School-Age Development: Erikson, Piaget, & Kohlberg

Nursing Care of Family with School-Age to Adolescent Child

• Focuses on the nursing care for families with children transitioning from school age to adolescence

Growth and Development of a School-Age Child

• Physical growth is a key aspect of development
• Sexual maturation is an important consideration
• Sexual and physical concerns arise during this stage for both girls and boys
• Dental health is also a factor of physical growth

Developmental Milestones

• Gross motor and fine motor skill development occurs
• Play activities are significant for development
• Language and emotional development are continuous milestones

Chronologic Development of Secondary Sex Characteristics

• Between ages 9-11, boys experience prepubertal weight gain
• Between 11-12, boys experience sparse growth of straight, downy, slightly pigmented hair at the base of the penis
• Also between 11 and 12 in boys; the scrotum becomes textured, growth of penis and testes begins, sebaceous gland secretion increases, and perspiration increases
• Between 12-13 in boys; pubic hair is present across the pubis, the penis lengthens, a dramatic linear growth spurt occurs, and breast enlargement may occur
• Between ages 9-11, girls will develop breast elevation of papilla with breast bud formation and areolar diameter enlarges
• Between 11-12, girls grow straight hair along the labia, the vaginal epithelium becomes cornified, and the pH of vaginal secretions becomes acidic with slight mucous vaginal discharge
• Also between 11 and 12 in girls, sebaceous gland secretion increases, perspiration increases, dramatic growth spurt
• Between 12-13, girls' pubic hair grows darker and spreads over the entire pubis, breasts enlarge with no protrusion of nipples, axillary hair appears, and menarche occurs

Industry vs. Inferiority: A Developmental Task

• Home and school environments are influential
• Structured activities and problem-solving skills play a role
• Learning to live with others is important
• Socialization and cognitive development are key

Cognitive Development

• Involves decentering
• Involves accommodation
• Conservatism
• Class Inclusion

Moral and Spiritual Development

• Preconventional reasoning and rule orientation are part of moral development

Factors in Development

• Language development advances
• Fears and anxieties may occur
• School phobia and home schooling can be relevant
• Lack of adult supervision is a concern
• Sex education is necessary

Safety

• Prioritize student safety
• Evaluate nutrition and diet
• Check for dental carries and malocclusion
• Look for any speech problems
• Address fear and anxiety

Assessing School-Age Children

• Evaluate for violence, terrorism or bullying
• Look for any Drug use

Health Maintenance Schedule

• Health history and physical assessment should be done every visit
• Developmental milestones should be checked every visit
• Growth milestones should be checked every visit

Immunizations

• DTaP vaccine at 11-12 years
• HepA vaccine if not previously administered
• HepB vaccine if not administered in infancy or 3 injections not completed
• HPV vaccine at 11-12 years; second injection 2 months later; third injection 6 months after first dose
• IPV if four doses not previously administered
• Influenza vaccine yearly
• MCV4 at 11-12 years
• Varicella vaccine at any age after 1 year if not previously immunized, or at 11-12 years if lacking reliable chickenpox

Nursing Diagnoses for School-Age Children

• Consider health-seeking behaviors related to normal school-age growth and development
• Assess readiness for enhanced parenting related to improved family living conditions
• Consider anxiety related to slow growth patterns
• Also note the risk for injury related to deficient parental knowledge about safety precautions

Health Promotion and Safety

• Teach common safety measures to prevent unintentional injuries during the school years
• Parents should actively teach preventive actions

Common Safety Measures

• Use seatbelts and booster seats
• Crossing street awareness
• Bus safety
• Bicycle Safety
• Stranger Danger
• Internet Safety
• Candle safety
• Microwave oven safety
• Sun Exposure awareness
• Avoiding electric poles
• Awareness of climbing on fences and roofs
• Skateboard, scooter and skating safety

Safe Sports

• Wearing equipment for sports such as hockey masks or batting helmets is smart management
• Teach that kids should know when to stop from exhaustion
• No baseball pitching or toe ballet in early school years
• Trampolines require adult supervision
• Teach how to swim and stress not to swim beyond limits of capabilities

Additional Considerations

• Help your child avoid recreational and prescription drugs
• Teach firearm safety and to keep firearms separate to bullets and locked away
• School age children should keep parents informed on their whereabouts
• Frequency of unintentional injuries increases when parents are under more stress and thus less attentive
• Some children are more active, curious and impulsive and require increased attention

Helping Children Avoid Sexual Maltreatment

• Teach them that their body is their property and only they can decide who can touch or look at it
• Secrets are fun to keep, but if a person asks you not to tell about being touched in a way you didn't like then it is not longer a secret and you can tell
• Do not go anywhere with a stranger
• Do not meet anyone from the internet in person, people may not be who they say they are
• A private part is the part that is covered by a bathing suit, if anyone asks you in this area, tell them to stop and tell someone what has happened

Health Promotion

• Establish healthy dietary eating patterns
• Foster industry and nutrition by improving eating
• Apply recommended dietary reference intake
• If vegetarian

Activities

• Dress
• Self Care
• Sleep
• Exercise
• Teach about teeth
• Teach Hygiene

Promoting Family Functioning

• Evaluate seriousness of illness
• Evaluate nutritional intake
• Evaluate puberty changes
• Be aware of age-specific diseases
• Reading with children increases cultural understanding

Topics for Sex Education

• Discuss reproductive organ function and physiology
• Talk about secondary sexual characteristics
• Talk about production of seminal fluid
• Talk about physiology of pregnancy and possibility of unintended pregnancies
• Discuss the social and moral implications of sexual maturity

Common Issues

• Stealing must require firm action
• Early theft should not involve emotion
• Must teach that parents should set a good example

Emotional Harm

• Violence can cause stress in children
• It can cause trauma
• Teach about disasters
• Parents should be there during events that children could find emotional harm

Tips for children who are spend time independently

• Should always lock doors
• Keep keys from others
• Say that parent is busy and not gone
• Have a plan if key is lost
• Never go into the house if a window broken or door open
• check in with parent by phone or laptop when home
• Identify caller when opening door
• Learn police and fire numbers
• Practice how to report a fire

Parents should be responsible for children even if they are independent

• Prepare safety kits
• Make sure food does not require cooking
• Lock firearms
• Keep Parents number
• Neighbors number
• Be certain children follow rules that are set in place

Parental Actions to Prevent Loneliness

• Leave messages of love
• Tape record messages
• Make parent time available
• Leave activity's so kid can follow
• Allow special privlages such as listening to music
• Get a pet
• Enchourage reading Urge kid to network with other children that spend a lot of time alone

Parental Actions to Increase Socialization and Self Esteem

• Praise the child for the ability to take care of himself or herself
• Walk with the child through the empty house and identify sounds
• Help the child to view the quiet as a beneficial time
• Allow children to have some say in family spending so they can see how their time alone contributes to family unity

Recreational Drug Use

• If the child regularly appears irritable, inattentive, or drowsy, consider drug use
• Counsel against steroid use; highlight cardiovascular irregularities, uncontrollable aggressiveness, and chances of cancer
• Teach to recognize advertisement techniques, and to caution smokeless tobacco
• Role model excellent health behavior by not smoking

Nursing actions for sense of idenity

• Allow choices of food that the adolescent will be able to achieve
• Allow suggestions as to how bulcky can be and were to apply
• Give suggestions on what the medicine consists of

Growth and Development of an Adolescent Child

• During the adolescent ages, prioritize physical development
• Also note pubertal changes and puberty

Emotional Development

• Body image
• Self esteem
• Identify values
• Sexuality and Sexual Activity

Factors for Adolescent Stages

• Pregnancy
• STDs
• Homosexuality
• Rape
• Bullying
• Substance Use
• Injury and self-harm

Measures to prevent unwanted injuries

• Use seat belts
• Do not drink and drive
• Avoid cell phones
• Wear helmet on motorcycle
• Firearms must be kept loaded and lethal
• Need to learn to swim

Common Problems and What to Do

• Acne, don't touch the affected area
• Hair should not be in way of face
• Apply topical treatments
• Make chart to remind child

More to Be Safe

• When participating in sexual relationships and actions, they need support through their lives
• Understand that relationships should add to their lives and not destruct from it

Symptoms of Substance Abuse

• Drugs, such as glue, can cause violence, drunken appearance, and a dreamy look
• Heroin, morphine, and codeine can cause Needle marks and sleepiness
• MariJuana can cause sleepiness and wandering minds
• Alcohol can cause Slurred speech and a drunken appearance
• All of which are bad for the patient

Education on Substance Abuse

• Warn that use of substance is harmful
• Using drugs will prevent you from handling situations
• Short use can be addictive

Signs of Suicide

• Giving away belongings
• Organ donation questions
• Increased mood
• Self Negligence
• Preference of death themes
• Inquiring on the afterlife

Runaway and Homeless Youth

• Arguements with parents
• Health factors could include pregnancy, hepatitis and substance abuse

Helping Chronically Ill Adolescents

• if they are on a diet, allow the patient to discuss favorites
• Tell the child the action and what the action does
• Offer an adolescents to choose site for injection or intravenous insertion to encourage a sense of control

Explore the psychosocial, cognitive, and moral changes in school-age children and adolescents. Understand Erikson's stages, Piaget's cognitive development, and Kohlberg's moral reasoning. Identify key physical concerns during this developmental period.