mod 5/6 ch9 treas Flashcards
1
Q
Development
A
Development refers to the process of adapting to one’s body and environment over time, which is enabled by increasing complexity of function and skill progression.
2
Q
Growth
A
Growth refers to physical changes that occur over time, such as increases in height, sexual maturation, or gains in weight and muscle tone. Growth is the physical aspect of development; the rest is behavioral.
3
Q
Nature vs nurture
A
Nature refers to genetic endowment, whereas nurture is the influence of the environment on the individual.
4
Q
Principles of Growth and Development:
A
Growth and development usually follow an orderly, predictable pattern.
However, the timing, rate of change, and response to change are unique for each individual.
5
Q
Growth and development follow a cephalocaudal pattern,
A
Growth and development follow a cephalocaudal pattern, beginning at the head and progressing down to the chest, trunk, and lower extremities. The following are examples:
Cephalocaudal growth—When an infant is born, the head is the largest portion of the body. In the first year, the head, chest, and trunk gain in size, yet the legs remain short. Growth of the legs is readily apparent in the second year.
Cephalocaudal development—This is the tendency of infants to use their arms before their legs.
6
Q
Growth and development proceed in a proximodistal pattern
A
Growth and development proceed in a proximodistal pattern, beginning at the center of the body and moving outward.
Proximodistal growth—This occurs in utero, for example, when the baby’s central body is formed before the limbs.
Proximodistal development—The infant first begins to focus his eyes, then lifts his head, and later pushes up and rolls over. As the infant gains strength and coordination distally, he will crawl and later walk.
7
Q
Simple skills develop separately and independently.
A
Simple skills develop separately and independently. Later they are integrated into more complex skills. Many complex skills actually represent a compilation of simple skills. For example, feeding yourself requires the ability to find your mouth, grasp an object, control movement of that object, coordinate movement of the hand from the plate to the mouth, and swallow solid food.
8
Q
Each body system grows at its own rate.
A
Each body system grows at its own rate. This principle is readily apparent in fetal development and the onset of puberty. In the years leading up to puberty, the cardiovascular, respiratory, and nervous systems grow and develop dramatically, yet the reproductive system changes very little. Puberty is a series of changes that lead to full development of the reproductive system and triggers growth in the musculoskeletal system.
9
Q
Body system functions become increasingly differentiated over time.
A
Body system functions become increasingly differentiated over time. Have you ever seen a newborn respond to a loud noise? The newborn’s startle response involves the whole body. With maturity, the response becomes more focused, for example, covering the ears. An adult is often able to identify the location of the sound and distinguish the origin of the sound.
10
Q
Developmental Task Theory
A
Robert Havighurst theorized that learning is a lifelong process. He believed a person moves through six life stages, each associated with a number of tasks that must be learned. Failure to master a task leads to imbalance within the individual, unhappiness, and difficulty mastering future tasks and interacting with others. Conceptually, a developmental task is “midway between an individual need and societal demand. It assumes an active learner interacting with an active social environment” (1971, p. vi). Table 9-1 presents the tasks associated with each stage of life.
11
Q
Infants and toddlers
A
Infants and Toddlers
Physical Development
Walking
Taking solid foods
Talking
Controlling bowel and bladder elimination
Learning sex differences and acquiring sexual modesty
Cognitive and Social Development
Acquiring psychological stability
Forming concepts; learning language
Getting ready to read
12
Q
Preschool and School Age
A
Physical Development
Learning physical skills necessary for ordinary games
Cognitive and Social Development
Building wholesome attitudes toward oneself as a growing organism
Learning to get along with age-mates
Learning masculine or feminine social role
Acquiring fundamental skills in reading, writing, and calculating
Developing concepts necessary for everyday living
Developing a conscience, morality, and a scale of values
Achieving personal independence
Acquiring attitudes toward social groups and institutions
13
Q
Adolescents
A
Physical Development
Accepting one’s physique and using the body effectively
Cognitive and Social Development
Achieving new and more mature relations with age-mates of both sexes
Achieving masculine or feminine social role
Developing emotional independence from parents and other adults
Preparing for future marriage and family life
Preparing for a career
Acquiring values and an ethical system to guide behavior; developing an ideology
Aspiring to and achieving socially responsible behavior
14
Q
Young Adults
A
Cognitive and Social Development
Choosing a mate
Achieving a masculine or feminine social role
Learning to live with a partner
Rearing children
Managing a home
Establishing an occupation
Taking on community responsibilities
Finding a compatible social group
15
Q
Middle Adults
A
Physical Development
Adjusting to the physiological changes of middle age
Cognitive and Social Development
Assisting teenage children to become responsible and happy adults
Achieving adult civic and social responsibility
Reaching and maintaining satisfactory performance in one’s occupational career
Developing adult leisure-time activities
Relating oneself to one’s spouse as a person
16
Q
Older adults
A
chapter 10
17
Q
Psychoanalytic Theory
A
Psychoanalytic theory was the foremost theory of early 20th-century psychotherapy. Freud developed his theory in the Victorian era, when societal norms were very strict; sexual repression and male dominance over female behavior were the cultural standard. Because of this, many of today’s social scientists question whether the theory is relevant to life in the 21st century.
KEY POINT: Freud’s psychoanalytic theory focuses on the motivation for human behavior and personality development. He believed that development is maintained by instinctual drives, such as libido (sexual instinct), aggression, and survival
18
Q
Freud’s Stages of Psychosexual Development
Oral
Birth–18 mo
A
The infant’s primary needs are centered on the oral zone: lips, tongue, mouth. The need for hunger and pleasure is satisfied through the oral zone. Trust is developed through the meeting of needs. When needs are not met, aggression can manifest itself in the form of biting, spitting, or crying.
19
Q
Anal
18 mo–3 yr
A
Neuromuscular control over the anal sphincter allows the child to have control over expulsion or retention of feces. This coincides with the child’s struggle for separation and independence from caregivers. Successful completion of this stage yields a child who is self-directed, cooperative, and without shame. Conversely, the anal child exhibits willfulness, stubbornness, and need for orderliness.
20
Q
Phallic
3–6 yr
A
The focus is on the genital organs. This coincides with the development of gender identity. Unconscious sexual feelings toward the parent of the opposite sex are common. Children emerge from this stage with a sense of sexual curiosity and a mastery of their instinctual impulses.
21
Q
Latency
6–12 yr
A
Ego functioning matures, and sexual urges diminish. The child focuses his energy on same-sex relationships and mastery of his world, including relationships with significant others (teachers, coaches).
22
Q
Genital
13–20 yr
A
Puberty causes an intensification of instinctual drives, particularly sexual. The focus of this stage is the resolution of previous conflicts and the development of a mature identity and the ability to form adult relationships.
23
Q
In Freud’s theory, the personality consists of the id, ego, and superego—different parts that develop at different life stages. Each factor, or force, has a unique function:
Id
A
The id represents instinctual urges, pleasure, and gratification, such as hunger, procreation, pleasure, and aggression. We are born with our id. It is dominant in infants and young children, as well as older children and adults who cannot control their urges.
24
Q
ego
A
The ego begins to develop around 4 to 6 months of age, and is thought to represent reality. It strives to balance what is wanted (id) and what is possible to obtain or achieve.
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superego
The superego is sometimes referred to as our conscience. This force develops in early childhood (aged 5–6) as a result of the internalization of primary caregiver responses to environmental events.
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the unconscious mind
The unconscious mind is composed of thoughts and memories that are not readily recalled but unconsciously influence behavior.
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defense mechanisms
In the mid-1950s, Freud’s daughter, the psychologist Anna Freud, identified a number of defense mechanisms, which she described as thought patterns or behaviors that the ego makes use of in the face of threat to biological or psychological integrity (Townsend, 2015). These defense mechanisms protect us from excess anxiety. All people use defense mechanisms to varying degrees.
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Cognitive Development Theory
Swiss psychologist Jean Piaget studied his own children to understand how humans develop cognitive abilities (i.e., the ability to think, reason, and use language). In this theory, cognitive development requires three core competencies:
Adaptation
Assimilation
Accommodation
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Adaptation
Adaptation is the ability to adjust to and interact with one’s environment. To be able to adapt, one must assimilate and accommodate.
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Assimilation
Assimilation is the integration of new experiences with one’s own system of knowledge.
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Accommodation
Accommodation is the change in one’s system of knowledge that results from processing new information. For example, an infant is born with an innate ability to suck. Presented with the mother’s nipple, the infant is able to assimilate the nipple to the behavior of sucking. If given a bottle, the infant can learn to accommodate the artificial nipple.
According to Piaget, cognitive development occurs from birth through adolescence in a sequence of four stages (see Table 9-3). A child must complete each stage before moving to the next. The rate at which a child moves through the stages is determined both by inherited intellect and the environment. Piaget does not address cognitive development after adolescence.
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Piaget’s Stages of Cognitive Development
Sensorimotor
Birth–2 yr
Learns the world through the senses
Displays curiosity
Shows intentional behavior
Begins to see that objects exist apart and separate from self
Begins to see objects separate from self
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Preoperational
2–7 yr
Uses symbols and language
Sees himself as the center of the universe: egocentric
Thought based on perception rather than logic
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Concrete operations
7–11 yr
Operates and reacts to the concrete: What the child perceives is considered actual.
Egocentricity diminishes, can see from others’ viewpoints
Able to use logic and reason in thinking
Able to conserve: To see that objects may change but recognizes them as the same (e.g., a tower of blocks is the same as a long fence of blocks)
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Formal operations
11-adolescence
Develops the ability to think abstractly: to reason, deduce, and define concepts in a logical manner
Some individuals cannot think abstractly, even as adults.
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Psychosocial Development Theory
Erikson’s theory of psychosocial development
hypothesized that individuals must master eight stages as they progress through life. Most people successfully move from stage to stage; however, a person can regress to earlier stages during times of stress or be forced to face tasks of later stages because of unforeseen life events (e.g., terminal illness). Failure to successfully master a stage leads to maladjustment. Erikson’s eight stages include the following:
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stages
Stage 1: Trust Versus Mistrust (Birth to About 18 Months)
Stage 2: Autonomy Versus Shame and Doubt (About 18 Months to 3 Years)
Stage 3: Initiative Versus Guilt (3 to 5 Years)
Stage 4: Industry Versus Inferiority (6 to 11 Years)
Stage 5: Identity Versus Role Confusion (11 to 21 Years)
Stage 6: Intimacy Versus Isolation (21 to 40 Years)
Stage 7: Generativity Versus Stagnation (40 to 65 Years)
Stage 8: Ego Integrity Versus Despair (Over 65 Years)
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Moral Development Theory: Kohlberg
Lawrence Kohlberg (1968) studied the responses to moral dilemmas of 84 boys whose development he followed for a period of 20 years. From that data, Kohlberg hypothesized that a person’s level of moral development can be identified by analyzing the rationale he gives for action in a moral dilemma.
In this theory, moral reasoning appears to be somewhat age related, and moral development is based on one’s ability to think at progressively higher levels. Increased maturity provides some degree of higher-level thinking but does not guarantee the ability to function at the highest level.
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Kohlberg described the following levels; each has two stages (1968, 1981; Waugh, 1978). Not all people are able to achieve the higher levels.
Preconventional level I
Level I. Preconventional
Stage 1—punishment–obedience orientation (right action is that which avoids punishment)
Stage 2—personal interest orientation (right action is that which satisfies personal needs)
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Level II. Conventional
Stage 3—“good boy–nice girl” orientation (right actions are those that please others)
Stage 4—law-and-order orientation (right action is following the rules)
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Level III. Postconventional, Autonomous, or Principled
Stage 5—legalistic, social contract orientation (right action is decided in terms of individual rights and standards agreed upon by the whole society)
Stage 6—universal ethical principles orientation (right action is determined by conscience and abstract principles such as the Golden Rule)
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Moral Development Theory: Gilligan
Although all his research subjects were male, Kohlberg claimed that his sequence of stages applies equally to everyone. The validity of his theory for women has been sharply criticized, most prominently by Carol Gilligan (1982, 1993). To address the moral development of women, Gilligan proposed an alternative theory that incorporates the concepts of caring, interpersonal relationships, and responsibility. She described a three-stage approach to moral development:
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Stage 1: Caring for Oneself.
The focus is on providing for oneself and surviving. The individual is egocentric in thought and does not consider the needs of others. When concerns about selfishness begin to emerge, the individual is signaling a readiness to move to stage 2.
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Stage 2: Caring for Others.
The woman recognizes the importance of relationships with others. She is willing to make sacrifices to help others, often at the expense of her own needs. When she recognizes the conflict between caring for oneself and caring for others, she is ready to move to stage 3.
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Stage 3: Caring for Self and Others.
This is the highest stage of moral development. Care is the focus of decision making. The woman carefully balances her own needs against the needs of others to decide on a course of action.
See Chapter 43 for more discussion of moral development.
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Spiritual Development Theory
James Fowler, a minister, defined faith as a universal human concern and as a process of growing in trust. He noticed that his congregants had very different approaches to faith, depending on their age. Basing his studies on the work of Piaget, Erikson, and Kohlberg, he developed a theory of faith development, which includes a pre-stage (stage 0) and six stages of faith (Fowler, 1981).
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Stages 0, 1, and 2
Stages 0, 1, and 2 are closely associated with evolving cognitive abilities. In these stages, faith depends largely on the views expressed by the parents, caregivers, and those who have significant influence in the life of the person.
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Stage 3
Stage 3 coincides with the ability to use logic and hypothetical thinking to construct and evaluate ideas. At this point, faith is largely a collection of conventional, unexamined beliefs. Fowler’s studies demonstrated that approximately one-fourth of all adults function at this level or lower.
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Stages 4, 5, and 6
Stages 4, 5, and 6 represent increasing levels of refinement of faith. With each increase in level there is decreasing likelihood that an individual can attain this stage of development. Fowler found that very few people achieve stage 6.
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Physical development of the toddler(ages 12-36months , 1-3 yrs)
growth rate/weight/height/head
This is a period of increased mobility, independence, and exploration. It is also the time of temper tantrums and negative behavior, stemming from the toddler’s desire to gain autonomy.
Growth rate for toddlers is much slower than it is in infancy.
Weight. The average toddler gains 5 lb (2.3 kg) per year. By the second birthday the typical toddler weighs 27 lb (12.25 kg).
Height. By the second birthday, the typical toddler is 34 in. (86 cm) tall. Length is added mainly in the legs.
Head. Head circumference is equal to the chest circumference. Between 12 and 18 months, the anterior fontanel closes
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respirations/stomach
Respirations and heart rate slow in comparison to infancy, but blood pressure increases.
The stomach increases in size to accommodate larger portions. Toddlers typically eat about six times a day, in relatively small portions, and join the family at mealtimes. Most toddlers enjoy picking up food with their hands to feed themselves.
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Potty training abilities
Physical ability to control the anal and urethral sphincters develops between 18 and 24 months. However, the child is ready to toilet train when she can signal that her diaper is wet or soiled or is able to say that she would like to go to the potty. This usually occurs at about 18 to 24 months of age, but it is not uncommon for a child to be in diapers until 3 years of age (Chobey & George, 2008).
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Gross motor skills/fine motor skills
Gross motor skills continue to be refined during toddlerhood. By 10 to 15 months, the toddler can walk using a wide stance. At the age of 24 months, many toddlers can walk up and down stairs one step at a time. At 30 months, he can jump using both feet. Before the age of 3, the toddler can stand on one foot and climb steps alternating feet.
Fine motor skills also continue to be refined. By 15 months the toddler can not only grab small objects but can release objects as well. By 18 months he can throw a ball overhand (Fig. 9-6). The toddler uses his new motor skills and all five senses to explore his environment, and safety continues to be an important concern
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Vision/hearing
Visual acuity improves to 20/40 by the end of the toddler stage, and strabismus (crossed eyes) may still be seen transiently.
Hearing should be fully developed by toddlerhood.
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cognitive development of toddler
During toddlerhood the child completes Piaget’s sensorimotor phase and moves into the preconceptual phase. This is a time of rapid language development and increasing curiosity. The toddler is able to name many things and begins to recognize that different objects (such as a ball, a block, and a puzzle) may be named the same thing (toys). This is the beginning of categorization and concept development. In the preconceptual phase, the child abandons trial and error and begins to solve problems by thinking. However, reasoning and judgment lag far behind. This discrepancy places the child at risk for accidents and injuries.
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Milestones of toddlerhood
The toddler can ride a tricycle, put simple puzzles together, build a tower of six to eight blocks, turn knobs, and open lids.
Most toddlers can copy a circle or a vertical line.
Not only can the toddler find an object that has been hidden in his view, but he can also actively search for and find a hidden object.
By age 3, most toddlers are toilet trained. However, it is not abnormal for toddlers to continue to experience toileting problems well into the preschool period.
Most toddlers can play matching games, sorting games, and simple mechanical games.
Most toddlers have only a limited understanding of jokes and hyperbole; thus, if teased, “That balloon is so big, it might fly away with you,” the child may become frightened and try to give the balloon away.
Many toddlers can speak sentences of four or five words. However, some perfectly healthy toddlers do not yet speak, whereas others can speak in sentences of 10 or 11 words in length and even tell complex stories. If the toddler does speak, enunciation is good enough by the end of this period that strangers can usually understand what is said.
Psychosocial milestones include the following: The toddler tolerates short separations from the primary caregiver, feels possessive of personal property, and openly expresses affection. Most toddlers object vehemently to changes in routine and may suffer regression following a move, change of school, or other upset.
The toddler imitates adults, peers, and characters seen on television and videos and enjoys pretending to cook, iron, repair something broken, and mimicking other familiar adult tasks.
In shared play, the toddler can understand the concept of “taking turns” and wait a short period of time for her turn.
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Psychosocial development of toddler
The most important psychosocial developmental task for the toddler is to initiate more independence, control, and autonomy. Erikson refers to this stage as autonomy versus shame and doubt. To successfully negotiate this stage, the child must learn to see herself as separate from mother, tolerate separation from the parents, withstand delayed gratification, learn to control anal and urinary sphincters, and begin to verbally communicate and interact with others.
Toddlers exert their independence by saying no to parental requests or actions or by “throwing a tantrum” to protest a parental decision they don’t like. This behavior is best understood as a necessary attempt to define boundaries and test parental limits;
A firm but calm parental response to such “misbehavior” allows toddlers to feel secure while exploring their boundaries.
Freud defined this phase as the anal stage. To Freud, a successful toilet-training experience accompanied by praise is necessary to becoming a well-functioning adult; difficulty in this phase leads to obsessive–compulsive behavior in adulthood. Contemporary theorists find this view somewhat narrow.
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Common health problems of toddlers
Drowning is the leading cause of accidental death in this age-group (Gholipour, 2014). Most drowning accidents result from unsupervised access to swimming pools or other water sources (bathtubs). Other common causes of injuries to toddlers are falls, accidents, burns and scalds, and choking. As toddlers gain increasing mobility, poisoning from household medications and toxic cleansers becomes a concern, as does access to knives, guns, and other dangers
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Infections
Infections The most common infections are colds, ear infections, and tonsillitis. Other common infections include parasitic diseases, such as lice and tapeworms. The shorter and flatter eustachian tube in infants and toddlers increases their risk for multiple ear infections, which in turn increase the risk for hearing loss. Upper respiratory infections are common among toddlers for the following reasons:
Toddlers no longer have the passive immunity acquired in utero.
Because breastfeeding usually ends before the first birthday, most toddlers no longer receive maternal antibodies in breast milk.
As toddlers enter into more public and social settings, they are exposed to more children. Those in day care and those who have school-age siblings are particularly at risk.
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Immunizations
The CDC (2015a) immunization schedule for toddlers includes the following vaccines: hepatitis A, hepatitis B, Haemophilus influenzae, meningococcal conjugate, tetanus and diphtheria toxoids (Td), acellular pertussis (Tdap), pneumococcal pneumonia, inactivated poliovirus, varicella, measles/mumps/rubella (MMR), and rotavirus.
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Delayed toilet training
Physiologically, most children develop sphincter and neurological control by age 2, but there is more involved in successful toileting. Children must be able to unfasten their clothing and pull down their pants, use toilet paper effectively, dress again, and wash their hands before complete independence is reached. The child also must be able to sense the need to go to the bathroom, even when preoccupied with play activities, before it is “too late.” Accidents are frequent and should be expected.
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Preschool age 4 and 5 years
The preschooler is growing increasingly verbal and independent and is refining gross and fine motor skills. She is able to maintain separation from parents, use language to communicate needs, control bodily functions, and cooperate with children as well as adults. These skills prepare the child to enter school.
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Physical development of the preschooler
Growth
Growth
By 4 years of age, the average preschooler weighs about 36 lb (16.3 kg) and is 40 in. (1 m) tall.
By age 5, the preschooler has gained an additional 5 lb (2.3 kg) and has grown 3 more in. (7.6 cm) in height.
The proportions of head to trunk are somewhat closer, and the “pot belly” and exaggerated lumbar curve of toddlerhood gradually disappear.
The average pulse rate is 90 to 100 beats/min, and respirations are 22 to 25 breaths/min.
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Sensorimotor development
The preschooler has mature depth and color perception and 20/20 vision. Hearing is also mature. The preschooler continues to develop eye–hand coordination. At age 4, the child can hop, skip, and jump on one leg. Improvement in fine motor skills is most evident in artwork. Drawings become much more precise and detailed. The child is becoming independent in the ability to dress.
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MIlestones of preschool development
By age 5, most children can stand on one foot for 10 sec, skip, jump, hop on one foot or both feet together, climb play structures with ease, repeat simple dance steps, and begin to learn to skate.
Most preschoolers can copy a triangle, square, and stick figure; print at least some letters; and use a fork and spoon.
Most can dress and use the bathroom without assistance.
Language abilities continue to be variable, but most preschoolers can tell stories, recall parts of a story told to them, and speak in sentences of more than five words. They can state their name, age, and address, and many can repeat their home phone number. A toddler who is not speaking intelligibly by age 4 requires evaluation.
Preschoolers can count 10 or more objects, such as buttons or coins, and may be able to name several colors and shapes. They can compare big and small, long and short, and so on and often delight in completing simple mazes and “connect the dots” games.
Preschoolers become increasingly aware of sex organ differences and curious about sexuality.
Preschoolers may begin to ask about God, death, how babies are born, and other questions of a philosophical or scientific nature.
Preschoolers typically can distinguish fantasy from reality and enjoy jokes and simple riddles.
Psychosocial milestones include assertion of independence; pride in showing off skills, new toys and clothes, and prize possessions to friends; and a strong desire to socialize with peers.
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Cognitive development of the preschooler
Cognitive Development of the Preschooler
According to Piaget, the preschooler has entered the phase of intuitive thought. She is able to classify objects and continues to form concepts. She continues to use trial and error as a way to solve problems but increasingly uses thought to reason them out. Verbal skills expand dramatically during this phase, allowing the child to interact with more people. Preschool children are very interested in books, learning to read, and counting.
Preschoolers still lack the ability to reason formally and are unable to understand that two objects that appear different may in fact be the same (e.g., two balls of clay in two different shapes). They have a limited ability to tell time or understand the passage of time, and they may say “yesterday” in describing an event of several months ago. They also retain a strong belief in magic, monsters, and mythic figures such as Santa Claus. Preschoolers often have irrational fears—for example, of tigers lurking in the basement. Their fascination with powerful figures, such as dinosaurs and superheroes, is one way of coping with their feelings of powerlessness.
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Psychosocial development of the preschooler
Psychosocial Development of the Preschooler
The preschooler is in Erikson’s stage of initiative versus guilt, in which the child develops a conscience and readily recognizes right from wrong. The child becomes socially aware of others and develops the ability to consider other people’s viewpoints. At this age, play is often used to teach life experiences.
The preschooler begins to fully express his personality and develop a self-concept
He readily expresses likes and dislikes. Encouraging the child to participate in his favorite activities helps foster a positive self-concept
Preschool children enjoy playing in small groups and use their language skills to facilitate imaginative play. Often elaborate stories, improvised costumes, and role-playing become part of the play experience. Many preschoolers have a best friend.
Freud identified the preschool years as the phallic stage of development. The child is aware of gender differences and often imitates the same-sex parent. He also develops an attraction to the opposite-sex parent and may feel jealousy toward the same-sex parent.
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Common health problems of preschoolers
Communicable Diseases Communicable diseases (e.g., respiratory infections, intestinal viruses, and parasites such as scabies and lice) remain a major health issue, especially as preschoolers start to come in contact with more children in play and structured preschool experiences. They interact more with playmates and are hands-on, so they can readily transmit viruses through direct contact and airborne vectors.
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Poisoning
Poisoning remains a significant risk for preschoolers. They use imitation as a way to learn about new things, so they may be predisposed to ingesting substances used by the adults in the house (e.g., prescription medicines and alcohol, or substances that appear similar).
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Enuresis
Parents of preschoolers may report a concern about bedwetting (enuresis), especially in boys. The causes of enuresis are not fully understood, but it is known that in some children the bladder is simply unable to hold a full night’s output of urine until later in childhood, whereas others lack the neurological ability to waken in response to a full bladder. Most cases resolve spontaneously with only an occasional episode past age 6. In contrast, daytime wetting or soiling (encopresis) requires evaluation.
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Example Problem: Child Abuse, Neglect, and Violence
Of the confirmed cases of abuse and neglect reported to Child Protective Services, more than half are under the age of 7. KEY POINT: Child abuse can occur at any age, in any culture, and at any socioeconomic or education level. The following are a few of the reasons why some people have difficulty meeting the demands of parenthood:
Parental characteristics:
Parents were themselves abused as a child.
Parents or caregivers have unrealistic expectations of the child.
Parent(s) have unmet emotional needs.
Parents themselves exhibit immaturity or lack parenting knowledge.
There are issues of difficulty in relationships.
There is alcohol and/or drug addiction.
Characteristics of the child:
The child has a physical or mental disability.
The child was born to unmarried parents.
The child was unwanted.
Situational characteristics:
The living space may be crowded for the number of people it holds.
There are the usual stresses of child care to contend with.
The parents face employment pressures or unemployment.
The family must cope with poor housing and frequent household moves.
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SCHOOL-AGE: AGES 6 TO 12 YEARS
The school-age child becomes more independent and confident, and places more importance on relationships outside the immediate family
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Physical Development of the School-Age Child
Growth
Growth During the school-age years, the child grows about 2 in. (5 cm) taller and gains 4 to 7 lb (2.3 to 3 kg) per year. The child takes on a slimmer appearance, with longer legs and a lower center of gravity.
Musculoskeletal. Muscle mass rapidly increases, and ossification of bones continues throughout this age. Strength and physical abilities rapidly improve, and the child gains more poise and coordination.
Brain and skull. The brain and skull grow slowly, and facial characteristics mature.
GI system. The gastrointestinal system matures and stomach capacity increases, although caloric demands decrease.
Immune system. As the immune system develops, the school-age child begins to produce antibodies and antigens.
Gender comparisons. Initially boys and girls vary little in size. Toward the end of this phase, marked differences become apparent. Girls grow rapidly in the latter school-age years, as puberty begins, and experience onset of puberty about 2 years before boys do.
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Vision
Visual acuity improves with age. By 6 years of age, distance visual acuity should be at least 20/30 in each eye with less than two lines’ difference between the two eyes. Any child not meeting these criteria should be referred for a complete eye examination.
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Dentition
School-age children begin to lose their primary teeth (baby teeth) at about age 6 or 7, and the permanent teeth appear soon after. Their large size in relation to the remaining primary teeth and the child’s jaw, as well as the gaps left by teeth not yet replaced, can make even the most beautiful children look somewhat awkward at this stage.
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Milestones of School-Age Development
By age 7, most children can tie their own shoelaces; print their names; and perform self-care, such as bathing and feeding themselves. Many can even prepare simple meals.
By age 8, improved fine motor skills allow the child to begin to write, learn to knit or crochet, and/or take up a musical instrument.
By age 9, motor development approaches that of an adult.
School-age children understand the concept of payment for work and the value of money.
Fears of ghosts and monsters may continue through age 7 but give way to more realistic fears, such as of school failure or divorce of parents, by age 8 or 9.
By age 6, the child has a vocabulary of 3,000 words and usually can read. By the end of the school-age period, the child can write complex compositions with appropriate grammar, spelling, and accurate description.
Psychosocial development includes team play, peer friendships, and ability to look beyond family members for social support.
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Cognitive Development of the School-Age Child
School-age children use their thought processes to experience actions and events. Piaget describes this as concrete operations.
Concrete and systematic thinking
Magical beliefs gradually replaced with a passion to understand how things really are
Can see another person’s point of view and develops an understanding of relationships
Learns to classify objects according to similarities
Enjoys learning by handling and manipulating objects
Learns to tell time; gains an experiential understanding of the length of days, months, and years
Reads independently; does numerical calculations without representative objects, such as fingers or beads
By the end of this stage, is able to think through a task and understand it without actually performing the task
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Psychosocial Development of the School-Age Child
Erikson describes this stage as a time of industry versus inferiority. During this stage, the child is able to work at more complex projects independently. Through participation in school, she is recognized for achievements and accomplishments. For the child to progress through this stage, the parent must provide praise for accomplishments. This recognition builds self-confidence. The child will develop a sense of inferiority and lack of self-worth if her accomplishments are met with a negative response.
Peers take on increasing importance, influencing the child’s choices of what to eat, wear, and do. Friendships during the school-age years are usually with children of the same gender and may be intense but short-lived (Fig. 9-8). However, some children have one best friend throughout their childhood. In the later school-age years, friendships become more reciprocal, with each child recognizing the unique qualities of the other.
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Common Health Problems of School-Age Children
School-age children are at risk for problems similar to those of preschoolers, including upper respiratory tract infections, parasitic infections such as scabies and lice, and dental caries. Although violence, bullying, smoking, and experimentation with alcohol, drugs, and sex are more common among adolescents, these problems are also seen toward the end of the school-age years. The presence of a gun in the home significantly increases the risk of accidental death, even in the school-age population.
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CHildhood obesity
Obesity is a growing problem for preschoolers. Despite recent declines in the prevalence among preschool-age children, obesity among school-age children is still too high. For children and adolescents aged 2 to 19 years, the prevalence of obesity has remained fairly stable at about 17% for the past decade and affects about 12.7 million children and adolescents
Nutrition and lifestyle are primarily responsible for this epidemic. Children spend much less time playing outside than in past generations and more time watching television and playing video games, texting, and using social media. They consume more fast food and bigger portions and eat fewer vegetables. Thirty percent of all meals are taken outside the home and fast food contributes to 10% of overall calorie intake
As a result of the obesity epidemic, more children now have obesity-related diseases, such as type 2 diabetes mellitus (type 2 DM), hyperlipidemia, and hypertension. Type 2 DM is an endocrine disorder characterized by insulin resistance: Insulin fails to effectively transfer glucose from the bloodstream into the body’s cells. Treatment involves lifestyle changes and perhaps medication.
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Childhood asthma
Asthma, a chronic inflammatory disorder of the airways, is one of the most common chronic disorders in childhood, currently affecting an estimated 7.1 million children under 18 years. Of those, 4.1 million suffered from an asthma attack or episode in 2011 (American Lung Association, 2014). Asthma is one of the leading causes of school absenteeism and the third leading cause of hospitalization among children under the age of 15 years. Even in children who do not require emergency care, asthma can decrease attention span in school and make participation in school activities difficult. Social problems may occur, as children are often teased and stigmatized as being “wheezers” or “lazy.”
Asthma has complex causes, including a strong genetic component, but poverty appears to play at least some role. Recent research has focused on indoor air allergens such as pet dander, dust mites, fungi or mold, and the decomposing corpses of cockroaches as significant triggers.
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Unintentional injuries
School-age children experience fewer injuries than preschoolers because of their improved coordination and reasoning abilities. Nevertheless, they have a high incidence of fractures, sprains, strains, cuts, and abrasions. Falls are the most common form of nonfatal injury for children aged 6 to 12 years, whereas the leading cause of unintentional injury death is motor vehicle and traffic injury (CDC, 2012a). Injuries also occur from riding bicycles on the street, skiing, skateboarding, sledding, and playing sports.
Concussions are one of the most commonly reported injuries in children and adolescents who participate in sports and recreation activities. Although many concussions may be considered mild, they can result in health consequences such as impaired thinking, memory problems, and emotional or behavioral changes
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assessment
The school-age child should have a routine health maintenance visit every 1 or 2 years. Annual physical exams are scheduled for those who participate in sports. Allow time to meet with the child alone as well as time with the caregiver present. School-age children often have questions about puberty and the changes their bodies are undergoing. Private time with the child will allow you to explore these concerns in a private manner.
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Nursing interview
Nutrition. Assess the child’s eating patterns and the intake of key nutrients such as calcium, vitamin D, and iron.
Allergies. Ask the child whether he ever experiences difficulty breathing or feels too tired to play. Ask about symptoms such clear nasal discharge, frequent sneezing, or watery eyes. Listen to breath sounds and observe for allergy symptoms.
Visual Acuity. Ask about any eye screening. Because children do not complain about visual difficulties, the AAP recommends that children aged older than 5 years should be screened every 1 to 2 years (2012). Many school systems have regular vision screening programs that are carried out by professionals and properly trained volunteers. Screening can be done there quickly, accurately, and with minimal expense.
Dental Hygiene. Interview the child to determine his knowledge of dental hygiene. Inspect the mouth for secondary teeth eruption according to expected patterns ands for tooth decay and gum disease.
Sleep Pattern. Assess the child’s sleep pattern. To remain healthy and function well at school, the school-age child needs 9 to 10 hours of sleep each night.
Safety. Determine the child’s awareness of safety. Be sure to assess risk-taking behavior.
Smoking—Has the child tried smoking? Does he have friends who are smoking?
Substances—What is the child’s experience with alcohol and drugs? Has he tried them? What does his peer group think about drinking and drugs?
Sexual activity—Has he ever been sexually active? Does he have friends who are sexually active?
Violence—Has the child engaged in fistfights or fights with knives or other weapons?
Weapons—Is there a gun in the home? Does the child have access to it?
Although these concerns are seen with greater frequency in adolescence, you should assess for them among school-age children.
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BMI
BMI At each visit, asses the child’s vital signs, height, weight, and developmental skills. After weighing the child, correlate your measurements with growth charts. The American Heart Association (2013) BMI classifications are as follows:
Overweight At 85th percentile
Obese At the 95th percentile or above
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Visual acuity
Visual Acuity should be at least 20/30 in each eye with less than two lines’ difference between the two eyes. Any child not meeting these criteria should be referred for a complete eye examination.
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Scoliosis screening
Scoliosis is an abnormal spinal curvature that affects primarily females. Screening is done in the preadolescent period, usually in the sixth grade. Refer to an orthopedic surgeon for evaluation and follow-up if an abnormal curvature is discovered.
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Immunizations
Review the immunization record. Although immunization against hepatitis B is recommended in infancy, many parents skip these immunizations. Several states require students to complete the hepatitis B series prior to entry into seventh grade. The child must begin the series at or before 12 years of age to complete it in time for seventh grade.
The CDC (2015a) recommends the following vaccines for school-age children: human papillomavirus; meningococcal; pneumococcal; influenza; hepatitis A; hepatitis B; inactivated poliovirus; measles, mumps, and rubella; varicella; and tetanus, diphtheria, and pertussis booster.
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INTERVENTIONS (SCHOOL-AGE)
The Healthy People 2020 campaign focuses on preventing injury rather than treating illness. Your efforts in teaching will help promote those objectives. Use age-appropriate teaching materials and objectives.
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Teaching for safety
To help prevent injury in the school-age child:
Educate the child and parents on safety and the proper use of equipment and gear.
Teach the child and parents to wear seat belts at all times when in a vehicle.
Encourage parents to be firm about the use of helmets for bicycle safety.
Stress that head injury is the most common cause of death in this group.
For those who play sports, stress the importance of warming up before playing, using proper safety equipment and gear that is properly fitted, and avoiding overtraining.
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Teaching About Nutrition and Exercise for Weight Loss
Counsel overweight and obese children about nutrition for weight loss and the importance of daily physical activity.
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Nutrition
Encourage children to develop good eating habits by choosing nutritious foods and snacks. For example, encourage them to avoid junk foods, such as sodas, and to choose instead milk, calcium-fortified orange juice, or water. If the diet is severely restrictive and if it has none of the child’s favorite foods, it is likely to fail. Focus on making small but permanent changes. Refer for further counseling, if indicated.
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Teaching about exercise
Recommend at least 60 minutes of enjoyable, moderate-intensity physical activities every day that are developmentally appropriate and varied
KEY POINT: Explain how important exercise is to weight loss—diet alone will not achieve it for them.
Exercise does not necessarily need to be structured. For example, it might consist of family walks in the community, bike riding or skateboarding, or swimming in a neighborhood pool. Even table tennis requires more activity than watching television. The American Academy of Pediatrics recommends the following:
Limit TV viewing and video game playing to 2 hours a day.
Boys should take at least 11,000 steps daily.
Girls should take at least 13,000 steps daily.
Suggest parents buy a pedometer, if possible, so the child can track the number of steps.
Teach children about self-regulation of impulse control, decision-making skills, and social competence. Making more informed choices could help reduce calorie intake and establish good physical activity habits early.
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The most effective programs for preventing obesity focus on children, rather than their parents. However, management of obesity does involve the whole family
A child cannot make lifestyle changes if his environment remains the same. Parents can help by modeling healthy eating.
Recommend group-based or family-based counseling. Many parents do not perceive that their child is overweight; of course they must come to recognize this if they are to cooperate with needed changes.
Work with the community to involve the schools in obesity prevention. Many schools have removed soda from their campuses and are now offering healthy menus in their cafeterias. In addition, physical education in the schools has been mandated in many U.S. states.
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Education (more)
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Teach about:
Diabetes
Asthma
Violence and risk taking behavior
Helping hospitalized child
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