The Preschool

Child
I
 Physical Development
— The child between 3 and 6 years of age grows taller and loses
the chubbiness seen during the toddler period
— Between 3 and 5 years of age, there will be an increase of 3
inches in height
— All 20 primary teeth have erupt
— Hand preference develops by 3 years of age
— Normal pulse rate is 90 to 110 beats/min
— Respirations during relaxation is about 20 breaths/min
— Systolic blood pressure is about 85 to 90 mm HG and diastolic
about 60
 Cognitive Development
Piaget calls this period the preoperational phase, it comprises


children from 2 – 7 years of age and is divided into two stages

 The preconceptualstage (2 to 4 years) and the Intuitive thought stage ( 4 – 7
years)

Symbolic functioning is seen in the play of children who pretend that an



empty box is a fort

Another characteristic of this period is egocentrism, a type of thinking in



which children have difficulty seeing any point of view other then there
own

Animism is the tendency to attribute life to inanimate objects



Artificialism the idea that the world and everything in it are created by


people

The intuitive stage involves centering, the tendency to concentrate on a



single outstanding characteristic of an object while excluding its other

features
 Language Development
— Typically, in the preschool period between 2 and 5 years of
age, the number of words in the child’s sentence should
equal the child’s age
— By 2 ½ most children show possessiveness like “my doll”
— By 4 years of age they can use the past tense
— By 5 years they can use future tense
— Children who have difficulty expressing themselves with
words often exhibit tantrums
 Development of Play
— At 2 to 3 years of age , the child imitates the adl’s of the parents
— Shaving, hammering and feeding the doll

— By 4 years of age, the child may develop a broader theme like trip to the
zoo

— By 5 years of age, a trip to the moon demonstrates the child’s

imagination

— Play enables the child to experience multiple roles and emotional outlets

— Appealing to the child’s magical thinking is the best approach to

communication
 Spiritual Development

Preschoolers learn religious beliefs and

practices from what they observe in the home
— They cannot yet understand abstract concepts,
so there concept of god is concrete and
sometimes treated as an imaginary friend
— Observing religious traditions practiced in the
home during hospitalization can help a child
deal with stressors
 Sexual Curiosity
—When guiding parents concerning the
sexual education of young children, the
nurse should use the following principles
of teaching
— First assess the knowledge base of the child
— Be honest and accurate in providing information at the child’s
level
— Use correct terminology so that misinformation or
misinterpretation can be avoided
— Provide sex education at the time the child asks the question
— Parents must understand that sexual curiosity starts as an inquiry
into anatomical differences
 Masturbation
— Masturbation is common in both genders during the
preschool years

— The child experiences pleasurable sensations which lead to

a repetition of the behavior

— Masturbation in the preschool child is considered harmless

if the child is outgoing, sociable and not preoccupied with
the activity

— Education of the parents consists of assuring them that this

behavior is a form of curiosity and is normal and not
harmful to the child
 Bedtime Habits
— Parents should engage the child in quiet activities
before bedtime
— Storytelling

— Attention getting behavior that results in taking

the child into the parents bedroom should be
discouraged because it rewards bad behavior and
defeats the purpose of bedtime rituals
 The Three Year Old
— They are helpful and can assist in simple chores
— Temper tantrums are less frequent
— They can help dress and undress themselves
— They eat independently and table manners have
improved

— Can talk in longer sentences and can express thoughts

and ask questions

— Parallel play (playing independently within a group)

and associative play are typical of this age period
 The Three Year Old
— Preschoolers begin to find enjoyment away from mom and
dad, although they want them nearby when needed

— Romantic attachment to the parent of the opposite gender

is seen during this period
— A daughter wants to marry daddy

— Preschool child have more fears than the infant or toddler

because of increased intelligence

— The fear of bodily harm, particularly the loss of body parts

is unique to this age group

— Other common fears are fear of the dark and fear of

strangers

— Night wandering is typical of this age group

— Masturbation is common during this stage
 The FourYear Old
— The four year olds are more aggressive and like to show off
newly refined motor skills

— Four year olds are boisterous, tattle on others, and may begin to
swear if they are around children or adults who use profanity

— At this age children become interested in how old they are and
want to know the exact age of each playmate

— Four year olds can use scissors with success

— There vocabulary has increased to about 1500 words

 The Four year old
— Raw materials are more appealing to a four year old then
toys that are already made
— A cardboard box

— Stories that interest young children are those that depict

their daily experiences

— Children between 3 and 4 begin to wonder about death

— Usually young children realize others die but do not relate death to
themselves
— Parents should encourage questions as they appear and gradually
help them accept the truth without causing fear
— Two books regarding death that are appropriate for the preschooler
are
— Geranium morning and My grandpa died today
 The Five Year Old
— The five year old is more responsible, enjoy doing what is
expected of them, have more patients and like to finish
what they started

— They talk constantly and are inquisitive about their

environment

— There height may increase by 2 to 3 inches, and may gain

3 to 6 pounds

— They may begin to lose their deciduous teeth at this time

— They can usually print there first name
 Discipline and Limit Setting
— Children need limits for their behavior, setting limits makes them feel more
secure

— Children who are taught acceptable behavior have more friends and develop
good self – esteem

— Discipline must be given at the time the incident occurred

— Warning the preschool child who appears to be getting into trouble may be
helpful

— Spankings are not productive

— Child associates the fury of the parents and the pain not the bad
behavior

— Time outs should last 1 minute per year of age, with the child sitting in a
straight chair facing a corner
— There should be no eye contact
— No interaction

— Time out should be preceded by a short explanation of the reason for the time
— Rewarding the child for positive behavior is an effective method
of discipline
— Hugs, smiles and praise

— Consistency must exist between parents and as well as on there

own

— It is suggested that parents establish a general style of what,

when and how

— Children imitate adult behavior so setting a good example is

very important for the preschooler
 Jealousy
— Children is this age group may envy the
newborn, they love the sibling but resent his
or her presence

— Jealousy of a new sibling is strongest in children under 5

— The Child may bite or pinch or may be more discreet and may
hug and kiss the infant with a determined look on there face

— The child may also revert to wetting the bed or wanting a bottle

— Parents can reduce jealousy of a new sibling by preparing the

preschooler for the upcoming arrival of a bother or a sister

— Allowing the child to help in the care for the newborn will also
help decrease jealousy
 Thumb Sucking
— Thumb sucking is an instinctual behavior pattern and is
considered normal

— It satisfies and comforts the infant

— The pacifier causes fewer dental problems then the rigid finger
and is more easily relinquished

— Finger or thumb sucking will not have a detrimental effect on the

teeth as long as the habit is discontinued before the second
teeth erupt

— Most children give up the habit by the time they reach school
age, although they may regress during period of stress or fatigue
 Enuresis
— Enuresis is the involuntary urination after the age at which bladder
control should have been established

— Two types primary and secondary

— Primary enuresis refers to bedwetting in the child who has never been dry
— Secondary enuresis refers to recurrence in a child who has been dry for a period of 1
year or more

— Diurnal or daytime wetting is less common then nocturnal or nighttime

wetting

— More common in boys then girls and there may be a genetic influence

— App. 92 % of children achieve daytime dryness by 5 years of age

— Parents who demand early toilet training can cause a child to rebel and defy
them by continuing to wet the bed

— Some organic causes of nocturnal enuresis include uti, diabetes mellitus,

diabetes insipidus, seizure disorders, obstructive uropathy and sleep disorders
 Treatment and nursing
— A detailed physical and psychological history is obtained
including
— Pattern of wetting, number of times per night or week, number of daytime
voidings, type of stream, dysuria and amount of fluids taken after dinner
and before bedtime

— Parents are reassured that many children experience enuresis

and that it is self limiting

— Parents should take a positive approach of rewarding dry nights

and charting the progress

— When the child does not respond to routine management other

tech. include
— Counseling, hypnosis, behavior modification and medication

— Imipramine hydrochloride (Tofranil) has been found to decrease

enuresis, It is admin. before bedtime and has s/e including mood
and sleep disturbances and GI upset
— Not recommended for children under 6
 Nursery School
— Some parents seek the preschool experience for their child to enhance
growth and development by providing experiences with other playmates

— Preschool programs provide structured activities that foster group

cooperation and development of coping skills

— The child can gain self – confidence and positive self esteem in a good
preschool program

— The parents should visit the preschool and personally observe the
environment, talking to parents of children in the school is also helpful
 Daily Care
— The child between 3 and 6 years does not require the extensive
physical care as infant does but still needs a bath everyday and
shampoo at least twice a week

— Clothing should be loose enough to prevent restriction of

movement and allow active play

— Preschool children should dress and undress themselves and

much as possible

— Shoes should be sturdy and supportive

— Protective gear such as helmets for bicycling should always be

worn
 Accident Prevention
— Accidents are a major threat during the years from 3 – 5
— There injury may be related to a bad fall since preschool
children hurry up and down stairs, they play hard with
there toys and like to climb and stand on things

— When buying toys for the preschooler make sure they are
sturdy and age appropriate

— Automobiles are threat, child should be taught where they

can ride there bike and play with a ball

— Never leave the child alone in or around a car

— Burns at this age usually occur from children
experimenting with matches
 Safety
— Burn from hot coffee are also common

— These things should be kept high and out of reach from the
child

— There dangers should also be explained to the child

— Poisoning is also a danger since children in this age group try

to imitate adults and are apt to sample pills

— Preschool children should also be taught the dangers of

talking to or accepting rides from strangers

— If they are stopped by a driver the should RUN to the house

of people they know

— Parents should make it clear to children in nursery school that

they will never send a stranger to pick them up

— They should also be warned about the dangers of playing in

places alone and accepting gifts from strangers
 Value of Play
— Play is important to the physical, mental, emotional and
social development of both healthy and sick children

— Play therapy in the hospitalized child is an important part

of every pediatric nursing care plan

— The diagnosis and energy level should be considered

when choosing an appropriate toy or game
— Example – stuffed toy for child with asthma

— Quit time should precede meals and bedtime for both well
and sick children
 Value of Play
— During routine procedures the nurse can entertain the
child with nursery rhymes, stories, songs and puppets

— Surprise boxes in which a gift is opened everyday provides

anticipation for the patient

— Older children enjoy listening to music and sending

messages to there friends over the computer

— Nurses should guide parents to play for the child who is

too weakened by illness and allow the child to be the
observer
 Types of Play
— Preschool children need playmates to promote social
development

— The Preschool child gradually moves from parallel and

associative play to cooperative play with playmates

— Play should be noncompetitive and supervised for safety

— Imaginary friends are common in the preschool age
— They serve to help the child adjust to an expanding world and
increased independence

— Some suitable toys for the preschooler are large

construction sets, number or alphabet games, play tools,
large puzzles and clay

— Active play can include simple climbing, sliding and

running
 Play and the Handicapped Child
— The child who is mentally impaired needs more stimulation
through play then the child who is not

— Consider the mental age not chronological age when guiding

parents of toy selection

— Environment should be as colorful and bright as possible

— Materials for play are presented one at a time

— These children may have to be taught how to play, making

repetition of play experiences necessary
 Therapeutic Play
— Play and toys can be therapeutic in value in retraining
muscles, improving hand – eye coordination and helping
children crawl and walk

— Blowing out the light of a flashlight as if it were a candle is

therapeutic play for a postoperative child
 Play Therapy
— Play therapy is used for children under stress
— A well aquipped playroom is provided
— A counselor may be in the room observing and talking
with the child or the child may be observed through a one
way glass window

— The counselor is observing the child for a better

understanding of the child’s struggles, fears and feelings
towards others and self

— Art therapy is also used with children to assist the child in

expressing him or her self
THE END!!!