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caloric expenditure and self-esteem. • Decrease TV/computer time to increase caloric expenditure. • Develop reward system to increase self-esteem. • Investigate joining weight-loss program for school-age children to increase self-esteem and to increase awareness that other children have the same problem. NURSING DIAGNOSIS: Growth and development, delayed related to speech, motor, psychosocial, or cognitive concerns as evidenced by delay in meeting expected school performances Outcome Identification and Evaluation Development will be maximized: School-age child will make continued progress toward attainment of expected school performances. Interventions: Promoting Growth and Development • Perform scheduled evaluation of the school-age child by school and physician to determine current functioning. • Develop realistic multidisciplinary plan to ensure maximizing resources. • Carry out interventions as prescribed by developmental specialist, physical therapist, occupational therapist, or speech therapist at home and at school to maximize benefit of interventions. • Have scheduled evaluation meetings to be able to adapt interventions as soon as possible. NURSING DIAGNOSIS: Caregiver role strain, risk for (risk factors: new sibling in household, knowledge deficit about school-age issues, lack of prior exposure, fatigue, ill or developmentally delayed child) Outcome Identification and Evaluation Parent will experience competence in role: will demonstrate appropriate caretaking behaviors and verbalize comfort in caring for a school-age child Interventions: Preventing Caregiver Role Strain • Assess parents’ knowledge of school-age children and the issues that arise as a part of normal development to determine parents’ needs. • Provide education on normal issues of school-age children so that parents are armed with the knowledge they need to appropriately care for their school-age child. • Provide anticipatory guidance related to upcoming expected issues related to school-age development to prepare parents for what to expect next and how to intervene. NURSING DIAGNOSIS: Injury, risk for (risk factors: curiosity, increasing cognitive skills and motor abilities) Outcome Identification and Evaluation School-age child’s safety will be maintained: will remain free from injury Interventions: Preventing Injury • Discuss safety measures needed for the following: bikes, scooters, guns, skateboards, cars, water, and playground to decrease risk of injury related to those areas. • Discuss and develop a fire safety plan to decrease risk of injury related to fire. • Discuss appropriate safety equipment needed for each sport to decrease risk of injury. • Discuss appropriate sports to participate in depending on age, sex, and maturity of child to prevent possible injury and to promote child’s self-esteem. • Instruct parents to post the Poison Control Center phone number (in the event of accidental ingestion, Poison Control can give parents the best advice for appropriate intervention). • Teach parents and child first-aid measures and child cardiopulmonary resuscitation (CPR) to minimize consequences of injury should it occur. • Discuss influence of peers on actions of school-age children to prevent possible injury due to mimicking behavior. FIGURE6.6 This school-age girl enjoys solitary play with her dollhouse and dolls. School-age children also enjoy solitary activities including board, card, video, and computer games, and dollhouse and other small-figure play (Fig. 6.6). Many school-agers start collections of stamps, cars, or other valuable or not-so-valuable items. During the school-age years, children may also begin a scrapbook or keep a diary. They may participate in activities such as dance or karate. Girls and boys may join clubs, gangs, or special interest groups. Active play has decreased in recent years as television viewing and computer games have increased. This trend has resulted in health risks such as obesity, type 2 diabetes, and cardiovascular problems. Promoting Learning School attendance and learning are very important to the school-age child. Parent-child, child-teacher, and child-peer relationships and activities influence the school-age child’s learning. Formal Education Most children are excited about starting school and making new friends. They like the notion of getting books, having book bags, and having homework assignments. The reality of the work involved with school and homework may decrease the enthusiasm about school. Peers are very important within this age group. Both peers and teachers influence children. Attending school may be their first experience interacting with a large number of children their own age. Through this interaction, children learn cooperation, competition, and the importance of following the rules. Peer approval and influences grow as the child matures. Teachers have significant influences on children. They help to guide the child’s intellectual development by rewarding successes and helping the child deal with failures. The student-teacher relationship is a key to success. Teachers play a role in fostering feelings of industry and preventing feelings of inferiority (Fig. 6.7). School-age children also learn skills, rules, values, and other ways to work with peers and other authority figures. FIGURE6.7 School is important to the school-age child. Parentalsupport is important for school

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