Therapeutic approaches for older children and developmental theory
School-aged children have perfected fine motor skills and can paint, draw, and play an instrument. They enjoy team activities and are expanding their reading and writing skills. Their intellectual skills are developing, and social skills are going through refinement as a sense of self-achievement and self-worth is developed. During this time, the child learns and tests the rules for socializing outside the immediate family as an independent individual.
Therapeutic approaches for school-aged children (7 to 11 years)
- Allow choices when possible, such as which arm to use for an injection.
- A parent or caregiver should always be present during examinations.
- Remove only as much clothing as needed for the examination or procedure.
- Explain procedures in concrete terms; use pictures and diagrams when possible.
- Give the child time to ask questions.
- School-aged children often are curious, and can be cooperative if they know what is expected of them.
- Address the conversation to the child; involve the child in decision making as much as possible.
- Provide privacy.
Adolescence, or the transition stage, is the time when the individual attempts to establish an adult identity. The teenager proceeds by trial and error, experimenting with adult roles and behavior patterns. Traditional values learned in childhood may be questioned, and peer relationships take on new importance. During this time, teenagers must develop the emotional maturity and motivation to make reasonable decisions. They look to family members for encouragement and guidance in making decisions that will help them develop self-confidence and become patient, in addition to becoming less impulsive and self-centered.
Therapeutic approaches for adolescents (12 to 18 years)
- Adolescents are self-conscious and strongly influenced by peers.
- Privacy is very important to them.
- Address how a procedure might affect the adolescent’s appearance.
- Do not be judgmental; listen without condemning.
- Encourage the adolescent to verbalize his or her concerns and fears.
- The adolescent may regress to more childish behaviors when sick.
- Teenagers want to be treated as adults; they want to know what is being done and why.
- To promote an honest discussion about lifestyle issues, encourage the teenager to see the provider without the parent present.
Centers for Disease Control and Prevention (CDC) weight status categories
At a well-child visit the medical assistant measures height and weight and plots the child’s BMI on a CDC growth chart for their age and sex. The resulting BMI-for-age percentile places the child in one of four weight status categories.
| Weight status category | Percentile range |
|---|---|
| Underweight | Less than the 5th percentile |
| Normal or healthy weight | 5th percentile to less than the 85th percentile |
| Overweight | 85th percentile to less than the 95th percentile |
| Obese | Equal to or greater than the 95th percentile |
Developmental theory
Psychologists have been researching and developing theories about human behavior since the beginning of the 20th century. Erik Erikson, a developmental psychologist, expanded on Sigmund Freud’s work. Erikson’s theory recognizes the cultural and social influences on individual development. His theory is based on stages of development that the individual must pass through and master. Each stage focuses on a developmental crisis, starting in infancy and ending in old age. According to Erikson, children must master the following stages:
- Trust versus mistrust: Infants learn to rely on caregivers; mistrust occurs if needs are not met.
- Autonomy versus shame and doubt: Toddlers learn language skills and gain independence; they may feel shame and doubt if they cannot meet parental expectations or are overprotected.
- Initiative versus guilt: Preschoolers actively seek out new experiences; children become hesitant if restrictions or reprimands make them feel guilty or afraid to try more challenging skills.
- Industry versus inferiority: School-aged children enjoy finishing projects and receiving recognition; they develop feelings of inferiority if they are not accepted by peers or cannot please their parents.
- Identity versus role confusion: Adolescents face many physical and hormonal changes in this stage. Teenagers work at figuring out who they are and where they fit; they are seeking a direction for their lives. If they are unable to establish an identity and sense of direction, they become role confused.
When working in pediatrics, it can be helpful to understand Erikson’s stages and how you can help someone master those stages.