The School-Age Child

The School-Age Child

General Characteristics and Development

School-age children between 6 and 12 years of age differ from preschool children in that they are more engrossed in fact than fantasy. They have an ardent thirst for knowledge and accomplishment. They admire teachers and adult companions whom they consider wise. They attempt to use the skills and the knowledge that they obtain to master activities that they enjoy—music, sports, art, and so on. Children in school learn that they must cooperate with others. Participation in group activities increases. Acceptance becomes paramount. The type of acceptance these children receive at home and at school affects the attitudes that they develop about themselves and their roles in life.

Children at this age are aware that their parents are only human and can make mistakes. Conflicts may arise, particularly if what the child learns in school differs from what is practiced at home. Between 6 and 12 years of age, children prefer friends of their own gender. They also prefer the company of their friends to that of their brothers and sisters. They find outward displays of affection by adults embarrassing. Sibling rivalry, intense feelings that can develop when a child feels he or she is competing for parental attention, can develop when a new infant sibling joins the family unit.

imagePhysical Growth

Growth is slow until the spurt, which occurs directly before puberty. Weight gains are more rapid than increases in height. The average gain in weight per year is about image to 7 pounds (2.5 to 3.2 kg). The average yearly increase in height is approximately 2 inches (5.5 cm). Head circumference increases only 2 to 3 cm throughout this entire period. This reflects slowed brain growth with complete brain growth occurring at 10 years of age. Myelinization, the growth process of the myelin sheath around the nerve fiber, is complete by 7 years of age and results in the refinement of fine-motor coordination (Kleigman et al., 2007).

Muscular coordination is improved, and the lymphatic tissues become highly developed. The skeletal bones continue to ossify. The body is supple, and sometimes skeletal growth is more rapid than the growth of muscles and ligaments. The child may appear gangling. There is a noticeable change in facial structure as the jaw lengthens. The sinuses are frequently sites of infection. Sinus headaches may occur. The 6-year molars (the first permanent teeth) erupt. The gastrointestinal tract is more mature. The heart grows slowly and is now smaller in proportion to body size than compared with any other point in time.

The shape of the eye also changes with growth. 20/40 vision is achieved by 3 years of age, 20/30 vision by 4 years of age, and 20/30 by 5 to 6 years of age. Visual acuity can be measured by image to 3 years of age (Kleigman et al., 2007). The capabilities of the child’s sense organs, including hearing, have an important bearing on learning abilities.

The vital signs of the school-age child are similar to those of the adult. Temperature is 98.6° F (37° C), pulse is 60 to 95 beats per minute, and the respiratory rate is 14 to 22 breaths per minute. The systolic blood pressure ranges from 100 to 120 mm Hg, and the diastolic blood pressure ranges from 60 to 75 mm Hg. (See Chapter 3 for further discussion on vital signs.) Boys are slightly taller and somewhat heavier than girls until changes indicating puberty appear. The differences among children are greater at the end of middle childhood than at the beginning.

Language skills continue to develop. School-age children speak in full sentences. They continually add new words to their vocabulary. School-age children may swear to try and impress other children or to express anger. They also delight in the newly found use of humor. In the early school-age years, they delight their parents by telling “knock-knock” jokes.

In evaluating language development, the parent and the nurse should discuss the child’s ability to comprehend and use both written and spoken language.

Developmental Theories

According to Piaget’s theory of cognitive development, the school-age child thinks and reasons in concrete terms, progressing from inductive to deductive logic. Children at this age learn to comprehend the ideas of conservation and reversibility. Conservation is the ability to recognize two equal quantities regardless of their form. For example, although the same amount of water appears less in a tall glass than in a short glass, the school-age child can determine that it is the same amount of water. Reversibility is the ability to think in either direction. School-age children can take a result and reverse it so as to determine whether it is correct or not. This concept is used in addition and subtraction.

According to Erikson’s theories of psychosocial development, the school-age child is in the stage of industry versus inferiority. The child is a worker and producer and wants to accomplish tasks. Competitiveness is common (Figure 9-1). The school-age child’s social world is continually expanding, and he or she achieves new competencies. However, without success in this area, they feel inferior. Parents and teachers need to support children in achieving success and developing self-esteem.

Kohlberg’s moral development theory describes the school-age child as being at the “conventional level.” Rules are the basis for moral judgments, and they must be followed to please others. The school-age child begins to understand what is right and what is wrong. As a result, the child develops a conscience.

Freud believes that at this stage romantic love for the parent of the opposite gender diminishes and that the children start to identify with the parent of the same gender. This is also a period of latency when the child’s energy is directed toward cognitive and physical skills. This, however, does not imply a complete lack of sexual activity at this age.

Biological and Psychosocial Development

Table 9-1 summarizes growth and development for the various school-age groups.

Table 9-1

Growth and Development During School-Age Years



8 to 9

10 to 12


From Hockenberry, M.J., and Wilson, D. (2007). Wong’s nursing care of infants and children (8th ed.). St. Louis: Mosby.

The 6-Year-Old

Six-year-old children are bursting with energy and are always on the go. They soon become overtired, and it is necessary to set limits to their activities. Although they like to start tasks, they do not always finish them because their attention span is fairly brief. They tend to be bossy and sometimes rude, but they are sensitive to criticism. Sex investigations begun in earlier years may persist. Their conscience is active, and they find it difficult to make decisions.

One of the most obvious physical changes at this age is the loss of the temporary teeth. The important 6-year molars also erupt. Six-year-old children can jump rope, throw and catch a ball, and tie shoelaces. They perform numerous other feats that require muscle coordination. Their language differs from that of the preschool child. These children use language for a purpose rather than for the pure joy of talking. Their vocabulary consists of about 2500 words. They need 11 to 13 hours of sleep a night.

Although 6-year-old children begin to show a preference for associating with children of the same gender, boys and girls do still play together at this age. Certain activities, such as imaginative play, are common to both genders. Most children enjoy collecting objects that catch their fancy, such as leaves, stones, and shells. Play at this time usually reflects events that occur in the immediate environment.

Six-year-old children need time and support to help them adjust to school. If they have nursery school or kindergarten experience, the transition may be more comfortable. Most children go to school expecting the same atmosphere they are accustomed to at home. For example, if parents are critical or overly protective, children automatically assume that the teacher will be too. When the experience at school differs markedly from their expectations, they feel insecure and may be hostile toward the teacher. Parents need to observe children for signs of fatigue and stress. Although they have reached the appropriate age, not all children are ready for school. Children who are ready for school still need time and support from parents and teachers before they can settle down and become completely comfortable in the classroom. At school, the child is also exposed more frequently to infection. Preschool immunizations and a physical examination are indicated.

The 7-Year-Old

Children at 7 years of age are generally less of a problem than they were at 6 years. It is a quieter age, and the child does not go looking for trouble. Some educators have noted that second graders are the easiest to teach. They set high standards for themselves and for their family, have a good sense of humor, tend to enjoy teasing (wiggle loose teeth to annoy adults), and are a little more modest than they were at an earlier age. They enjoy being active but can also appreciate periods of rest. The second grader may acquire a “crush” on a friend of the opposite gender.

These children know the months and seasons of the year. They also begin to tell time. They have a beginning concept of arithmetic, can count by twos and fives, and know that money is valuable. Their hands are steadier. Interest in God and heaven is heightened.

Active play is still important to both genders (Figure 9-2). The boys are more apt to tease the girls than to participate in such games as jump rope or tag. Both genders enjoy bike riding and table games. Realistic toys, such as dolls that can be bathed and fed or trains that back up and whistle, appeal to the 7-year-old. Comic books are also popular (Figure 9-3). Becoming increasingly independent, these children imagine themselves accomplishing feats more adventurous than those of their parents.


Stealing is one problem that may arise during this age. This is generally a sign that some need of the child is not being met. It may be actual or perceived. In many cases, the child steals only to distribute the loot to neighborhood friends. This may in actuality be an attempt to buy friendship. The children’s independence has separated them to a degree from their parents. As a result, if they cannot establish good relationships with their friends, they may feel left out. When children steal something, parents should tell them that they are aware of the fact and should insist on some form of restitution. They should not humiliate the child, but they must make it clear that such actions are not permitted. As always, accept the child but not the deed. Afterward, try to understand the circumstances that are causing such behavior.

The 8-Year-Old

The 8-year-old wants to do everything and can play alone for longer periods than a 7-year-old. Work is usually creative. Group activities such as Brownies and Cub Scouts are enjoyed, and companions of the same gender are preferred. Group fads begin to appear. Eight-year-olds like to be considered important, particularly by adults. They may behave better for company than for the family. Hero worship is evident.

The arms and hands of the 8-year-old seem to grow faster than the rest of the body. The large and small muscles are better developed, and movements are smoother and more graceful. The child can write rather than only print. The child also understands that a certain number of days must pass before special events, such as Christmas, birthdays, or discharge from the hospital, can occur.

Competitive sports are enjoyed, but the child is generally a poor loser. Long involved arguments occur over decisions made by referees. Wrestling is frequent, and dramatic play is popular. Most children like to be the hero or heroine of their favorite program. Neighborhood secret clubs are organized, and all members must pay strict attention to the rules.

The 9-Year-Old

The 9-year-old is dependable and is not as restless as the 8-year-old child. More interest is shown in family activities, and more responsibility is assumed for personal belongings and for younger brothers and sisters. Tasks are also more likely to be completed. Children resist adult authority if it does not coincide with their opinions or ideals. They are, however, more able to accept criticism regarding their actions. Individual differences are pronounced.

Worries and mild compulsions are common. Children avoid cracks in the pavement: “Step on a crack, break your mother’s back.” They realize that these actions are senseless but still feel obliged to repeat them. Nervous habits may also appear and may widely vary; nail biting is one example. The child should not be scolded for such actions because they are caused primarily by tension. Nervous habits usually disappear when home and social life become more relaxed.

Hand-eye coordination is well developed, and manual activities are managed with skill. The child works and plays hard and often becomes overtired. About 10 hours of sleep a night are needed. The permanent teeth are still erupting.

Competitive sports, reading, listening to music, and watching television and movies are popular. Contact sports should be limited to minimize permanent growth-related injuries (Figure 9-4). The child begins to develop interests such as music and may desire to take lessons. Children know the date, can repeat months of the year in order, can multiply, and do simple division. They take care of their bodily needs, and by now table manners have considerably improved.

The 10-Year-Old

This marks the beginning of the preadolescent years. Girls are more physically mature than boys. The child begins to show self-direction, is courteous to adults, and thinks quite clearly about social problems and prejudices. Although 10-year-olds want to be independent and resent being told what to do, they are receptive to suggestion. The ideas of the group are more important than individual ideas. Interest in sex and sex investigations continue.

Girls are often more poised than boys. Both genders are fairly reliable about household duties. Slang terms are used. The 10-year-old can write for a relatively long period of time and maintains a good writing speed. The child uses fractions and knows numbers over 100. Boys and girls begin to identify themselves with skills that pertain to their particular gender role. There is an intolerance of the opposite gender. The play enjoyed by the 10-year-old is similar to that enjoyed by the 9-year-old. In addition, the child takes more interest in appearance.

The 11- to 12-Year-Old

Adjectives that describe this age group include intense, observant, all-knowing, energetic, meddlesome, and argumentative. This period before the onset of puberty is one of complete disorganization. It may begin earlier in some children than others because the onset and rate of physical maturity greatly vary. Before the end of this period, the hormones of the body begin to influence physical growth. Posture is poor. There are 24 to 26 permanent teeth.

The child has an overabundance of energy and is constantly on the go. Girls become “tomboyish” in their actions. Table manners are a thing of the past, and the refrigerator is constantly emptied. Children this age are less concerned with appearance. They seem to be preoccupied a great deal of the time. This, along with physical activities and numerous anxieties, partially accounts for the decline in school grades. Ability to concentrate decreases and parents complain that the children “never hear anything.” When asked to do a new task, they moan and groan.

Groups of friends are still important (Figure 9-5). They are not ready to stand alone, but they cannot bear the thought of depending on their parents. They insist that they must overcome their problems without parental help. Their attitude implies, “Can’t you see that I’m not a child anymore?”

Dec 22, 2016 | Posted by in NURSING | Comments Off on The School-Age Child
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