Mental health & crisis management 7 APRIL qui z

Jack Fowler

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Chapter 39

The School-Age Child and Family

Promoting Optimal
Growth and Development

“School age” generally defined as ages 6 to 12 years
Physiologically begins with shedding of first deciduous teeth; ends at puberty with acquisition of final permanent teeth
Gradual growth and development
Progress with physical and emotional maturity

Fig. 39-1. Middle childhood is the stage of development when deciduous teeth are shed.

Biological Development

Height increases by 5 cm/year.
Weight increases by 2 to 3 kg/year.
Males and females differ little in size.

Maturation of Systems

Increase in bladder capacity
Heart smaller in relation to rest of body
Immune system increasingly effective
Increase in bone ossification
Physical maturity not necessarily correlated with emotional and social maturity**

Prepubescence

Defined as two years preceding puberty
Typically occurs during preadolescence
Varying ages from 9 to 12 (girls about 2 years earlier than boys)
Beginning of puberty at age 10 in girls and age 12 in boys

Psychosocial Development

Relationships centre around same-sex peers.
Freud described it as the “latency” period of psychosexual development.

Psychosocial Development—cont.

*Erikson; A sense of industry or stage of accomplishment
Eagerness to develop skills and participate in meaningful and socially useful work
Acquisition of sense of personal and interpersonal competence
Growing sense of independence
Peer approval strong motivator

Psychosocial Development—cont.

Erikson; inferiority
Feelings may derive from self or social environment.
Sense of inferiority arises if child is incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment.
All children feel some degree of inferiority regarding skill(s) they cannot master.

Cognitive Development

Piaget; concrete operations
Uses thought processes to experience events and actions
Develops understanding of relationships between things and ideas
Is able to make judgements based on reason (“conceptual thinking”)
Masters the concept of conservation

Fig. 39-3. Common examples that demonstrate the child's ability to conserve (ages are only approximate).

Moral Development

Kohlberg; development of conscience and moral standards
Age 6 to 7: Reward and punishment guide choices.
Older school-age children are able to judge an act by the intentions that prompted it.
Rules and judgements become more founded on needs and desires of others.

Spiritual Development

Children think in very concrete terms.
Children begin to learn the difference between natural and supernatural.
Religious rituals comfort them.

Social Development

Importance of the peer group
Identification with peers a strong influence in child gaining independence from parents
Gender roles strongly influenced by peer relationships

Social Relationships

Clubs and peer groups
Formation of formalized groups
Bullying (incidence doubles from 2002-2012)

CHI, 2013.

Relationships with families
Parents primary influence in shaping child's personality, behavior, and value system
Increasing independence from parents primary goal of middle childhood
Children not ready to abandon parental control

Social Relations cont’d

Relationships with families
Parents primary influence in shaping child's personality, behavior, and value system
Increasing independence from parents primary goal of middle childhood
Children not ready to abandon parental control

Play

Rules and rituals
Team play
Quiet games and activities
Ego mastery…conscious decision making

Developing a Self-Concept

Definition: a conscious awareness of a variety of self-perceptions (e.g., abilities, values, appearance)
Importance of significant adults in shaping child's self-concept
Positive self-concept leading to feelings of self-respect, self-confidence, and happiness

Fig. 39-6. School-age children take pride in learning new skills.

Developing a Body Image

Generally children like their physical selves less as they grow older.
Body image is influenced by significant others.
Increased awareness of “differences”
may influence feelings of inferiority (e.g., hearing or visual defects).

Coping With Concerns Related to
Normal Growth and Development

School experience
Second only to the family as socializing agent
Transmission of values of the society
Peer relationships becoming increasingly important

Coping With Concerns Related to
Normal Growth and Development—cont'd

Teachers
Parents
Latchkey children
Limit-setting and discipline
Dishonest behaviour
Stress and fear

Promoting Optimal Health
During the School Years

Nutrition
Importance of balanced diet to promote growth
Quality of diet related to family's pattern of eating
“Junk-food” concerns…obesity rates

Journal List Health Promot Chronic Dis Prev Canv.36(9); 2016 Sep

Sleep and Rest

Average 9.25 hours per night by about age 12 but highly individualized
May resist going to bed at ages 8 to 11
12 years and up generally less resistant to bedtimes

Exercise and Activity

Sports
Controversy regarding early participation in competitive sports
Concerns with physical and emotional maturity in competitive environment
Acquisition of skills
Generally like competition

Fig. 39-7. The activities engaged in by school-age children vary according to interest and opportunity. A: Little League competitors. B: Playing tug-of-war.

Dental Health

Eruption of permanent teeth
Good dental hygiene
Trauma
Prevention of dental caries
Periodontal disease
Malocclusion
Dental injury
Dental avulsion—replacement or reattachment

Fig. 39-8. Sequence of eruption of secondary teeth.

Sex Education

Sex play as part of normal curiosity during preadolescence
Middle childhood as ideal time for formal sex education
Lifespan approach
Information on sexual maturity and process of reproduction
Effective communication with parents

Nurse's Role in Sex Education

Treatment of sex as normal part of growth and development
Questions and answers
Differentiation between “sex” and “sexuality”
Values, problem-solving skills
Open for communication with parents

School Health

Responsibilities of parents, schools, and health departments
Ongoing health maintenance through assessment, screening, and referrals
Routine services, emergency care, safety and communicable disease control, counselling and follow-up care
Need to increase knowledge of health and health habits

Injury Prevention

Motor vehicle crashes as most common cause of severe injury and death in school-age children—pedestrian and passenger
Bicycle injuries—benefits of bike helmets
Appropriate safety equipment for all sports

Stress Fractures

Occur as result of repeated muscle contraction
Seen most often in repetitive weight-bearing sports
Common symptoms
Sharp, persistent, progressive or deep, dull ache
Pain over the involved bony surface
Diagnosis based on clinical observation, possibly bone scan

Therapeutic Management
of Stress Fractures

Rest—alleviation of repetitive stress that initiated symptoms
Training with alternative exercise regimens
Physical therapy, cryotherapy, cold whirlpools
Rx: nonsteroidal anti-inflammatory medications for discomfort

Nurse's Role in Sports
for Children and Adolescents

Evaluation for activities
Prevention of injury
Treatment of injuries
Rehabilitation after injuries
Instruction to student and parents

Altered Growth and Maturation

Often are the result of simple physiological (“constitutional”) delay
Endocrine dysfunction
Chromosome abnormalities
Chronic disease (e.g., malabsorption, asthma)
Stress
Poor nutrition

Tall Stature

May cause anxiety, perceived social handicap among some patients
Gender perceptions related to height
Use of estrogens to control height if initiated before menarche
Use of hormone therapy controversial

Short Stature

May be first manifestation of serious disorder
May be of no consequence to health
Most common cause worldwide: inadequate nutrition
Also chronic disease, endocrine dysfunction, primary gonadal failure

Sex Chromosome Abnormalities

Most caused by altered number of sex chromosomes
Most due to nondisjunction
Cognitive impairment less common

Turner Syndrome

Absence of one of the X chromosomes (45,X)
Females
Manifestations
Infertile
Short stature
No secondary sex characteristics
Webbed neck, widely spaced nipples, low posterior hairline and edema of the hands and feet

Klinefelter's Syndrome

Most common of all chromosome abnormalities
Presence of one or more additional X chromosomes (47,XXY most common)
Occurs in males
Rarely seen before puberty
Failure of adolescent virilization

Klinefelter's Syndrome—cont.

May not be diagnosed until person presents for infertility
Azoospermia, small testes
Defective development of secondary sex characteristics
Cognitive impairment of varying degrees, behavioural problems, possibly gross motor difficulties

Attention Deficit Hyperactivity
Disorder and Learning Disability

ADHD: inattention, impulsiveness, and hyperactivity
LD: a heterogeneous group of disorders with difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, math, and/or social skills

Diagnostic Evaluation

Quality of motor activity
Developmentally inappropriate inattention, impulsivity, and hyperactivity
Wide variation of severity

Battery of Tests for LD
and ADHD

IQ
Hand–eye coordination
Visual and auditory perception
Comprehension
Memory

Therapeutic Management
of ADHD

Medication
Environmental manipulation
Classroom
Family education and counselling
Behavioural and/or psychotherapy for child

Medications for ADHD

Stimulants
Dexedrine
Ritalin
Tricyclic antidepressants
Clonidine
Guanfacine
Norepinephrine transport inhibition
Atomoxetine

Enuresis

Bed-wetting
More common in boys
Usually ceases between 6 and 8 years of age
Diagnosis
Developmental age of more than 5 years
Two times per week or more for three months
May have urgency, frequency

Enuresis—cont.

Organic causes
Structural defects
Urinary tract infection, impaired kidney function, chronic renal failure
Neurological deficits, endocrine disorders (diabetes)
Sickle cell disease
Bladder volume of 300 to 350 mL sufficient to hold a night's urine

Treatment for Enuresis

Drugs
Tofranil
Oxybutynin
Desmopressin (DDAVP ®)
Bladder training
Fluid restriction in evenings
Interruption of sleep to void
Conditioned-reflex response device

Posttraumatic Stress Disorder (PTSD)

Development of characteristic symptoms following exposure to extremely traumatic experience or catastrophic event
May function adequately but have foreboding regarding the future

PTSD: Response to the Event

Initial response
Intense arousal; lasts one to two hours
“Fight or flight” response
Second phase
Lasts approximately two weeks
Denial, period of quiescence
Third phase
Appear to get worse; lasts two to three months

PTSD Symptoms

Depression, anxiety, conversion reactions
Phobic symptoms, repetitive actions
Flashbacks common
Inquiry about what has happened
Nursing care management

School Phobia

Defined as extreme reluctance to attend school for a sustained period of time as a result of severe anxiety or fear of school-related experiences
Also called “school refusal” and “school avoidance”

Impact of Social Media

Benefits include entertainment, development of communication and technological skills.
Risks include cyberbullying, sexual predators.
Children need parental monitoring with participation and discussion of their children's online activity.