The School Age Child
- Lead Poisoning:
began in 1900's when lead was added to paint, decreased in the 50's & again in 1971 for “The Lead Paint Poisoning
Act” in 1971 which provided funding for screening
- Causes: inhalation
of fumes when houses are renovated, ingestion of led products (paints made before 1978), exposure to lead contaminated soil,
pottery, ceramics, dyes, playground equipment
-Pathophysiology:
retained lead largely stored in bone, during chronic ingestion the rate of absorption exceeds the rate of excretion, excess
lead is deposited in tissues & circulatory system, 90% of lead attaches to erythrocytes so even when ingestion stops the
lead is still present d/t slow excretion, children are more susceptible to lead absorption & they absorb 50% of exposed
lead, adults absorb only 10%
- Systems affected:
- Hematological System: prevents formation of
hemoglobin resulting in anemia, anemia is the initial sign of the disease, when only present in the circulatory system the
effects are reversible.
- Renal System: changes cells in the proximal
tubes resulting in abnormal excretion of glucose, proteins, & amino acids & phosphate, these effects are usually reversible
- CNS: initially there is a shift of fluid in
the brain r/t increased membrane permeability, this increase in intracranial pressure leads to convulsions, MR, paralysis,
blindness, coma, & death; there are several behavioral changes that occur first: hyperactivity, aggression, impulsiveness,
lethargy, irritability, & loss of newly acquired motor skills - not reversible in the CNS
- Diagnosis:
blood lead level test - 10mcg/dL indicates that there is lead poisoning
- Treatment:
management: use chelation therapy: removal of metal by combining it with another metal - mobilize the lead from the blood
& soft tissue by enhancing its deposit in the bone where it’s normally stored & it’s excretion in urine
- medications: chemet (Succimer) - oral &
dimercaprol - injection
- can also do blood transfusions, give iron d/t
anemia, encourage fluids to aid excretion (IV & PO fluids), educate parents & kids, give Folic Acid (to increase RBC’s),
& hospitalize child
- Growth
& Development: gradual growth between infancy & puberty which are the fastest periods of growth
- gain 2 inches/year
in height, gains 1-2 feet in height from 6-12, 4.5-6.5 pounds/year in weight, weight doubles from 6-12, child gets a little
pudgy
- more graceful,
taller, steadier, limber, more agile d/t proportional changes
- Fine Motor:
print, write, musical instruments, telephone, computer
- Facial Changes:
face grows faster than head, lose teeth, face is big
-GI:
increased stomach capacity & decreased calorie need, blood glucose is better maintained, eats less than preschooler d/t
food retained in stomach longer
- Immune
System: can fight infection better
- Skeletal:
ossification occurs but bones are more forgiving than in adults so fractures heal quickly
- Prepubescence:
secondary sex characteristics age 9 girls get breast buds & menses usually follows within 2 years; girls 10-11, boys around
age 12
- Freud:
Oedipal & Electra complexes, boys want to kill dad & have mom; girls want to kill mom & have dad
- Erikson:
Industry vs. Inferiority: sense of accomplishment for doing well
- egocentric,
bossy, knows everything, temper tantrums
- successful
completion leads to confidence, independence, & a sense of feeling good about self
- also begin
to search for adults to identify w/ besides parent & starts to measure parent against new role model & probably decides
that parent is a loser
- may revert
to childish behavior, craves attention & needs constant praise & encouragement
- needs constant
reassurance of worth & value & “goodness”
- peer relationships
are very important, they learn to cooperate
- are trying
to master skills, must learn to accept that they can’t master everything
- have trouble
losing, not good at losing even into the early 20's
- Piaget:
- Concrete
Operations - able to articulate a process & can perform the action mentally w/o having to act it out
- see things (begin to) from other’s viewpoints,
develop logical thought & perceive & reason
1. Conservation - matter does not appear or disappear,
physical properties are not changed by altering the way a thing appears
2. Classification - grouping objects, putting
things in order, sorting things
3. Combinational Skills - math, telling time,
& reading
- Spiritual
Development: Stage 2 - Mythical Literal - “conscience” really starting to work, may accept that there is a
God, will have their own view, pray for what they want and expect answers, can articulate their faith
- Social
Development: Peers are important, conformity is expected, early school ages mix sexes, sexes separate as they get to age
10, there is bullying,
- Family: parents
are key
- Play: team
play, play sports, want rigid rules, ego master (sense of accomplishment)
- Body Image:
girls may be ashamed around age 10 when develop breasts, prepare girls for breasts & menses
- prepare boys
for nocturnal emissions
- Sex Education:
parents are most important!! They also learn from school & peers (usually wrong)
