Ch. 39

Welcome toWong, et al.Maternal Child Nursing Care, 3/eChapter 39 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 1 of 75 Welcome toWong, et al.Maternal Child Nursing Care, 3/eChapter 39

Chapter 39 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 2 of 75 Chapter 39 The School-Age Child and Family

Promoting Optimum Growth and Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 3 of 75 Promoting Optimum Growth and Development “School age” generally defined as 6-12 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

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Biologic Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 5 of 75 Biologic Development Height increases by 2 inches a year Weight increases by 2-3 kg per year Males and females differ little in size

Maturation of Systems : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 6 of 75 Maturation of Systems Bladder capacity increases Heart smaller in relation to the rest of body Immune system increasingly effective Bones increase in ossification Physical maturity not necessarily correlated with emotional and social maturity

Prepubescence : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 7 of 75 Prepubescence Defined as 2 years preceding puberty Typically occurs during preadolescence Varying ages from 9-12 (girls about 2 years earlier than boys) Average age of puberty is 12 in girls and 14 in boys

Psychosocial Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 8 of 75 Psychosocial Development Relationships center around same-sex peers Freud described it as “latency” period of psychosexual development

Erikson:Developing a Sense of Industry : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 9 of 75 Erikson:Developing a Sense of Industry Eager to develop skills and participate in meaningful and socially useful work Acquire sense of personal and interpersonal competence Growing sense of independence Peer approval is strong motivator

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Erikson: Inferiority : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 11 of 75 Erikson: Inferiority Feelings may derive from self or social environment May occur if 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

Piaget: Cognitive Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 12 of 75 Piaget: Cognitive Development Concrete operations Use thought processes to experience events and actions Develop understanding of relationships between things and ideas Able to make judgments based on reason (“conceptual thinking”)

Kohlberg: Moral Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 13 of 75 Kohlberg: Moral Development Development of conscience and moral standards Age 6-7: reward and punishment guide choices Older school age: able to judge an act by the intentions that prompted it Rules and judgments become more founded on needs and desires of others

Spiritual Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 14 of 75 Spiritual Development Children think in very concrete terms Children expect punishment for misbehavior May view illness or injury as punishment for a real or imagined misdeed

Social Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 15 of 75 Social Development Importance of the peer group Identification with peers is a strong influence in child gaining independence from parents Sex roles strongly influenced by peer relationships

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Relationships with Families : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 17 of 75 Relationships with Families Parents are primary influence in shaping child’s personality, behavior, and value system Increasing independence from parents is primary goal of middle childhood Children not ready to abandon parental control

Play : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 18 of 75 Play Involves physical skill, intellectual ability, and fantasy Form groups, cliques, clubs, secret societies Rules and rituals See need for rules in games they play

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Play (cont’d) : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 20 of 75 Play (cont’d) Team play Quiet games and activities Ego mastery

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Developing a Self-Concept : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 22 of 75 Developing a Self-Concept Definition: a conscious awareness of a variety of self-perceptions (abilities, values, appearance, etc.) Importance of significant adults in shaping child’s self-concept Positive self-concept leads to feelings of self-respect, self-confidence, and happiness

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Developing a Body Image : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 24 of 75 Developing a Body Image Generally children like physical selves less as they grow older Body image influenced by significant others Increased awareness of “differences” may influence feelings of inferiority

Coping with Concerns Related to Normal Growth and Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 25 of 75 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 become increasingly important

Coping with Concerns Related to Normal Growth and Development : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 26 of 75 Coping with Concerns Related to Normal Growth and Development Teachers Parents Limit-setting and discipline Dishonest behavior Stress and fear

Promoting Optimum Health during the School Years : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 27 of 75 Promoting Optimum Health during the School Years Nutrition Importance of balanced diet to promote growth Quality of diet related to family’s pattern of eating “Fast food” concerns

Sleep and Rest : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 28 of 75 Sleep and Rest Average 9½ hours/night during school age but highly individualized May resist going to bed at ages 8-11 12 years and up generally less resistant to bedtimes

Exercise and Activity : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 29 of 75 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

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Dental Health : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 31 of 75 Dental Health Eruption of permanent teeth Good dental hygiene Prevention of dental caries Malocclusion Dental injury Dental evulsion—replacement/reattachment

Sex Education : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 32 of 75 Sex Education Sex play as part of normal curiosity during preadolescence Middle childhood is ideal time for formal sex education Life span approach Info on sexual maturity and process of reproduction Effective communication with parents

Nurse’s Role in Sex Education : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 33 of 75 Nurse’s Role in Sex Education Treat 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 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 34 of 75 School Health Responsibilities of parents, schools, and health departments Ongoing assessment, screening, and referrals Routine services, emergency care, safety and infection control instruction Increase knowledge of health and health habits

Injury Prevention : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 35 of 75 Injury Prevention Most common cause of severe injury and death in school-age children is motor vehicle crashes—pedestrian and passenger Bicycle injuries—benefits of bike helmets Appropriate safety equipment for all sports

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Anticipatory Guidance—Care of Families : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 37 of 75 Anticipatory Guidance—Care of Families Parents adjust to child’s increasing independence Parents provide support as unobtrusively as possible Child moves from narrow family relationships to broader world of relationships

Health Problems Related to Sports Participation : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 38 of 75 Health Problems Related to Sports Participation Acute overload injuries Overuse syndromes Repetitive microtrauma Inflammation of the involved structure C/O pain, tenderness, swelling, disability Examples: tennis elbow, Osgood-Schlatter disease

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Stress Fractures : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 40 of 75 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 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 41 of 75 Therapeutic Management of Stress Fractures Rest—alleviate repetitive stress that initiated symptoms Training with alternative exercise regimens PT, cryotherapy, cold whirlpools Rx: NSAIDs for discomfort

Nurses’ Role in Sports for Children and Adolescents : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 42 of 75 Nurses’ Role in Sports for Children and Adolescents Evaluation for activities Prevention of injury Treatment of injuries Rehab after injuries Instruction to student and parents

Altered Growth and Maturation : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 43 of 75 Altered Growth and Maturation Often are the result of simple physiologic (“constitutional”) delay Endocrine dysfunction Chromosomal aberration Chronic disease, e.g., malabsorption, asthma Stress Poor nutrition

Tall Stature : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 44 of 75 Tall Stature May cause anxiety, perceived social handicap among some clients Gender perceptions related to height Use of estrogens to control height if initiated before menarche Use of hormone therapy is controversial

Short Stature : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 45 of 75 Short Stature May be first manifestation of serious disorder May be of no consequence to health Most common cause worldwide is inadequate nutrition Also chronic disease, endocrine dysfunction, primary gonadal failure

Short Stature: Other Causes : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 46 of 75 Short Stature: Other Causes Congenital defects and disorders Inborn errors of metabolism Psychosocial (deprivation) dwarfism Definition: growth retardation in children >2 years old Environmental stress and delayed development When children are removed from deprived environment, growth proceeds at normal or increased rate

Skeletal Disorders Affecting Growth : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 47 of 75 Skeletal Disorders Affecting Growth Replacement therapy for treatment of growth hormone deficiency Management of deprivation dwarfism Testosterone therapy Growth hormone therapy Hormone therapies highly controversial in children with constitutional delay

Sex Chromosome Abnormalities : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 48 of 75 Sex Chromosome Abnormalities Occur with relatively high frequency Most caused by altered number of sex chromosomes

Turner Syndrome : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 49 of 75 Turner Syndrome Absence of one of the X chromosomes (45,X) Females Incidence 1:2500 female births Manifestations Sterile Short stature No secondary sex characteristics Webbed neck, shield-shaped chest, widely spaced nipples, low posterior hairline

Klinefelter Syndrome : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 50 of 75 Klinefelter Syndrome Most common of all chromosomal abnormalities (1 in 850 male births) Presence of one or more additional X chromosomes (47,XXY most common) Occurs in males Rarely seen before puberty Adolescent virilization fails

Klinefelter Syndrome Manifestations : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 51 of 75 Klinefelter Syndrome Manifestations May not be diagnosed until they present for infertility Azoospermia, small testes Defective development of secondary sex characteristics Cognitive impairment of varying degrees, behavioral problems, possibly gross motor difficulties

Treatment of Klinefelter Syndrome : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 52 of 75 Treatment of Klinefelter Syndrome Testosterone administration to enhance masculine characteristics

Attention Deficit Hyperactivity Disorder (ADHD) and LD : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 53 of 75 Attention Deficit Hyperactivity Disorder (ADHD) and LD ADHD: inattention, impulsiveness, and hyperactivity ADHD typically onset before age 7 LD (learning disability): a heterogeneous group of disorders with difficulties in acquisition and use of listening, speaking, reading, writing, reasoning, math, and/or social skills

Diagnostic Evaluation : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 54 of 75 Diagnostic Evaluation Quality of motor activity Developmentally inappropriate inattention, impulsivity, and hyperactivity Wide variation of severity Diagnostic criteria developed by American Psychiatric Association

Battery of Tests for LD and ADHD : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 55 of 75 Battery of Tests for LD and ADHD IQ Hand-eye coordination Visual and auditory perception Comprehension Memory

Therapeutic Management of ADHD : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 56 of 75 Therapeutic Management of ADHD Classroom Family education and counseling Behavioral and/or psychotherapy for child Environmental manipulation Medication

Medications for ADHD : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 57 of 75 Medications for ADHD Not all children benefit from pharmacologic therapy Stimulants Dexedrine, Adderall Ritalin Side effects Insomnia, anorexia and weight loss, hypertension LT may suppress growth

Therapeutic Management of LD : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 58 of 75 Therapeutic Management of LD Primarily educational interventions Wide variation of diagnostic severity

Nursing Considerations : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 59 of 75 Nursing Considerations Community settings School nurses Hospital settings

Enuresis : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 60 of 75 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 wk or more for 3 months May have urgency, frequency

Enuresis (cont’d) : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 61 of 75 Enuresis (cont’d) Organic causes Structural defects UTI, impaired kidney function, chronic renal failure Neurologic deficits, endocrine disorders (diabetes) Sickle cell disease Bladder volume of 300-350 mL is sufficient to hold a night’s urine

Normal Bladder Capacity in Child : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 62 of 75 Normal Bladder Capacity in Child Child’s age + 2 = expected bladder capacity in ounces

Psychologic Factors : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 63 of 75 Psychologic Factors Sleep more soundly than other children Emotional factors Familial tendency

Treatment for Enuresis : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 64 of 75 Treatment for Enuresis Drugs Tofranil Oxybutynin DDAVP Bladder training Fluid restriction in evenings Interruption of sleep to void Conditioned reflex response device

Encopresis : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 65 of 75 Encopresis Repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose Not caused by any physiologic effect, e.g., laxative or medical problem Primary encopresis = fecal incontinence after age 4 Secondary encopresis = >4 years old fecal incontinence after period of prior established fecal continence

Encopresis (cont’d) : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 66 of 75 Encopresis (cont’d) More common in males May follow psychologic stress May be secondary to constipation or impaction Therapeutic management Determine cause Dietary intervention, management of constipation Psychotherapeutic interventions

Posttraumatic Stress Disorder (PTSD) : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 67 of 75 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 : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 68 of 75 PTSD: Response to the Event Initial response Intense arousal; lasts 1-2 hours “Fight or flight” response Second phase Lasts approximately 2 weeks Denial, period of quiescence Third phase Appear to get worse; lasts 2-3 months

PTSD Symptoms : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 69 of 75 PTSD Symptoms Depression, anxiety, conversion reactions Phobic symptoms, repetitive actions Flashbacks are common Inquiry about what has happened Nursing considerations

School Phobia : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 70 of 75 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” Most common in ages older than 10 years

School Phobia (cont’d) : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 71 of 75 School Phobia (cont’d) Physical symptoms Symptoms subside after staying at home No symptoms on weekends, holidays, etc. Nursing considerations

Recurrent Abdominal Pain (RAP) : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 72 of 75 Recurrent Abdominal Pain (RAP) May have psychogenic origin May have real pain Psychologic aspects Nursing considerations

Conversion Reactions : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 73 of 75 Conversion Reactions AKA hysteria, hysterical conversion reaction, and childhood hysteria Sudden onset, traced to a precipitating event Symptoms: abdominal pain, fainting, pseudoseizures, paralysis, headaches, visual field restriction R/O true seizures with EEG

Childhood Depression : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 74 of 75 Childhood Depression Temporary: acute depression precipitated by a traumatic event Chronic depression May accompany chronic illness or disability Familial circumstances Nursing considerations

Childhood Schizophrenia : 

Mosby items and derived items © 2006, 2002 by Mosby, Inc. 75 of 75 Childhood Schizophrenia Severe deviation in ego functioning Psychotic disorders that appear after age 4 or 5 Characterized by gradual onset of neurotic symptoms Lack of contact with reality; “a world of their own” Nursing considerations