PEDIATRIC NURSING EXAM #3- STUDY GUIDE
CHAPTER 15 & 16: SCHOOL-AGE CHILD NOTES
School-Age Period (6–12 years)
• The school-age stage spans from approximately 6 to 12 years old. From a physical development
standpoint, this period begins with the loss of the first primary (deciduous) tooth and concludes
with puberty and the eruption of most permanent teeth, excluding third molars (wisdom teeth).
Role of School and Cognitive Characteristics
• School becomes the child’s primary social environment outside the family.
• It is often considered the closest developmental experience to adulthood during childhood.
• Children at this stage develop a strong sense of fairness and justice in how they view the world.
• Thinking remains somewhat concrete and limited in abstraction.
Erikson: Industry vs. Inferiority
• The central psychosocial conflict is industry versus inferiority.
Industry (positive outcome):
• Essential for developing self-concept.
• Focuses on achievement and productivity.
• Children are motivated to learn new skills and participate in socially meaningful tasks.
• The goal is to develop personal and interpersonal competence through mastery of academic,
social, and practical skills.
• Children show eagerness to contribute and succeed in structured environments.
• This stage supports growing independence and increasing reliance on peer approval.
• Peer groups become highly influential and provide emotional support and belonging.
Inferiority (negative outcome):
• Develops when children feel they do not measure up to expectations or peer standards.
• Can result from repeated failure or lack of readiness for developmental demands.
• Negative reinforcement from the environment can intensify feelings of inadequacy.
• Persistent failure may lead to avoidance of new challenges and fear of comparison with peers.
• Some level of perceived inadequacy is normal, especially in skill development.
• A healthy environment encourages children to see themselves as capable contributors.
• In clinical or educational settings, giving children manageable responsibilities helps build
confidence and competence.
• Children should never be made to feel worthless or incapable.
Freud: Latency Stage
• This period corresponds to Freud’s latency phase of psychosexual development.
• It is characterized by a relative calm in sexual development.
• Social relationships primarily involve same-sex peer groups.
• It occurs between early childhood psychosexual conflicts and the onset of adolescent sexual
development.
Piaget: Concrete Operational Stage
• School-age children are in the concrete operational stage of cognitive development.
Key characteristics:
• Thinking becomes more logical but remains tied to concrete, observable experiences.
• Children can mentally represent actions and events and express them verbally or symbolically.
• An “operation” refers to a mental transformation rather than a physical action.
• Children can now perform mental operations on objects and situations.
• They begin to understand different perspectives and viewpoints.
Cognitive advances include:
• Moving from perception-based judgments to reasoning-based (conceptual) thinking.
• Developing conservation skills (understanding that quantity remains the same despite changes in
shape or appearance).
, • Gaining classification abilities (grouping objects by shared characteristics).
• Learning seriation and relational concepts.
• Beginning to reason more logically about situations.
Example concept:
• School-age children think concretely and may struggle with abstract moral dilemmas, while
adolescents begin abstract reasoning.
Moral Development
• Moral reasoning and conscience continue to develop during this stage.
• Ages 6–7:
o Behavior is guided mainly by reward and punishment.
o Children may interpret accidents or misfortunes as punishment for wrongdoing.
• Older school-age children:
o Begin to evaluate actions based on intent rather than outcome.
o Moral judgments increasingly consider the needs and perspectives of others.
o Thinking remains concrete but becomes more socially aware.
• Children often:
o View illness or injury as consequences of wrongdoing.
o Show strong curiosity about spirituality and may describe God in human-like, caring
terms.
o Develop early spiritual understanding.
Peer Relationships
• Peer influence becomes increasingly important and gradually expands beyond the family unit.
• Early in the stage, family remains the primary reference group, but peer importance grows over
time.
• Children develop friendships based on shared interests and same-sex peer groups.
• Peer acceptance becomes a strong motivator for behavior.
Latchkey Children and Social Change
• The term “latchkey child” refers to children who are home alone before or after school without
adult supervision.
• This trend increased as more parents entered the workforce.
Consequences include:
• Increased reliance on after-school programs and structured care environments.
• Potential for feelings of loneliness, isolation, or fear.
• Higher risk for injury and behavioral concerns due to limited supervision.
Attention-Deficit/Hyperactivity Disorder (ADHD)
• ADHD is characterized by two core symptom clusters:
o Hyperactivity/impulsivity: difficulty remaining still, excessive movement, poor impulse
control.
o Inattention: distractibility, disorganization, difficulty sustaining focus.
Key points:
• Exact cause is unknown, but genetics play a role; children with an affected parent have a
significantly increased risk.
• Symptoms often appear early, but academic problems may become more evident once school
demands increase.
• First-line medications are typically stimulants such as methylphenidate and
dextroamphetamine.
• Nonstimulant options (including norepinephrine reuptake inhibitors and adrenergic agonists)
are also used and may have fewer side effects.
Physical Growth and Development
• Growth is steady but slower than in earlier childhood stages.
• Average growth includes:
, o About 2 inches (5 cm) per year in height.
o Weight gain of approximately 2–3 kg per year.
o Total height increase of 1–2 feet over the period.
• Boys and girls are generally similar in size during this stage.
• By the end of this period, long bones approach adult length.
Important concept:
• Physical growth does not necessarily match emotional or intellectual maturity.
System Maturation
• Caloric needs are lower than in preschool years and lower than during adolescence.
• Heart rate and respiratory rate gradually decrease, while blood pressure increases.
• The immune system becomes more efficient in responding to infections and producing
antibodies.
• Prepubescence typically occurs during late school age and lasts about two years before puberty.
• Girls generally enter puberty about two years earlier than boys.
Sex differences:
• Girls may experience earlier growth spurts and may have body image concerns with early
maturation.
• Boys grow more steadily; late maturation in boys can negatively affect self-concept.
Sex Education
• Children develop attitudes about sexuality indirectly from early experiences.
• School-age years are an appropriate time for structured sex education.
• Sexuality should be presented as a normal part of development.
• Education should be honest, age-appropriate, and straightforward.
• Topics may include anatomy, reproduction, contraception, and sexually transmitted infections.
• Teaching responsibility is a key goal.
Play and Games
• Play becomes more structured and rule-based.
• Children shift from informal, flexible games to structured games with fixed rules.
• Rule adherence becomes important because it fosters belonging and fairness.
• Conformity to rules is strongly valued.
• Board games, card games, and electronic games become increasingly popular.
• Children may argue about rules and refer to official guidelines to resolve disputes.
• Team play introduces concepts of shared responsibility and group success.
• Children learn how individual actions affect group outcomes.
Self-Concept and Self-Esteem
• Self-concept becomes more defined and influenced by external comparisons.
• Children model themselves after parents, peers, and media influences.
• Awareness of physical appearance increases significantly.
Self-esteem:
• Positive self-esteem develops when children successfully navigate developmental challenges.
• Children who feel competent tend to be more confident and resilient.
• Low self-esteem is associated with feelings of inadequacy and reluctance to try new tasks.
Social Development
• Emotional stability increases compared to earlier childhood.
• Peer relationships become central to social development.
• Children begin separating emotionally from parents while still relying on family support.
• Same-sex friendships become especially important.
• Peer groups establish rules, norms, and expectations.
• Friendships become more stable and meaningful over time.
• Teachers also play an important role in academic motivation and social development.
Family Relationships
, • Although peers become increasingly influential, parents remain the primary source of values and
behavioral standards.
• Children begin to question parental authority and recognize that parents are not infallible.
• Parents must gradually allow more independence while maintaining appropriate boundaries.
• Consistent structure and expectations support healthy development.
Sports and Body Image
• As children grow older, they may become less satisfied with their physical appearance.
• The head (especially hair and eye features) is often emphasized in body image perception.
• Body image is strongly influenced by parents, peers, and media.
• Awareness of differences (such as disabilities or physical variations) may contribute to feelings of
inferiority.
• Overemphasis on competitive sports and performance pressure can lead to burnout and injury.
• Excessive parental pressure may negatively impact enjoyment, self-esteem, and motivation.
Language Development
• Grammar becomes more complex and accurate.
• Children improve use of correct verb tenses, plurals, and pronouns.
• Narrative and storytelling abilities strengthen significantly.
• Metalinguistic awareness develops, allowing children to think about and analyze language itself.
Discipline
• Effective discipline is best delivered within a warm, supportive parent–child relationship. It
should focus on teaching, guiding, and encouraging appropriate behaviors while reducing
behaviors that are ineffective or undesirable.
• The purpose of discipline is to help children gradually learn self-control over their own behavior.
• Punitive approaches, including corporal punishment, are discouraged because they have limited
effectiveness and are linked to negative outcomes.
• Physically aggressive parenting practices, such as spanking, are associated with increased
internalizing symptoms in children, including anxiety, depression, and feelings of hopelessness.
• For school-age children, reasoning is a particularly effective form of discipline.
Dishonesty
• Stealing in younger children is often developmentally normal and not necessarily a sign of serious
behavioral problems.
• Between ages 5 and 8, children have a limited understanding of ownership and may take items
simply because they are appealing or because they want what the item can provide.
• Children may steal for several reasons, including:
o Immature understanding of ownership
o Desire to obtain items for bargaining or social exchange
o Strong attraction to an object
o Attempts at retaliation or “getting back” at a parent or peer
• In some cases, stealing can signal unmet emotional or environmental needs in a child’s life.
• When children’s own rights are respected, they are more likely to respect the rights of others. This
includes having private personal space within the home.
• Most cases can be addressed with a clear reprimand and appropriate consequences, such as
returning the stolen item or repaying money.
Promoting Health Behavior
• By late middle childhood, children should begin taking responsibility for personal care activities,
including hygiene, nutrition, physical activity, recreation, sleep, and safety practices.
• Education about balanced nutrition is essential to support growth and development.
• Since children typically adopt their family’s eating patterns, household dietary habits strongly
influence their nutritional status.
Sleep
CHAPTER 15 & 16: SCHOOL-AGE CHILD NOTES
School-Age Period (6–12 years)
• The school-age stage spans from approximately 6 to 12 years old. From a physical development
standpoint, this period begins with the loss of the first primary (deciduous) tooth and concludes
with puberty and the eruption of most permanent teeth, excluding third molars (wisdom teeth).
Role of School and Cognitive Characteristics
• School becomes the child’s primary social environment outside the family.
• It is often considered the closest developmental experience to adulthood during childhood.
• Children at this stage develop a strong sense of fairness and justice in how they view the world.
• Thinking remains somewhat concrete and limited in abstraction.
Erikson: Industry vs. Inferiority
• The central psychosocial conflict is industry versus inferiority.
Industry (positive outcome):
• Essential for developing self-concept.
• Focuses on achievement and productivity.
• Children are motivated to learn new skills and participate in socially meaningful tasks.
• The goal is to develop personal and interpersonal competence through mastery of academic,
social, and practical skills.
• Children show eagerness to contribute and succeed in structured environments.
• This stage supports growing independence and increasing reliance on peer approval.
• Peer groups become highly influential and provide emotional support and belonging.
Inferiority (negative outcome):
• Develops when children feel they do not measure up to expectations or peer standards.
• Can result from repeated failure or lack of readiness for developmental demands.
• Negative reinforcement from the environment can intensify feelings of inadequacy.
• Persistent failure may lead to avoidance of new challenges and fear of comparison with peers.
• Some level of perceived inadequacy is normal, especially in skill development.
• A healthy environment encourages children to see themselves as capable contributors.
• In clinical or educational settings, giving children manageable responsibilities helps build
confidence and competence.
• Children should never be made to feel worthless or incapable.
Freud: Latency Stage
• This period corresponds to Freud’s latency phase of psychosexual development.
• It is characterized by a relative calm in sexual development.
• Social relationships primarily involve same-sex peer groups.
• It occurs between early childhood psychosexual conflicts and the onset of adolescent sexual
development.
Piaget: Concrete Operational Stage
• School-age children are in the concrete operational stage of cognitive development.
Key characteristics:
• Thinking becomes more logical but remains tied to concrete, observable experiences.
• Children can mentally represent actions and events and express them verbally or symbolically.
• An “operation” refers to a mental transformation rather than a physical action.
• Children can now perform mental operations on objects and situations.
• They begin to understand different perspectives and viewpoints.
Cognitive advances include:
• Moving from perception-based judgments to reasoning-based (conceptual) thinking.
• Developing conservation skills (understanding that quantity remains the same despite changes in
shape or appearance).
, • Gaining classification abilities (grouping objects by shared characteristics).
• Learning seriation and relational concepts.
• Beginning to reason more logically about situations.
Example concept:
• School-age children think concretely and may struggle with abstract moral dilemmas, while
adolescents begin abstract reasoning.
Moral Development
• Moral reasoning and conscience continue to develop during this stage.
• Ages 6–7:
o Behavior is guided mainly by reward and punishment.
o Children may interpret accidents or misfortunes as punishment for wrongdoing.
• Older school-age children:
o Begin to evaluate actions based on intent rather than outcome.
o Moral judgments increasingly consider the needs and perspectives of others.
o Thinking remains concrete but becomes more socially aware.
• Children often:
o View illness or injury as consequences of wrongdoing.
o Show strong curiosity about spirituality and may describe God in human-like, caring
terms.
o Develop early spiritual understanding.
Peer Relationships
• Peer influence becomes increasingly important and gradually expands beyond the family unit.
• Early in the stage, family remains the primary reference group, but peer importance grows over
time.
• Children develop friendships based on shared interests and same-sex peer groups.
• Peer acceptance becomes a strong motivator for behavior.
Latchkey Children and Social Change
• The term “latchkey child” refers to children who are home alone before or after school without
adult supervision.
• This trend increased as more parents entered the workforce.
Consequences include:
• Increased reliance on after-school programs and structured care environments.
• Potential for feelings of loneliness, isolation, or fear.
• Higher risk for injury and behavioral concerns due to limited supervision.
Attention-Deficit/Hyperactivity Disorder (ADHD)
• ADHD is characterized by two core symptom clusters:
o Hyperactivity/impulsivity: difficulty remaining still, excessive movement, poor impulse
control.
o Inattention: distractibility, disorganization, difficulty sustaining focus.
Key points:
• Exact cause is unknown, but genetics play a role; children with an affected parent have a
significantly increased risk.
• Symptoms often appear early, but academic problems may become more evident once school
demands increase.
• First-line medications are typically stimulants such as methylphenidate and
dextroamphetamine.
• Nonstimulant options (including norepinephrine reuptake inhibitors and adrenergic agonists)
are also used and may have fewer side effects.
Physical Growth and Development
• Growth is steady but slower than in earlier childhood stages.
• Average growth includes:
, o About 2 inches (5 cm) per year in height.
o Weight gain of approximately 2–3 kg per year.
o Total height increase of 1–2 feet over the period.
• Boys and girls are generally similar in size during this stage.
• By the end of this period, long bones approach adult length.
Important concept:
• Physical growth does not necessarily match emotional or intellectual maturity.
System Maturation
• Caloric needs are lower than in preschool years and lower than during adolescence.
• Heart rate and respiratory rate gradually decrease, while blood pressure increases.
• The immune system becomes more efficient in responding to infections and producing
antibodies.
• Prepubescence typically occurs during late school age and lasts about two years before puberty.
• Girls generally enter puberty about two years earlier than boys.
Sex differences:
• Girls may experience earlier growth spurts and may have body image concerns with early
maturation.
• Boys grow more steadily; late maturation in boys can negatively affect self-concept.
Sex Education
• Children develop attitudes about sexuality indirectly from early experiences.
• School-age years are an appropriate time for structured sex education.
• Sexuality should be presented as a normal part of development.
• Education should be honest, age-appropriate, and straightforward.
• Topics may include anatomy, reproduction, contraception, and sexually transmitted infections.
• Teaching responsibility is a key goal.
Play and Games
• Play becomes more structured and rule-based.
• Children shift from informal, flexible games to structured games with fixed rules.
• Rule adherence becomes important because it fosters belonging and fairness.
• Conformity to rules is strongly valued.
• Board games, card games, and electronic games become increasingly popular.
• Children may argue about rules and refer to official guidelines to resolve disputes.
• Team play introduces concepts of shared responsibility and group success.
• Children learn how individual actions affect group outcomes.
Self-Concept and Self-Esteem
• Self-concept becomes more defined and influenced by external comparisons.
• Children model themselves after parents, peers, and media influences.
• Awareness of physical appearance increases significantly.
Self-esteem:
• Positive self-esteem develops when children successfully navigate developmental challenges.
• Children who feel competent tend to be more confident and resilient.
• Low self-esteem is associated with feelings of inadequacy and reluctance to try new tasks.
Social Development
• Emotional stability increases compared to earlier childhood.
• Peer relationships become central to social development.
• Children begin separating emotionally from parents while still relying on family support.
• Same-sex friendships become especially important.
• Peer groups establish rules, norms, and expectations.
• Friendships become more stable and meaningful over time.
• Teachers also play an important role in academic motivation and social development.
Family Relationships
, • Although peers become increasingly influential, parents remain the primary source of values and
behavioral standards.
• Children begin to question parental authority and recognize that parents are not infallible.
• Parents must gradually allow more independence while maintaining appropriate boundaries.
• Consistent structure and expectations support healthy development.
Sports and Body Image
• As children grow older, they may become less satisfied with their physical appearance.
• The head (especially hair and eye features) is often emphasized in body image perception.
• Body image is strongly influenced by parents, peers, and media.
• Awareness of differences (such as disabilities or physical variations) may contribute to feelings of
inferiority.
• Overemphasis on competitive sports and performance pressure can lead to burnout and injury.
• Excessive parental pressure may negatively impact enjoyment, self-esteem, and motivation.
Language Development
• Grammar becomes more complex and accurate.
• Children improve use of correct verb tenses, plurals, and pronouns.
• Narrative and storytelling abilities strengthen significantly.
• Metalinguistic awareness develops, allowing children to think about and analyze language itself.
Discipline
• Effective discipline is best delivered within a warm, supportive parent–child relationship. It
should focus on teaching, guiding, and encouraging appropriate behaviors while reducing
behaviors that are ineffective or undesirable.
• The purpose of discipline is to help children gradually learn self-control over their own behavior.
• Punitive approaches, including corporal punishment, are discouraged because they have limited
effectiveness and are linked to negative outcomes.
• Physically aggressive parenting practices, such as spanking, are associated with increased
internalizing symptoms in children, including anxiety, depression, and feelings of hopelessness.
• For school-age children, reasoning is a particularly effective form of discipline.
Dishonesty
• Stealing in younger children is often developmentally normal and not necessarily a sign of serious
behavioral problems.
• Between ages 5 and 8, children have a limited understanding of ownership and may take items
simply because they are appealing or because they want what the item can provide.
• Children may steal for several reasons, including:
o Immature understanding of ownership
o Desire to obtain items for bargaining or social exchange
o Strong attraction to an object
o Attempts at retaliation or “getting back” at a parent or peer
• In some cases, stealing can signal unmet emotional or environmental needs in a child’s life.
• When children’s own rights are respected, they are more likely to respect the rights of others. This
includes having private personal space within the home.
• Most cases can be addressed with a clear reprimand and appropriate consequences, such as
returning the stolen item or repaying money.
Promoting Health Behavior
• By late middle childhood, children should begin taking responsibility for personal care activities,
including hygiene, nutrition, physical activity, recreation, sleep, and safety practices.
• Education about balanced nutrition is essential to support growth and development.
• Since children typically adopt their family’s eating patterns, household dietary habits strongly
influence their nutritional status.
Sleep
