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growth, a helmet can be worn into adolescence. It is important for the child to have a bicycle that is appropriate for his or her size and age. The child should be able to plant both feet on the ground when sitting on the seat of the bike (Fig. 6.8). It is important to stress to parents the importance of appropriate size and not to get a bike for the child to “grow into.” If older school-agers are using the bike for transportation on busy streets, they should be taught to use bike lanes and to give appropriate hand signals for turning. Nonmotorized and motorized scooters also place children at risk for injury, so counsel families about the use of protective gear, including helmets, elbow pads, and kneepads. HEALTHY PEOPLE 2020 Healthy People Objectives based on data from http://www.healthypeople.gov. FIGURE6.8 Wearing the appropriate safety equipment and having an appropriately sized bicycle are important to prevent injuries in school-age children. Fire Safety School-age children are eager to help parents with cooking and ironing. They are curious about fire and are drawn to play with fire, matches, and fireworks. Serious burns can occur from any exposure to fire. Educate children about the hazards of fire. In addition, teach children proper behavior around fires at home and outdoors. Always supervise children in the use of matches. In the home setting, parents should develop a fire safety plan with their children, teach children what to do if their clothes catch on fire, and practice evacuating the house in the event of a fire. In the schoolsetting, children should be aware of the appropriate response to fire drills and fire drills should be conducted on a regular basis. Water Safety Teach school-age children swim and water safety. An adult should always supervise children when they are swimming to prevent water-related accidents. Abuse in Children Child abuse, including physical abuse and sexual abuse, is a common crime of violence against children. An estimated 6 million reports of child abuse are made annually to child protective services in the United States (CDC, 2008a). Over 900,000 cases were substantiated in 2006, with 64% being victims of neglect, 16% victims of physical abuse, 9% victims ofsexual abuse, and 7% victims of emotional or psychological abuse (CDC, 2008b). The abusers of children are family, friends, and strangers. It is important for parents to teach children the concept of “good touch” versus “bad touch” prior to school-age years. Whenever the school-age child’s behavior yields suspicion of physical or sexual abuse, the nurse should report to the appropriate authorities in his or her state. These topics will be discussed in more depth in Chapter 30. Remember Lawrence Jones, the 10-year-old presented in the case study? What anticipatory guidance related to safety should you provide to his mother? Promoting Nutrition Growth, body composition, and body shape remain constant during late school-age years. Needed calories decrease while the appetite increases. In preparation for adolescence, the body fat composition of school-age children increases. This tendency toward increased body fat occurs earlier in girls than in boys, with the amount of increase greater in girls. Boys have more lean body mass per inch of height than girls. BOX 6.2 DIETARY QUESTIONS Questions for the Child • How often do you eat together as a family? • What are the usual mealtimes? • How often does the family eat out? • Do you eat breakfast regularly? • Where do you eat lunch? • What do you drink/how much? • What foods do you eat most often? • What is your favorite food? • How often do you eat fast foods? • What type of exercise do you do? Questions for the Parents How would you describe your child’s usual appetite? • Do you have any special cultural/religious practices regarding food? • Has your child gained or lost weight recently? • Do you have any concerns about his or her eating behaviors? • How does your child exercise? Your family? • Is there a family history of cancer, hypertension, diabetes, obesity, or heart disease? Diet preferences established in the preschool years continue during the school-age period. As the child grows older, influences of family, media, and peers can impact the eating habits of this age group. Some of these influences are parents’ work schedule, outside activities, and exercise level of the child. Decreased exercise levels and poor nutritional choices lead to the mounting problem of obesity seen in this age group. See Box 6.2 for appropriate questions to ask the child and parent regarding nutritional status. Healthy People 2020 provides objectives and actions to improve the nutritional health of children. HEALTHY PEOPLE 2020 Nutritional Needs The school-age child’s calorie needs vary based on age, gender, and activity level. In general, children with higher activity levels and male gender have higher calorie needs (U.S. Department ofAgriculture and U.S. Department of Health and Human Services, 2010). Boys and girls 4 to 8 years old who are moderately active will need about 1,400 to 1,600 calories a day (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010). Boys 9 to 13 years old who are moderately active need about 1,800 to 2,000 calories a day, while girls this age who are moderately active need about 1,600 to 2,000 calories a day (U.S. Department ofAgriculture and U.S.
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