GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

I. Promoting Optimum Growth and Development A sense of industry or a stage of accomplishment is achieved
A. Biologic Development somewhere between age 6 years and adolescence. School-age
School aged children are children aged 6 to 12 years old. This period children are eager to develop skills and participate in meaningful and
begins with entrance into the wider sphere of influence represented socially useful work. They acquire a sense of personal and
by the school environment, which has a significant impact on interpersonal competence; receive the systematic instruction
development and relationships. Between the ages of 6-12 years, prescribed by their individual cultures; and develop the skills needed
children will grow an average of 5cm (2 inches) per year to gain 30- to become useful, contributing members of their social communities.
60cm (1-2 feet) in height and will almost double in weight, increasing Interests expand in the middle years, and with a growing sense of
2-3kg (4.4-6.6 pounds) per year. The average 6-year old child is about independence, children want to engage in tasks that can be carried
116cm (46 inches) tall and weighs about 21kg (46.3 pounds); the through to completion. They gain satisfaction from independent
average 12-year old child stands about 150cm (59 inches) tall and behavior in exploring and manipulating their environment and from
weighs approximately 40kg (88.2 pounds). During this age, boys and interaction with peers. Often the acquisition of skills provides a way to
girls don’t have much difference but boys tend to be slightly taller and achieve success in social activities. Reinforcement in the form of
a little bit heavier than girls. grades, material rewards, additional privileges, and recognition
Proportional Changes provides encouragement and stimulation.
School-age children are more graceful than they were as preschoolers, A sense of accomplishment also involves the ability to cooperate, to
and they are steadier on their feet. Their body proportions take on a compete with others, and to cope effectively with people. Middle
slimmer look, with longer legs, varying body proportion, and a lower childhood is the time when children learn the value of doing things
center of gravity. Posture improves over that of the preschool period with others and the benefits derived from division of labor in the
to facilitate locomotion and efficiency in using the arms and trunk. Fat accomplishment of goals. Peer approval is a strong motivating power.
gradually diminishes, and its distribution patterns change, contributing The danger inherent in this period of development is the occurrence
to the thinner appearance of children during the middle years. of situations that might result in a sense of inferiority. Children with
physical and mental limitations may be at a disadvantage in the
By the end of this age period, both boys and girls double their strength acquisition of certain skills. When the reward structure is based on
and physical capabilities and increases their poise and skill. Although evidence of mastery, children who are incapable of developing these
strength increases, muscles are still functionally immature when skills risk feeling inadequate and inferior. Even children without
compared with those of adolescents, and they are more readily chronic disabilities may experience feelings of inadequacy in some
damaged by muscular injury caused by overuse. Middle childhood is areas. No child is able to do everything well, and children must learn
the stage of development when deciduous teeth are shed. that they will not be able to master every skill they attempt. All
children, even children who usually have positive attitudes toward
Specific physiologic and anatomic characteristics are typical of children
work and their own abilities, will feel some degree of inferiority when
in middle childhood. Facial proportions change as the face grows faster
they encounter specific skills that they cannot master.
in relation to the remainder of the cranium. The skull and brain grow
Children need and want real achievement. Children achieve a sense of
very slowly during this period and increase little in size. Because all of
industry when they have access to tasks that need to be done and they
the primary (deciduous) teeth are lost during this age span, middle
are able to complete the tasks well despite individual differences in
childhood is sometimes known as the age of the loose tooth. The early
their innate capacities and emotional development.
years of middle childhood, when the new secondary (permanent)
C. Temperament
teeth appear too large for the face, are known as the ugly duckling
Temperament is a social information processing system through which
stage.
children view and interact with the world, both altering the responses
Maturation of Systems
of others and contributing toward their own development. It is defined
Maturity of the gastrointestinal system is reflected in fewer stomach
to describe the individual styles or the “how” of behavior. Personal
upsets; better maintenance of blood glucose levels; and an increased
characteristics can be seen when children are playing with friends,
stomach capacity, which permits retention of food for longer periods.
doing their math assignment, or watching television. There are
School-age children do not need to be fed as promptly or as frequently
different characteristics of each child, there are those children who are
as preschool-age children. Caloric needs are less than they were in the
always on the go, as compared to others who move at a slow and
preschool years.
deliberate pace. Some children who are overly intense, who have a
Physical maturation is evident in other body tissues and organs.
short fuse, and who are easily irritated and upset. While other children
Bladder capacity, although differing widely among individual children,
are shy, uneasy in new situations and with new people. These
is generally greater in girls than in boys. The heart grows more slowly
individual differences in temperament are biologically based, apparent
during the middle years and is smaller in relation to the rest of the
early in life, and characteristic of individuals over time and in different
body than at any other period of life. Heart and respiratory rates
situations. It also affects how they get along in school. It is especially
steadily decrease, and blood pressure increases from ages 6 to 12
important to recognize individual differences in temperament when a
years.
child has a learning or attention problems. In school they must adapt
The immune system becomes more competent in its ability to localize
to new environment, demands, teachers, and classmates. They must
infections and to produce an antibody–antigen response. However,
learn to follow complex rules in the classroom and on the playground,
children have several infections in the first 1 to 2 years of school
and they must learn that their personal wishes and needs are not
because of increased exposure to other children.
always a priority. Children recognizes that they differ in their reactions
Bones continue to ossify throughout childhood but yield to pressure
to new situations. For example, children entering elementary schools
and muscle pulls more readily than with mature bones. Children need
are encouraged to interact with their classmates and with school
ample opportunity to move around, but they should observe caution
personnel. Such social experiences may be distressful to some
in carrying heavy loads.
children, but pleasurable for others. Likewise, some children find it
B. Psychosocial Development
difficult to attend to classroom assignments while it comes naturally
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

to others. This variety of stylistic reactions to new or stressful In the cognitive development the teachers should also encourage the
situations is often conceptualized as temperament. following within the classroom:
Dimensions of temperament are identified by Psychiatrists Alexander • Focus on the process of learning, rather than the end product of
Thomas and Stella Chess (1977). Eight of these dimensions are directly it.
relevant to the interactions between students and teachers and • Using active methods that require rediscovering or
contribute to students’ adjustment in school. The eight dimensions are reconstructing "truths."
Sensory threshold, Activity level, Intensity, Adaptability, Mood, • Using collaborative, as well as individual activities
Approach/withdrawal, Persistence and Distractibility • Devising situations that present useful problems and create
There are also types of temperament that are formulated by Thomas disequilibrium in the child.
and Chess which they described as “easy,” “slow to warm up,” and • Evaluate the level of the child's development so suitable tasks can
“difficult.” In temperament terms: be set.
a. Easy children= adaptive, positive mood, and interested in new E. Moral Development (Kohlberg)
experiences. Get along with others and are outgoing and friendly. As children move from egocentrism to more logical patterns of
b. Slow-to-warm-up children= withdrawn and negative when faced thought, they also move through stages in development of conscience
with new situations and new people. Slow to adapt to change. and moral standards. Growth in moral thought and judgment
c. Difficult children= intense, low in adaptability, and negative in progresses between ages 6 and 12. Young children do not believe that
mood, as well as negative in their response to newness. standards of behavior come from within themselves but that rules are
Temperament can affect the child in school. Achievement in school established and set down by others. At first, rules are perceived as
related to a child’s ability, motivation, experiences, and quality of definite, covering limited situations, and requiring no reason or
instruction being received. Achievement is also related to explanation. Children learn the standards for acceptable behavior, act
temperament. An example is how a child must adapt to a reading or according to these standards, and feel guilty when they violate the
math assignment, especially if the assignment is long and demanding. standards. Although children 6 or 7 years old know the rules and what
The child must focus their energy and attention, adapt to new they are supposed to do, they do not understand the reasons behind
directions, resist distraction, and persist. In a research at UCLA there them. Young children usually judge an act by its consequences.
has been identification of temperament dimensions and factors that Rewards and punishment guide their judgment; a “bad act” is one that
affected a child’s academic success in school. Most important is task breaks a rule or does harm. When a child and an adult differ in judging
orientation, which is related to temperament dimensions of activity an act, the adult is right. Children may believe that what other people
level, distractibility, and persistence. Teachers like students with these tell them to do is right and that what they themselves think is wrong.
temperament characteristics and find them easy to teach. Children Consequently, children 6 or 7 years old are more likely to interpret
with less positive temperaments are often viewed by teachers as lower accidents and misfortunes as punishment for misdeeds or “bad” acts.
in “teachability,” requiring more teacher time, management, and Older school-age children are able to judge an act by the intentions
instruction. that prompted it rather than just by the consequences. Rules and
D. Cognitive Development (Piaget) judgments become less absolute and authoritarian and begin to be
Jean Piaget's theory of cognitive development explains how a child founded more on the needs and desires of others. Rules of conduct
constructs a mental model of the world. He disagreed with the idea are more readily considered in terms of mutual agreement and are
that intelligence was a fixed trait and regarded cognitive development based on cooperation and respect for others. For older children a rule
as a process which occurs due to biological maturation and interaction violation is apt to be viewed in relation to the total context in which it
with the environment. According to Piaget, children are born with a appears; reactions are influenced by the situation, as well as by the
very basic mental structure which are genetically inherited and morality of the rule itself. However, it is not until adolescence or
evolved on which all subsequent learning and knowledge are based. beyond that children are able to view morality on an abstract basis
There are four stages of Cognitive development by Piaget: with sound reasoning and principled thinking. Although a younger
Sensorimotor, Preoperational stage, Concrete operational stage and child can judge an act only according to whether it is right or wrong,
Formal operational stage. In school age children they fall under on older children take into account a different point of view to make a
concrete operational stage. Piaget considered the concrete stage a judgment. They are able to understand and accept the concept of
major turning point in the child's cognitive development because it treating others as they would like to be treated.
marks the beginning of logical or operational thought. Elementary age F. Spiritual Development
and pre-adolescent children aging from 7 to 11 are under this School-age children think in very concrete terms but are avid learners
category, they demonstrate logical, concrete reasoning. Children's and has a great desire to learn about their God Hockenberry & Wilson,
thinking becomes less egocentric and they are increasingly aware of 2007). They picture God as human and use adjectives such as “loving”
external events. They begin to realize that one's own thoughts and and “helping” to describe their deity. They are also fascinated by
feelings are unique and may not be shared by others or may not even heaven and hell and because of that, they fear going to hell for
be part of reality. The child can already work things out internally with misbehavior and punishment. Children in this age also begin to learn
the use of their minds rather than physically try things out in the real the natural and supernatural but have difficulty understanding the
world. During this stage, however, most children still can't think symbols that’s why it is important to present religious concepts in
abstractly or hypothetically. concrete terms.
According to Piaget, assimilation and accommodation require an Children are comforted by prayer or other religious rituals, and if these
active learner, not a passive one, because problem-solving skills activities are a part of children’s daily lives, they can help children cope
cannot be taught, they must be discovered. Within the classroom with threatening situations. They are also able to discuss their feelings
learning should be student-centered and accomplished through active about their faith and how it relates to their lives.
discovery learning. The role of the teacher is to facilitate learning, G. Language Development
rather than direct tuition. During the school-age years, the children’s abilities to use language are
enhanced (Hockenberry & Wilson, 2007). They learn to correct
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

previous syntactic errors and begin to use more complex grammatical Second, children become increasingly sensitive to the social norms and
forms (i.e. correct past tenses from irregular verbs). By 8 years old, pressures of the peer group. The peer group establishes standards for
they can already use language as a tool for reasoning. Also, they can acceptance and rejection, and children may be willing to modify their
already learn the literal meaning of words and are beginning to behavior in order to be accepted by the group. They are judged by the
understand the words’ nonliteral meanings (Potts & Mandleco, 2007). physical impression they convey, the skills they can perform, and other
By 11 years of age, they can already understand and use metaphors in abilities they can demonstrate. The need for peer approval becomes a
various conversations. powerful influence toward conformity. Children learn to dress, talk,
School -age children gradually become more proficient at making and otherwise behave in a manner acceptable to the group. A variety
inferences about meanings and learn the subtle expectations to of roles, such as class joker or class hero, may be assumed by the
grammatical rules. Despite all that, however, temperament, social & individual child in order to gain approval from the group. However, no
cultural factors, and verbal & language environment affect language child will be able to adapt perfectly to all the requirements made by
acquisition. This is especially true of experience verbal stories. the peer group. If some children find the discrepancies between the
Because their mental capacity and control of language is not fully values of the peer group and the values of their families to be too
developed, nurses need to use words school age children can great, they may be forced to relinquish the pleasure of interaction with
understand and carefully assess their comprehension. the group in order to abide by the regulations established in the home.
H. Social Development Thus, to diminish conflict within the family, some children may be
At the beginning of the middle childhood years, children enter a period forced into a position outside the peer group.
of less intense emotions, secure in their dependency on their parents Third, the interaction among peers leads to the formation of intimate
and family and with self-confidence tempered by a more realistic friendships between same-sex peers. School age is the time when
perspective. Their energies are now available to explore the children have “best friends” with whom they share secrets, private
environment beyond the family, to gradually increase the scope of jokes, and adventures and come to one another’s aid in times of
interpersonal interactions, and to invest their curiosity in a greater trouble. In the course of these friendships, children also fight,
understanding of the world. threaten, break up, and reunite. These dyadic relationships, in which
Identification with peers appears to be a strong influence in children’s children experience love and closeness for a peer, seem to be
gaining independence from parents. The aid and support of the group important as a foundation for heterosexual relationships in adulthood.
provide children with enough security to risk the moderate parental The conflicts encountered in the relationship are usually resolved in
rejection brought about by each small victory in their development of terms that children are able to control. Since neither child has
independence. authority over the other, as in an adult-child relationship, children
Questions of masculinity and femininity take on importance as sex-role must work through their differences within the framework of their
learning assumes more prominence. Boys associate with boys, and commitment to each other.
girls with girls, each pursuing their own interests, with communication Clubs and Peer Groups
between the sexes confined to that which is necessary. Much of the One of the outstanding characteristics of middle childhood is the
child’s concept of the appropriate sex role is acquired through formation of formalized groups or clubs. Initially, children in the early
relationships with peers. During the early school years there is little middle years merely hang around the periphery of the formalized
difference relative to sex in the play experiences of children. Games group, watching, learning, practicing various skills, and participating in
and many other activities are shared by both girls and boys. However, group activities whenever the members of the group allow them to do
in the later school years the differences become marked. Boys and girls so. As they advance in age, children eventually take their places as full-
grow more intolerant of each other, especially on the surface. fledged participating group members.
Social Relationships and Cooperation One of the prominent features of middle childhood groups is the code
Daily relationships with age-mates provide the most important social of rigid rules imposed on the members. There is an exclusiveness in
interactions in the life of school-age children. For the first time, the selection of persons who have the privilege of joining. They often
children are able to join in group activities with unrestrained adopt a “uniform” and special words that signify membership in the
enthusiasm and steady participation. Previously, interactions had been group. Acceptance in the group is often determined on a pass-fail basis
limited to short periods under considerable adult supervision. With that is based on social or behavioral criteria. Conformity is the core of
increased skills and wider opportunities, children are able to become the group structure. There are often secret codes, shared interests,
involved with one or more peer groups in which they can gain status and special modes of dress, and each child must abide by a standard
as respected members. of behavior established by the group. Understanding of and
Valuable lessons are learned from daily interaction with age-mates. conformity to the rules provide children with feelings of security and
First, children learn to appreciate the numerous and varied points of relieve them of the responsibility of making decisions.
view that are represented in the peer group. As they play together, Membership in the group provides children with a comfortable place
children discover that there are numerous occupations for fathers and in society. Many of the values of the group, such as physical strength,
mothers, more than one version of the same song, different rules for daring, ingenuity, and comradeship, have not been stressed in the
the same game, and different customs for celebrating the same family, but these are values that contribute to an individual child’s total
holiday. As children interact with peers who see the world in ways that personality. By merging their identity with the identities of their peers,
are somewhat different from the way they see it, they become aware children are able to move from the family group to an outside group
of the limits of their own point of view. Because age-mates are peers as a step toward seeking further independence. They substitute
and are not forced to accept one another’s ideas as they are expected conformity to a peer-group pattern for conformity to a family pattern
to accept those of adults, other children have a significant influence on while they are still too shaky and insecure to function independently.
decreasing the egocentric outlook of the individual child. During the early school years, groups are rather small and loosely
Consequently, they learn to argue, persuade, bargain, cooperate, and organized, with changing membership and little formal structure. They
compromise in order to maintain friendships. do not demonstrate the elements of give-and-take, cooperation, and
order that are seen in groups of older children. As a rule, girls’ groups
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

are less formalized than boys’ groups, and although there may be a knowledge and authority of the parents who previously were
mixture of both sexes in the earlier school years, the groups of later considered to be all-knowing and all-powerful.
school years are composed predominantly of children of the same sex. Although increased independence is the goal of middle childhood,
Common interests are a frequent basis around which a group is children are not yet prepared to reject parental control. Children need
structured. and want restrictions placed on their behavior; they are not yet
Children’s strong desire not to be different creates problems for those prepared to cope with all of the problems of their expanding
who are, for various reasons, unable to meet the accepted standards environment. They feel more secure knowing that there is an authority
of the peer group. Children with disabilities or those who are in some greater than themselves to implement such controls and restrictions.
way unable to compete have a difficult time. Self-consciousness results Children may complain loudly about the restrictions and try to break
when children are unable to dress as other children dress, do not have down parental barriers, but they are uneasy if they succeed in doing
spending money like other children, or appear different from other so. Children feel secure with reasonable, consistent controls. They
children, such as the child who has numerous freckles, red hair, or respect the adults on whom they can rely to prevent them from acting
minor physical defects, such as strabismus. Any of these differences on each and every urge. Children sense in this behavior an expression
will set a child apart from the group and often make the child a target of love and concern for their welfare.
for the criticism and ridicule of the peer group. Children also need their parents as adults, not as “pals.” Sometimes
parents, hurt by their children’s rejection, attempt to maintain their
Poor relationships with peers and a lack of group identification can also love and gratitude by assuming the role of pal. Children need the
contribute to bullying behavior. Bullying is defined as one or more stable, secure strength provided by mature adults to whom they can
individuals inflicting physical, verbal, or emotional abuse on another. turn during troubled relationships with peers or stressful changes in
Bullying can also involve the threat of bodily harm, weapon possession, their world. During a disruption in their lives, such as times of failure,
gang activity, and assault and battery. Bullying behavior occurs periods of illness, or a move that separates them from the security of
frequently in school-age children who lack appropriate academic or friends, children need the firm, secure anchor of parental interest and
social skills and often represents an attempt to act out anger and concern. With a secure base in a loving family, children are able to
resentment about poor peer relationships. develop the self-confidence and maturity needed to break loose from
Bullying also has a negative effect on the health of the school-age the group and stand independently.
children who experience this behavior. An increase in common Children’s relationships with siblings change during the middle years.
pediatric symptoms such as headache, stomachache, and sleep Siblings are viewed as being more equal in power and status. In earlier
disturbances has been associated with increased bullying in school. years, older siblings were influential in the younger siblings’ learning.
Although peer-group identification and association are essential to a In the middle years the relationship becomes one of companionship.
child’s emergence into the world, there can be dangers inherent in Positive emotional tone increases, but sibling conflict also increases as
strong peer-group attachment. Peer pressures may force children into the siblings get older. Middle childhood is a period of transition for
taking risks, even against their better judgment. Minor infractions, sibling relationships, a juncture between the open bickering of early
such as stealing apples from a neighbor’s tree, are disturbing to adults childhood and the supportive relationship observed in adult siblings.
but seem to be a normal part of peer-group activity. However, peer- 1) Development of Sexuality
group activities that result in unacceptable, unlawful, or criminal gang Sexual behaviour is a mostly typical and healthy part of a child’s
violence are increasing in the United States and represent a significant development. Many children experience some form of sex play during
challenge for health professionals and teachers who work with or before preadolescence as a response to normal curiosity, not as a
children. result of love or sexual urges. Children are experimentalists by nature,
Relationships with Families and sex play is incidental and transitory. Any adverse emotional
consequences or guilt feelings depend on how the behavior is
Although the peer group is highly influential and necessary to a normal managed by the parents, if it is discovered, or whether children view
child development, parents are still the primary influence in shaping their actions as wrong in the eyes of significant persons, particularly
children’s personalities, setting standards for behavior, and the parents.
establishing value systems. Family values usually predominate when The child’s attitude toward sex is acquired indirectly at an early age.
parental and peer value systems come into conflict. Although children Initial curiosity about differences in body structure between boys and
may appear to reject parental values while testing the new values of girls and between children and adults arises in the preschool years.
the peer group, ultimately, they will retain and incorporate into their Middle childhood is an ideal time for formal sex education, and many
own value systems the parental values they have found to be of worth. authorities believe that the topic is best presented from a life span
Peer associations seem to remain within the social class system, and approach. Information about sexual maturation and the process of
not infrequently there may be discriminate membership on the basis reproduction minimizes children’s uncertainty, embarrassment, and
of ethnic or racial origin. feelings of isolation that often accompany puberty.
As children move into the wider world of peer-group relationships, Typical school-age sexual behaviour:
parents are faced with the task of relinquishing their hold. They may • Touch his genitals or masturbate
find it difficult to face the rejection that is demonstrated as their • Be more private about his body and bodies in general – for
children stand solidly with the peer group. Children may want to spend example, he might not like you to see him naked anymore when
more time in the company of their peers, may seem eager to leave the he’s bathing or dressing
house, and will often prefer activities of the group to family activities. • Compare genitals with other same-age children – for example,
During this time parents can best serve the interests of their children penis or vulva size or shape
through tolerant understanding and support even when there may be • Play doctors and games involving exploration but mixed with
intolerance and criticism of the parents and their ways when those other play, like giving injections and medicines
ways deviate from those of the group. In the child’s eyes, the parents • Kiss and hold hands with other children
no longer assume the stature they previously enjoyed. Children
• Copy behaviour he has seen – for example, pinching a bottom
discover that parents can be wrong, and they begin to question the
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

• Engage in sexual play or talk about sexual topics, but in a matter- some parents express their unconscious attempts to delay their child’s
of-fact or sometimes silly way maturity by clinging behavior, particularly with their youngest child.
• Have the sense that talking about sexuality or engaging in sexual Anticipatory socialization
play is private or not allowed. By the time they enter school, the majority of children have a fairly
The child might behave in these ways because: realistic concept of what school involves. They receive information
• It feels good regarding the role of pupil from parents, playmates, and the
• She’s curious about the differences between boys’ and girls’ communication media. In addition, most children have had some
bodies experience with daycare or preschool, and kindergarten.
• She’s working out how bodies work Children’s attitudes toward school and the extent of their adjustment
• She’s trying to understand relationships are strongly influenced by the attitude of their parents. Middle-class
• She’s adjusting to the new environment and rules of primary children have fewer adjustments to make and less to learn about
school. expected behavior, since the school tends to reflect middle-class
2) Play customs and values, although this may be tempered by the school’s
Through the improved capabilities and adaptability of school-age location and predominant teachers and student body. Parents who
children, there is an increase in motor activities which require greater view school as a place that they have helped to create and support and
speed and effort. Larger, stronger muscles allow longer and that is directed toward the same objectives for socialization as their
increasingly strenuous play without exhaustion. School-age children own usually prepare their children with useful anticipatory
acquire the coordination, timing, and concentration that are required socialization and furnish them with confidence to meet the challenge.
to participate in adult-type activities, but they may lack the strength, Parents who view the school as an agency of an alien culture and one
stamina, and control of adolescents and adults. They can engage in a that they have little, if any, power to affect may unknowingly teach
greater amount of physical activity during the school years. However, their children to be fearful of school, even though they agree with its
parents, teachers, and coaches must remember that although children purposes and objectives.
this age are large and appear strong, they may not be ready for Anticipatory socialization is also provided by television, which
strenuous competitive athletics. influences the acquisition of information and attitudes. Television
Appropriate activities during the school-age years include: viewing has the potential to increase a child’s vocabulary, extend the
• running child’s horizons, and pave the way for the school experience. However,
• jumping rope television relies heavily on images to convey information.
Consequently, difficult complex issues are often not adequately
• swimming
explored by this medium. Extensive television viewing may also
• roller skating
encourage children to seek simple answers to tough problems and to
• ice skating
believe that violence is the most effective and quick solution to conflict
• dancing (American Academy of Pediatrics, 1995).
• bicycle riding Although most children have had some experience with schooling
Exercise is essential for muscle development and tone, refinement of before they enter the first grade, the extent to which early childhood
balance and coordination, increased strength and endurance, and education prepares children for primary school varies. Some preschool
stimulation of body functions and metabolic processes. Children need programs merely provide custodial care; other emphasize emotional,
ample space to run, jump, skip, and climb in addition to safe indoor social, and intellectual development as well. The type of early
and outdoor facilities and equipment. Most children have abundant childhood programming that stresses a cognitive over a social
energy and need little encouragement to engage in physical activity. emphasis appears to be more effective in facilitating later academic
Children with disabling conditions or those who hesitate to become performance.
involved in active play (e.g., obese children) require special assessment Role of the Teacher
and help so that activities appeal to them and are compatible with To facilitate the transition from home to school, educators select
their limitations while also meeting their developmental needs. teachers with personality characteristics that allow them to deal with
potential problems of young children. Because they react to the
I. Coping with Concerns Related To Normal Growth And teacher on the basis of past experience, children respond best to
Development teachers with attributes that they would find warm, loving parent. As
A. School experience a parent surrogate, the teacher in the early grades performs many of
Secondary to the family, school probably is the single most important the activities formerly assumed by the parents, such as recognizing the
influence during middle childhood or to the school age group of children’s personal needs (such as a need to go to the bathroom or for
children. The school serves as the agent for transmitting the values of help with clothing) and helping to develop their social behavior
the society to each succeeding generation of children and as the (manners).
setting for many relationships with peers. As a socializing agent, it Teachers, like parents, are concerned about the psychologic and
exerts a profound influence on the social development of children. emotional welfare of children. Although the functions of teachers and
School entrance causes a sharp break in the structure of a child’s parents differ, both place constraints on behavior, and both are in a
world. For some children It is their first experience in conforming to a position to enforce standards of conduct. However, the teacher’s
group pattern imposed by an adult who is not a parent and who has primary responsibility is stimulating and guiding children’s intellectual
responsibility for too many children to be constantly aware of each development, as opposed to providing for their physical welfare
child as an individual. Children want to go to school and usually adapt beyond the school setting.
to the new condition with little difficulty. Successful adjustment is Teachers share the parental influence in shaping a child’s attitudes and
directly related to the child’s physical and emotional maturity and the values. They serve as models with whom children can identify and
parent’s readiness to accept the separation associated with school whom they try to emulate. Teacher approval is sought; teacher
entrance. Cooperation among parents and support for the child are disapproval is avoided. The teacher is a very significant person in the
successful ways of coping with school entry stress. Unfortunately,
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

life of the early school-age child, and hero worship of a teacher may can be included in the process of determining appropriate disciplinary
extend into late childhood and preadolescence. It is not uncommon measures.
for the first or second grader to be heartbroken and tearful at leaving Dishonest Behavior
a familiar teacher at the end of the school term or to be upset when During middle childhood, children may engage in what is considered
faced with a substitute teacher for even a short period. to be antisocial behavior. Lying, stealing, and cheating may become
Children’s interest in school and learning and much of their social manifest in previously well-behaved children. It is especially disturbing
interaction and self-concept are related to interactions of with the to parents, who may have difficulty coping with this behavior. Lying,
teacher. The differential systems of rewards and punishment can occur for a number of reasons. Preschool children often have
administered by teachers affect the emotional adjustment and self- difficulty distinguishing between fact and fantasy. They do not have
concept of children, as well as how they respond to school in general. the cognitive capacity to deliberate mislead. Sometimes, they
The interaction between the teacher and individual pupils affect the misperceive or fail to remember an event. By the time they reach
pupil’s acceptance by other children, which in turn affects the child’s school age, they still tell stories but can distinguish between what is
self-concept. Behaviors praised by the teacher usually acquire a real and what is make-believe. If not, they need to be taught to
positive value, whereas those viewed negatively by the teacher are distinguish between fantasy and reality. Often children will aggregate
devalued by the children. In this way the teacher exerts considerable a story or situation as a means to impress their family or friends. Young
influence in a number of areas, such as attitudes toward minority children will lie to escape punishment or get out of some difficulty,
groups, the disabled, or less favorably endowed children. Teacher even when the evidence of their misbehavior is before their eyes, Lying
approval of children and their self-acceptance are very closely related. is more common in families in which punishment is severe. Honesty
The teacher sets the emotional tone of the classroom. Those who are and veracity modeled by the parents is repeated in the children. If
able to establish a positive social climate are usually concerned about parents lie, the children will emulate their behavior. Older children
the mental health and social dynamics of the children. Feeling a may lie to meet expectations set by others to which they have been
responsibility for personality development in their pupils, they are unable to measure up. They may also life because of low self-esteem
alert and sensitive to a child’s anxieties, peer-group relationships, self- or as a means of getting ahead or acquiring something with little effort.
concepts and general attitudes toward school. Learner-centered However, most children are very concerned with the wrongfulness of
behaviors, such as supportive statements that reassure or commend lying and cheating- especially in their friends. They are quick to tell on
children, accepting and clarifying statements that help them refine others when they detect cheating. Parents need to be reassured that
ideas and feelings to provide a sense of being understood, and all children lie sometimes and that they often have difficulty separating
constructive assistance that aids them with their own problem solving, fantasy from reality. Parents should be helped to understand the
contribute to the expansion and development of a positive self- importance of their own behavior as role models and of being truthful
concept. in their relationship with children. The issue can be discussed with the
Role of the Parents children directly to impress on them how much of their own security
Parents share responsibility within the schools for helping children and respect is lost when they are not believed.
achieve their maximum potential. There are numerous ways in which Cheating is most common in young children, ages 5-6. They find it
parents can supplement the school program. Cultivating responsibility difficult to lose at a game or contest, and they cheat to win. They have
is the goal of parental assistance. Being responsible for schoolwork not yet acquired the full realization of the wrongfulness of this
helps children learn to keep promises, meet deadlines, and succeed at behavior and do it almost automatically. It usually disappears as they
their jobs as adults. Responsible children may occasionally ask for help mature. However, when children observe parental behaviors such as
but usually they like to think through their work by themselves, boasting about cheating on income taxes, they assume this to be
excessive pressure or lack of encouragement from parents may inhibit appropriate behavior. Parents need to be aware of the types of
the development of these desirable traits (Schmitt, 1990). behaviors they model for their children. When they set examples of
B. Limit Setting and Discipline honesty, children are more likely to conform to these standards.
Numerous factors influence the amount and manner of discipline and As with other ethical related behavior, stealing is not an unexpected
limit-setting imposed on school-age children: the psychosocial event in the younger child. Between ages 5 and 8 years old, children’s
maturity of the parents, the childhood childrearing experiences of the sense of property rights is limited, and they tend to take something
parents, the temperament of the children, the context of the children’s simply because they are attracted to it, or they take money for what it
misconduct, and the response of the children to rewards and will buy. They are equally likely to give away something valuable that
punishments. The purpose of discipline is 1) to help the child interrupt belongs to them. When young children are caught and punished, they
or inhibit a forbidden action; 2) to point out a more acceptable form are penitent- they “didn’t mean to”, and promise “never to do it
of behavior so that the child knows what is right in a future situation; again”, but it is quite likely that they will repeat the performance the
3) to provide some reason, understandable to the child, that explains following day. Often, they not only steal, but will lie about it as well or
why one action is inappropriate and another action is more desirable; attempt to justify the act with excuses. It is seldom helpful to trap
and 4) to stimulate the child’s ability to empathize with the victim of a children into admission by asking directly if they did the offensive
misdeed (Newman and Newman, 1991) thing. Children do not take on such responsibility until nearer the end
As children are increasingly able to see a situation from the point of of middle childhood.
view of another, they are able to understand the effects of their There are several reasons why children steal: lack of a sense of
reactions on others and themselves. Disciplinary techniques should property rights, an attempt to acquire the means with which to bribe
help children control their own behavior. Reasoning is an effective favors from other children, a strong desire to own the coveted item,
technique for this age group. With advancing cognitive skills they are or as a means for revenge in order to “get back at someone” (usually
able to benefit from more complex types of disciplinary strategies. For a parent) for what they consider to be unfair treatment.
example, withholding privileges, requiring recompense, imposing It is difficult for many parents to cope with stealing by their children.
penalties, and contracting can be used with great success. Problem In most situations it is best not to attempt to find a hidden or deep
solving is the best approach to limit-setting and children themselves meaning to the stealing. An admonition, together with an appropriate
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

and reasonable punishment, such as having the older child pay back select and pursue. According to Rew, Horner, and Fouladi (2010), aside
the money or return the stolen items, will take care of most cases. from personal traits, children establish health behaviors. In general,
Most children can be taught to respect the property rights of others school-age children view themselves as healthy and can manage their
with little difficulty despite the temptations and opportunities own care in the areas of seat belt use, exercise, emergency situations,
presented to them. Some children simply need more time to learn the and dental health. Health education is a primary component of
importance of the culture’s rules regarding private property. comprehensive health care, and health education programs should
promote desired health behavior through guided learning and
C. Coping with stress modeling. Health promotion projects teach school-age children that
Children today experience more stress than children in previous social decision making to promote health is important. Children who
generations. This stress comes from a variety of sources. Stress in attain skills in self-control social awareness and problem solving
children can be due to hospitalization, illness, abuse, disabling injuries, through classroom discussions and practice may engage in fewer risk-
and death or the threat of death. taking behaviors. Providers can teach children how to ask these
In the normal course of growing up, children are pressured by their questions so they can learn about their health during well-child visits
peers to identify with their friends; to eat, dress, and look like their to the pediatrician, nurse practitioner, and school nurse.
friends; to talk about the same things that their friends talk about; to B. Nutrition
engage in the same activities as their friends talk about; to engage in Parents and children need to be aware of the value of a balanced diet
the same activities as their friends; and yet to compete with them. to promote growth because children usually eat what their family
They are pressured by parents to excel in school, in athletics, and in members eat. The quality of the child’s diet depends on the family’s
social situations at ever-younger ages. Children in the middle school pattern of eating. Likes and dislikes established at an early age
years are often overprogrammed with activities such as ballet lessons, continue in middle childhood, although preferences for single foods
music lessons, athletics and other activities until the cumulative effect subside, and children develop a taste for a variety of foods. However,
is overwhelming. the easy availability of fast-food restaurants, the influence of the mass
Although children receive better treatment than in earlier times when media, and the temptation of “junk food” make it easy for children to
beatings and child labor were common, their physical and emotional fill up on empty calories. Foods that do not promote growth, such as
well-being is threatened by different stresses, especially violence. sugars, starches, and excess fats, are common in school-age children’s
Children are stressed by conflict at home. The high divorce rate and diets. The easy avail- ability of high-calorie foods, combined with the
the number of single-parent families results in altered relationships tendency toward more sedentary activities, has also contributed to an
and increasing responsibilities for children. epidemic of childhood obesity. Parents are unable to monitor what
Exposure to violence in the family, school, or community affects their children eat when they are away from home. A parent may pack
children’s ability to concentrate and function. Children may be a lunch for school but is unaware of how much is eaten, traded, sold,
traumatized by witnessing violence and develop fear and a sense of or thrown away. Nutrition education can and should be integrated in
helplessness. Children exposed to repeated violence often display the curriculum throughout the school years. Important aspects of
symptoms associated with posttraumatic stress disorder such as nutrition education include the U.S. Food and Drug Administration’s
nightmares, flashbacks, fatalistic orientation to the future, depression MyPlate; elements of a whole- some diet; and how food products are
and anxiety. grown, processed, and prepared. However, school cafeterias may not
School itself is stressful for many children, and school has become always provide healthy, nutritious meals. School nurses can take an
more a violent environment. Between 19994 and 1999, 172 students active role in nutrition education by working with teachers to plan and
ages 5 to 18 were killed on school grounds or at school related implement units on nutrition instruction and by working with parents
activities. Students were reported carrying weapons such as gun, knife and children to give nutritional guidance.
or club to school and some get involved in physical fights. The school
environment may also pose a threat to the middle schooler’s self- Outside Influences
image. Competing with classmates for grades and teacher recognition,
failing an examination, being teased or made fun of in school, or being With the influence of mass media and the temptation of an immense
labeled as “stupid” or “learning disabled” all result in emotional variety of “junk food”, it is all too easy for children to fill up on empty
distress. Teachers or parents may not always recognize or appreciate calories – foods that do not pronounce growth, such as sugars,
the worries or sources of stress for school-age children. starches and excess fats. They have more freedom to move without
Children also get distressed when teachers raise their voices, yell or parental supervision and often have small amounts of money to spend
scream, or use fear or physical punishment in the classroom. Students on candy, soft drinks, and other easily accessible treats. Midafternoon
exposed to such may show symptoms of stress, express excessive snacks are common, and it is wise enough to encourage consumption
worry about school, demonstrate negative self-perceptions, and of fruits, nuts, and other wholesome finger foods to meet this need.
verbalize fear of physical harm by the teacher. Nutrition is a joint responsibility of both the child and the family. The
Children may be encouraged to feel, think, and behave at a level of popularity of fast-food restaurants has aroused the interest of
maturity far beyond what could reasonably be expected of individuals nutritionists and other health care professionals concerned with
their age. They are expected to take on many adult-type children’s nutrition. Because the nutritional content of fast food is
responsibilities, to make decisions they are not really able to make and usually known, it is easier for nutrition-conscious parent to help
to achieve more. A school’s emphasis on high test score achievement children select appropriate items from the available menu. Childhood
can cause stress in adulthood. Children have little time for being young obesity is an increasingly prevalent health problem in school age
and enjoying the spontaneous activities of childhood. children. The easy availability of high-calorie foods, the tendency
II. Promoting Optimum Health During The School Years toward more sedentary activities (such as watching television and
A. Health Behaviors playing or working at a computer), and the trend away from walking or
During the school age years, children acquire increased cognitive skills cycling and toward transportation by automobile and bus have
that allow them to make decisions about health behaviors they will reduced caloric expenditure. The consumption of high fat diet has
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

contributed to obesity. 2. Sleep Walking

It is associated by the transition from stage 4 to 1 of non-REM sleep.
School Programs Sleep walking occurs in the first 3-4 hours of sleep. Children often have
no memory of sleepwalking in the morning. The episodes begin when
Working parents assume that their kids are mature and every now and the child sits up abruptly and walks. Any attempts to communicate
then leave the obligation of meal preparation to them. Although with the child elicit only mumbled and slurred responses.
almost older school-age children are equipped for preparing simple 3. Sleep Talking
meals, very frequently breakfast as well as lunch might be deficient, It is not purposeful, and speech is usually incomprehensible and
alternative, or nonexistent. Most schools subscribe to programs, and monosyllabic. Preventive measures include avoiding over fatigue,
in spite of the fact that outcomes are hard to gauge straightforwardly, getting adequate rest, employing relaxation techniques and relieving
it is believed that these school meal programs positively influence the any stress the children maybe experiencing.
behavior and learning capacity of kids. Notwithstanding, the normal 4. Nightmares
school lunch may likewise surpass the suggested dietary rules for They are common in the children ages 6 to 12 years old. It may indicate
saturated and absolute fat. Furthermore, children who buy school specific underlying conflict that strongly influences the child’s behavior
snacks regularly select just the things they want. and thought. Resolving worries will often reduce nightmares.
However, if nightmares became chronic, professional counseling
Nutrition Education should be considered. (Ferber and Kryger, 1995)
5. Posttraumatic Nightmares
Nutrition education should be integrated throughout the school years This is produced by a traumatic event which are anxiety provoking and
into classroom learning. Guidelines from the American Dietetic literal in their depiction of the trauma. Current external stresses,
Association (20014) include the following: movies or stories may also precipitate a nightmares and night terrors.
D. Physical Activity
Throughout middle childhood, children’s increasing capabilities and
• Choose a lifestyle that combines sensible eating with regular
adaptability permit greater speed and effort in motor activities and
physical activity. Children should participate in 60 minutes of
larger, stronger muscles with greater efficiency and skill permit longer
physical activity each day.
and increasingly strenuous plays and exhaustion. During this period,
• Choose a diet with plenty of grain products, vegetables, and
children acquire the necessary coordination, timing, and
fruits.
concentration that are required ro participate in adult type activities,
• Choose a diet low in fat, saturated fat, and cholesterol.
even though they may lack the strength, stamina and control of the
• Eat a variety of foods. adolescent and adult. Consequently, a larger amount of physical
• Choose a diet moderate in salt and sodium. activity is expected and encouraged during the school years.
• Choose a diet moderate in sugars. Most children need little encouragement to engage in physical activity.
They have so much energy that they seldom know when to stop.
The school nurse should take an active role in nutrition education and Physical Fitness
work with teachers to implement nutrition instruction that is relevant Has been considered to be the physical prowess needed to engage in
and interesting to children. competitive sports. The perception that aerobics are not pleasurable
and the increasing attractions of televisions as a spare time activity are
C. Sleep and Rest believed to contribute to the lack of motivation in children to acquire
There is no specific amount given by a child at any given age. The a lifelong habit of maintaining physical fitness. Nurses can support
amount depends rather on the child's age, activity level, and other efforts to include physical fitness as an integral part of school programs
factors such as health status. During the school years children usually and encourage children to find and engage in activities they find both
do not require a nap but approximately 9 1/2 hours (Blum, Ditmar & pleasurable and beneficial and that have the potential to contribute to
Charney, 1997). Usually there is little problem for children 6 and 7 lifelong fitness. Enjoyment of sports and fitness in childhood can be
years old, and the task of going to bed can be facilitated by encourage by well-organized extracurricular sports programs based in
encouraging quiet activity before bedtime, such as coloring and the community or in school.
reading. However, 8-9 and 11-year-old children are particularly Parents who pressure their children to perform beyond their
resistant. Often children are unaware that they are tired; if they ate capabilities run the risk of child being injured, developing a distaste for
allowed to remain up later than usual, they are fatigued the following the activity and developing a lowered self- image.
day. Sometimes bedtime resistance can be resolved by allowing a later Acquisition of Skills
bedtime in difference to their advancing age. Parents can help children School-age children also demonstrate increasing capacity in fine
by giving them a little advancing warning, but children should realize muscle facility and complex artistic skills. It is a period of energetic and
that when the final bedtime is announced, the parents really mean it. vibrant creative productivity. With the tools of language and reading,
12- year-old children usually offer no difficulty in relation to bedtime. children can create poems, stories and plays. They can also do variety
of handicrafts, such as ceramics, needlework, wood carving and
Sleep Problems beadwork. They can also enter programs offered by organizations of
During middle childhood there is a marked reduction in the need for boys and girls, scouting or other special interest groups. Music is a
sleep initiation and maintenance. If a child's sleep problems concern favorite form of expression in school age children. Parents can
the family, a thorough assessment is needed to plan appropriate encourage them to enroll in Music Classes for them to sing in harmony,
interventions. play instruments and compose original songs.
Types of Sleep Problems: School age children can and want to assume their share of household
1. Bedtime Resistance tasks, which usually reacted to the male and female roles that had
For some children it is related to normal fears of their age such as fear
of the dark, strange noises, intruders or other imagined phenomena.
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

been defined by their culture, and many assume responsibility for possible so the blood supply to the tooth can be reestablished and the
tasks outside the home, such as babysitting, yardwork or paper routes. tooth kept alive. A tooth that is replanted promptly has a good survival
E. Dental health rate. Avulsed primary teeth are usually not reimplanted.
Permanent teeth erupt during school-age years that is why dental Nursing responsibilities:
hygiene and regular attention to dental carries are important parts of • Oral inspection is an integral part of the physical assessment of
health supervision during this period. The first permanent teeth erupt every child because many children are exposed to health care but
at about 6 years of age, beginning with the 6-year molar, which erupts not dental care. If there is any evidence of unhealthy dental state,
posterior to the deciduous molars. Other permanent teeth appear in the child should be referred for dental services.
approximately the same order as eruption of the primary teeth and • The nurse or anyone faced with dental trauma should be
follow shedding of the deciduous teeth.With the appearance of the prepared to provide support and reassurance during the dental
second permanent (12-year) molar, most permanent teeth are trauma.
present. However, permanent dentition is more advanced in girls than F. School health
in boys. A school health program is involved in ongoing health maintenance
Children should be taught to perform their own dental care with the through assessment, screening, and referral activities. Routine health
supervision and guidance of the parents. Parents should learn the services provided by most schools include health appraisal, emergency
correct brushing technique with their children, and they should care, safety education, communicable disease control, counseling, and
monitor their child’s efforts until the child can assume full follow-up care. Health education of school-age children is directed
responsibility. Although there are several methods of brushing that toward providing knowledge of health and influencing habits,
have been described and recommended for children, there is no attitudes, and conduct in relation to health and injury prevention.
conclusive evidence that one method is superior to another. Teeth Traditionally, school nurses were viewed as the individuals who
should be brushed after meals, after snacks, and at bedtime. Children detected diseases in the school, applied bandages, and cared for
who brush their teeth frequently and become accustomed to the feel students who were ill or injured. Although these functions remain
of a clean mouth at an early age usually maintain the habit throughout important parts of the school nurse’s job, the role has expanded
life. Flossing follows brushing. Parents should perform the flossing until considerably. There are cases wherein not all schools have a school
children acquire the manual dexterity required (usually at about 8 or 9 nurse, so the use of unlicensed assistive personnel (UAP) is needed in
years of age). this situation. After appropriate training and supervision, UAPs can
Dental problems provide standardized routine health care to students.
Limited or inadequate dental care results in the most common dental
problems: Nursing Responsibilities:
• Dental caries (cavities) • School nurses manage and coordinate all the care required by
This is the principal oral problem in children and adolescents. The regular students and students with special health care needs.
prevalence rate of caries increases steadily across the life span; • School nurse practitioners provide health care that includes
whereas 28% of children ages 2 to 5 years have caries, 59% of children assessment of physical, psycho- medical, psychoeducational,
7 years of age have caries. If untreated, dental caries can result in total behavioural, and learning problems, as well as comprehensive
destruction of the involved teeth. well-child care.
• Periodontal diseases • School nurses are responsible for the medical and nursing needs
An inflammatory and degenerative condition involving the gums and of these children while they are in the school setting.
tissues supporting the teeth, often begins in childhood and accounts • School nurses develop, implement, and evaluate individualized
for a significant amount of tooth loss in adulthood. Children should see health care plans for these children.
a dentist at any signs of inflammation or irritation. G. Injury prevention
o Gingivitis (simple inflammation of the gums) Because school age children have developed more refined muscular
The most prevalent periodontal disease is a reversible coordination and control and can apply their cognitive capacities to
inflammatory disease that can begin in early childhood and is their behavior, the number of injuries in middle childhood is
most often associated with the buildup of plaque on the teeth. diminished compared with the number in early childhood. The most
o Periodontitis (inflammation of the gums and loss of connective common cause of severe injury and death in children older than 4
tissue and bone in the supporting structures of the teeth) years old is motor vehicle crashes- either as a pedestrian or a
• Malocclusion passenger (National Highway Traffic Safety Administration,2013). It is
Occurs when teeth of the upper and lower dental arches do not important that nurses continue to emphasize three automobile safety
approximate in the proper relationships therefore chewing is less measures that have been found to reduce the severity of injuries
effective and also it may be predisposed to disease in later years. effective car restraints systems, door lock mechanisms, and
Orthodontic treatment is most successful when it is started in the late appropriate passenger seating locations in the motor vehicle.
school-age or early teenage years after the last primary teeth have School age children’s desire for riding bicycles increases the risk of
been shed and before growth ceases. injury on streets. Other serious injuries include accidents on skate
• Dental injury boards, scooters, and other sports equipment.
This may occur in childhood and includes fractures of varying degrees Most injuries in or near the home or school. The most effective mean
of severity, chipping, dislocation, or avulsion. All tooth injuries require of prevention is education of the child and family regarding the
prompt treatment because delayed examination and diagnosis of hazards of risk taking and the improper use of equipment. Safety
tooth damage can result in infection or pulp involvement. It can affect helmets, protective eye and mouth shields, and protective padding are
the remaining teeth; replacement of the lost tooth is needed to strongly recommended for children engaging in active sports, even
maintain normal alignment and position of the other teeth. though they may not be required. Falls from bicycles are the cause of
A tooth that is avulsed (exarticulated, or “knocked out”) should be a significant number of head injuries in school age children, and the
replanted by the child, parent, or nurse and stabilized as soon as
 GROWTH AND DEVELOPMENT OF SCHOOL AGE CHILDREN

most important aspect of bicycle safety is to encourage children to Firearms - Teach safe firearm use. Keep firearms in
wear protective helmets (Mechan, Lee, Fischer, et al, 2013 locked cabinets with bullets separate from
ACCIDENT PREVENTIVE MEASURE gun
General - School-age children should keep adults
Motor - Insist children use seat belts in a car; role informed regarding where they are and what
Vehicle model their use. they are doing.
Accident - Teach street-crossing safety; stress that - Be aware that the frequency of accidents
streets are no place for rough-housing, increases when parents are under stress and
pushing, or shoving. therefore less attentive. Special precautions
- Teach bicycle safety, including advice not to must be taken at these times.
take “passengers” on a bicycle and to use a - Some children are more active, curious, and
helmet. impulsive and therefore more vulnerable to
- Teach parking lot and school bus safety (do accidents than others.
not walk in back of parked cars, wait for
crossing guard, etc.). H. Anticipatory guidance – care of families
Community - Avoid unsafe areas, such as train yards, grain The parents of the school-age child find themselves in the position of
silos, back alleys. sharing their child’s time and interests with the increasingly important
- Do not go with strangers (parents can peer group. As a child feels the need to fit into a peer group and gain
establish a code word with child; child does a sense of industry through individual and cooperative production and
not leave school with anyone who does not performance, he or she moves away from the close, familiar
know the word). relationships of the family group. It is through these early peer
- Children should say “no” to anyone who relationships that children prepare for moving from narrow, sheltered
touches them if they do not wish it, including family relationships to a broader world of relationships and increased
family members (most sexual abuse is by a independence. Parents must learn to provide support as unobtrusively
family member, not a stranger). as possible without feeling rejected, hurt, or angry. The nurse can help
- For late school-age, teach rules of safer sex parents of the school-age child by providing anticipatory guidance and
(use of condoms; inspecting partner, etc.). reassurance throughout his period of child development and
Burns - Teach safety with candles, matches, maturation.
campfires—fire is not fun. REFERENCES
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(remember to include microwave oven appropriate sexual behaviour in children and young people:
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Drowning - Teach how to swim; dares and rough-housing
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