School Age PDF

7589_Ch09_131-148 29/08/17 12:01 PM Page 131 CHAPTER 9 School Age Key Words Chapter Outline bullying cyberbullying epiphyseal cartilage industry latency malocclusion ossification puberty reciprocity saturated fats school phobia scoliosis somatic team play Physical Characteristics Height and We...

7589_Ch09_131-148 29/08/17 12:01 PM Page 131 CHAPTER 9 School Age Key Words Chapter Outline bullying cyberbullying epiphyseal cartilage industry latency malocclusion ossification puberty reciprocity saturated fats school phobia scoliosis somatic team play Physical Characteristics Height and Weight Bone and Muscle Development Sensory Development Dentition Development of the Gastrointestinal and Nervous Systems Development of the Immune System Vital Signs Developmental Milestones Motor Development Sexual Development Psychosocial Development Industry Peer Relationships Other Developments Discipline Special Psychosocial Concerns Cognitive Development Formal Education Moral Development Communication Nutrition Obesity Sleep and Rest Play Safety Stranger Danger School Violence Health Promotion Special Health Concern: Substance Abuse Summary Critical Thinking Multiple-Choice Questions Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • • • List four physical characteristics common to school-age children. Describe three developmental milestones common to school-age children. Describe the psychosocial task identified by Erikson for the school-age period. Describe the cognitive levels of functioning during the school-age period. Describe moral development in school-age children. List three factors that help contribute to the health of school-age children. 131 7589_Ch09_131-148 29/08/17 12:01 PM Page 132 132 Journey Across the Life Span The period of development known as school age, the middle years, or late childhood starts with the child’s entry into formal education and ends with the onset of puberty, roughly from ages 6 to 11. Puberty commonly refers to the developmental period in which the body prepares for the changes necessary for reproduction. Five significant accomplishments occur during the school-age period: 1. Growth remains slow and steady. 2. Children move away from the family toward peer relationships. 3. Children become less self-centered and more goal-directed. 4. Deciduous teeth are lost, and the permanent teeth appear (Fig. 9.1). 5. Sexual tranquillity replaces sexual curiosity and preoccupation. PHYSICAL CHARACTERISTICS Height and Weight The school-age period begins with slow, consistent growth and ends with a growth spurt just at the time of puberty. The average expected growth rate for the child during this period of development is 2 to 3 inches (5 to 7 cm) per year. Weight increases on an average of 4.5 to 6.5 pounds (2 to 3 kg) per year. The average 6-year-old girl measures 45 inches (116 cm) and weighs 46 pounds (21 kg); the average 10-year-old girl measures 59 inches (150 cm) and weighs 88 pounds (40 kg). Boys may appear taller and heavier in the early school-age period, but for a brief time toward the end of this stage, girls are taller and heavier than boys. Bone and Muscle Development Bone growth and maturation can be affected by several factors, including gender, race, nutrition, and general state of health. The bones mature 2 years earlier in girls than in boys. African American children, in general, show earlier bone development than do white children. Growth in the long bones stretches the ligaments and muscles, causing most children to experience “growing pains,” mostly at night. The child’s arms and legs lengthen, producing a thin, spindly appearance. School-age children’s posture changes because their center of gravity shifts downward as their muscle strength increases. The abdominal muscles also grow stronger, causing the pelvis to tip backward. The chest broadens and flattens, but the shoulders continue to appear rounded. Exercise encourages muscle development and improves strength and flexibility. Poor posture causes fatigue and may indicate minor skeletal pathology. Health screening for defects in the skeletal system is discussed in the section titled “Health Promotion.” Generally, muscle mass and muscle strength increase, but the school-age child’s muscles are still relatively immature and easily injured. Fine and gross motor skills show marked improvement, allowing the child to be more independent and self-sufficient both at home and at school. Sensory Development Visual maturity is usually achieved by 6 to 7 years of age. Peripheral vision and depth perception improve, permitting better hand–eye coordination. School-age children no longer require large print in books and schoolwork. Dentition FIGURE 9.1 The school-age period is marked by the appearance of permanent teeth. An important hallmark of this stage is the loss of the deciduous teeth and the appearance of the permanent teeth (Fig. 9.2). Children should be told in advance that they will lose their baby teeth so that 7589_Ch09_131-148 29/08/17 12:01 PM Page 133 School Age 133 Development of the Gastrointestinal and Nervous Systems Because the gastrointestinal system matures during this stage, school-age children have fewer digestive intolerances and disturbances than do younger children. As the capacity of the stomach increases, the child needs to eat less often. Three meals a day are now sufficient. The nervous system continues to mature, as evidenced by the child’s improved motor skills and expanded cognitive processes. The senses of taste, smell, and touch fully mature, making the schoolage child more discriminatory. At this stage children develop many distinct food preferences based on personal taste and peer influences. Development of the Immune System FIGURE 9.2 Loss of deciduous teeth is common at this stage. they are not frightened when it happens. This can be done when the first tooth starts to loosen, usually at 6 to 7 years of age. Parents can emphasize that this is a sign that the child is growing up. Some parents play the “tooth fairy” game, rewarding the child with money for each lost tooth. The first tooth to fall out is the lower central incisor. Teeth should not be pulled or forced to fall out but allowed to progress naturally. The permanent teeth grow in the same order as the deciduous teeth. They usually appear very large in relation to the rest of the facial structures. The result is what is sometimes called the “ugly duckling” stage of development. Up to 75% of children have some degree of malocclusion, or malposition, of the teeth that may affect their chewing, facial relaxation, and appearance. Children should visit the dentist regularly, at least every 6 months, to have their teeth inspected and cleaned and any dental disease corrected. Daily dental care should include regular toothbrushing after meals and before bedtime. The use of fluoride toothpaste is strongly recommended to help decrease the incidence of dental caries. Dental caries begins with the buildup of plaque around the tooth surface and margins. Regular brushing and limiting children’s intake of concentrated sweets help prevent plaque formation. Certain snack foods such as apples, raw carrots, and sugarless gum can help reduce plaque formation. The school-age period is marked by the maturing of the immune system, producing a peak in the child’s antibody levels. Lymphatic tissues known as the tonsils and adenoids are located in the nasopharynx. These tissues may be disproportionately large, but unless they are causing infection or obstruction, surgical removal is not recommended. When children begin school, they are exposed to a greater number of microorganisms, and as a result they often have an increased incidence of upper respiratory tract infections. Once their immune systems adjust to the increased exposure, their resistance improves. The school-age period is generally a healthy period of development. VITAL SIGNS Because school-age children’s hearts are small in proportion to their body masses, they may feel tired after strenuous exercise. During this stage of development, the heart rate decreases to an average of 90 beats per minute. Functional (innocent) heart murmurs may be present in 50% of school-age children. These murmurs do not usually require intervention. Blood pressure readings are generally higher than at the earlier stages—usually 100/60 mm Hg—because of the development of the left ventricle. Hemoglobin and hematocrit levels also increase slightly, whereas red and white blood cell counts decrease slightly during this period of development. 7589_Ch09_131-148 29/08/17 12:01 PM Page 134 134 Journey Across the Life Span The respiratory system of the school-age child continues to develop. By 8 years of age the child’s alveoli (air sacs) are fully mature. The normal respiratory rate decreases; the average resting respiratory rate is 20 breaths per minute. DEVELOPMENTAL MILESTONES Motor Development During the school-age period there is a marked increase in muscle mass and muscle strength and significant improvement in gross and fine motor skills. School-age children can run faster, farther, and for longer periods. At this stage they are able to jump higher and throw farther and with more accuracy than children in younger age groups. Most children are stronger and better coordinated at this stage. Gender differences exist in motor skills. On average, boys are stronger; better at running, jumping, and throwing; and have greater endurance than girls. Girls are better at balance and coordination than boys. Girls perfect their fine motor skills before boys perfect theirs. Motor accomplishments are very important to both girls and boys during this stage. School-age children have developed enough proficiency in gross and fine motor skills to permit independence in many areas at school and home, including play and self-care. Although 6-year-old children appear grown-up and independent, they are easily frustrated and fatigued. It is not uncommon for them to cry and become irritable and infantile. Children of this age group often play on their own and select activities that they find enjoyable. Many of their newfound skills can be accomplished without parental assistance. Some of the skills that validate their independence include swimming, skating, and bicycle riding. During this stage children show competence in performing necessary self-care activities such as bathing, dressing, and feeding themselves. School-age children learn to write, draw, dance, and develop many other creative talents. Most 6- to 7-year-old children can print letters and their names and can throw, catch, swim, and run with better control. Children of 6 and 7 years start to learn to tie their shoelaces. The gross motor skills of 7- and 8-year-old children improve, permitting smoother movements while running, jumping, and skipping. Many at this stage are capable of using a ball and bat with greater control and accuracy. Fine motor skills continue to improve, and by 8 years of age fine movements become steadier and more controlled. Children now prefer a pencil or pen to a crayon and can print smaller and learn script lettering. With their improved fine motor development, they can now begin to learn to play many musical instruments. Children of 8 to 9 years are usually outgoing, talkative, and enthusiastic. They are ready to take on any project regardless of their capabilities. This fearlessness may put them at greater risk for injury. At this stage they appear more graceful and have smoother motor coordination. Their strength and endurance also increase, improving their motor performances. Eight-year-old children practice a skill longer and with more commitment. Once they master the skill, they are ready to show off their talents. Various new activities may be attempted, such as gymnastics, karate, ballet, and other dance forms. Their fine motor skills also improve to now permit mastery in the areas attempted at an earlier age. There no longer seems to be a random selection of games and activities. Instead, children select activities based on their specific interests and likes. By the end of this stage, their physical strength is almost equal to that of an adult. Endurance and skills improve through practice. Children of 9 and 10 years show improved motor development. As their strength and endurance increase, so does their interest in sports and other activities. By this age, children can actively participate in team sports (Fig. 9.3). They are now better able to understand rules and complex plays. Fine motor coordination improves, permitting them to learn to write and print. Sexual Development Sexual curiosity continues during this stage. Young school-age children ask many questions. Parents need to answer the questions honestly on the level of their child’s understanding, being mindful not to give more information than the child can digest or understand. Children learn much about their own sexuality and about the sexuality of others from their parents’ behaviors. Critical for the child’s understanding are not only the details of sexual intercourse, but also how people feel about and treat others and how they handle issues of responsibility. School-age children need to learn about respect for other people’s feelings and values even if they differ from their own. They should learn never to force another child to do something simply because it is what they themselves want 7589_Ch09_131-148 29/08/17 12:01 PM Page 135 School Age FIGURE 9.3 Skill and practice teach discipline and confidence during school age. to do. This teaches a valuable point without even focusing on sexual content. Parents can use issues on television or song lyrics to form the basis of conversations relating to sexuality. Children should be asked questions such as, “Does that make sense?” or “How would you feel in that situation?” Parents should provide all the information children need and keep the lines of communication open so that their children will be able to make future decisions regarding sex. Freud describes this period as latency, a time when sexual energies are relatively dormant. During this stage children are more involved with cognitive skills and learning than with sexual concerns. Peer relationships are mainly with children of the same sex. The ability to establish meaningful, caring relationships at this stage helps children prepare for caring relationships in adulthood. Psychosocial Development Industry Erikson believed that school-age children are able to see themselves as producers. Thus he viewed the primary task for this stage of development as industry. Children at this time are more focused on the real world and see themselves as part of a larger group, allowing them to accomplish more and get along 135 better with others. Their motivational drive increases, and they gain satisfaction from their accomplishments. Schoolwork takes on a great deal of importance to children of this age. They often set very high standards of achievement in their academic endeavors. When they fall short of their goals, they may be very disappointed and develop a sense of failure. Some children become very upset if they do not get a grade of 100% or receive praise from their teachers for their efforts. For this reason it is important to use positive reinforcement as motivation for learning. Children of 6 to 7 years of age are full of energy and anxious to try new skills. Many begin new projects but do not have the patience or attention span to see things to completion. For example, a mother and child may begin to bake cookies, but halfway through the task the child loses interest, leaving the mother alone to complete the task. At the beginning of this stage, children need immediate gratification for their work efforts. They are in a hurry to finish what they start and proudly show it off to others. They need praise and rewards from others to help strengthen their self-esteem and motivate them. Nine-year-olds can initiate a task and are motivated to see the task to completion. They know what is expected of them and are more likely to conform to win the regard of adults. By age 11 most children are capable of working on more complex projects and can accept delayed rewards. Praise still helps strengthen their self-esteem. Without reinforcement and praise, children may develop a sense of inferiority. Peer Relationships During this period, children begin for the first time to move away from the family toward peer relationships (Fig. 9.4). These relationships are generally numerous and of short duration. Most of the time children gravitate toward peers of the same sex and openly express dislike for the opposite sex. Among 7- to 8-year-old children friendships become more intense and serious but are still mainly with children of the same gender. These friendships are made up of several children who have common needs and interests. They frequently form one strong friendship or best friend. Heroes or idols may be worshipped and fantasized about by children of both sexes. Thinking and behavior become more complex. Activity levels vary greatly, with some periods of quiet sitting and other periods of high energy and activity. 7589_Ch09_131-148 29/08/17 12:01 PM Page 136 136 Journey Across the Life Span FIGURE 9.4 School-age children move toward peer relationships. School-age children are frequently engaged in rivalry with their siblings and often wind up in tears, still wanting things to go their way. They keep track of whose cookie has more chips in it or who got to choose the radio station in the car during the last outing. Their words, anger, and level of competition seem out of proportion to the issues. For example, they might say, “I wish you were dead” to a brother or sister who is sitting in the favorite chair. Jealousy is a common emotional expression that may intensify when the child enters school and leaves younger siblings at home with undivided parental attention. Another form of this emotion occurs when the child believes that his or her peers are more accomplished. Although at all ages children need love and affection, boys of this age tend to feel that they are too old to be kissed or hugged and may resent their parents’ use of endearing terms or displays of public affection. Family relationships appear to be less important to school-age children than their new peer relationships. Inside the home they often express negative feelings and are openly hostile toward family members, whereas outside the home they firmly defend, support, and even boast about their family members. Friendships are very important and are the cornerstone of the school-age child’s social world. The patterns of interpersonal relationships that are learned at this stage continue into adulthood. School-age children are able to develop reciprocal relationships with their peers. These relationships are based on genuine feelings and appreciation of the other person’s unique qualities. It is common for children to establish intimacy with their friends and to share their possessions and their innermost secrets and feelings. Toward the end of this stage friendships become more intense and serious but are still mainly with children of the same gender. Other Developments Privacy Privacy becomes important to children of this age group. They want their belongings and valuables to be off-limits to others. They also want privacy in self-care activities and appear modest and shy. For example, when shopping for new clothes with a parent, the child may insist on going into the dressing room alone. These feelings should be respected and not ridiculed. Fears It is not uncommon for children at this age to have an exaggerated fear of physical harm to themselves and to members of their families. Some of these fears may be increased by watching violence on television or in the movies. To help reduce these fears, children should be given realistic reassurance, and their exposure to violent programming should be limited. At this age they may spend time worrying about issues such as divorce, illness, and dying. As children move toward adolescence, they tend to become more nonverbal about their worries, keeping feelings to themselves. 7589_Ch09_131-148 29/08/17 12:01 PM Page 137 School Age Concept of Money Preschool children recognize that money can buy things, but their concept of money is yet unclear. For example, they may believe that coins are worth more than paper money and that nickels are more valuable than dimes because they are larger. School-age children begin to place importance on money and possessions. Parents should establish with their children a predetermined amount of money as an allowance and use the allowance to help teach them how to handle money. School-age children are also now capable of working at small jobs; in fact, many ask, “How much will you pay me?” before doing a simple household chore. Allowances and home chores should be kept separate. Children should be taught that they are expected to help around the home simply because they are part of the family unit. This teaches them responsibility within the family setting, and these principles can later be applied to the larger environment. Hygiene During this period there are often conflicts regarding the child’s personal hygiene and other home-care activities. School-age children frequently have to be reminded to bathe and change their clothes. They may spend a great deal of time in the bathroom but may emerge no cleaner than when they went in. By the end of this stage children frequently leave their rooms in a mess, suggesting that puberty and the teen years are rapidly approaching. Box 9.1 offers hints on preparation for puberty. Emotions Emotions have wide ranges of expression, depending on the child’s chronological age and psychological maturity. In the early part of this stage of development, children may use simple emotions to express their feelings. Tears, for example, are still used but are quickly seen as a babyish form of expression. Some children are shyer than others. Some have many fears or worry about social acceptance or school performance. Table 9.1 lists common school-age fears. Children may express anger, a powerful emotion, in different ways. Some may B O 9.1 X P r ep ar at i on s f or P u b er t y • Offer information and answer questions regarding puberty. • Expect adult appearance to precede adult behavior. • Promote positive self-esteem. • Treat puberty as a positive experience. 137 T A B L E 9.1 Co mmo n Scho o l-Ag e Fears Age Fear 6–7 years Strange loud noises, ghosts and witches, being alone at night, bodily injury, school 7–8 years Dark places, catastrophes, not being liked, physical harm 8–9 years Failure in school, being caught in a lie, divorce or separation of parents, being a crime victim 9–11 years Becoming ill, heights, pain, evil people be negative or sulk, others may withdraw or refuse to speak, and still others may be openly disagreeable and hostile. Anger may represent the child’s frustration and need for independence. Discipline Discipline continues to be an important need for children of this age group. It teaches them boundaries and helps to set limits on their behavior. Children also need a certain amount of freedom to explore. The proper amount of discipline is crucial. Too much may lead to acting-out behavior, with the child attempting to prove and assert himself or herself. However, toolenient parental control may lead to insecurity and doubt. Children need adequate praise and rewards to help reinforce desirable behavior. Physical discipline refers to just that—using physical force such as hitting or spanking. This type of discipline leads to a decrease in the child’s selfesteem. Better forms of discipline include time-outs and clear explanations of appropriate behavior. Several studies have looked at the relationship between parental physical discipline and different ethnic groups. Results have indicated that in families using physical discipline, there was a higher incidence of children having behavior problems regardless of the ethnic group. Many researchers believe that findings support parental nurturance and gentle disciplinary tactics as a means toward positive child outcomes. School-age children are usually able to take responsibility for their rooms and possessions. They can be given small jobs around the house as part of their chores. These jobs help give children a sense of importance within the family structure and help teach them responsibility. 7589_Ch09_131-148 29/08/17 12:01 PM Page 138 138 Journey Across the Life Span Special Psychosocial Concerns Television Violence Studies have indicated that violence on television can have an adverse effect on young viewers. Even children who have no problems dealing with aggression have been shown to become more aggressive after watching violent television. The belief that television portrays real-life events further complicates the school-age child’s distorted views. It is not uncommon for children of this age to imitate and idolize cartoons or other characters from television shows. Parents can help children choose shows to watch and limit their viewing of excessively violent programs. In addition, parents need to discuss values and practice nonviolent behavior. Video Games/Internet Use Playing video games may help develop hand–eye coordination, and some games help children strengthen their problem-solving skills. Parents can assist by helping children select age-appropriate games. Extra care must be taken not to simply rely on the rating stamped on the package. Instead, parents must view the contents before having the child use the product. Computers should be placed in an open area where the family gathers and parents can oversee the child, and time spent using games or computers should be limited. Parents must monitor the Internet sites their child visits. Children should be instructed not to go into chat rooms and give out personal information. Children should know that sometimes individuals misrepresent themselves on the Internet (Box 9.2), and that at no time should any child plan to meet in person someone that they met on the Internet. Bullying School-age children are often critical of others but may brag and boast about themselves. It is common to overhear them teasing, bullying, or using insulting comments when talking about others. Bullying is defined as repeated negative actions by one or more persons against chosen victims. Bullies are often children who have been bullied themselves and may pick on others to feel powerful, popular, or B O 9.2 • • • • • • X Cy be r R i s ks Avoid exposure to inappropriate, explicit content. Avoid sharing personal information. Limit the amount of time spent in cyberspace. Report “cyberbullying.” Never share passwords. Avoid chat rooms and chatting with strangers. in control. Some children even find humor at someone else’s expense. There are usually three groups involved: the bully, the victim, and the bystander. Bullies pick on individuals whose responses provide instant gratification. Male bullies are at risk for poor long-term outcomes unless counseling or other help stops their pattern of bullying. Victims of repeated bullying may begin to feel that they deserve the teasing. The bystander is the individual who just observes the bullying incident without any active involvement. This person fails to assist the victim, which may leave the bystander with feelings of powerlessness. Bullying is more widespread than we would like to believe. If your child is a bully, it is important to emphasize that this kind of behavior is unacceptable. Some children may assume the role of the victim and fall prey to a bully. Parents can help reduce the intimidation and fear of being bullied by listening to their child and offering help. Besides bumps and bruises, signs that a child is being bullied include sleeping problems, irritability, poor concentration, problems with schoolwork, missing belongings or money, and frequent unexplained psychosomatic complaints. Box 9.3 gives parental guidelines for dealing with bullies and victims. Cyberbullying refers to the use of the Internet, phone, or other technology to repeatedly harass or taunt persons. Parents must monitor their children’s B O 9.3 X P arental G uid elines fo r B ullies and V ictims For the Bully: • • • • • Teach the child to respect the rights of others. Set clear, firm rules with regard to social behavior. Teach and use negotiation techniques. Set positive examples. Praise desirable behavior. For the Victim: • Offer coping strategies. • Encourage verbalization about incidents. • Encourage participation in activities that build selfesteem. • Praise child for achievements. • Avoid intervening if at all possible. For the Bystander: • • • • Recognize that this is a serious problem. Encourage the child to shout for adult assistance. If that fails, leave and find adult help. Discuss that a lack of action may further support the bully. 7589_Ch09_131-148 29/08/17 12:01 PM Page 139 School Age H E L P F U L H I N T S Latchkey Children • Arrange for the child to report to a specific place. • Have the child check in with an adult at a specific time. • Teach the child how to respond to emergencies. • Designate a neighbor or nearby adult the child can call if he or she is worried or concerned. • Rehearse how the child should answer the telephone and door. • Arrange a schedule of activities for the child to follow. Internet usage and investigate any sudden onset of school phobia, attention problems, grade slippage, or psychosomatic complaints. “Latchkey” Children Approximately one-quarter of all elementary school children care for themselves for a short time after school. In some inner-city areas there may be after-school programs, but in more rural areas children are more likely to be at home unsupervised. It is difficult to generalize or predict how these “latchkey” children are doing. Some of them go straight home, report to their parents, and have a schedule of duties to complete. These children are less likely to get into trouble than those who are unsupervised and just “hang out.” Cognitive Development According to Piaget, between ages 5 and 7 most children make the transition from the preoperational stage to concrete operational thought. School-age children have grasped the concept of conservation. For example, by 7 years of age the child understands that someone dressed in a costume is really just another human being and not some alien being to fear. Piaget believed that the school-age child develops causation—that is, understands the cause and effect of relationships. For example, 8-year-old children usually know that rain does not always cause thunder. According to Piaget, school-age children can also place objects in order according to size (seriation). Piaget also suggested that school-age children have improved conservation and classification skills. They learn to develop their conservation skills in an orderly sequence—that is, first they understand the concept of number and then the concepts of substance, length, area, weight, and volume. 139 At this age they can recognize the relationships of a part to the whole and between sets and subsets. For example, 7- to 8-year-old children frequently have collections of stickers, baseball cards, books, videos, and so forth. These can be arranged and sorted according to several characteristics. Children who are 8 to 9 years old can readily recognize and name different makes and models of cars. A car is not simply a Ford; it is a Taurus sedan. They can break down items into smaller parts and then reassemble them. Children at this age can enjoy working on more complex puzzles, assembling model cars, and so forth. School-age children can take into consideration the views of other people, thereby widening their own perspectives. Typically, they have an increased attention span and are less restless, which makes them better able to stay focused on activities for longer periods. Seven-year-old children are more serious than younger children. School-age children are very productive and adventurous. Their abilities have increased to allow a more organized style of thinking, which includes problem solving. They are better able to understand and follow rules. School-age children can understand concepts such as time, space, and dimension with more clarity than they could at earlier developmental stages. Their increased cognitive abilities enable them to master reading, mathematics, and science. During elementary school, children begin to learn how to tackle and solve problems. School-age children have improved memory, which enhances their learning skills. Formal Education Starting formal education is a major accomplishment for this age group. School becomes the focus of the child’s environment. In preschool the focus is on protection, play, and caring; in elementary school the emphasis is on education and learning. School offers children the opportunity to establish themselves as individuals, separate from their parents and family. Children spend more time in school than anywhere else outside the home. This is where they try on different roles within a group setting, test their negotiation skills, and experiment with learning. Adjustment to school depends on the individual child, the home setting, and the school environment. For some, leaving home is difficult and results in the onset of school phobia, which is an intense fear of going to school. The onset of various somatic (physical) complaints—stomachache, headache, or other unexplained pains—may be manifestations of school phobia and should be thoroughly investigated 7589_Ch09_131-148 29/08/17 12:01 PM Page 140 140 Journey Across the Life Span to rule out any underlying medical pathology or problems at school with the teacher, a bully, and so forth. Once the child has been medically evaluated, he or she should be treated if necessary, given support, and gently encouraged to return to the school routine. School places several stresses on children. They must find a classroom by themselves, speak in front of the class, or be reprimanded by a teacher. School, however, is also the place for rewards, recognition, and success. In kindergarten, children learn to socialize and get along with their peers. Children at this age respond favorably to an authority figure, such as a teacher, and to praise and rewards. During the early grades (1 through 4), children learn to follow routines and concentrate on specific tasks. Children 8 and 9 years old are serious about their academic performance and are more ready to take responsibility for their learning and for their actions. They are concerned about being wrong and worry about being humiliated in front of their peers. They accept the teacher with unconditional respect. Later, during the upper grades (5 through 8), learning becomes more of an independent task. Children of this age group are more judgmental and critical. Respect for teachers and authority wanes, giving the teacher less control in the classroom. Children need clear-cut rules, with an emphasis on fairness. Box 9.4 provides guidelines for a good classroom environment. At an earlier age, homework was considered fun, but by 8 or 9 years of age children regard homework as something to avoid, rush through, forget, or put off. Homework and studying are the basis of many arguments between parents and older school-age children. Parents of young children are very involved with the mechanics of studying, assisting with assignments, and checking completed work efforts. Children who develop a routine for doing homework are generally more successful in school than those who do not. B O 9.4 Homeschooling Homeschooling is an alternative to formal school that some parents elect for their children. The advantage of homeschooling is the control parents gain over the environment and their child’s learning. They can modify the teaching to individual learning styles and needs. Some of the disadvantages may include decreased socialization experiences for the child and time-consuming parental responsibilities that may lead to parental stress. Moral Development Just as school-age children are making a transition in their cognitive abilities, they are also moving from one stage of moral development to the next. According to Kohlberg, most 6-year-old children are still likely to be at the preconventional level of moral thought—that is, they are primarily egocentric. They react to situations mainly to be rewarded or to avoid punishment or reprimand, without concern for other moral implications. Later, children move to the conventional level of moral reasoning. They begin to make moral decisions based on what their families or others in society expect of them. They want to conform to what they believe will make them “good” girls or boys. By middle childhood, children can be counted on to act “the right way.” School-age children tell different types of lies than younger children do. They lie to improve their self-esteem and status and to win recognition. This lying is a type of bragging that helps them cope with new social pressures. These lies, if infrequent, should not be of concern to parents. X D e si rab l e C l as s r oom En vi r on m ent To create a desirable classroom environment, teachers should do the following: • • • • • • • By ages 9 to 11, most children would rather be at home or with their friends following their interests than in school. The children who thrive and succeed in school are usually more motivated and receive positive reinforcement from both parents and teachers. Poor performance in school at this time should not be ignored by parents or teachers. Give ample praise. Structure comfortable work areas. Encourage sharing of responsibilities. Stress academic achievement. Use positive reinforcement. Be positive role models. Promote open communication. H E L P F U L H I N T S Homework • • • • • Try to make homework a pleasant experience. Set aside a specific time for homework. Make homework a top priority. Offer a lot of reassurance. Provide attention and contact with the child during homework sessions by offering a snack, a hug, or a reassuring touch. 7589_Ch09_131-148 29/08/17 12:01 PM Page 141 School Age Toward the end of this stage, at about age 11, children begin to balance their self-interests and needs against what they know to be right. They also begin to consider what is fair to others. Kohlberg described their concern for others as the beginning of reciprocity. The 11-year-old child has a need to be trusted. Trust reinforces the child’s concept of self-worth. At this point children demand loyalty from their friends and reciprocate this feeling. School-age children also learn self-regulation and control of their behavior. Some studies have supported Kohlberg’s views on moral development and have indicated that children’s moral thinking is stimulated when they are involved in ethical discussions or in decision making. Other studies suggest that moral development is different for girls and boys: Girls base moral reasoning on considering and preserving human relationships, whereas boys base moral decisions on protecting and defending others. Regardless of which theory one ascribes to, it is important to keep in mind that moral reasoning, like cognition, develops gradually, with some overlapping at each stage. A child’s moral code is based on his or her parents’ teachings and behaviors. Once children internalize a moral code, they use it to judge the actions of others. Box 9.5 gives an example of a moral exercise. unacceptable. The unacceptability of these forms helps to reinforce language acquisition. School places an emphasis on building vocabulary, proper grammar, pronunciation, and sentence structure. School-age children can use nouns, verbs, and adjectives in their sentences. For the most part, they use the proper tense in speech. Their sentences describe their feelings, thoughts, and points of view. The use of swear words or slang increases as a result of peer influence. These words help to express their emotions and give them a sense of importance. A secret language is sometimes used by this age group to transmit messages back and forth to one another. Not only does this give children a degree of privacy, but it also enhances their sense of group belonging. Table 9.2 provides a schedule of language development. NUTRITION For continued growth of the musculoskeletal system, nutritional requirements during this stage include an T A B L E 9.2 L ang uag e Dev elo pment Age Development 6 years Has vocabulary of 3,000 words, understands meaning of complex sentences, and can read 7 years Tells time and prints well 8 years Writes and prints 9 years Describes objects in detail and writes well 10–11 years Writes lengthy compositions, begins dictionary skills, and develops good grammar Communication Language improves so that school-age children are able to communicate more effectively with others. The ability to use language is important and enhances socialization and group belonging. Earlier forms of communication, which may have been more limited to gestures and crying, are now socially B O 9.5 X M or al Ex er c i s e Read the following exercise to the class. Ask the children how they would react in similar circumstances. Discuss the responses with the class. Two brothers are walking home from school and are approached by a classmate, who gives the older boy a joint (marijuana cigarette) to smoke. The younger brother watches his brother accept and begin to smoke the cigarette. Despite his younger brother’s protests, the older boy tells him not to tell anyone what he has just seen. He reminds the younger boy that he must keep this to himself or risk losing his (the older brother’s) respect and friendship. What should the younger brother do: keep the information to himself, or share it with his parents and risk upsetting his sibling? 141 H E L P F U L H I N T S Lying • Parents should set good examples. Do not ask your child to lie on the phone, for example, saying that you are not home when you are but do not feel like talking. • Give your child permission to tell the truth by listening and not setting excessive punishments. • Admit your own mistakes. 7589_Ch09_131-148 29/08/17 12:01 PM Page 142 142 Journey Across the Life Span adequate intake of calories from proteins, carbohydrates, fats, vitamins, and minerals. Calcium is especially important at this time to allow the building of dense bones. Caloric requirements vary from child to child based on body size, activity, and metabolism. In the 1,800-calorie diet recommended by MyPlate for this stage, children need 5 ounces of proteins, 3 cups of dairy, 21⁄2 cups of vegetables, 11⁄2 cups of fruit, and 6 ounces of grains per day. Box 9.6 lists indicators of good nutrition. The child’s food preferences result from cultural influences, family preferences, and peer influences. By the time children enter school, their food habits are well established. These habits can be further influenced by increased exposure to different cultures. Important considerations in planning meals for the school-age child include maintaining weight within normal limits and avoiding a diet high in cholesterol. The recommended daily intake of cholesterol is 300 mg or less per day. Between 3% and 25% of school-age children have rising blood cholesterol levels, increasing their risk for cardiovascular disease. To keep cholesterol intake down, provide a diet that is low in saturated fats—that is, fats from animal sources, such as meat and dairy products. Both blood cholesterol levels and weight should be monitored during the child’s routine health checkups. Breakfast is one of the most important meals of the child’s day. It should supply children with onefourth to one-third of their daily nutritional needs. Children should not be allowed to skip breakfast before going to school. Lunch programs often supply children with the noontime meal. Parents should monitor the school lunch program to make absolutely certain that it meets the standards and nutritional needs of the growing child. Food fads and new habits begin at this time. Excessive sweets and caffeine should be avoided B O 9.6 • • • • • • X S i gn s of G ood N u t r i t i on An alert, energetic attitude Height and weight within the normal range Skin is smooth, moist, and has good color Hair is shiny Eyes are clear, with no circles underneath them Teeth are white, bright, straight, and without discoloration • Good gastrointestinal health, including a good appetite and proper elimination • Well-developed, firm muscles and good posture • A good attention span because they may interfere with concentration and cause hyperactivity. Children should be encouraged to become involved in shopping for, preparing, and serving food and cleaning up after meals. Obesity Obesity is a rapidly growing problem beginning in early childhood. The causes of this problem include poor nutrition, unhealthy eating patterns, social pressures, and genetics. Excessive weight gain contributes to decreased physical abilities, making it more difficult for the child to engage in sports and athletic activities. Prevention and treatment must begin early to ensure successful results. In some cultures being overweight is not a concern. Other contributing factors to obesity include family lifestyles, family dynamics, peer pressure, and socioeconomic level. Busy families may use fast foods or prepackaged foods that are calorie dense as a way to save time. Advertisements and commercials precondition children to seek out undesirable foods. The psychological impact of obesity on the growing child is a concern because it often results in lowering the individual’s self-esteem. Children may fear being teased about their weight by their peers. Teasing only furthers the child’s feelings of shame and despair. Studies of Western civilization indicate that society generally views obese individuals very negatively. Overweight children have been shown to be more likely to become overweight adults, with an increased risk of developing diabetes, cardiovascular disease, or both. Strategies for managing obesity should include selecting healthy foods and engaging in an active lifestyle. Lifestyle changes work best when they involve the whole family. Regular meals must be planned ahead of time and should include nutritious foods, and exercise should be incorporated into the daily schedule. Parents should encourage schools to promote healthy meals and snacks for their children to enjoy. SLEEP AND REST Sleep routines should be well established by this stage. An average 6-year-old child needs about 12 hours of sleep, whereas an 11-year-old child needs about 10 hours. A 6-year-old child can tire easily and become very irritable. For this reason parents need to supervise activities and incorporate quiet, restful activities to prevent overexhaustion. 7589_Ch09_131-148 29/08/17 12:01 PM Page 143 School Age Some children may even benefit from a short afternoon nap. If children are chronically tired during school hours, their academic performances and social relationships will suffer. Sleep for some younger children may continue to be restless and interrupted by nightmares. As the child grows older, nightmares usually decrease. They also become less terrifying and less real as the child begins to be able to separate fantasy from reality. PLAY The focus of play illustrates the movement that school-age children make from pretending and fantasy toward reality and concrete thinking. Schoolage children are full of energy and willing to learn new skills. The style of play for this age group permits the use of cooperation and compromise. Many younger children are not yet ready for competitive activities and become upset at losing. Parents must be careful not to push their child into competitive play before he or she is actually ready to handle this kind of demand. Most 9- to 11-year-old children are involved in many play activities. They are usually very competitive and active. Children are now able to learn and follow rules and regulations. The style of play for this period of development is referred to as team play. Team play usually is with groups of the same sex and may be competitive in nature. Boys are likely to be better than girls at running, jumping, and throwing. This difference may be because girls have fewer opportunities to engage in these activities and are less encouraged to do so. Efforts are now being made to emphasize and fund girls’ sports activities to the same degree as boys’ sports activities. This may help to enhance girls’ sports performance and competitiveness. Much of the play of both sexes is based on group or team activities. Children are chosen by their peers to participate on a team based on their abilities to excel in the skills required to play the game. Being selected first helps validate the child’s self-esteem and worth. By this stage children have learned that practice helps to improve their skills. Skill and motor coordination determine the child’s overall performance and acceptance by others. Organized team sports such as Little League or team swimming may appeal to this age group. Competition now serves as a motivating force to practice and improve. 143 Although most of the play during this stage involves sports and athletic activities, some children prefer sedentary activities such as crafts and board games. Collections of all sorts (cards, little boxes, cars, stickers, dolls, and other items, some of little or no value) are very popular at this stage. Ownership seems to have greater importance than actual monetary value. SAFETY The leading cause of accidental deaths for this age group continues to be motor vehicle accidents. State regulations for car safety should be carefully observed. Children should be taught to use seat belts whenever they are passengers in automobiles and school buses. The increased motor skills of school-age children help contribute to the increased numbers of accidents and injuries they sustain. An additional factor is that most children at this stage are ready to attempt any new skill with or without practice or training. For the most part they are much less fearful than they were during earlier years. To minimize danger from biking accidents, skating, or skateboarding, children should be encouraged to wear helmets and protective gear when engaged in these popular activities. School-age children should be taught common water safety practices, such as never swimming alone and only diving in water approved for diving. Children should be instructed not to swim in canals, in drainage basins, or in water with unknown currents. Many bone and muscular injuries occur during this stage because of the child’s physiological development and increased participation in sports. During the school-age period, the epiphyseal cartilage, or bone end, is the site for future bone growth. These H E L P F U L H I N T S Safety Precautions to Teach Children • Wear protective equipment. • Observe traffic signals. • Practice water safety: Learn to swim, and never swim alone. • Use the buddy system when walking to and from school. • Never talk to or accept rides from strangers. • Always follow your instincts and avoid peer pressure. 7589_Ch09_131-148 29/08/17 12:01 PM Page 144 144 Journey Across the Life Span points are weak and become potential sites for fractures. Final bone ossification, or hardening, occurs at puberty. Stranger Danger Children at this stage of development must be advised to avoid being lured away by strangers. They need to know how to protect themselves by avoiding walking alone in dark, remote areas. Today parents and teachers must advise children to avoid chat room and Internet sites that child predators frequent. Children must be advised not to divulge any personal information to anyone on the Web. Parents need to make certain that they supervise and monitor their children’s computer usage. Software to monitor a child’s computer use is available. School Violence In recent years the media has brought to our awareness the rapidly increasing incidences of violence in school. School violence can be defined as any harm, whether physical or psychological, that is directed toward schoolchildren and their property. School violence involves those acts not only in the school, but also around the school or on playgrounds. The increase in these incidences has led to parental concerns for the safety of their children and increased school security. Schools around the nation are adopting a zero-tolerance policy toward school violence. To accomplish this, authorities must first understand the causes of violence and the signs of impending trouble. The two most common factors known to contribute to school violence are a breakdown in communication in the home and school and the easy availability of weapons. Consider that an estimated 1.2 million elementary school children come home every day to a house with a gun and no guardian. Other contributing factors to violence are bullying behavior and stress in the home and school. Children under stress do not have the ability to cope effectively and may resort to violence. When they feel hurt or become angry, some children use revenge to regain control and feel powerful. This is especially true of some boys who are unduly influenced by peer pressure. Male children are often encouraged to be tough and unfeeling, and their expression of power can lead to violence. Good parenting can help decrease violent behavior. Parents and teachers should be diligent in recognizing behaviors that can quickly lead to violence. Such signs include difficulty getting along with peers, outbursts of temper, violence directed toward pets, decreased productivity in the home or at school, sleeping and eating problems, social isolation, and preoccupation with violent video games and movies. Box 9.7 lists some helpful hints to decrease school violence. HEALTH PROMOTION In general, the school-age years are considered a healthier period than earlier years of development. It is common to see a slight increase in the incidence of upper respiratory tract infections when children first enter school, probably because of exposure to many other children. Once their immune systems adjust, children are able to resist many infections. As their organs continue to mature, there is less risk of ear infections, febrile seizures, and dehydration. School-age children continue to need supervision in hygiene and daily care. There may be a higher incidence of urinary tract infections in girls related to their anatomy and daily toileting practices. Yearly checkups should also include a urine examination for infection and diabetes mellitus and blood tests for iron-deficiency anemia and cholesterol levels. Blood pressure screening should be instituted at this time. Other routine measurements include continued monitoring of weight, height, and growth. Health promotion must include nutritional guidance. By school age all of the primary immunizations have been completed, and children need to receive boosters to help maintain immunity. They normally receive a tetanus–diphtheria booster every 10 to 14 years, the human papillomavirus immunization, and the meningococcal vaccine. Refer to Appendix B for the complete immunization schedule. Before beginning school and every year thereafter, children should get their eyes checked by an ophthalmologist. Most visual problems can be corrected with B O 9.7 X Decreasing Scho o l V io lence • Spend more family time with children. • Maintain open communication lines in school and at home. • Regulate the viewing of violent programs on the Internet and television. • Store any weapons securely in the house. • Perform random checks of lockers and school bags. • Supervise entry and exit points at school. • Have only one entry or exit to the school. • Use metal detectors at the school entry. • Encourage peer counseling. • Teach conflict resolution in the home and at school. 7589_Ch09_131-148 29/08/17 12:01 PM Page 145 School Age glasses and retraining exercises. Adequate lighting is important to help maintain proper vision. Regular hearing tests should be scheduled to determine baseline hearing levels. Parents should instruct children about avoiding exposure to excessive noise, which may damage the ears and lead to hearing loss. School-age children need adequate exercise to help develop strength and muscle endurance. Poor posture can indicate fatigue or a minor skeletal defect. Children should be screened for scoliosis— the abnormal lateral curvature of the spine—by the school nurse and by the doctor during their physical examinations. To examine a child for scoliosis, have him or her bend over, and examine the lumbar thoracic region for unequal curvature. This condi- 145 tion is seen more frequently in girls than in boys. Early recognition can lead to prompt treatment and correction with exercises or a brace. Special Health Concern: Substance Abuse School-age children are easy prey to substance abuse through peer pressure. Some may gravitate toward alcohol, tobacco, or drugs based on a familiarity with such items in their homes. Parents need to model desired behaviors and offer information and guidance to prevent substance abuse in their children. For a complete discussion of substance abuse, see Chapter 10. SUMMARY 1. The period of development known as school age, the middle years, or late childhood is characterized by slow, consistent growth. 2. This stage begins with entrance into formal school and ends with the onset of puberty. 3. Five important accomplishments occur during this stage: (1) growth becomes slow and steady; (2) children move away from the family and toward peer relationships; (3) children become less self-centered and more goal-directed; (4) deciduous teeth are replaced by permanent teeth; and (5) sexual tranquillity replaces sexual curiosity and preoccupation. 4. The permanent teeth develop in the same order as the deciduous teeth. 5. Initially, school-age children experience an increased number of respiratory infections because of their increased exposure to other children. Once the immune system matures, this becomes a relatively healthy period of development. 6. Heart rate and respiratory rate slow, whereas blood pressure readings increase. Changes in the nervous system permit expanded cognitive processes. 7. There is marked improvement in existing gross and fine motor skills, permitting children more independence. 8. This period is sometimes called latency, a time when sexual energies are dormant. Peer relationships at this stage are mainly with children of the same sex. 9. According to Erikson, the task for this stage of development is industry. Children are now capable of focusing on reality, and they gain satisfaction from their accomplishments. 10. Friendships are very important and are the cornerstone of the school-age child’s social world. During this stage children are able to develop reciprocal relationships with their peers. It is common for them to establish intimacy with their friends and share their feelings and possessions. 11. Discipline teaches the child boundaries and helps to set limits on behavior. Too much discipline may lead to acting-out behavior; insufficient discipline may lead to insecurity and doubt. 12. Television violence may adversely affect m