Pediatrics Chapter 18

If a parent says "He never made those funny baby sounds or said 'mama' and 'dada,' and now he just repeats anything I say." then what should this be classified as?

Language disorder

If a parent says "He used to say things like 'Joey go bye-bye,' but now he doesn't talk at all." then what should this be classified as?

Language loss

What are some examples of suitable toys for the preschool child to play with?

Large construction sets Number or alphabet games Crayons Play tools Housekeeping toys Musical toys Pop-up books large puzzles Clay

Preconceptual Stage

One half of the preoperational phase (2 to 4 year olds). In this stage there is a increasing development of language and symbolic functioning

What can cause problems in language expression?

Physiological, psychological or environmental stressors

time-out

A period in a safe place that helps the child to develop the ability to tolerate delayed gratification and self-regulation. Timing should not begin until the child has settled down. Timing is usually based on 1 minute per year of age.

What are some characteristics of language development in the preschool child?

*1.* Between 2-5 the number of words in the child's sentence should equal their age *2.* By 4 they can use past tense *3.* By 5 they can use the future tense

What are the major tasks of the preschool child?

*1.*Preparation to enter school *2.*Development of a cooperative type of play *3.*Control of body functions *4.*Acceptance of separation *5.*Increase in communication skills, memory and attention span

When is thumb sucking typically seen on a sonogram?

29th week of embryonic life

What is visual acuity in the 3 year old? 4 year old? When might they reach 20/20 vision?

3 - 20/40 4 - 20/30 May reach 20/20 by school age

How much height is gained between 3 and 5 years of age?

3 inches

What is the age range for the preschool child and what Erikson stage are they in?

3-5; Erikson's stage is initiative vs guilt

Modeling

A good example. Adult models influence a child's education. Children identify and imitate adult behavior, both verbal and nonverbal. Parents who are aggressive and repeatedly lose control demonstrate the power of action over words.

Animism

A tendency to attribute life to inanimate objects

Egocentrism

A type of thinking in which children have difficulty seeing any point of view other than their own

How many of the primary teeth should be erupted by 3 years of age?

All 20

What are some misconceptions that can arise due to a child's knowledge and understanding being restricted?

Animism Artificialism

What benefits does nonnutritive sucking in the form of thumb sucking or use of a pacifier have in the first year of life when the infant is in the oral stage of development?

Increased weight gain Decreased crying Development of self-consoling ability Increased behavioral organization

If a parent says "I'm the only one who understands what she says." what should this be classified as?

Articulation disorder

What is the development of play for the preschool child?

At 2-3 years old they imitate the activities of parents (hammering, shaving, feeding the doll) At 4 years old they develop broader themes such as a trip to the zoo At 5 years old a trip to the moon demonstrates the child's imaginary abilities

When does hand preference (left or right handed) develop?

At 3

Enuresis

Involuntary urination after the age at which bladder control should have been established

Why do preschool children have more fears than the infant or older child?

Because of increased intelligence ( which enables them to recognize potential dangers), memory development, and graded independence (which brings them into contact with many new situations)

When does finger or thumb sucking need to be stopped?

Before the permanent teeth erupt

Preschool Growth and Development for 5 year old: Intelligence

Beginning concept of past, present, and future, although time is evidenced in activity rather than hours Knows the days of the week Attention span reaches 30 minutes Can count to 10 Knows name and address Behaviors that result in rewards are considered right; behaviors that result in punishment are considered wrong

How is separation anxiety manifested?

By the stages of protest, despair, detachment and regression.

Preschool Growth and Development for 5 year old: Emotional Aspects

Is less egocentric and has beginning awareness of the outside world Enjoys activities with parent of the same sex

Preschool Growth and Development for 4 year old: Intelligence

Can count to 5 Knows simple songs Sexual curiosity is high Has attention span of 20 minutes Adds logic to thinking Understands that feelings are connected to actions

What is a distinctive characteristic of intuitive thinking?

Centering (concentrating on a single outstanding characteristic of an object while excluding its other features)

Preschool Growth and Development for 5 year old: Parental Guidance

Child can participate in own care Teach front to back wiping after bowel movements Provide information concerning vision and hearing assessment facilities in community Review immunization status Prepare parent for separation and entrance of child into school

Preschool Growth and Development for 3 year old: Parental Guidance

Child usually wants to please parents Guidance techniques are based on this principle Overprotection during this stage of initiative can frustrate the development of a coping mechanism in the child Having the child "help" the parent will enhance self esteem

What can be done if a child does not respond to routine management for enuresis?

Counseling, hypnosis, behavior modification, pharmacotherapy Moisture activated conditioning devices that have a alarm that rings when the child is wet. Bladder training exercises

What is involved in the intuitive stage?

It is one of prelogical thinking. Experience and logic are based on outside appearance (the child does not understand that a wide glass and a tall glass can both contain 4 oz of juice)

What do children have difficulty expressing themselves often exhibit?

Development of language skills includes both the understanding of language and the expressing of oneself in language. If they have difficulty expressing themselves in words they often exhibit tantrums and other acting out behaviors

What is the most common type of bed wetting?

Diurnal (daytime wetting) is less common than nocturnal (nighttime wetting) More common in boys than girls

Preschool Growth and Development for 4 year old: Play

Engages in rough and tumble play Learns how much he or she can control Demonstrates sibling rivalry

What type of toys does the four year old like?

Enjoys simple toys and common objects. Raw materials are more appealing than toys that are ready made and complete in themselves. An old cardboard box that can be moved about and climbed into is more fun than a dollhouse with tiny furniture.

If a parents says "She'll do what I say, but when she wants something, she just points." what should this be classified as?

Expressive language delay

What are some fears the preschooler has?

Fear of bodily harm such as the loss of body parts. Fear of animals Fear of the dark Fear of strangers

Preschool Growth and Development for 3 year old: Emotional Aspects

Freud's phallic stage Oedipus complex may develop in boys Erikson's stage of initiative vs. guilt Wishes to please parents Ritualism provides security Egocentric (unable to see viewpoint of others)

How can preschoolers who are going to be given a shot be calmed down?

Give pretend shots to their doll and have a parent comfort the doll. The child cannot yet understand detailed explanations even if verbal ability is high.

If a parents says "He can't play 'show me your nose,' and the only word he says is mama." then what should this be classified as?

Global language delay

Preschool Growth and Development for 4 year old: Language

Has vocabulary of 1500 words Uses four to five word sentences Experiments with language and words May use offensive words without understanding the meaning

Preschool Growth and Development for 5 year old: Language

Has vocabulary of 2000 words Can name four colors Uses six to eight word sentences with pronouns

Preschool Growth and Development for 3 year old: Language

Has vocabulary of 300-800 words Uses plurals Forms three word sentences Can repeat three numbers Understanding occurs before expressive ability

How is jealousy expressed by the preschool child?

Jealousy of a new sibling is strongest in those less than 5 years old. Children may be aggressive and may bite or pinch or they may be rather discreet and may hug and kiss the infant with a determined look on their faces. They may attempt to identify with the infant. They revert to wetting the bed or want to be powdered after they urinate. They may become jealous of the attention their mom gives to their dad.

How much weight should be gained between 1 year and 5 years old?

If the infant tripled their birth weight at 1 year then they should have doubled their 1 year weight by the age of 5.

What is a drug that has been found to decrease enuresis?

Imipramine hydrochloride (Tofranil). It is given before bedtime. Not recommended for those less than 6 years old.

Preschool Growth and Development for 3 year old: Play

Kohlberg: beginning moral development Identifies with same sex parent Develops understanding of good/bad Explains different emotions in pretend play Starts to engage in group play Is highly imaginative

Look over table 18-2 on page 423

Look over table 18-2 on page 423

Preschool Growth and Development for 4 year old: Emotional Aspects

May use tantrums to relieve frustrations and, if successful, these may become a coping mechanism Has mood swings Is highly imaginative Asks many questions Likes to "show off" accomplishments Experiments with masturbation

Preschool Growth and Development for 4 year old: Parental Guidance

Minimize passive activity, such as doing puzzles, for the child Repetition of words without comprehension; should be referred for follow up care Teach self control through setting limits Guide parent in discipline techniques Provide nutritious snacks Answer questions truthfully

What are some side effects of Tofranil?

Mood and sleep disturbances and gastrointestinal upsets. Overdose can lead to cardiac dysrhythmias.

What are some of the things play enables the child to experience?

Multiple roles and emotional outlets such as the aggressor, the victim, the superpower, or the acquisition of toys or friends they desire. Appealing to the child's magical thinking is the best approach to communication.

Preschool Growth and Development for 3 year old: Intelligence

Piaget's preoperational phase Understands time in relation to concrete activities Knows own sex Has attention span of 15 minutes; is easily distracted

Therapeutic Play

Play that is of therapeutic value in retraining muscles, improving eye-hand coordination, and helping children crawl and walk (push-pull toys).

Associative Play

Playing in loosely associated groups

Parallel Play

Playing independently within a group

What two stages is the preoperational phase divided into?

Preconceptual Stage (2-4 year olds) Intuitive Thought Stage (4-7 year olds)

What is the difference between primary enuresis and secondary enuresis?

Primary refers to bed wetting in the child who has never been dry. Secondary refers to a recurrence in a child who has been dry for a period of 1 year or more.

What are normal vitals for the preschool child?

Pulse 90-110 RR 20/min BP 85-90/60

Echolalia

Repetition of words without comprehension

How does rewarding the child help them?

Rewarding them for good behavior is a positive and effective method of discipline. This can be done with hugs, smiles, tone of voice, and praise.

Symbolic Functioning

Seen in the play of children who pretend that an empty box is a fort; they create a mental image to stand for something that is not there

Why do children need limits for their behavior?

Setting limits makes them feel secure, protects them from danger and relieves them from making decisions that they may be too young to formulate. Children taught acceptable behavior may have more friends and develop good self esteem.

What is involved in active play for the preschooler?

Simple climbing, sliding and running activities. Imaginary friends are common and serve as relief from loneliness, mastery of feats and provision of a scapegoat.

What marks the period of the preschool child that enables them to be successful in their school years?

Slowing of the physical growth process, and mastery and refinement of the motor, social, and cognitive abilities

What are some characteristics of a 3 year old's attitude?

Temper tantrums are less frequent and they are less eratic. They seem better able to direct their primitive instincts than before. They can help dress and undress themselves, use the toilet and wash their hands. They eat independently and their table manners have improved. They do parallel play and associative play

Artificialism

The idea that people created the world and everything in it

What should be considered when selecting toys for a child with a neurodevelopmental, sensory or mental disorder?

The nurse must consider the mental age and motor ability of the child rather than the chronological age. Objects should be bright and colorful. They should be different sizes and textures.

Centering

The tendency to concentrate on a single outstanding characteristic of an object while excluding its other features

What is the 3 and 4 year olds concept of death?

The view of the family is important to the interpretation of this complex phenomenon. Their questions about death are direct. They usually realize others die but don't relate death to themselves. Parents should encourage questions as they appear and gradually help them accept the truth without undue fear.

What are some physical traits of the five year old?

Their height may increase by 2 to 3 inches Weight may increase by 3 to 6 lbs They begin to lose deciduous teeth They can run and play games simultaneously, jump three or four steps at once, and distinguish a penny from a nickel or a dime. They can name the days of the week and understand what a weeklong vacation is.

Art Therapy

Therapy where feelings are expressed and communication is done through drawing, clay and other media

What are some characteristics of the four year old?

They are aggressive, like to let others know they are superior and they are prone to pick on playmates. They are boisterous, tattle on others, may swear if they are around children or adults who use profanity. Can recount personal family activities but forget where they left a tricycle They are interested in how old they are and their classmate ages, it bolsters their ego to know they are older than others. Vocabulary increases to 1500 words

What are some characteristics of the five year old?

They are more responsible, enjoy doing what is expected of them, have more patience and like to finish what they have started. They are serious about what they can and can't do. They talk constantly and are inquisitive about their environment. They can play games governed by rules. They are less fearful, because they believe that authorities control their environment.

How do preschoolers view mom and dad?

They begin to find enjoyment away from them but want them close when needed. Lose some interest in mom and the dad's prestige increases. A daughter may want to marry daddy. They begin to identify themselves with the parent of the same sex.

What are some of the unpleasant social behaviors of the preschool child that is normal and necessary to their total pattern of development?

They get angry when others attempt to take their possessions. They grab, slap, and hang onto them for dear life. They become very distraught if toys don't work like they should. They resent being disturbed from play. They are sensitive and their feelings are easily hurt.

Can three year olds play cooperatively?

They will for short periods. They can ask others to come out and play however if they are placed in a strange situation with children they don't know then they commonly revert back to parallel play because it is more comfortable.

What is usually involved in giving a child a time out?

Timing is usually based on 1 minute per year of age. Done with the child in a straight chair facing a corner. There should be no interaction or eye contact during the time out period and a timer with a buzzer should be used to signal the end. If a child attempts interaction during time out time then they should learn that any interaction restarts the timer at zero. Time-out should be preceded by a short (no longer than 10 word) explanation of the reason and followed by a short (no more than 10 words) restatement of why it was necessary.

What are some organic causes of nocturnal enuresis?

UTIs Diabetes mellitus Diabetes insipidus Seizure disorders Obstructive uropathy Abnormalities of the urinary tract Sleep disorders

Play Therapy

Used for children under stress. It is a form of counseling or psychotherapy in which play is used as means of helping children express or communicate their feelings.

Preschool Growth and Development for 5 year old: Play

Wants to play "by the rules" but cannot accept losing Can copy sample shapes and print first name Establishes preference for hand use

Should the play of preschool children be competitive?

no

Preoperational phase

the second stage in Piaget's theory of cognitive development. This stage begins around age two and last until approximately age seven. During this stage, the child learns to use the symbols of language.