development
Articulation issues, such as difficulty pronouncing
certain sounds, are common during this period
but typically resolve by the third grade without
the need for speech therapy.
• Common Fears and Anxieties: Starting grade
school can be daunting for children, leading to
anxiety. Parental reassurance and support are
crucial during this transition.

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• School Refusal or Phobia: Some children develop a fear
of attending school, which may stem from various factors
including separation anxiety, bullying, or family dynamics.
Counseling and gradual reintroduction to school may be
necessary.
• Sex Education: Educating school-age children about
puberty, reproductive health, and responsible sexual
practices is essential. Parents or healthcare providers often
serve as valuable resources for sex education.
• Stealing: Some children may experiment with stealing
money or small items, typically due to a lack of
understanding of ownership rather than malicious intent.
Parental guidance and counseling may be needed to
address this behavior.

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• Violence or Terrorism: Exposure to violence or terrorism
can cause significant stress and anxiety in children. Parents
should reassure children of their safety and establish a
family disaster plan to increase feelings of security.

• Bullying: whether in person or through social media, can

have serious consequences for both victims and
perpetrators. School personnel and parents should work
together to address bullying behavior and provide support
to affected children.

• Recreational Drug Use: Children as young as elementary

school age may experiment with drugs and alcohol. Parents
should be vigilant and provide education about the risks
associated with substance abuse. Counseling may be
necessary for children engaging in risky behaviors.

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• Tobacco Use: Smoking and other forms of
tobacco use may start during the school-age
years.
• Parents and healthcare professionals should
serve as role models for healthy behaviors and
educate children about the dangers of tobacco
use, including emerging risks associated with e-
cigarettes and vaping.

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 References
Chapter 32, Pages 1870 – 1935, Pillitteri, A. “Maternal and Child
Health Nursing”

Thank you
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