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    Objectives
    • Respond to school-age children’s changing bodies and uncertainty about puberty in supportive ways.
    • Promote good oral health and hygienic practices for maintaining toothbrushes and sharing toothpaste.
    • Recognize and promote healthy ways of dealing with stress and supporting children’s emotional health.
    • Understand what to do in the event a school-age child has a toilet accident.
    • Describe ways to maintain hygienic conditions in restrooms.

    Learn

    Learn

    Know

    Personal Health

    School-agers range in age from anywhere from 5 to 12 years old. This large span includes a great deal of change as far as personal health is concerned.

    Younger school-age children are still learning proper personal hygiene skills and will rely on you to model good hand-washing techniques (see Lesson Two) and hygiene habits. School-age children may have occasional bathroom accidents. If a child does have an accident, keep in mind that they will probably be very embarrassed. Do not make the incident any bigger than it needs to be. Make sure to provide the child with privacy, clean clothes, plastic bags, and any necessary items he or she will need for cleanup. Your program will have specific policies on this topic, check with your coach, trainer, or administrator if you have any questions or concerns. In the Learn Activities section, you will find a Changing Soiled Clothing guide to understand how to handle accidents to reduce contamination.

    School can be very tiring for school-age children and they may want some quiet time to relax and build up energy while at your program. Resting is a necessary part of personal health as it gives our bodies and brains a chance to relax. Children may need a break when they arrive at your program before they are able to focus on homework or other tasks.

    You can help model personal hygiene and resting behaviors by taking care of your own personal health. Be sure to get enough sleep so that you are refreshed and energized to working with school-age children.

    Puberty

    Older school-age children experience a great deal of change inside their growing bodies. Changes associated with puberty may be embarrassing or startling for children. It's important to be sensitive to these changes. According to KidsHealth.org, puberty can begin as early as age 8, especially in girls. The Physical Development course provides more information on body changes and developmental milestones you can anticipate in the school-age period. You can also find more information about body changes during early puberty by visiting Healthy Kids.org, a website developed by the American Academy of Pediatrics: https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Physical-Development-of-School-Age-Children.aspx.

    It is important to have an understanding of the changes children and youth might be going through and the ways you can help support them through this stage of development.

    • Create a fun, safe environment. Do not tolerate teasing, name calling, or bullying.
    • Have books on puberty available in your professional library and safe websites identified that children can visit for more information. When older school-agers ask questions, it is important to have accurate and age-appropriate information available.
    • Have sanitary pads and tampons available in the girls' bathroom.
    • Have a stock of sample-size deodorants on hand.
    • Be sensitive to children going through puberty changes.
    • Be aware that hormone changes can cause mood swings.
    • Promote healthy habits.

    Chances are, you remember the awkwardness of your preteen years when it felt like everything was changing, including yourself. When working with older school-age children, there's a chance you will be faced with students who are beginning to grow and change as they enter puberty. Puberty can be a difficult topic to discuss, but it is important to remember that it is your responsibility to help, support, teach, and protect these children. They may come to you with questions they aren't comfortable discussing with their families. Remember to always stick to the facts when answering questions, and use quality resources whenever possible, such as the suggested books in the Staying Fit (Body and Mind) booklist located in the Learn Activities section below. The following websites also contain great information, resources, and downloads:

    Another great resource is the Boys and Girls Clubs of America. They have programs for children of this age group concerning puberty and growing into teenage youth. The programs are called SMART Girls and Passport to Manhood. Each program has activities and information appropriate for school-age children. 

    Oral Health

    There are many reasons school-age children may want or need to brush their teeth. Older school-age children may be sensitive about or embarrassed by bad breath. Children with braces, retainers, or other orthodontia are required to brush regularly. When a child spends the entire day in your care, for example during summer programs, they may need the opportunity to brush their teeth throughout the day, most likely after eating a meal.

    toothbrushes in a clean plastic toothbrush holder

    Toothbrushes should be labeled and stored in a way that they are not touching each other and are allowed to air dry. You should speak with the families of children with braces or retainers to make sure you know of any foods or beverages the children should avoid. You will also want to ask about any cleaning procedures needed before or after-school hours.

    For storing toothbrushes, programs can make their own storage containers using egg cartons, or you can talk with your coach, trainer, or administrator about purchasing a toothbrush holder from a childcare supply company. You also want to be sure that each child has their own toothpaste tube, or if you are sharing toothpaste, that you prevent cross contamination of germs by dispensing smears or pea-sized amounts of toothpaste onto a large piece of wax paper, a paper plate, or bottom of a rinsing cup, and then onto each child’s brush.

    Dispense toothpaste in pea-sized amounts onto a paper plate or wax paper then transfer to each child's toothbrush in order to prevent cross-contamination of germs
    You may be caring for children who are in a variety of stages of dental development. Some may still have the majority of their primary teeth, while others may have a mouth full of permanent teeth. When working with younger school-age children who are in the process of losing their primary teeth, you should be prepared to store teeth. However, you should never assist a child in pulling out a loose tooth. Instead, let it come out naturally.

    Emotional Health

    School-age children can experience many stressors throughout their day. You can help alleviate stress by creating a safe, healthy, caring, and fun environment where school-age children can learn and grow. In the Self & Cultural Understanding course, you will learn more about how to help school-age children cope with stress, how to encourage a healthy self-image, and ways to incorporate these methods into your daily plans. For now, here is a list of potential stressors for school-age children:

    • Common childhood fears like moving to a new home, going to a new school, making new friends, etc.
    • Parents' divorce
    • Current events, war, media coverage, deployment of parent or loved one
    • Death of loved one
    • Being abused (physically, emotionally, sexually)
    • Peer pressure
    • Pressure to do well in school
    • Puberty
    • Sports loss
    • Fight with friend

    Since eliminating all of the sources of stress in children's lives is not possible, it is vitally important that we teach children healthy methods to cope with stress. The Learn Activities resource, My Personal Stress Plan, contains concrete steps youth can take to reduce their stress.

    Examples of healthy methods of handling stress:

    • Exercising
    • Meditation or yoga
    • Listening to music
    • Journaling
    • Talking with somebody you trust
    • Getting organized
    • Knowing when to ask for help

    (American Academy of Pediatrics, 2015)

    Self-Esteem

    Self-esteem refers to the way people feel about themselves, their self-worth, and their abilities. Children with a healthy self-esteem have the following characteristics, according to the American Academy of Pediatrics (2015):

    • Sense of security, belonging and trust
    • Sense of pride and purpose
    • Sense of responsibility and contribution
    • Sense of encouragement, support, and reward
    • Sense of making real choices and decisions
    • Sense of self-discipline and self-control
    • Ability to accept mistakes and failures
    • A sense of family self-esteem

    All of the qualities listed above are ones staff members hope their school-agers will possess. It is the role of the staff member to help school-age children see that each person is valued. You can do this by demonstrating respect for:

    • Each child as an individual
    • The needs of the group
    • Yourself and your colleagues

    You will learn specific methods to promote and encourage positive self-esteem in the Self & Cultural Understanding course. In addition, more information to support mental health, especially for children and youth of military service members, is provided in Lesson Six.

    See

    Supporting school-age children's emotional health isn't necessarily something that can be caught on video. You will do this in a variety of ways, including protecting them from teasing or bullying, encouraging them, or sometimes just by lending an ear.

    Emotional Health

    Watch a school-age staff members talking with children.

    Do

    General Hygiene Procedures for Toileting

    There are many ways to maintain a healthy environment throughout your classroom. The restroom is an important place to start. Follow these steps to create healthy habits for yourself and children:

    • Check the restroom regularly to make sure toilets are flushed.
    • Check to make sure floors, doors, and walls are clean.
    • Make sure paper towels and other trash are thrown away properly.
    • Make sure running water, soap, paper towels, plastic bags for soiled clothing, and toilet paper are available.
    • Make sure you put disposable gloves on before handling soiled clothing. Remove gloves before handling clean clothing.
    • If possible, use a separate sink for general use and hand washing after toileting. If you must use the same sink, disinfect it before using it for general or food-related use.
    • Always wash your hands after helping children use the toilet, assisting with soiled clothing, or touching contaminated surfaces. Even if you wear disposable gloves, you must wash your hands.
    • Make sure all children and adults wash their hands properly.

    While toilet accidents are typically rarer in school-age settings, when compared to younger children, it is still helpful to prevent accidents by encouraging children to use the restroom at regular intervals (e.g. when they arrive at the program or before you go outside). Be sure to remind school-age children to use the restroom before going on a field trip or before a special event. Also watch for signs that a child needs to use the restroom. Holding the genital area, squirming, or moving uncomfortably could all mean a child needs to use the restroom.

    Supporting School-age Children's and Youth's Personal and Emotional Health

    • Lead by example. Model healthy habits by being active and dealing with your own stress and emotions in healthy ways.
    • Show respect. Demonstrate respect for yourself, your co-workers and your school-age children.
    • Plan. Plan activities that teach children good oral health.
    • Teach. Educate school-age children on healthy methods of managing and coping with stress.
    • Talk. Promote an atmosphere where children can discuss their feelings without fear of being teased or bullied
    • Listen. Be a kind, trustworthy staff member who school-age children can come to when they need to discuss difficult topics.
    • Learn. Use the booklist located below in the Learn Activities section of this lesson. There are some read-aloud book suggestions on the topic of military deployment.
    • Provide resources. When children or their families are concerned about puberty, developmental changes, of life stresses share some of the resources in this lesson with them so that they can have accurate, age-appropriate information

    Suicide Awareness

    While it’s normal and healthy for school-age children to experience manageable amounts of stress, children who are depressed or have suicidal thoughts need professional help. Suicide is the second leading cause of death for children, youth, and young adults age 5-to-24-years old in the United States (American Academy of Child & Adolescent Psychiatry, 2017). Some risk factors for suicide in children and youth include:

    • Previous suicide attempt
    • Family history of suicide
    • Identifying as LGBTQ
    • Depression and other mental health concerns
    • Drug and alcohol abuse
    • Impulsivity and behavior problems
    • Local epidemic of suicide in a community
    • Easy access to guns
    • Victim of bullying

    Children and youth who are suicidal may make statements such as, “I wish I were dead,” or “You’d be better off without me.” Other warning signs of suicide include:

    • Extreme sadness and hopelessness
    • Loss of interest in friends, family, and hobbies
    • Changes in sleep and appetite
    • Skipping school and decline in school performance
    • Irritability and difficulty concentrating

    If you are concerned that a child or youth in your program is suicidal, you should promptly communicate this concern with your trainer, coach or administrator, and together, communicate your concern to the child, their family, and a mental health professional. Tell the child that you are worried about them and ask open-ended questions in a calm, empathetic way. You can ask, “Are you feeling more sad than usual?” or “Have you become so sad that you’ve thought about hurting or killing yourself?” Use direct questions and developmentally appropriate language. Younger children may not know the meaning of the word, “suicide,” but they may be able to describe symptoms related to depression such as stomach aches or feeling more angry than usual.  Research shows that asking someone if they have suicidal thoughts does not trigger suicide. Children who are suicidal often don’t talk to anyone about it because they fear others will react with anger or by ignoring their feelings. Let the child know you want to help them feel better. Like being a mandated reporter, you should not agree to swear to secrecy. Let them know suicide is preventable and treatment is effective. Regardless of the child’s response to your questions, if your gut tells you something is wrong, get help immediately. For more information on how to respond to a child or youth’s suicidal thoughts, review this information from The Center for Suicide Research and Prevention at Nationwide Children’s Hospital.

    Explore

    Explore

    Use the Modeling Healthy Behaviors - Stress activity to think about each scenario and consider how you would react. Then, think about how you could model healthy coping methods for children. When you are finished, share your answers with your trainer, coach, or administrator.

    Apply

    Apply

    Explore the websites listed below designed for youth and see what resources and activities are available to help children and families better understand their personal health, puberty, and some of the challenges of growing-up. Then use the Online Resources on Puberty and Personal Health attachment to jot down some pages you might share, or activities you might do with the children and youth in your program.  Then discuss your answers with your trainer, coach or administrator.

    Centers for Disease Control and Prevention

    Nemours Foundation

    For specific concerns, visit the U.S. National Library of Medicine's Medline Plus resource to see a list organized by target audience and topic at https://medlineplus.gov/puberty.html.

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Eleven-year-old Tanya is experiencing the physical changes that accompany puberty. What can you do to offer Tanya support during this stage of her development?

    Q2

    True or False? School-age children will not have bathroom accidents.

    Q3

    Which of the following are good ways to teach school-age children how to cope with stress?

    References & Resources

    American Academy of Child & Adolescent Psychiatry. (2017). Suicide in children and teens. Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Teen-Suicide-010.aspx

    American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2015). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs, 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Retrieved from http://nrckids.org

    American Academy of Pediatrics. (1995). Caring for Your School-Age Child.

    American Academy of Pediatrics. (2015.) Helping Your Child Develop a Healthy Sense of Self-Esteem. Retrieved from https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Helping-Your-Child-Develop-A-Healthy-Sense-of-Self-Esteem.aspx

    American Foundation for Suicide Prevention. (n.d.) Teens and Suicide: What Parents Should Know. Retrieved from https://afsp.org/campaigns/talk-about-mental-health-awareness/teens-and-suicide-what-parents-should-know/

    Boston Children’s Hospital. (n.d.). Suicide in teens & children symptoms and causes. Retrieved from http://www.childrenshospital.org/conditions-and-treatments/conditions/s/suicide-and-teens/symptoms-and-causes

    The Center for Suicide Research and Prevention at Nationwide Children’s Hospital. (n.d.). Suicide warning signs and how to respond. Retrieved from https://www.nationwidechildrens.org/-/media/nch/research/documents/suicidewarning_factsheet.ashx?la=en&hash=B649790C805487658B91341E483A82696AF5CC4A

    Centers for Disease Control and Prevention, CDC. (2012.) Youth Risk Behavior Surveillance-United States, 2011. Morbidity and Mortality Weekly Report 2012;61(SS04); 1-162.

    Council on Accreditation. (2018) Child and Youth Development Early Childhood Education (CYD-ECE) Standards for Health. New York: Council on Accreditation. Retrieved from http://coanet.org/standard/cyd-ece/4/

    Council on Accreditation. (2018). Standards for Child and Youth Development Programs. Out-of-School Time. (CYD-OST) Standards for Health. New York: Council on Accreditation. Retrieved from http://coanet.org/standard/cyd-ost/11/

    Everett, A. (2019). Shining a light on suicide prevention strategies. SAMHSA, Substance Abuse and Mental Health Services Administration. Retrieved from https://blog.samhsa.gov/2019/05/01/shining-a-light-on-suicide-prevention-strategies

    Massachusetts Department of Public Health, Office of Oral Health (2009). Growing Healthy Smiles in the Child Care Setting: Implementing a Tooth Brushing Program to Promote Oral Health and Prevent Tooth Decay. Retrieved from http://www.mass.gov/eohhs/docs/dph/com-health/oral-grow-healthy-smiles-child-care.pdf

    Ohio State University Extension. (2009). Preschool Children May Have Daytime Toileting Accidents. Retrieved from http://articles.extension.org/sites/default/files/w/5/55/JITP45-46mo.pdf#page=4

    U.S. National Library of Medicine, Medline Plus. (2018). Puberty. Retrieved from https://medlineplus.gov/puberty.html