School Age and Adolescent Development

The Early School- Age Period: Ages 6-9

This period is a time of good health, intellectual curiosity,
and few responsibilities. Strength, coordination, and
endurance are increasing, allowing for a broader range of
activities.
-Physical growth slows and follows an established pattern.
They grow in spurts.
-Gross Motor
o Increased muscle strength and coordination
o Participation in individual and group sports
-Fine Motor
o Prints, draws, uses simple instruments
o Progresses to cursive writing and more detailed
drawings
o Able to tie knots, and manage buttons and zippers
-Cognition
o Language becomes descriptive and stories elaborate
o Develop concepts of time and money
o Understands concepts of space, cause & effect,
conservation, and reversibility.
o Moves to a more fluid and enjoyable reading pattern

-Socialization
o Able to share and cooperate better
o Enjoys games and plays in a group. Clubs/organizations
become apparent.
o They enjoy friendly competition.
o Very interested in peers, especially those of the same
sex
o The child can easily separate from their family allowing
them to go to school.
The Late School- Age Child: Ages 10-12 years
This is a time of transition between childhood to
adolescence. Awkwardness and unsureness about self are
more the rule than the exception.
-Gross Motor
o Skills become more controlled and purposeful
o Skills are perfected with practice
-Fine Motor
o The child uses each hand separately with more fluidity
and speed.
o This is the time when they can be more adept with
musical instruments.

-Cognition
o Logical thought starts making the transition to abstract
thinking
o Uses language as a tool for understanding new
experiences and problem solving
o They can understand the difference between word
meanings i.e. literal meaning of the word is not always the
only meaning of that word
o They can understand jokes and riddles
-Socialization
o Peer group becomes a source of support, guidance, and
self-esteem
o More selective in friendships and may have a best
friend, and dress and talk like peers
o Still good relationship with parents
o Can perform household chores

Screening during your well child School-Age visits:

-Height, weight, blood pressure: at all visits
-Vision: at all visits- by history, visual acuity, and
examination
-Hearing: at all visits- by history, examination, and
audiometry
-Scoliosis: annually starting at age 10
-Hemoglobin/Hematocrit: as needed based on dietary

history and risk factors

-Cholesterol: children at risk
-Urinalysis: as history and/or symptoms indicate

Anticipatory Guidance for the School-Age Child:

1.Feeding
-Daily requirements are
o Meats: 2-3 servings per day
o Milk: 16-20 oz daily
o Vegetables & Fruits: 4-5 servings per day
o Breads and Cereals: 4-5 servings per day
o Fluids: 1 -2 qts. Daily
o 8- calories/kg or 35 cal/lb in early school-age period
decreases to 50 cal/kg by 10 years
-Child should be able to participate in meal planning,
shopping, and preparing.
2.Dental Care
-This is a time of replacement of baby teeth with
deciduous teeth
-They should see a dentist at least every 6 mos

o Fluoride treatments
o Teeth sealants
o Learn brushing and flossing techniques with parental
supervision

3.Sexuality
-Increased curiosity about sexuality and sex
-Time for parents to establish open communication with
child on sexual issues
-Toward the end of this period, the girls may begin to
mature sexually so they need education prior to this about
sexual changes, as do boys
4.Sleep
-Need 8-10 hours per night
-Indication of sufficient sleep is the ability for the child to
awaken on time in the morning
-Decrease in nightmares
-Continue a regular nighttime routine and minimize
stimulation before bedtime
-Parent needs to understand the difference in times based
on the childs school schedule
5.Behavior

-Expanded influence of people outside of the family on the

child i.e. teachers, peers, organized sports and activities
-Peers become more important and parents less important
across this period
-Child needs to try various activities and identify their own
strengths i.e. arts, competitive sports, etc
-Lying: The child may use untruths to avoid unpleasant
outcomes. They also are aware when parents are not
telling the truth
-Limit television to 1 hr/day of appropriate programs
6.Discipline
-Parents still need to be consistent. Children need
guidelines and limits set for them.
-Discipline is best handled through natural and logical
consequences (STEP program)
-Other methods of managing behavior are by parents
withdrawing privileges.
-Give the child chores.
7.Promotion of Self-esteem
-This is developed through strong relationships with family
and peers and success at some activities.
-Late school-age is when girls start to develop less
positive self imagesneed to encourage them through
positive reinforcement for accomplishment of
tasks/activities.

8.Safety
-Motor vehicle accidents are the most frequent cause of
death, followed by pedestrian accidents, drownings, fire,
and falls. Wear seatbelts.
-Help children learn survival skills call 911, their
address/phone number, parents name and cell phone
number
-Bicycle/skateboard safety: wear protective equipment,
know rules of the road
-Educate the child about the internet: use security settings,
monitor their activity
-Firearms: If they are kept in the house, they need t be
unloaded and locked with ammunition in a different
location.
-Discuss swimming safety and the use of sunscreen.
-Discuss stranger safetyteach child how to behave with
strangers using role play situations
Common problems in the School-Age Child:
1.School Phobia/Refusal
-Prevalence is 0.4%- 18% of all children
-A form of separation anxiety
-Criteria for diagnosis
o Severe difficulty or refusal to attend school

o Severe emotional upset when attempting to go to school

o Absence of antisocial disorders
o Staying at home with the parents knowledge
-Child feels better as the day progresses and feels better
on weekends and holidays
-Physical complaints: stomaches, headaches, dizziness,
tiredness
-Management support for parents, return the child to
school full time. If no improvement after 2 weeks, refer to
child psychologist/psychiatrist
2.Growing Pains
-Occur in 15-30% of children and seen most frequently
between ages 3-13.
-Usually occur at night and involve the front of thighs,
calves, and behind the knees, NEVER the joints
-Evaluate child for fever, limb discrepancy, range of
motion, and generalized fatigue/weakness, fractures.
-Treatment: usually respond to supportive measures i.e.
heat, analgesia, stretching exercises and massage. Refer
to orthopedics if pains are severe and persistent and lab
work and PE fail to generate a specific diagnosis.
3.Effects of Divorce on Children
-Ages 2 -4 yrsRegressive behavior
-Ages 3 -5 yrsAggressive behavior
-Ages 5-6 yearsWhiny, immature behavior

-Age 6-adolescentDepression, somatic complaints, poor

school performance
-Guidance The child should be told by both parents. The
teachers, physicians, should also be told. Watch for
depression and/or withdrawal from activities.

Developmental red flags for the School-Age Child:

Ages 6-9 years old:
-Poor school adjustment and not working to capability
-Using aggressive or inappropriate behavior to gain
attention
-Accident prone or frequent illnesses
-Problems with peer group- lack of hobbies, lack of friends
-Unable to state dates, add & subtract, and identify right
from left
-Unable to read simple phrases
Ages 10-12 year old:
-Regressive patterns of overdependence on family,
shyness, aggression
-Using food as a way to gain attention and satisfaction
-Using illness as a means to avoid challenges
-Poor school performance
-Lack of operational thinking cause & effect
-Lack of motivation to have responsibilities

-Risk taking behaviors drugs, alcohol, sex

Goals of Adolescents:
-To come to term with bodily changes
-To cope with sexual development and psychosexual
drives
-To establish and confirm a sense of identity and struggle
for independence
-To refine sex role
Development:
Early Adolescence: 12-15 years
-Physical Abilities
o Maximum growth increase Peak height velocity
o Long and gangly appearance
o Menses begins in females
o Nocturnal emissions begin in males
-Cognitive Abilities
o Display concrete thinking
o Daydream frequently
o Able to use humor
-Social and Emotional Abilities

o Narcissistic, egocentric
o Wide mood swings
o Conforms to the norms of his/her peer group
o Close friendships with peers of the same sex
o Expresses anger outwardly
Late Adolescence: 16-19 years
-Physical Abilities
o Males attain maturity
o Become comfortable with physical attributes
o Attains sexual identity
-Cognitive Abilities
o Use formal operational thought as capacity for abstract
thinking improves
o Enjoys intellectual abilities
o Worries about schoolwork
-Social and Emotional Abilities
o Emotions become more constant
o Self-esteem is more stable
o Pushes for independence
o Close relationships with opposite sex is becoming
important
o Setting up life goals towards a career is apparent