School age Flashcards
School age
6-12 years
Freuds School age stage
latency stage
ages 6-12years
-marked by repression of sexual urges as children play mostly with peers of the same sex
Jean Piaget school age
concrete stage
age 7-11years
-children become more organized and rational in thinking
-quantity remains constant even if its appearance changes
Erik Erickson school age
age 6-12
industry vs. inferiority
-desire to please adults
-complex tasks
WCC
school age annually
-2nd dose of MMR vaccine ages b/t age 4 and 6: prior to school entry
-ages 11 and 12 get Tdap, HPV, Varicella, and Meningococcal conjugate vaccine
-Dental assessment and cleaning every 6months
Average wt increase
5-7lbs per year
Average ht increase
2-3inches per year
Female peak height velocity (PHV)
ages 11 and 12
prior to menarche
Obesity in school age?
-indicated by BMI over the 95th percentile
Visual Acuity
20/20
eruption of permanent teeth
age 6
Precocious Puberty
uses Tanner Stage
females younger 8years of age
males younger than 9years of age
PPD
test for tuberculosis
-given annually with any risk factors:
-low socioeconomic status, residence in area where TB is prevalent, exposure to TB, or immigrant status
scoliosis test
Adam forward bend test or scoliometer
hematocrit done annually
assess for anemia before child becomes symptomatic
hand dominence begins?
appears by age 5
screen time limited to what?
less than 2 hours a day
dental health for school age
-floss
-encouraged to brush teeth after meals and before bed
-dental cleaning every 6months
-sealant should be placed on the Childs premolars and molars as soon as the come in
Injury Preventions
communicate risks
-tobacco
-drugs
-alcohol abuse
-use of safety devices, helmets and seatbelts
Sleep for School age
8-10 hours per night
-night terrors resolve by age 12
Obesity of School age
determines by BMI
-overweight if BMI is above 85th percentile
-Obese if BMI is above 95th percentile
obesity is a combination of genetic, physiologic, and environmental factors
-obesity can sometimes be caused by genetic disorders such as Prader-Willi syndrome and Trisomy 21
-medications like antipsychotics produce obesity
NP should take patients Hx, eating patterns, activity Hx, Medications Hx, Psychological Hx
-review for comorbidities like DM type 2, sleep apnea, PCOS, Vitamin D deficiency
-safest way to lose wt is healthy eating and active lifestyle, no diets!
Child Abuse
acts of omission or commission, including emotional, physical, and sexual acts, that pose a clear risk to the development and health of the child.
-many abusers are parents
-child abusers have traits “a breakdown of impulse control”
-abusers are usually former victims themselves
most common type of child abuse
neglect
injuries that indicate abuse
soft tissue markings with any outline of any object, weapon, cigarette burn, or hand
-delay in seeking care is suspicious of abuse and may result in bruises and fractures in various stages of healing
-Differential:
-homeopathic or cultural practices
cupping/ coining
-NP consider coagulation disorder
Lab test for abuse
coagulation profile
CBC, platelet, PT, PTT, serum calcium, alkaline phosphates, and phosphorous levels may be measured if bone disease is suspected
-Skeletal Survey: picks up old fractures
-NP r/o other conditions like Osteogenesis Imperfecta (brittle bone disease)
Suspected child abuse
NPs are required to report suspected child abuse
ADHD
chronic neurodevelopcenttal disorder
-usually onset before age 7
-more common in boys
-Overactive and unable to focus or control their behavior
-inattention, distractibility, impulsive, and hyperactivity
Risk Factors for ADHD
-prenatal exposure of tobacco, alcohol, or cocaine
-perinatal factors include prematurity, prolonged labor, perinatal asphyxia, and signs of fetal distress
-post natal factors: cerebral palsy, epilepsy, CNS trauma or infection
-possible LEAD
-Psychosocial: child abuse, disorganized or chaotic environments, family Hx of alcoholism, hysterical or sociopathic behaviors, developmental learning disorders, Hx family ADHD
ADHD has 2 categories
-inattention
-hyperactivity and impulsivity
diagnosis: at least 6 symptoms form either category or combination of both and be present at least 6months and in at least 2 different settings
6+6=12
before age 7 dx
and as late as age 12
ADHD standardized test
-Conners Parent and Teacher Rating Scale
-Achenbach Child Behavior Checklist
-Vanderbilt Assessment Tool
ADHD management
medication and behavioral therapy
stimulants most common
-increase avail or neurotransmitters to strengthen focus and attention
Stimulants:
-methylphenidate and amphetamines
-methylphenidate:
Ritalin, Metadate, Focalin
-amphetamines:
lisdexanfetamine (Vyvanse), dextroamphetamine (Dexedrine), Adderall
-Prescribe low and go slow
-0.3mg/kg-0.7mg/kg
starting in morning 5-10mg
-increase 2.5-5mg per week
-change in behavior identifies w/in 30-90min of ingestion
-short-acting for children younger than 6 years of age
-long acting last 10-12hours used with children who require duration of action longer than 4 hours.
-avoid evening dose to minimize insomnia
Contraindications for ADHD medication
-heart disease
-HTN
-Glaucoma
Psychiatric:
-marked anxiety and increased risk for suicide
Drug holidays
implemented around school breaks or summer vacations
ADHD nonpharm measures
behavioral treatment
parent education
support
ADHD medication side effects
-stomach aches
-headaches
-anorexia
-weight loss
-tachycardia
-tics (usually remain despite long term use)
-sleep disturbances
ADHD legal
-need to sign control substance abuse form
-Perform drug testing to make sure they are taking med and not selling
