NCM 107: Care of the Mother and Child ( Well )

San Pablo Colleges

College of Nursing
San Pablo City, Laguna

NCM 107: Care of the

Mother and Child ( WELL)

LESSON # 9: The Family with a Schooler

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 NCM 107: Care of the Mother and Child ( Well )

LESSON # 9 : The Family with a Schooler

LESSLESSON2LESSI

At the end of the lesson, you should be able to:h

1.Learning Objectives
Describe the normal growth and development pattern
2. Discuss the developmental milestones of Schooler.
3. Identify emotional development of Schooler.

Key Concepts

1. Milestones of Schooler
2. Emotional Development of Schooler

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Lesson Overview

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. Because of this, there are many differences among children from one year to the
next. For example, 7- and 10-year-old children have very different need and outlooks, as do 11- and 12-
year-old children. Because of these big differences, it is always of great importance to assess children
as individuals to understand the particular developmental needs of each child based on what
developmental status has been achieved, not on what stage you think the child should have reached
(Pillitteri, 2010).The nurses knowledge about these things should be shared to the members of the
family to better guide them as they grow towards the succeeding stages of life.

Engagement

Recall an exciting event or moment of your life during the

school age period.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

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EXPLORE

Nursing Process Overview - For Healthy Healthy Development of the

School-age Child
or Healthy Development of the Preschooler

Assessment
Use both history and physical examination to assess growth and development of a school-
age child. Include questions about school activities and progress. School-age children are interested
and able to contribute to their own health history; to allow for this, it is useful to interview children
10 years or older at least in part without their parents present. During the physical examination,
show your respect for children’s adult-level modesty by furnishing a cover gown. Parents of school-
age children often mention behavioral issues or conflicts during yearly health visits. Some parents
feel they are losing contact with their children during these years. This can cause them to
misinterpret a normal change in behavior, especially if they are not prepared for what to expect from
their child. Other parents may consider children who behave differently from their siblings as
“abnormal” when children are just expressing their own personality. When problems are discussed
in the health care setting, take the history from the parent but also allow the child to express the
problem. It may be necessary to obtain the opinion of school personnel (with the parents’ permission)
regarding the problem or even just determine whether school personnel feel a problem exists. In
some instances, a counselor’s opinion may be necessary. If the problem is related to a medical
condition, its effect on the family should also be assessed, because the illness of a child affects the
functioning of the entire family.
Nursing Diagnosis
Common nursing diagnoses pertinent to growth and development during the school-age
period are:
• Health-seeking behaviors related to normal school-age growth and development
• Readiness for enhanced parenting related to improved family living conditions
• Anxiety related to slow growth pattern of child
• Risk for injury related to deficient parental knowledge about safety precautions for a school-age
child
• Imbalanced nutrition, more than body requirements, related to frequent consumption of snack
foods
• Delayed growth and development related to speech, motor, psycho-social, or cognitive concerns

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Outcome Identification and Planning

When identifying expected outcomes and planning care, keep in mind that school-age
children tend to enjoy small or short-term projects rather than long, involved ones. A child with
diabetes, for example, in her early school years may gain a feeling of achievement by learning to
assess her own serum glucose level, but she may have difficulty continuing glucose assessment on a
regular basis. Behavior problems need to be well defined before outcomes are identified and
interventions planned. Often, it is enough for parents to accept the problem as one consistent with
normal growth and development. A helpful Web site to recommend to parents to learn more about
school-age growth and development is the American Academy of Pediatrics (http://www.aap.org).
For questions about car seats, parents can consult the U.S. Department of Transportation National
Highway Traffic Safety Administration (http://www.nhtsa.dot.gov).

Implementation
School-age children are interested in learning about adult roles, so this means they will
watch you to see your attitude as well as your actions in a given situation. When giving care, keep in
mind children this age feel more comfortable if they know the “hows” and “whys” of actions. They
may not cooperate with a procedure until they are given a satisfactory explanation of why it must be
done.

Outcome Evaluation
Yearly health visits covering both physical and psycho-social development are important at
this age. It may be useful for parents to look back on problems identified at the last visit and discuss
if and how they were resolved. Often, some problems and conflicts fade away without anyone really
noticing. As some problems recede, however, others may emerge. At times, the same concerns of
parents and the child may appear to be unresolved at each visit. Make sure no underlying problem
exists that prevents resolution. Examples of expected outcomes are:
• Parent states he allows child to make own decisions about how to spend allowance.
• Child lists books she and her parents have read together in past 2 weeks.
• Child states he understands his growth is normal, even though he is the shortest boy in his
eighth-grade class.
• Child does not sustain injury from sports activities during the summer recess.

GROWTH AND DEVELOPMENT OF A SCHOOL-AGE CHILD

Growth and development for a school-age child occur slowly, and over a relatively
long time span so children grow and develop extensively during this period.

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Physical Growth
School-age children’s annual average weight gain is approximately 3 to 5 lb (1.3 to 2.2 kg);
the increase in height is 1 to 2 in (2.5 to 5 cm). Children who did not lose the lordosis and
knock-kneed appearance of toddlers during the preschool period lose these now. Posture
becomes more erect (Goldson & Reynolds, 2008). 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. If the eruption of
permanent teeth and growth of the jaw do not correlate with final head growth,
malocclusion (a deviation from the normal) with teeth malalignment may be present.
The immunoglobulins IgG and IgA reach adult levels, and lymphatic tissue
continues to grow up until about age 9.
DEVELOPMENTAL MILESTONES
Because the lymphatic system grows so rapidly, this results in an abundance of
tonsillar and adenoid tissue in the early school years, which is often mistaken for disease
during respiratory illness as the tonsils seem so enlarged in the back of the throat.
Enlarged tonsils may also result in temporary conduction deafness from eustachian tube
obstruction until this tissue recedes normally. 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) in the early school-age child. Frontal sinuses develop at about
6 years, so sinus headache becomes a possibility (before then, headache in children is
rarely caused by a sinus infection). The left ventricle of the heart enlarges to be strong
enough to pump blood to the growing body. Innocent heart murmurs may become
apparent because of the extra blood crossing heart valves. The pulse rate decreases to 70
to 80 beats per minute; blood pressure rises to about 112/60 mm Hg. 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 over age 8 should be screened for this at all health
appraisals (see Chapter 51).
Sexual Maturation
At a set point in brain maturity, the hypothalamus transmits an enzyme to the
anterior pituitary gland to begin production of gonadotropic hormones, which activate
changes in testes and ovaries and produce puberty. Hormone changes that occur with
puberty are discussed in Chapter 5. Table 32.1 describes the usual order for secondary
sex characteristics to develop.
Timing of the onset of puberty varies widely, between 10 and 14 years of age. The
length of time it takes to pass through puberty until sexual maturity is complete also varies.
Sexual maturation in girls usually occurs between 12 and 18 years; in boys, between 14
and 20 years. Puberty is occurring increasingly earlier, however, and, in a class of 10-year-
old sixth graders, it is not unusual to discover that more than half of the girls are already

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menstruating. This means that for sex education to be effective, parents must introduce
this material when their children are in grade school, not in middle school or high school.
Sexual and Physical Concerns. The changes in physical appearance that come with
puberty can lead to concerns for both children and their parents. School age is a time for
parents to discuss with children the physical changes that will occur and the sexual
responsibility these changes dictate. This is also a time to reinforce previous teaching with
children that their body is their own, to be used only in the way they choose. Specific
measures for children to help prevent sexual abuse . School nurses can play a major role
in this type of education as well. In both sexes, puberty brings changes in the sebaceous
glands. Under the influence of androgen, glands become more active, setting the stage for
acne. Vasomotor instability commonly leads to blushing; perspiration also increases
(Kaplan & Love-Osborne, 2008).
Concerns of Girls. Prepubertal girls are usually taller, by about 2 in (5 cm) or more, than
pre-adolescent boys because their typical growth spurt begins earlier. In a culture in which
boys are expected to be taller than girls, this can cause concern. Sometimes a girl notices
the change in her pelvic contour when she tries on a skirt or dress from the year before
and realizes her hips are becoming broader. She may misinterpret this finding as a gain in
weight and attempt a crash diet. She can be reassured that broad bone structure of the
hips is part of an adult female profile.
Girls are usually conscious of breast development, and whether they are
overdeveloped or underdeveloped. Also, breast development is not always symmetrical, so
it is not unusual for a girl to have breasts of slightly different sizes. After the condition has
been checked during a physical examination, she can be reassured that this development
is normal. Supernumerary (additional) nipples may darken or increase in size at puberty.
Be sure girls understand that a supernumerary nipple is affected by the hormones in her
body in the same way as other breast tissue, so she understands these changes are
normal.
Early preparation for menstruation is important for future childbearing and for the
girl’s concept of herself as a woman (Box 32.2). In addition to an explanation of the reason
for menstrual flow, girls need an explanation of good hygiene and reassurance they can
bathe, shower, and swim during their periods. They can use either sanitary napkins or
tampons; if they choose tampons, they must take precautions to avoid toxic shock
syndrome (see Chapter 47).

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TABLE 32.1 ✽ Chronologic Development of Secondary Sex Characteristics

Age (yr) Boys Girls

9–11 Prepubertal weight gain occurs. Breasts: elevation of papilla with breast
bud formation; areolar diameter
enlarges.
11–12 Sebaceous gland secretion Straight hair along the labia. Vaginal
increases. Sparse growth of epithelium becomes cornified.
straight, downy, slightly
Sebaceous gland secretion increases.
pigmented hair at base of penis.
Perspiration increases. Perspiration increases.
Scrotum becoming textured; of Dramatic growth spurt.
penis and testes begins.
growth pH of vaginal secretions acid;
slight mucous vaginal discharge
present.
12–13 Pubic hair present across Pubic hair grows darker; spreads over
pubis. Penis lengthens. entire pubis.Breasts enlarge, still no
Dramatic linear growth spurt. protrusion of nipples.
Breast enlargement occurs. Axillary hair present.
Menarche occurs.

Concerns of Boys. Boys who are not prepared for the physical changes of puberty are as equally
concerned about them as are girls. Just as girls are keenly aware of breast development, boys are
aware of increasing genital size. If they do not know testicular development precedes penis growth,
they can worry that their growth will be inadequate. Boys should also be informed that hypertrophy
of breast tissue (gynecomastia) can occur in prepuberty (most often in stocky or obese boys), and
that this is a transitory phenomenon and, although it may cause self-conscious reactions, it will fade
as soon as the male hormones become more mature and active. Some boys also become concerned
because, although they have pubic hair, they cannot yet grow a beard or do not have chest hair—
outward, easily recognized signs of maturity. You can assure them that pubic hair normally appears
first and that chest and facial hair may not grow until several years later. As seminal fluid is
produced, boys begin to notice ejaculation during sleep, termed nocturnal emissions. Preadolescent
boys may believe an old myth that loss of seminal fluid is debilitating; also, boys may have heard
the term “premature ejaculation” and worry this is a forewarning of a problem in years to come.
Both are fallacies.

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Teeth
Deciduous teeth are lost and permanent teeth erupt during the school-age period (Fig. 32.1).
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 (Fig. 32.2).

Developmental Milestones
As with all ages, you can measure school-age children’s progress by whether they meet
typical developmental milestones.
Gross Motor Development
School-age development is summarized in Table 32.2. At the beginning of the school-age
period (age 6), children endlessly jump, tumble, skip, and hop. They have enough coordination to
walk a straight line. Many can ride a bicycle. They can skip rope with practice. A 7-year-old appears
quiet compared with a rough-and-tumble 6-year-old. Gender differences usually begin to manifest
in play: there are “girl games,” such as dressing dolls, and “boy games,” such as pretending to be
pirates.
The movements of 8-year-olds are more graceful than those of younger children, although as
their arms and legs grow, they may stumble on furniture or spill milk and food. They ride a bicycle
well and enjoy sports such as gymnastics, soccer, and hockey. Nine-year-olds are on the go
constantly, as if they always have a deadline to meet. They have enough eye–hand coordination to
enjoy baseball, basketball, and volleyball. By 10 years of age, they are more interested in perfecting
their athletic skills than they were previously. At age 11, many children feel awkward because of
their growth spurt and drop out of sports activities rather than look ungainly in their attempts. They
may channel their energy into constant motion instead: constantly drumming fingers and tapping
pencils or feet. This fall in sports participation may bother parents who see sports as the key to
popularity or self-esteem.
Twelve-year-olds plunge into activities with intensity and concentration. They often enjoy
participating in sports events for charities such as walk-a-thons. They may be refreshingly
cooperative around the house, able to handle a great deal of responsibility, and complete given tasks.
Fine Motor Development
Six-year-olds can easily tie their shoelaces. They can cut and paste well and draw a person
with good detail. They can print, although they may routinely reverse letters. Seven year-olds
concentrate on fine motor skills even more than they did the year before. 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 8 years of age, children’s eyes are developed enough so they can read regular-size type.
This can make reading a greater pleasure and school more enjoyable . Eight-year-olds learn to write
script rather than print. They enjoy showing off this new skill in cards, letters, or projects. By age 9,

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their writing begins to look mature and less awkward. Older school-age children begin to evaluate
their teachers’ ability and may perform at varying levels, depending on each teacher’s expectations.
The middle school curriculum involves more challenging science and mathematics courses than
previously and includes good literature. This may be a child’s first exposure to reading as a fulfilling
and worthwhile experience rather than just as an assignment and may be the time a child is “turned
on” to reading.

Play
Play continues to be rough at age 6; however, when children discover reading as an
enjoyable activity that opens doors to other worlds, they can begin to spend quiet time with books.
Many children spend hours playing increasingly challenging video games, an activity that can either
foster a healthy sense of competition or create isolation from others. By 7 years of age, children
require more props for play than when they were younger, which indicates the start of a decline in
imaginative play; this may continue unless a child receives adequate encouragement to use
imagination. Children also begin to develop an interest in collecting items such as baseball cards,
dolls, rocks, or marbles. The type of item may not be as important as the quantity. By age 8,
collections may become increasingly structured as children develop skills for sorting and cataloging.
Competitive behaviors can develop and cause children to change the rules in the middle of a game
to keep from losing. At about 10 years of age, children become very interested in rules and fairness
in competitive play situations .
Children also begin discovering the Internet and how other children out there are waiting to
talk to them in chat rooms. Not yet wise enough to recognize the dangers talking to strangers can
create, this is an activity parents need to supervise. Music and artistic expression also become
important during this time. During preteen years, listening to music and learning popular dances
take the place of earlier simple games. Both boys and girls seem to feel they are on the verge of
something great and anxiously wait to turn 13 and be a teenager.

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.
They still define objects by their use: a key is to unlock a door; a fork is to eat with. 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 and watches. They know the months of
the year and can name the months in which holidays fall. They can add and subtract and make
simple change (if they have had experience), so they can go to the store and make simple purchases.
Much of children’s talk is concerned with these concepts as they practice them and show them off
for family or friends. As children discover “dirty” jokes at about age 9, they like to tell them to
friends or try to understand those told by adults. They use swear words to express anger or just to
show other children they are growing up. They may have a short period of intense fascination with
“bathroom language,” as they did during preschool years. As before, if they want to discourage this,

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parents should make it clear they find such language unacceptable and refrain from using it
themselves in their child’s presence.
By 12 years of age, a sense of humor is apparent. Twelve year-olds can carry on an adult
conversation, although stories are limited because of their lack of experience.

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. They should have practiced or mimicked adult roles and had the
opportunity to explore at preschool or other social environments. They should have learned to share,
to have discovered that learning is fun and an adventure, and have learned that doing things is more
important and more rewarding than watching things being done (a sense of initiative).
Developmental Task: Industry Versus Inferiority
During the early school years, children attempt to master yet another developmental step:
learning a sense of industry or accomplishment (Erikson, 1993). If gaining a sense of initiative can
be defined as learning how to do things, then gaining a sense of industry is learning how to do things
well. If children are prevented from achieving a sense of industry or do not receive rewards for
accomplishment, they can develop a feeling of inferiority or become convinced they cannot do
things they actually can do. These children will have difficulty tackling new situations later in life
(new job, new school, new responsibility) because they cannot envision how they could be
successful in handling them. This can result in frustration in school or work activities.
The questions a preschool child asks reflect curiosity, such as “how,” “why,” and “what.”
During the early school years, children concentrate their questions on the “how” of tasks: “Is this the
right way to do this?” “Am I making this right?” “Is this good?” Often school-age children will
comment, “I can’t do anything right” because their craft project does not look perfect or falls short
of expectations. School-age children need reassurance they are doing things correctly and this
reassurance is best if it comes frequently rather than infrequently after long waits.
The best type of book for school-age children has many short chapters; children feel a sense
of accomplishment when they finish each chapter, rather than having to wait until the end of the
book. Small chores that can be completed quickly also give this type of reward. Children can survey
their finished work and see that they have done a good job. A child may dislike vacuuming, for
instance, because the rug may not look very different when the task is complete. Picking up the
scattered contents of a toy box, however, is a more obvious task that clearly makes a difference in
the appearance of the room. Hobbies and projects also are enjoyed best if they are small and can be
finished within a short time. Most school-age children, for example, prefer putting together two or
three fairly simple model-car kits to assembling one extremely complicated kit. The three kits offer
three rewards; the involved one delays the reward so long the child may become bored and never
complete it. With adolescence will come more respect for quality. Children will realize if they want

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the better model, they will have to spend the extra energy and attention , quality products involve
quality work (Fig. 32.5).
Home as a Setting to Learn Industry. Parents of a school age child need to take a step forward in
development along with their child. For the first time, they realize their child looks to other role
models than themselves. Parents who enjoyed fostering imagination in a preschooler may feel
frustrated when a school-age child begins to conform to rules and insists on the “right way” to do
things. They may feel they have failed to encourage the child’s creativity, but conformity is vital to
children at this age. It is how they learn more about their world’s rules. Eight- or 9-year-olds begin
to spend more and more time with their peers and less time with their family. They forget to do
household chores they once enjoyed, such as setting the table or mowing the lawn, or they may do
the work sloppily so they have more time with their friends. Although this may seem like a
regression in behavior, it is actually a step of independence away from the parents and into the
larger world, a developmental task that will help them become emotionally mature. This is an
example of a new role the child is trying out, one of many that will be tried in the process of
reaching maturity, when an eventual “right-fit” is found.
School as a Setting to Learn Industry. Adjusting to and achieving in school are two of the major
tasks for this age group. Ideally, a child’s teacher will think of learning as fun and will encourage a
child to plunge into new experiences. Unfortunately, parents must monitor teachers and school
activities to make sure their children are being led this way while not being pushed too hard.
Schools are increasingly assuming responsibility for education about sex, safety, avoidance of
substances of abuse, and preparation for family living. These discussions are generally superficial,
however, and if the classes are large, they may raise more questions than they answer. Although
learning these skills with peers helps children learn other people’s opinions in these areas, such
classes should not replace parental teaching. If given adequate encouragement and preparation by
health care providers, most parents are eager to maintain such responsibility.
Structured Activities. Girl Scouts, Boy Scouts, Campfire Girls, and 4-H clubs are respected
school-age activities. If the local chapters are well run by leaders who understand children’s needs,
they can provide hours of constructive activity and strengthen a sense of industry. Merit badge
systems are geared to the needs of school-age children, offering small but frequent rewards. As with
school activities, parents should determine the worth of each organization for their individual child.
Urge parents to evaluate competitive sports programs as well. Before children can compete
successfully, they must be able to lose a game without feeling devastated in other words, to be able
to say, “I lost because I played badly,” not “I lost because I am a bad person.” Children do not
usually develop sufficient ego strength to do this until they are about 10 years old. Another problem
to consider with organized contact sports is the possibility of athletic injuries. Encourage parents to
consider their child’s maturity and the risk of injury before they decide whether team competition is
right for their child. Problem Solving. An important part of developing a sense of industry is
learning how to solve problems. Parents and teachers can help children develop this skill by
encouraging practice. When a child asks, “Is this the right way to do this?” a parent can encourage
problem solving by saying, “Let’s talk about possible ways of doing it” rather than offering a quick
solution. The world depends on machinery, so mishaps and breakdowns (and therefore sudden

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changes) do occur. A child who can create an indoor playhouse with a card table and blanket when
it is too wet or cold to use an outdoor playhouse will be able, as an adult, to problem solve another
solution to a data distribution problem when a computer malfunctions. This attitude of optimism
rather than pessimism toward problem solving produces adults who rarely say, “It can’t be done.”
Just as important, it leaves these adults with confidence and a sense of pride, feeling good about
themselves because they have control of their environment and abilities.
Learning to Live With Others. School-age children are sometimes so interested in tasks and in
accomplishing physical projects that they forget they must work with people to achieve these goals.
A good time to urge children to learn compassion and thoughtfulness toward others is during the
early school years, when children are first exposed to large groups of other youngsters. Writing
thank-you letters and shoveling an older neighbor’s sidewalk are examples of activities that can help
children develop empathy toward others. Learning to give a present without receiving one in return
or doing a favor without expecting a reward is also a part of this process, and this can be taught by
example. Children should see their parents doing such things with an attitude not of “What will I
get?” but “What can I contribute?” Children may show empathy toward others as early as 20 months,
but cognitively they cannot relate others’ experiences to their own until about 6 years of age.
Therefore, it is usually ineffective to lecture a child by saying, “That was cruel to call Mary names.”
The child may feel she had every right to do so. A better technique is to ask children to put
themselves in Mary’s place for a minute and imagine how they would feel if they were Mary. A
school-age child will generally be able to do this and understand why name-calling hurts and makes
children feel rejected. Following this, a simple statement such as, “It doesn’t feel good to be called
names, does it?” may suffice.
Socialization
Six-year-old children play in groups, but when they are tired or under added stress, they
prefer one-to-one contact. In a first-grade classroom, students compete actively for a few minutes of
special time with their teacher. At the end of a day, they enjoy time spent individually with parents.
You may have to remind parents this is not babyish behavior but that of a typical 6-year-old.
Seven-year-olds are increasingly aware of family roles and responsibility. Promises must be
kept, because 7-year-olds view them as definite, firm commitments. These children tattle because
they have a strong sense of justice. This tattling may dissolve play groups quickly.
Eight-year-olds actively seek the company of other children. Most 8-year-old girls have a
close girlfriend; boys have a close boyfriend. Girls begin to whisper among themselves as they share
secrets with close friends, annoying both parents and teachers.
Nine-year-olds take the values of their peer group very seriously. They are much more
interested in how other children dress than in what their parents want them to wear. This is typically
the gang age because children form clubs, usually “spite clubs.” This means if there are four girls on
the block, three form a club and exclude the fourth. The reason for exclusion is often unclear; it
might be that the fourth child has a chronic disease, that she has more or less money than the others,
that she was at the dentist’s the day the club was formed, or simply that the club cannot exist unless
there is someone to exclude. Such clubs typically have a secret password and secret meeting place.

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Membership is generally all girls or all boys. If an excluded child does not react badly to being shut
out, the club will probably disband after a few days because its purpose is lost. The next day, the
excluded member may meet with two others and snub a different child. Parents have to be careful
not to intervene with this type of play, because loyalties shift quickly: the child they defend today
may be the excluded one tomorrow. Because they are so ready for social interaction, 9-year old are
ready for activities away from home, such as a week at camp. They can take care of their own needs
and are mature enough to be separated from their parents for this length of time. Going to camp
before this age usually results in homesickness and can be a negative introduction to being away
from home.
Although 10-year-olds enjoy groups, they also enjoy privacy. They like having their own
bedroom or at least their own dresser, where they can store a collection and know it is free from
parents’ or siblings’ eyes. One of the best gifts for a 10-year-old is a box that locks.
Girls become increasingly interested in boys and vice versa by 11 years of age. Favorite
activities are mixed-sex rather than single-sex ones. Children of this age are particularly insecure,
however, and girls tend to dance with girls while boys talk together in corners. Better socialization
patterns need not be rushed. Just as infants crawl before they walk, so 11- year-olds must attempt
many awkward and uncomfortable social experiences before they become comfortable forming
relationships with the opposite sex.
Twelve-year-olds feel more comfortable in social situations than they did the year before.
Boys experience erections on small provocation so may feel uncomfortable being pushed into boy–
girl situations until they know how to control their bodies better. As some children develop faster
than others, every group has some members who are almost adolescent and some who are still
children, making social interests sometimes difficult.
Cognitive Development
The period from 5 to 7 years of age is a transitional stage where children undergo a shift
from the pre-operational thought they used as preschoolers to concrete operational thought or the
ability to reason through any problem they can actually visualize (Piaget, 1969) (Fig. 32.6).
Children can use concrete operational thought because they learn several new concepts, such as:
• Decentering, the ability to project oneself into other people’s situations and see the world
from their viewpoint rather than focusing only on their own view.

FIGURE 32.6 School-age children learn concrete operational thought or concentrate on phenomena they can actually see occurring.

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• 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. A preschooler
might expect to see the same nurse in the morning who was there the evening before; a school-age
child can understand that different nurses work different shifts.
• Conservation, the ability to appreciate that a change in shape does not necessarily mean a change
in size. If you pour 30 mL of cough medicine from a thin glass into aide one, the preschooler will
say that one glass holds more than the other; a school-age child will say both glasses hold an equal
amount.
• Class inclusion, the ability to understand that objects can belong to more than one classification. A
preschooler can categorize items in only one way, for example, such as stones and shells are found
at the beach; a school-age child can categorize them in many ways such as stones and shells are both
found at the beach but are made of different materials, are different in sizes, etc.
These cognitive developments lead to some of the typical changes and characteristics of the
school-age period. Decentering enables a school-age child to feel compassion for others, which was
not possible in younger years. Because understanding conservation is possible, a school-age child is
not fooled by perceptions as often as before; because of this, sibling arguments over food (your
piece of pie is bigger than mine, his glass of cola is bigger than mine) decrease during the school-
age years. The ability to classify objects leads to the collecting activities of the school-age period.
Class inclusion is also necessary for learning mathematics.

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 (Kohlberg, 1984). 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. School-age children begin to learn about the rituals and meaning behind their
religious practices, so the distinction between right and wrong becomes more important to them than
it was when they were preschoolers. Parent role modeling is also important. Remember that school-
age children are rule-oriented; when they pray, they may expect their God to follow rules also (if
you are good and pray for something, you should receive it). This makes children of this age
confused if a prayer is not immediately answered. 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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EXPLAIN

Name: Score:
Group No.: Date:

Explain the following in your own words.

1. In your own understanding discuss Industry vs. Inferiority.

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

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EVALUATE

Name: Score:
Group No.: Date:

Answer the following accordingly:

1. A female child, age 6, is brought to the health clinic for a routine checkup. To assess the
child’s vision, the nurse should ask:
a. “Do you have any problems seeing different colors?”
b. “Do you have trouble seeing at night?”
c. “Do you have problems with glare?”
d. “How are you doing in school?”

2. A nurse is teaching the parents of a school-age child. Which teaching topic should
take priority?
a. Accident prevention
b. Keeping a night light on to allay fears
c. Normalcy of fears about body integrity
d. Encouraging the child to dress without help

3. The nurse is caring for a 7-year-old female on the school-age unit. Her mother is concerned
that she may have some developmental delays. Which of the following statements would
indicate to the nurse that the child is not developmentally on track for her age:
a. The child is able to follow a four-to-five-step command.
b. The child started wetting the bed on this admission to the hospital.
c. The child has an imaginary friend named Kelly.
d. The child enjoys playing board games with her sister.

4. An 8-year-old is NPO while he awaits surgery for central line placement later in the
afternoon. The nurse is trying to engage the child in some form of activity to distract him from
thinking about his upcoming surgery. Which is the best method of distraction for a child of
this age in this situation?
a. Encourage the child to use the telephone to call friends.
b. Encourage the child to watch television.
c. Encourage the child to play a board game.
d. Encourage the child to read the central line pamphlet he was given

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5. he mother of 11-year-old fraternal twins tells the nurse at their well-child checkup
that she is concerned because her daughter has gained more weight and height than
her twin brother. The mother is concerned that there is something wrong with her
son. The nurse's best response is:
a. "I understand your concern. I will talk with the physician, and we can draw some lab
work."
b."I understand your concern. Has your son been ill lately?"
c. "It is normal for girls to grow a little taller and gain more weight than boys at this age."
d."It is normal for you to be concerned, but I am sure your son will catch up with your
daughter eventually."

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 NCM 107: Care of the Mother and Child ( Well )

Work Sheet for Print Module # 9

ANSWER SHEET
Name: ___________________________________________
Engagement Activity:

Explain :
1.

Evaluation:
Answer questions 1-4

1. _____________________ 2. ____________________

3. _____________________ 4. ____________________

5. _____________________

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NCM 107: Care of the Mother and Child ( Well )

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