Preschooler & Pre Adolescent

PRESCHOOLER/SCHOOLE R AND THE FAMILY

Pre-Schooler 

The preschool years are a time of new initiative and independence. Language skills are well developed and the child is able to understand and speak clearly.

PRE-SCHOOLER PHYSICAL GROWTH AND DEVELOPMENT 

Preschoolers grow slowly and steadily, with most growth taking place in long bones of the arms and the legs. The short chubby toddler gradually gives way to a slender, long-legged preschooler.

Physical Growth and Development Milestones    

Physical Growth: Gains 1.5 - 2.5 kg (3-5 kg)/year; grows 4-6cm (1 ½ - 2 ½ in)/year Gross Motor Ability: Throws a ball overhand; rides bicycle; climbs well Sensory Ability: Visual acuity continues to improve; can focus and learn letters and numbers Fine Motor Ability: Eats 3 meals with snacks; uses spoon, fork and knife; uses scissors; draws circle, square and cross; draws at least a 6 part person; enjoys projects such as pasting, stringing beads and using clay; learns to tie shoes at the end of the preschool years; buttons; brushes teeth

COGNITIVE DEVELOPMENT 

The preschooler exhibits characteristics of the preoperational thought. Symbols or words are used to represent objects and people and enabling the young child to think about them. This is a milestone n intellectual development; however, the preschooler still has some limitations in thought.

Characteristics of Preoperational Thought  Egocentrism: Ability to see things from only one’s point of view.  Transductive Reasoning: Connecting two events in a cause-effect relationship simply because they occur together in the same time.  Centration: Focusing on only one particular aspect of a situation.  Animism: Giving lifelike qualities to nonliving things.

PLAY  The preschooler has begun playing in a new way. Toddlers simply play side by side with friends, each engaging in his or her own activities. One child cuts out colored paper for example, while her friend glues it on paper in a design. This is a new type of interaction called associative play.  The materials provided for play can be simple but should guide activities in which the child engages.  Because fantasy of life is so powerful at this age, the preschooler readily uses his props to engage in dramatic play, that is the living out of drama of human life.

Psychosocial Development During the Preschool  Associative Play: Facilitated by simple games, puzzles, nursery rhymes and songs  Dramatic Play: Fostered by dolls and doll clothes, play houses and hospitals, dressup cloths and puppets.  Stress: Relieved by pens, pencils, scissors and glue  Cognitive Growth: Fostered by educational television shows, music, stories and books

PERSONALITY AND TEMPERAMENT 

Characteristics of personality observed in infancy tend to persist over time. The preschooler may need assistance as these characteristics are expressed in new situations of preschool or nursery school. An excessively active child for example, will need gentle, consistent handling to adjust to the structure of a classroom. Encourage parents to visit preschool programs to choose the one that would best foster growth in their child.

COMMUNICATION  Language skills blossom during the preschool years. The vocabulary grows to over 2,000 words, and children speak in complete sentences of several words and use all parts of speech. Hey practice these new found language skills by endlessly taking and asking questions. 

The child may have difficulty focusing in the content of a conversation. The preschooler is egocentric and may be unable to move from individual thoughts to those the nurse is proposing in a teaching situation.

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Concrete visual aids such as pictures of a child undergoing the same procedure or a book to read together enhance teaching by meeting the child’s developmental needs. Handling medical equipments such as intravenous bags and stethoscopes increase interest and help the child to focus. Teachings may be done in several long sessions rather that in long session.

SCHOOL AGE PHYSICAL GROWTH AND  School age is the last period in which girls and boys are close in size and body proportions. As long bones continue to grow, leg length increases. Fat gives way to muscles and children appear to be leaner. Jaw proportions change as the 1st deciduous tooth is lost at 6 years and permanent teeth begin to erupt. Physical skills are also refined as children begin to play sports, and fine motor skills are well developed through school activities.  The school age child should be closer and monitored during brushing teeth to ensure that flossing and brushing is adequate.

COGNITIVE DEVELOPMENT  The child enters the stage of Concrete Preoperational thought at about 7 years old. This stage considers school age children to consider alternative solutions and solve problems. However, school age children continue to rely on concrete experiences and materials to form their thought content.  During the school age years, the child learns the thought of conservation (that matter is not changed when its form is altered). At earlier ages a child believes that when water is poured from a short, wide glass into a tall, thin glass, there is no more water in the taller glass. The school age child recognizes that although it may look like the taller glass holds more water , the quantity is the same. The concept of conservation is very helpful.

PLAY 

The characteristic of play exhibited by school age children are cooperation with other’s ability to play a part in order to contribute a unified whole. This type of play is called cooperative play. The concrete nature of cognitive thoughts lead to a reliance on rules to provide structure and security. Children have increasing desire to spend much of play time with friends which demonstrates the social component of play.

PERSONALITY AND TEMPERAMENT  The enduring aspects of temperament continue to be manifested during the school years. The child classified as “difficult” at an earlier age may now have trouble in the classroom. Advise parents to provide a quiet setting for homework and reward the child for concentration. Creative efforts and alternative methods of learning should be valued. Encourage the parents to see their children as individuals who may not all learn in the same way. The “slow-to-warm-up” child may need encouragement to try new activities to share experiences with others, while the “easy” sill readily adapt to new schools, people and experiences.

SEXUALITY  Early school age covers approximately ages five, six, and seven.  Children become more aware of gender differences, and tend to choose same-sex friends and playmates, even disparaging the opposite sex. Children may drop their close attachment to their opposite-sex parent and become more attached to their same-sex parent.  During this time children, especially girls, show increased awareness of social norms regarding sex, nudity, and privacy. Children may use sexual terms to test adult reaction. "Bathroom humor" (jokes and conversation relating to excretory functions), present in earlier stages, continues.  Masturbation continues to be common.

PREADOLESCENT/ADOLESCE NT AND THE FAMILY

Definition of Terms 

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Psychosocial development as articulated by Erik Erikson explain eight stages through which a healthily developing human should pass from infancy to late adulthood. Super-ego - controls our sense of right and wrong and guilt, it aims for perfection Fundamentalism refers to a belief in a strict adherence to a set of basic principles (often religious in nature), sometimes as a reaction to perceived doctrinal compromises with modern social and political life. Culpability describes the degree of one's blameworthiness in the commission of a crime or offense. Gonad is the organ that makes gametes. Vas deferens transport sperm from the epididymis in anticipation of ejaculation.

Health Promotion during Adolescents 

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establishing health habits of daily living in relation to personal care, such as posture, hearing, vision, bodypiercing and sun-tanning education in stress-reducing techniques providing information on nutritional requirements and eating habits and behaviors accident prevention in relation to vehicle-related injuries and sports injuries immunization exercise and activity education about sexuality and guidance on avoiding STIs and unplanned pregnancies substance abuse

ADOLESCENT HEALTH CONCERNS AND HEALTH

Adolescent Health Concern  Accidents Health Promotion  Provide information on proper use of sports equipment  Emphasize proper pedestrian behavior  Promote proper behavior while a passenger in a vehicle  Use of seatbelts  Encourage attendance at driver education course, reinforce dangers of drugs when driving  Teach basic rules of water safety  Promote use of safe sports and recreational facilities  Instruct in safe use and respect for firearms

Adolescent Health Concern  Suicide Health Promotion  Be alert for signs of depression  Offer suicide prevention education  Teach methods to cope with a suicidal peer  Promote alternatives to suicide

Adolescent Health Concern  Substance Abuse Health Promotion  Educate about the risks of tobacco, alcohol and drug use  Screen for substance abuse

Adolescent Health Concern  Sexually transmitted infections Health Promotion  Provide information about mode of transmission and symptoms  Encourage use of condoms, abstinence from sexual activity  Educate about consequences of sexual activity

Adolescent Health Concern  Nutrition 

Health Promotion  Provide information about nutritional requirements during adolescence  Educate about the risks of snacking and irregular mealtimes  Promote regular consumption of breakfast and balance diet 

Psycho-social Development      

According to Erikson Teenage: Identity vs. Role Confusion (12 to 20 years) Psychosocial Crisis: Identity vs. Role Confusion Main Question: "Who am I?" Ego quality: Fidelity The adolescent is newly concerned with how he or she appears to others. Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is pleasant. In later stages of Adolescence, the child develops a sense of sexual identity.

Moral Development According to Kohlberg  Conventional  Stage Four (authority and social order obedience driven), it is important to obey laws, dictums and social conventions because of their importance in maintaining a functioning society. Moral reasoning in stage four is thus beyond the need for individual approval exhibited in stage three; society must learn to transcend individual needs. A central ideal or ideals often prescribe what is right and wrong, such as in the case of fundamentalism. If one person violates a law, perhaps everyone would—thus there is an obligation and a duty to uphold laws and rules. When someone does violate a law, it is morally wrong; culpability is thus a significant factor in this stage as it separates the bad domains from the good ones. Most active members of society remain at stage four, where morality is still predominantly dictated by an outside force. 

Physical Changes during Adolescent Period  Increase in height and weight is associated with redistribution of fat in the body and an increase in the proportion of bone and muscle tissues.  The growth spurt: in boys generally begins about two years later than it does  in girls, but, continues for a longer period.  There are also changes in body proportions:  Girls generally broaden in the hips  Boys mostly in the shoulders. The waist line proportionately drops.

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There are also major changes in the secretion of hormones by the various glands in the body. The gonads, or the sex glands begin to function bringing about sexual development. Both boys and girls develop sex characteristics, which are broadly classified as

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primary, and secondary.

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Primary Sex Characteristics 

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Primary sex characteristics in boys refer to the growth of the main male sex organs which include the Penis, scrotum, testes and vas deferens. For girls the primary sex characteristics refer to the growth of sex organs like uterus, fallopian tubes and breasts, acquisition of body hair, change of voice change in" skin texture etc. These sex characteristics are acquired over a span of time. The period during the bodily changes occur is called puberty.

Stages of Puberty    

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Prepubescent Stage Pubescent Stage Post-pubescent Stage During the pre-pubescent stage, the secondary sex characteristics begin to develop in the child. These are followed by development of the primary sex characteristics In the pubescent stage the hall mark of this stage in girls ia the commencement of menstruation or menarche and in boys the beginning of wet dreams or nocturnal emissions. The post pubescent stage is the one when both boys and girls come to full reproductive maturity. Thus puberty itself is a long sequential process which actually launches the child into adolescence.

Needs and Tasks  As children get closer to the teen years, they become more independent. It’s important that parents should:  Allow them to make some choices and take part in family decision making  Help decide the chores they’ll be responsible for completing  Support their children’s growing need for more freedom.  Friendships become important to older school age children. Friends may use secret codes, made-up languages, and passwords to feel closer to each other. Having friends provides children the:  Security they need to begin separating from their parents and families.

 Children’s thinking also changes at this time. Children can think about and understand why certain things happen. This ability helps them predict what might happen in similar situations in the future. Their new way of thinking also affects their behavior.  For example, older school age children are capable of playing more complex games.  They are better able to understand the relation of rules to games.  As children continue to improve their motor skills, they may be more willing to try new activities.  School age children also need to feel they’re valued members of the family.

WHAT SHOULD THE PARENTS  Provide opportunities DO? for older school-ages to help out with real skills.         

Cooking, sewing, and designing dramatic play props are useful ways to use their skills. Provide time and space for an older child to be alone. Time to read, daydream, or do school work uninterrupted will be appreciated. Encourage your child to make a call to a school friend. Encourage your child to participate in an organized club or youth group. Many groups encourage skill development with projects or activities that can be worked on at home. Encourage your older child to help with a younger one but avoid burdening older children with too many adult responsibilities. Allow time for play and relaxation. Provide opportunities for older children to play games of strategy. Checkers, chess, and Monopoly are favorites. Remember to provide plenty of food. Older children have larger appetites than younger children and will need to eat more. Provide phone privileges to call a friend or classmate. Provide time to participate in an organized club or youth group. Many groups encourage skill and leadership development.

Problems Arising during Adolescence Stage  Drug and Alcohol Abuse: The 1960s and 1970s marked a sharp increase in drug use that accompanied the social and political unrest of the time. After a slight decrease in the 80s and early 90s, the use of drugs is rising again. Drugs used include marijuana, stimulants, LSD, inhalants and cocaine, but by far alcohol is the most commonly abused drug.  Juvenile Delinquency: Juvenile delinquency refers to a variety of behaviors, ranging from socially unacceptable behavior (such as acting out in school) to status offenses (such as running away) to criminal acts (such as burglary). For some, these criminal behaviors become acts of violence.  Adolescent Pregnancy: Adolescent pregnancy has become a national dilemma. 4 out of 5 of the 1 million teens who become pregnant are unmarried. 30,000 of them are under the age of 15. Overall, 1 of every 10 adolescent females becomes pregnant each year. Consequences include the increased possibility of health risks, and the mother usually drops out of school, fails to gain employment, and becomes dependent on welfare.

 Depression and Suicide: Suicide is a growing problem. Suicide accounts for about 12% of deaths among adolescents and young adults. Worse, for every successful suicide, 6 to 10 attempts are made.

 Factors that can trigger suicide include:        

High stress, loss of a boyfriend or girlfriend School problem such as: poor grades, missing classes, truancy An unwanted pregnancy Early experiences such as family instability and unhappiness Loss of appetite Withdrawal from peers and friends An explicit announcement of thoughts of suicide

 Eating Disorders: Two types of eating disorders are anorexia nervosa and bulimia. Anorexia nervosa is an eating disorder that involves the relentless pursuit of thinness through starvation. Bulimia involves a binge-and-purge sequence on a regular basis. These are primarily female disorders caused by societal, psychological, and physiological factors.