Preschool Child

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 

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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

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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!!!