Chapter 31: Nursing Care of a Family with a Preschool Child

During a well-child visit, the parent of a 3-year-old child tells the nurse, "Just recently, my child started sucking the thumb again. I thought we were done with this." Which response by the nurse is appropriate?

*"Has anything changed lately in your home or family situation?"* Some preschool-age children, generally in relation to stress, revert to behavior they previously outgrew, such as thumb-sucking, negativism, loss of bladder control, and inability to separate from their parents. Although the stress that causes this may take many forms, it is usually the result of such things as a new baby in the family, a new school experience, stress in the home from financial or marital difficulties, or separation caused by hospitalization. Therefore the nurse should ask about any recent stressors. Regression in these circumstances is normal and removing the stress is the best way to help a child eliminate this behavior. Unfortunately, the stressor may not be one that is easily controlled.

A nurse is observing a group of 4-year-old children in a play area. What action, when observed by the nurse, would alert the nurse to typical play for this age group?

*A child pretends to be a teacher and asked another child to be the pretend student in "class."* Preschool-aged children enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and store clerks. They imitate exactly what they see their parents doing. Parallel play is characteristic of toddlers and would be demonstrated by children playing next to each other with different toys. Preschool-aged children typically enjoy cooperative play with other children in the group, rather than playing alone. Older preschool-aged children are interested in group games.

Which gross motor skill would the 4-year-old child have most recently attained?

*The child can hop on one foot.* Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.

The nurse is supervising lunch time for children on a pediatric ward. Which observation is considered abnormal for this age group?

*The child uses his fingers and refuses to use a fork.* The preschool child has learned to use utensils fairly effectively to feed himself or herself, has a full set of primary teeth, and is able to chew and swallow competently. Preschool children may be picky eaters. They may eat only a limited variety of foods or foods prepared in certain ways and may not be very willing to try new things

A nurse planning the care of a 4-year-old child observes the child playing with 3 other children. All the children are building large towers with blocks, but no one is taking the lead or giving directions. The nurse determines that the children are engaged in which type of play?

*associative* Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what one wishes. In parallel play, children play alongside each other but independently. Dramatic play allows a child to act out troubling situations and to control the solution to the problem. This is important to remember when reinforcing teaching with children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. In cooperative play, children play in an organized group with each other, as in team sports.

The nurse is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler?

*button clothes* The 3-year-old should be able to button his clothes and use a pencil or crayon. By the age of 4 to 5, the child should be able to use scissors, tie shoelaces, and print his first name.

During a well-child visit, the nurse is providing anticipatory guidance to the parents of a 3-year-old about language development. When talking with the parents about this topic, the nurse would instruct that most of the preschooler's questions typically focus on which? Select all that apply.

*how, why* The preschooler can ask up to 400 questions a day. Although the preschooler asks questions constantly, the majority of those questions focus on how and why.