PB Chap 18 The preschool child

The many questions of the preschool child must be

listened to carefully and answered thoughtfully and truthfully.

Erikson's stage

Initiative vs. Guilt

Play pattern

Play cooperatively for short periods of time

Play pattern

Prefers playing with friends of the same sex

Corporal punishment of the preschool child can nurture rebellion and aggression.

Appropriate discipline techniques can assist the child to develop self-control

Compared with toddlers, 5-year-olds ______.

Are more responsible

Describe this as related to the preschool child. Normal respiratory rate

20 breaths/min

Normal respiratory rate

20 breaths/min

By age 5 the child has a vocabulary of ________ words.

2000

Common concerns of parents during this period include how to set limits,

handle jealousy, and respond to thumb sucking and masturbation

Normal blood pressure

85 to 90 mm Hg systolic/60 mm Hg diastolic

Normal blood pressure of preschooler

85 to 90 mm Hg systolic/60 mm Hg diastolic

Normal heart rate

90 to 110 beats/min

Masturbation

A common display of sexual curiosity in both sexes during the preschool years

primary enuresis refers to bed-wetting in a child who

has been dry for a period of 1 year of more.

Symbolic functioning

Behavior describing creating a mental image to represent something that is not there

The 3-year-old child commonly fears ______.

Bodily harm

Motor development

Can assist with simple household chores

Describe this as related to the 5-year-old child. Motor development

Can ride a tricycle with speed and dexterity

Describe this as related to the 4-year-old child. Motor development

Can use scissors successfully

Egocentrism

Characteristic describing difficulty seeing any point of view other than their own

Preschool children

Children between 3 and 5 years of age

Average weight gain of preschooler

Doubles 1-year weight by 5 years of age

Describe this as related to the preschool child. Average weight gain

Doubles 1-year weight by 5 years of age

The child atged 3 to 5 years is often referred to as the "preschool child".

During this period the child grows taller and loses the chubbiness of the toddler period.

Artificialism

Idea that people created the world and everything in it

Death

Keep conversations about death casual and reassuring

Erikson's preschool stage involves the development of initiative.

Kohlberg's theory concerning preschoolers refers to the moral development and the beginning awareness of the needs of others

Describe this as related to the preschool child. .Kohlberg's theory

Moral development

Kohlberg's theory

Moral development

Piaget's cognitive phase

Preoperational

Consistent bedtime rituals

Provide security and minimize conflicts

Sexual curiosity

Providing honest and accurate information at the child's level

Preferred toys

Simple toys and common objects

Growth

Slows; focuses on refinement of abilities

Animism

Tendency to attribute life to lifeless objects

Centering

Tendency to concentrate on single outstanding object while excluding its other features

Associative play

Type of play when children are engaged in a common activity

Gross and fine motor skills vecome more developed,

as evidenced by participation in running, skipping, and drawing pictures

Cooperative and highly iimaginative play is

characteristic of the preschool child

the major tasks of the preschool child include preparation to enter school, the development of a cooperative type of play,

control of body functions, acceptance of separation, and increase in communication skills, memory, and attention span

Social issues of the preschool period include

learning to share and to control impulses

During the preschool years, the parents need guidance to understand the developmental road map of physical,

emotional, and cognitive growth to help the child to meet life's challenges ad goals and to enrich family interaction

Play is the business of children. It contributes to physical and mental well-being by

encouraging communication socialization and outlets for energy

Careful evaluation of day care and nursery school programs is

important to ensure high-quality care

Language ability develops rapidly, and the child is able to construct

rather complicated sentences by the end of this period

Accidents are still a major hazard for preschool children because of

the child's immature judgment and increased locomotive skills

Piaget refers to the preschool period as one in

which symbolic thought processes and language emerge.

Accident Prevention

• Accidents are a major threat for 3- to 5-year-olds • Car safety is essential • Burns occur due to child's experimentation • Poisoning can occur due to increased freedom and access to items within the environment • Child should be taught about the dangers of talking to or getting in the car with strangers, as well as the dangers of playing in secluded areas • Indirect supervision necessary due to poor judgment

The 3-Year-Old (cont.)

• Become angry when someone tries to take their possessions • Resent being disturbed during play • Are sensitive and feelings are easily hurt • Has fear of bodily harm

Effects of Cultural Practices

• Can influence the development of a sense of initiative • Parents and older siblings model language development

Enuresis (Bedwetting) (cont.)

• Child needs to be center of management program • Liquids should be limited after dinner • Child should void before going to bed • Treatment options - Counseling - Hypnosis - Behavior modification - Pharmacotherapy - Bladder training exercises to stretch and increase the bladder size

Discipline and Limit-Setting

• Children need limits for their behavior • Teach and gradually shift control from parents to child • Self-discipline or self-control • Timing the time-out - 1 minute per year of age, no interaction or eye contact during • Reward - Don't confuse with bribes - Encourage positive behavior • Consistency & modeling

Play and the Handicapped Child

• Cognitively disabled child needs more stimulation through play than the child who is not impaired • Consider mental and not chronological age • Play needs to be supervised due to poorer judgment and potential for aggressive behavior • Repetition of play experiences is necessary

The 4-Year-Old (cont.)

• Concept of death - Begin to wonder about death and dying - Realize others die, but do not relate death to themselves - Parents should reassure child that people do not generally die until they have lived a really long time - Parents should encourage questions as they appear and help the child accept the truth about death without fear

Language Development

• Delays or problems can be caused by - Physiological - Psychological - Environmental stressors • Includes both the understanding of language and the expressing of oneself in language

Daily Care

• Does not require extensive physical care but still needs to bathe each day and shampoo hair at least twice a week • Clothing should be loose enough to prevent restriction of movement, washable; sturdy and supportive shoes

Physical Development

• Doubles the 1-year-old weight by 5 years of age • Between 3 and 6 years of age, grows taller and loses chubbiness from toddler age • All 20 primary teeth have erupted • Has good control of muscles • Hand preference develops by 3 years of age • More adept at using old skills as each year passes

The 3-Year-Old

• Helpful and can assist in household chores • Temper tantrums less frequent • Better able to direct primitive instincts • Can help dress themselves, use the toilet, wash their hands, and eat independently • Talk in longer sentences • Able to express thoughts and ask questions

Nursing Tip

• Imaginary playmates are common and normal during the preschool period and serve many purposes, such as relief from loneliness, mastery of feats, and a "scapegoat"

Nursing Implications of Preschool Growth and Development (cont.)

• Important nursing assessment includes observing the child - What is the child's approach to play? - Does the child join in freely or linger outside the group? - Does the child prefer active or quiet activities? - Can the child talk with his or her playmates and convey ideas? - What type of attention span does the child have?

Thumb-sucking

• Instinctual behavioral pattern • Finger- or thumb-sucking will not have a detrimental effect on the teeth as long as the habit is discontinued before the permanent teeth erupt • The child who is trying to stop thumb-sucking is given praise and encouragement - May regress during periods of stress or fatigue

Spiritual Development

• Learn religious beliefs and practices at home • Cannot understand abstract concepts • In the hospitalized preschooler, observing religious traditions practiced in the home may be calming for the child

General Characteristics (cont.)

• Major tasks of preschool-age child - Preparation to enter school - Development of a cooperative-type play - Control of body functions - Acceptance of separation - Increase in communication skills - Memory - Attention span

The 4-Year-Old

• More aggressive • Eager to let others know they are superior • Pick on playmates • Boisterous, tattle on others • Can use scissors with success • Can tie their shoes

The 5-Year-Old

• More responsible • Enjoys doing what is expected of them • Have more patience • Tend to want to finish what they have started • Talk constantly • Inquisitive

Jealousy

• Normal response to actual, supposed, or threatened loss of affection • Jealousy of a new sibling strongest in children under 5 years • May revert to behaviors seen at an earlier age • May be aggressive, bite, or pinch • Tends to be seen less in an "only" child • Children should feel they are helping with the care of their sibling

Sexual Curiosity

• Nurses should use the following principles of teaching and learning common to other patients

Cognitive Development

• Piaget calls this preoperational phase - Has two phases •Preconceptual occurs in the 2- to 4-year-old child •Intuitive thought occurs in 5- to 7-year-old child - Increasing development of language and symbolic functioning - Egocentric, as they have difficulty seeing any point of view other than their own - Animism and artificialism

Cognitive Development (cont.)

• Piaget's intuitive thought stage - Occurs in the 4- to 7-year-old child - Prelogical thinking - Experience and logic are based on outside appearance - Distinct characteristic is centering •Tendency to concentrate on a single outstanding characteristic of an object and exclude other features

Development of Play

• Play activities increase in complexity • Enables child to experience multiple roles and emotional outlets • Appealing to child's magical thinking is best approach to communicating with a preschooler

The 5-Year-Old (cont.)

• Play games governed by rules • Less fearful of environment • Worries less profound • May begin losing deciduous teeth

The 3-Year-Old (cont.)

• Play in loosely associated groups • Highly imaginative play • Begin to lose interest in mother and prestige of the father begins • Develop romantic attachment to parent of opposite gender • Identify themselves with parent of same gender

General Characteristics

• Preschool child is age 3 to 5 years • Marked by - Slowing of physical growth - Mastering and refining of motor, social, and cognitive abilities

Sexual Curiosity (cont.)

• Preschool children are as matter-of-fact about sexual investigation as they are about any other leaning experience and are easily distracted by other activities • May be displayed in the form of masturbation - Considered harmless if the child is outgoing, sociable, and not preoccupied with the activity - Assure parents that this behavior is normal

Preschool School

• Preschool programs - Structured activities - Foster group cooperation - The development of coping skills • Child gains - Self-confidence - Positive self-esteem if in a good program

Enuresis (Bedwetting)

• Primary - The child has never been dry • Secondary - Bedwetting recurrence in a child who has been dry for a period of 1 year or more • More common in boys than girls • Organic causes - Urinary tract infection - Diabetes mellitus - Diabetes insipidus - Seizures - Obstructive uropathy - Abnormalities of urinary tract - Sleep disorders

Nursing Implications of Preschool Growth and Development

• Provide parental guidance concerning the changing behavior patterns of the preschool-age child • The use of time-outs and alternative methods of discipline should be stressed • • Hospitalization can be frightening - May perceive hospitalization as a form of punishment - Child may feel abandoned - Separation anxiety is manifested by •Stages of protest, despair, detachment, and regression to earlier behaviors

The 5-Year-Old (cont.)

• Should be encouraged to develop motor skills, such as hammering a nail • Should not be scorned for failure to meet adult standards • Must learn to do tasks themselves for the experience to be satisfying

Value of Play

• Should be noncompetitive • Helps the child adjust to an expanding world and increased independence

Play

• Therapeutic play - Retrain muscles - Improve eye-hand coordination - Help children to crawl and walk • Other types of play - Play therapy •Used when child is under stress - Art therapy •Child can express feelings and communicate with others through drawings

Enuresis (Bedwetting) (cont.)

• Treatment and nursing care • Data collection • Pattern of wetting • Number of times per night or week • Number of daytime voidings • Type of stream • • Dysuria • Amount of fluid taken between dinner and bedtime • Family history • Stress • Medications • Developmental landmarks, including toilet training

Play in Health and Illness

• Value of Play - Important to physical, mental, emotional, and social development - Increases communication with other children • The Nurse's Role - Important to include in the child's plan of care • Factors to consider - State of health - Overstimulation and fatigue - Diagnosis should be considered when choosing toys for the child

The 4-Year-Old (cont.)

• Vocabulary has increased to about 1500 words • Many feats done for a purpose • Begin to prefer playing with friends of same gender