School-Age Children Leik Flashcards
Still’s Murmur
A benign systolic murmur that is described as having a vibratory or musical quality.
Becomes louder in supine position or with fever. Minimal radiation. Grade I or II intensity.
Most common in school-age children.
Usually resolves by adolescence
Top Causes of Death
Age 1 to 24 Years (Toddlers to Young Adults)
accidents or unintentional injuries
Hypertrophic cardiomyopathy
Sudden cardiac death
Atlantoaxial instability (Down syndrome, juvenile rheumatoid arthritis)
Instability between C1 and C2
Marfan syndrome with aortic aneurysm
Aortic aneurysm risk: Lens eyes displacement, joint
hypermobility
Ehlers–Danlos syndrome (vascular form)
Cerebral or cervical artery aneurysm, spondylolisthesis,
joint hypermobility
Acute rheumatic fever with carditis
Worsens condition, heart inflamed
Mitral valve prolapse, especially if significant mitral
valve pathology
Sudden cardiac death
Fever
Heat stroke
Age 5-14 years - top causes of death
Accidents or unintentional injuries
Cancers
Developmental and genetic conditions
Immunizations 4- 6 years
Administer vaccines: Measles, mumps, rubella (MMR); varicella, inactivated poliovirus vaccine (IPV); and diphtheria, tetanus, acellular pertussis (DTaP)
If history of chickenpox and documented on chart by health provider, does not need varicella.
If child is 7 years or older, give Tdap instead of DTaP.
Immunizations Middle School - age 11-12 years
Tdap booster
Meningococcal conjugate vaccine/Menactra (MCV4)
Human papillomavirus (HPV) vaccine/Gardasil
HPV vaccine
HPV vaccine is now indicated for both girls and boys. Need a total of three doses of vaccine.
Gardasil used for both genders.
Age 13 to 14 years (or older):
Give Tdap if did not receive it at age 11 to 12 years
If no history of varicella immunization (or the disease),
then give the varicella vaccine.
If child did not complete hepatitis B series (fewer than three doses),
administer hepatitis B booster. Do not restart hepatitis B series.
Meningococcal Vaccines
Administer Menactra or Menveo vaccine first dose age 11 to 12 years. If missing, catchup age is 13 to 15 years. Booster (second dose) at age 16 years.
Also used for first-year college students (living in dorms) and people with asplenia, functional asplenia (sickle cell), splenectomy, HIV infection, complement deficiencies,
and others at higher risk.
Primary Series of Vaccination: Missing or Not Done
After Seventh Birthday (Never Been Vaccinated)
Td (three doses primary, then every 10 years); substitute Tdap for one dose of Td (once in a lifetime)
IPV (three doses)
Hepatitis B (three doses)
MMR (two doses)
Varicella (two doses) if no history of chickenpox
HPV (three doses; give if younger than age 26 years)
Immunizations: Age 10 and older
see following cards
Hepatitis B
Total of three doses over 6 months. If missing a booster, give until total of three doses. Do not repeat series.
Measles, mumps, rubella
MMR
Give second dose (if needs to catch up). Live virus precautions.
Varicella
Give second dose (if needs to catch up) if no proof of varicella. Live virus precautions.
Tetanus
Give Tdap at age 11 to 12 years (or older if missed this dose). Replace one Td booster with Tdap.
Hepatitis A
Needed for high-risk groups (homosexuals) and endemic areas (certain areas of southwestern United States).
Influenza
Needed annually after age of 6 months.
Human papillomavirus
Indicated for boys and girls. Give first dose at age 11 to 12 years. Catch-up dose at age 13 years if missed. Gardasil: Need three doses. Give second dose 1 to 2
months after first dose. Give third dose 6 months after the first dose.
Meningococcal
First does at age 11 to 12 years. Give booster at age 16 years. Meningococcal conjugate vaccine (MCV4) needed for all college freshmen living in
dormitories.
6 Years Old (Kindergarten)
Gross Motor
Copies a triangle (copies a diamond at age 7)
Ties shoes
Rides a bicycle
Age 7 to 11 Years (Middle Childhood)
Freud classified this age group under the “latency stage.”
The major task for this age group is to succeed in school and to interact with their peer group. May have a “best” friend(s).
Starts to think of the future. Some girls may start puberty at age 8 years.
According to Piaget, this age group is in concrete operations stage (early abstract thinking starts at about
age of 11 years).
Functional Constipation (Encopresis)
Rome IV criteria diagnosis of functional constipation in children (age 4 years or older; criteria are slightly different for infants and toddlers up to 4 years of age).
Must meet two (or more) of the criteria at least once per week (for at least 1 month).
- History of withholding of stool
- History of painful or hard bowel movements
- History of large-diameter stools that may obstruct the toilet
- Presence of large fecal mass in rectum
- Two or fewer defecations in toilet per week
- At least one episode of fecal incontinence per week (thin fluid with feces that bypasses a
- large stool mass and leaks around it); ask patient whether fecal soiling of underwear
- Up to 80% of children with functional fecal incontinence may also have constipation (Sood, 2017).
- Order a plain film (x-ray) of the abdomen to check for retained stool.
All 11- to 12-year-old children should be vaccinated with single dose of quadrivalent meningococcal vaccine (MenACWY)
brand names are Menactra or Menveo.
Immunizations are needed at age 11 to 12 years
Tdap
HPV
MCV4
Child at age of 11 years is at
“early abstract” thinking stage (Piaget).
HPV vaccine (Gardasil):
Know that youngest age group for vaccination is 9 years.
- About one third of children in the United States are considered obese. Which of the following methods is an appropriate intervention for obese school-aged
children?
A) Severe restriction of dietary carbohydrates
B) Increase physical activity and outdoor play
C) Prescribe appetite suppressants
D) Over-the-counter herbal weight-loss pills
B) Increase physical activity and outdoor play Lifestyle changes, such as increasing physical activity and spending more time outdoors, are appropriate
recommendations for children. Consider referral to a registered dietician for dietary recommendations and counseling. Participation in an exercise program designed for children (if available) is also appropriate. Severe caloric and/or carbohydrate restriction is not recommended for this age group.