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Course: Pediatric Nursing�Topic: Growth and Development of School-Aged Children

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the normal developmental changes (e.g., physiologic, cognitive, psychosocial) that occur in a school-aged child.
Examine the common developmental theories (Erikson, Freud and Piaget) in relation to the growth of a school-aged child.
Explain the nutritional requirements of a school-aged child.
Identify the common developmental concerns of the school-aged child.
Discuss the nurse’s role in the growth and development of a school-aged child.

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School-Aged Child

CDC, 2021a

Paris et al., 2019

Ages 6 years to 12 years old
Also referred to as “Middle Childhood”
Physical, social, and mental skills develop quickly
Critical time for children to develop confidence in all areas of life

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School-Aged Child: Physical Development

Girls: Grow breasts, start menstruating, grow pubic hair
Boys: Grow facial hair and pubic hair
Brain reaches adult size at age 7

Significant improvement in gross motor skills (e.g., Riding a bike that is bigger or running longer and further)
Child's reaction time improves

Eye-hand coordination and fine motor skills facilitate better writing, cutting
Will begin or continue losing deciduous teeth
Maybe nearsighted, corrected with glasses

Paris et al., 2019

NorthShore University HealthSystem, n.d.

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School-Aged Child Development: Erik Erikson’s Psychosocial Theory

Industry vs. Inferiority

Sense of industry achieved through the development of skills and knowledge that allow the child to provide meaningful contributions to society.
Sense of accomplishment gained through the ability to cooperate and compete with others.
Children should be challenged to accomplish tasks and allowed to work through individual differences in order to complete those tasks.

Paris et al., 2019

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School-Aged Child Development: Erik Erikson’s Psychosocial Theory

Industry vs. Inferiority (Continued)

Focus on accomplishments and begin making comparisons between themselves and their classmates.
Creating systems that reward successful mastery of skills and tasks may create a sense of inferiority in children unable to complete the tasks or acquire the skills.
Need to understand that not everyone will master every skill.

Paris et al., 2019

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School-Aged Child Development: Sigmund Freud’s Theory

Latency occurs during middle childhood when a child’s urges quiet down and friendships become the focus.

Ego and superego can be refined as the child learns how to cooperate and negotiate with others.

Paris et al., 2019

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School-Aged Child Development: Jean Piaget’s Theory of Cognitive Development

Early School-Age Years (Ages 2-7) are in the preoperational stage

Do not understand how the physical world operates
Do not understand the reasoning behind rules and expectations for behaviors
Believes what others tell them is right
Judgment guided by reward and punishment
May interpret accidents as punishments
Uses symbols and language (words or gestures) that facilitate knowing and communicating about the world

Paris et al., 2019

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School-Aged Child Development: Jean Piaget’s Theory of Cognitive Development

Later School-Age Years (Ages 7-11) concrete operational stage:

Develops the ability to think logically about the physical world
Understands concepts such as size, distance, constancy of matter, and cause and effect relationships
Able to judge the intentions of an act rather than just its consequences
Understands differing points of view instead of whether something is right or wrong
Conceptualizes treating others as they like to be treated

Paris et al., 2019

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Critical Thinking Question

Discussion

Think of a child you know who is between 6-12 years old.

Do they show the characteristics proposed by Erik Erikson, Sigmund Freud, and Jean Piaget?

Detail your response with examples and share it with peers.

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School-Aged Child: Cognitive Development

Frontal lobes more developed and myelination complete contributing to increased:

Logic, planning, and memory functioning
Information processing speed
Reaction time
Attention time

Understands what others think of them and deals socially with its positive and negative consequences

Paris et al., 2019

CDC, 2021a

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School-Aged Child: Cognitive Development (Continued)

6-8 years of age:

Learning better ways to describe experiences, thoughts, feelings
Have less focus on one’s self and more concern for others

9-12 years of age:

Takes in more abstract and symbolic ideas
Faces more academic challenges at school
Becomes more independent from the family
Begins to see the point of view of others more clearly
Has an increased attention span

CDC, 2021a

CDC, 2021b

NorthShore University HealthSystem, n.d.

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School-Aged Child: Emotional and Social Development

Paris et al., 2019

CDC, 2021a

Develops a more realistic sense of self

Exaggerated sense of self as “biggest,” “smartest,” or “tallest” gives way to an understanding of one’s strengths and weaknesses.

6-8 years of age:

Shows more independence from parents and family.
Starts thinking about the future.
Understands more about their place in the world.
Pays more attention to friendships and teamwork.
Wants to be liked and accepted by friends.
Prefers the company of same-sex companions.

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School-Aged Child: Emotional and Social Development (Continued)

9-11 years of age:

Form stronger, more complex friendships/peer relationships.
Becomes more emotionally important to have friends, especially of the same sex, but develops an interest in others toward the end of the school-age years.
Experiences more peer pressure.
Becomes more aware of their body as puberty approaches.
Starts forming general personal identity.
Internalizing others’ appraisals and creating social comparisons that impact the level of self-esteem.

CDC, 2021b

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Critical Thinking Question:

What concepts would the nurse include in a health class at school to address the needs of a 9-11 year old related to approaching puberty?

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School-Aged Child: Nutritional Needs

Requirement for macronutrients and micronutrients higher relative to body size, compared with nutrient needs during adulthood
Nutrient-dense food during mealtime and snack time

Eat with the family, without distractions like mobile or television

Energy requirements depend on growth and level of activity

Ages 6-8 years:

Both boys and girls require 1200 to 1400 calories a day

Ages 9-12 years:

Girls: 1400-1800 calories/day
Boys: 1600-2000 calories/day

(Paris et al., 2019)

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School-Aged Child: Nutritional Needs

Paris et al., 2019

For a child on a strict vegan diet:

Planning is required to be able to include an adequate intake of protein, iron, calcium, vitamin B12, and vitamin D in the diet
Legumes and nuts for protein
Soy or almond milk fortified with calcium and vitamins D and B12 to replace cow’s milk

Vegan diets are low in Vit B12

Overfeeding a child should be avoided

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Critical Thinking Question

Are there people in your community who are from different cultures and ethnic backgrounds?

What are the food practices related to their cultures?

How do these cultural food practices affect the nutrition of children?

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School-Aged Child: Developmental Concerns

Paris et al., 2019

CDC, 2021b

NorthShore University HealthSystem, n.d.

More physical ability and independence put the child at risk of fall injuries and other accidents

Traffic education, swimming lessons, keeping harmful household products away

Body image and eating disorders

Family environment, societal trends, taste preferences, media bias to a slim body or fat body
Important to direct the child toward healthy choices

May be subject to bullying leading to low self-esteem

Ensure the child is not isolated

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School-Aged Child: Developmental Concerns (Continued)

Discrepancy between how children view themselves and what they consider to be their ideal selves can negatively affect their self-esteem.

Large discrepancies between self-efficacy and ability can create motivational problems for the individual.

Paris et al., 2019

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School-Aged Child: Nutritional Concerns

Risk for malnutrition and obesity:

TV commercials entice consumption of sugary products, fatty fast foods, excess calories, refined ingredients, and sodium
Replacement of nutritious food with high-fat fast food cultures like pizza, hamburgers, chicken nuggets or “lunchables” with soda
Decreased physical activity

Higher risk for obesity

Bullying: rejection, ridicule
Low self-image/esteem
Diabetes, heart disease, depression

Paris et al., 2019

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School-Aged Child: Sleep Concerns

Requires 9 to 12 hours of sleep per 24
Inadequate sleep increases the risk for obesity, diabetes, injuries, poor mental health, problems with attention and behavior
Support good sleep habits/hygiene:

Physically active in daytime
Limit technology/screens use in the evenings
Avoid large meals, caffeine, and alcohol before bedtime
Consistent sleep schedule, including weekends
Environment: Quiet, dark, relaxing, comfortable temperature

CDC, 2020

CDC, 2016

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Nurse’s Role in the Growth and Development of School-Aged Child

Knowledgeable about and assess for age-appropriate growth and development of the child
Family education

Growth and development process (physical, cognitive, psychosocial)
Nutritional requirement

Knowledgeable about local foods containing essential protein, iron, calcium, vitamin B12, and vitamin D

Dental hygiene
Safety issues

Paris et al., 2019

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Nurse’s Role (Continued)

Paris et al., 2019

Education for the child:

Good hygiene for all, menstrual hygiene for girls
Dental hygiene: brushing twice daily, morning and evening, preferably after meals
Healthy diet, physical activities

Assess and address the child’s physical, emotional, and social concerns
Advocate for creating

Recreational parks in the community
Physical education and sports in schools
Nutritional programs in schools, community

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Nurse’s Role (Continued)

Assist families in accessing available resources for child health and care

Health insurance
Child care services
Parenting support groups
Other community/social resources

Coordinate care between family and health care providers

Paris et al., 2019

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Critical Thinking Question

A nurse is providing anticipatory guidance to the caregivers of a school-aged child.

Developmental Stage: Identify the child’s developmental stage according to Piaget and Erikson.
Physical Development: Identify 3 facts relevant to the child’s physical development.
Nutrition: List 3 strategies the family can implement to reduce the risk of obesity.
Health Promotion: Identify 3 teaching points that the nurse can provide to the parents about Injury prevention in this age group.

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Red Flags

Health care concerns of the School-age child

Obesity
Malnutrition
Enuresis
Attention-deficit/hyperactivity disorder (ADHD)
Learning disorders
Dental caries

Low-self esteem, isolating

Bullying
Emotional, sexual abuse

Physical injuries: physical abuse, sexual abuse

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Obesity- Our diet has changed drastically as processed foods, which did not exist a century ago, and animal-based foods now account for a large percentage of our calories. Not only has what we eat changed, but the amount of it that we consume has greatly increased as well, as plates and portion sizes have grown much larger. All of these choices impact our health, with short- and long-term consequences as we age. Possible effects in the short-term include excess weight gain and constipation. The possible long-term effects, primarily related to obesity, include the risk of cardiovascular disease, diabetes, hypertension, as well as other health and emotional problems for children. Excess weight and obesity in children are associated with a variety of medical conditions, including high blood pressure, insulin resistance, inflammation, depression, and lower academic achievement. Being overweight has also been linked to impaired brain functioning, which includes deficits in executive functioning, working memory, mental flexibility, and decision-making.

Malnutrition- Many may not know that malnutrition is a problem that many children face in both developing nations and the developed world. Even with the wealth of food in North America, many children grow up malnourished or even hungry. Millions of children grow up in food-insecure households with inadequate diets due to both the amount of available food and the quality of food. Growing up in a food-insecure household can lead to a number of problems. Deficiencies in iron, zinc, protein and vitamin A can result in stunted growth, illness, and limited development.

Dental caries- Children in middle childhood will start or continue to lose teeth. They experience the loss of deciduous, or “baby,” teeth and the arrival of permanent teeth, which typically begins at age six or seven. Children should floss daily and brush their teeth at least twice daily: in the morning, at bedtime, and preferably after meals. Younger children need help brushing their teeth properly. The best defense against tooth decay is flossing, brushing and adding fluoride, a mineral found in most tap water.

Enuresis- Children should be able to control their bowel and bladder functions by school-age years. Accidents should be uncommon. If a child is showing regressive tendencies and is not able to control their bladder and/or bowel functions, then there could be a physiological problem that needs to be assessed by a provider.

Attention-deficit/hyperactivity disorder (ADHD)- The exact causes of AD/HD are unknown. People with AD/HD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Among children, AD/HD frequently occurs along with other learning, behavior, or mood problems such as learning disabilities, oppositional defiant disorder, anxiety disorders, and depression.

Learning Disorder-

A learning disorder is a classification of disorders in which an individual has difficulty learning in a typical manner within one of several domains. Types of learning disorders include difficulties in reading (dyslexia), mathematics (dyscalculia), and writing (dysgraphia). These disorders are diagnosed with certain criteria.
A learning disability has problems in a specific area or with a specific task or type of activity related to education.

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be accepted in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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Cultural Considerations: Examples of Concern

Be aware of harmful cultural practices and take actions as required by the law

Female genital mutilation is a violation of the human rights of girls and women.
Child marriage is illegal in many countries.
“Chhaupadi,” a practice where menstruating girls are banished to sheds, is outlawed in Nepal.

World Health Organization, 2022

UNICEF, n.d.

UNWomen, n.d.

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References:

Anzilotti, A.W. (2022, May). Understanding Puberty. The Nemours Foundation. https://kidshealth.org/en/parents/understanding-puberty.html#:~:text=For%20most%20females%2C%20the%20first,the%20next%20year%20or%20two.

Centers for Disease Control and Prevention [CDC]. (2020, September 10). Sleep in Middle and High School Students. https://www.cdc.gov/healthyschools/features/students-sleep.htm

Centers for Disease Control and Prevention [CDC]. (2021a, February 22). Middle childhood (6-8 years of age). https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.html

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References:

Centers for Disease Control and Prevention [CDC]. (2021b, September 23). Middle childhood (9-11 years of age). https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle2.html

Centers for Disease Control and Prevention [CDC]. (2016, July 15). Tips for better sleep. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

NorthShore University HealthSystem. (n.d.). K-8 (5 - 12 years). https://www.northshore.org/pediatrics/ages-and-milestones/k-8-5---12-years/

Paris, J., Richardo, A., & Rymond, D. (2019). Child growth and development: ECE 101 (A. Johnson, Ed.). College of the Canyons, licensed under a Creative Commons Attribution 4.0 International License. https://open.umn.edu/opentextbooks/textbooks/750

Contact info: info@nursesinternational.org

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References:

United Nation Children’s Fund [UNICEF]. (n.d.). Child marriage. https://www.unicef.org/rosa/what-we-do/child-protection/child-marriage#:~:text=Child%20Marriage%20is%20defined%20as,disproportionately%2C%20especially%20in%20South%20Asia.

UNWomen. (n.d.). Abolishing chhaupadi, breaking the stigma of menstruation in rural Nepal. https://www.unwomen.org/en/news/stories/2017/4/feature-abolishing-chhaupadi-breaking-the-stigma-of-menstruation-in-rural-nepal

World Health Organization. (2022, January 21). Female Genital Mutilation. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation#:~:text=FGM%20is%20mostly%20carried%20out,This%20is%20known%20as%20medicalization.

Contact info: info@nursesinternational.org

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