Chapter 27Growth and Development of the Preschooler

The nurse is providing teaching about preventing poisoning. Which statement by the parent would warrant further discussion? "I never transfer cleaning products out of their original containers." "All medicine in our bathroom is in childproof containers." "We have the poison control number located near our phone." "We keep our lawn and garden products on a high shelf in the garage."

"All medicine in our bathroom is in childproof containers." The nurse should emphasize that while childproof caps on medications are important, all medications including those with childproof caps should still be kept locked. (Vitamins are medications.)

The nurse is conducting a well-child exam of a 4-year-old child. Which statement would alert the nurse that the child is at risk for iron deficiency? "He eats a well-balanced diet." "He does not like spinach, but he does like chicken and beef." "He loves milk and drinks it every time he is thirsty." "He enjoys eggs and fortified cereal for breakfast."

"He loves milk and drinks it every time he is thirsty." Calcium in milk consumed in large quantities can block iron absorption.

The parent of a 4½-year-old boy has contacted the nurse because he is concerned that his son is frequently touching his genitals. The nurse explains that this is normal during the preschool years. Which statement by the parent would indicate a need for further teaching? "This is probably a good time to talk about safety and who can touch him." "I have heard that both boys and girls often touch themselves at this age." "I will need to find an appropriate punishment for him if this continues." "I should teach him certain rules about this activity."

"I will need to find an appropriate punishment for him if this continues."

Respiratory (Physiologic Changes)

-Alveoli increase in number -Airways increase in size

The nurse is conducting a physical examination of a young preschooler and detects the odor of tobacco smoke on the parents' hair and clothing. How should the nurse respond? "You should stop smoking around your child." "Are you aware that exposure to tobacco smoke can be associated with behavioral difficulties?" "Tell me about your child's exposure to tobacco smoke." "Tobacco smoke is linked with an increased number of ear infections."

"Tell me about your child's exposure to tobacco smoke."

The parents of a 5-year-old child are discussing bicycle safety with the nurse. What comment indicates further teaching is needed? "We just got him a new bike he can grow into." "He never rides in the street." "He is able to ride without training wheels." "Our son always wears a helmet."

"We just got him a new bike he can grow into." The bicycle should fit the rider. The balls of his feet should reach both pedals while he is sitting on the seat and has both hands on the handlebars

Preschool Social skills:

-Cooperation -Sharing (of things and feelings) -Kindness -Generosity -Affection display -Conversation -Expression of feelings -Helping others -Making friends

HEENT (Physiologic Changes)

-Eustachian tubes remain short and straight -20 deciduous teeth should be present

Preschool Fears

-Exhibit variety of fears -Parents should acknowledge child's fears

Building Healthy Eating Habits

*Often erratic eaters!* -Small portions on smaller-sized plates and bowls with appropriately-sized utensils. -Encourage child to serve self. -Allow child to decide when to stop eating (don't force food). -Snacks should be high quality (lean proteins, whole grain, fruits, veggies, dairy). -Family meal times allow parents to model appropriate behaviors at meals and facilitate communication.

Cardiovascular (Physiologic Changes)

-Heart rate decreases -Blood pressure increases slightly -Innocent heart murmur may be heard

Consequences of childhood obesity include:

-Hypertension -Hyperlipidemia -Insulin resistance

Preschool Temperament

-Influenced by parent's expectation of child's behavior -Determines child's task orientation, social flexibility, and reactivity.

Potential Nursing Diagnoses for preschooler

-Risk for injury (or falls, poisoning, trauma) -Imbalanced nutrition, less than body requirements -Risk for delayed development -Risk for overweight -Interrupted family processes -Readiness for enhanced parenting -Risk for caregiver role strain

A parent describes the 4-year-old child's eating habits as "picky" and goes on to describe using, coaxing, and threatening measures to get the child to eat. The nurse determines the child is growing normally. What interventions will the nurse suggest? (Select all that apply.) A. Ignore the pickiness. B. Offer a variety of healthy foods including those liked and refused. C. Allow the child to decide how much the child will eat. D. Approach mealtime matter-of-factly. E. Offer only nutritious between-meal snacks. F. Focus on quality, not quantity.

All of the above.

Parents say they have been using measures to lessen the struggle of getting their preschooler to bed at night and to sleep. Which practice will the nurse suggest they discontinue? Eliminating caffeine sources beginning late afternoon. Taking the TV set out of the child's room. Allowing the preschooler to fall asleep wherever and whenever the child is tired enough. Providing a nightlight.

Allowing the preschooler to fall asleep wherever and whenever the child is tired enough. Consistent bedtimes and places for sleep promote good sleep habits.

The nurse is organizing an indoor play area for preschoolers. What play materials are least important? Balls, blocks, and puzzles Electronic teaching toys Cut, paste, drawing, and painting materials Dress-up clothes and hats and puppets

Electronic teaching toys

A 4-year-old child has begun stuttering. Which practice by the parents will the nurse discourage? Giving the child opportunity to speak and finish ideas. Asking the child to slow down and to think before talking. Enunciating clearly and slowing down parental speech. Looking at the child while the child is speaking.

Asking the child to slow down and to think before talking. Calling attention to the dysfluency often exacerbates it.

Animism

Attributes life-like qualities to inanimate objects.

Preschooler height

Average increase of 2.5 to 3 in per year

Preschooler weight

Average increase of 5 lb per year

The nurse realizes that the 5-year-old's growth chart and BMI indicate the child is at risk for obesity. What other findings reinforce this risk? (Select all that apply.) A. Fast food eaten once a month B. A parent who is overweight C. Food used as reward or punishment D. Expectations to eat everything on plate E. Television on during meals F. Mealtimes organized and regular

B, C, D, E

Magical thinking

Believes thoughts are all-powerful.

Imaginary friend

Creative way to sample activities/behaviors and practice conversation skills.

Signs of Developmental Delay 5yrs

Doesn't have interest in playing with other children, cant build tower of 6 to 8 blocks, cannot use plurals or past tense, easily distracted and cannot concentrate on single activity for more than 5 mins.

Transduction

Extrapolates from one situation to another.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize: Adults learning infant/child cardiopulmonary resuscitation (CPR). Having the child wear a personal flotation device whenever near or on the water. Enrolling the child in swimming lessons. Using and renewing sunscreen regularly.

Having the child wear a personal flotation device whenever near or on the water. Wearing a personal flotation device adds additional protection and should be as routine as "buckling up" in the car.

Parents tell the nurse their 3½-year-old refuses to eat meat but are pleased the child drinks "lots of milk." What risk does the nurse identify?

Iron deficiency. Calcium in milk consumed in large quantities can block iron absorption.

Overweight preschooler

Is defined as BMI at or above the 85th percentile and below the 95th percentile for age and sex.

Obesity preschooler

Is defined as BMI greater than the 95th percentile for age and sex.

Preschool Friendships

Learn how to make and keep a friend.

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium? Banana Apple Orange Peach

Orange A medium orange contains 50 mg of calcium and is a good nondairy choice.

Freud Preschooler

Phallic stage (3 to 7 years)

Piaget Preschooler

Preoperational substages: preconceptual (2 to 4 years) and intuitive phases (4 to 7 years)

Kohlberg Preschooler

Punishment-obedience orientation (2 to 7 years)

Communication Skills 4 yrs

Speaks in complete sentence with adult like grammar, follows 3 part command, names common objects and familiar animals, vocab of 1,500 words.

A male child exhibits the following growth pattern. How should the nurse interpret these data? 3 yrs: Ht. 37 in Wt. 32 lb 4 yrs: Ht. 39 in Wt. 39 lb 5 yrs: Ht. 40 in Wt. 46 lb

The child is growing slowly in height but rapidly in weight. The child should grow about 2½ to 3 in and gain around 5 lb yearly.

In counseling a group of parents regarding the development of school readiness in preschoolers, the nurse emphasizes:

The home environment. The home environment is the foundation for the child's learning and is the most important element for developing school readiness.

True/False Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption.

True.

Is the following statement true or false? The nurse should recommend that parents of a 3- to 5-year-old receive 700 to 1,000 mg calcium and 7 to 10 mg iron daily.

True. The preschool child needs 700 to 1,000 mg calcium and 7 to 10 mg iron daily. Rationale: Preschool children need 700 to 1,000 mg calcium and 7 to 10 mg iron daily. Parents should be aware that drinking excess amounts of milk may lead to iron deficiency as the calcium in milk blocks iron absorption.

Genitourinary (Physiologic Changes)

Urethra remains short in children, making them susceptible to urinary tract infections.

The nurse is doing a well-child exam of a 5½-year-old child. Which statement by the parent would alert the nurse that further teaching is needed about healthy eating habits? "I try to set a good example and eat a variety of fruits and vegetables." "Our family rule is that all children clean up their plates at each meal, and we feed them a lot." "We eat fast food less than once a month." "My child enjoys planning meals and helping me in the kitchen."

"Our family rule is that all children clean up their plates at each meal, and we feed them a lot." Children should not be expected to always eat everything on their plates, nor should they be rewarded for doing so.

Developmental Issues and Concerns

-Sleep -Nightmares vs. night terrors -Discipline -Lying -Sex education -Masturbation

Neurologic (Physiologic Changes)

-Spinal cord myelinated by age 3 -Allows for bowel and bladder control to be achieved

____ minute per year of age is the appropriate length of a time-out.

1. 5mins max.

Daily Nutritional Requirements of the Preschooler

700 to 1,000 mg calcium 10 mg iron 19 mg fiber Fat intake no less than 10% and no more than 35% daily calories Saturated fats less than 10% Diet high in nutrient-rich foods Limited amounts of poor, high-calorie foods

The nurse is providing teaching about car seat safety for a parents' meeting at the preschool their children attend. Choose the points the nurse should make. (Select all that apply.) A. The back seat remains the safest place for children to ride. B. Children large enough for a front-facing care seat with a harness for as long as possible. C. Booster seats should be used with both a shoulder and lap belt. D. Children who weigh less than 40lb should use a rear-facing car seat. E. Many car seats are installed improperly, making them unsafe.

All of the above.

Parents ask for disciplinary guidance for their 4-year-old. The nurse suggests which of these actions? (Select all that apply.) A. When discussing improper behavior, call the behavior "bad" or "naughty," not the child. B. A time-out of about 8 minutes would be appropriate for intentional misbehavior. C. Books and stories can help preschoolers master proper behavior. D. Anticipate situations likely to cause misbehavior and redirect the child to another activity. E. Spank with an open hand only and never with an object.

A, C, D

In assessing the bilingual 4-year-old's speech and language development, the nurse should find that the child will: Be able to use each language as a separate system. Avoid asking questions. Mix the two languages in the same sentence. Be prone to stuttering.

Be able to use each language as a separate system. The ability to use both languages separately is developed by 4 years. Mixing the two languages occurs during toddlerhood.

Musculoskeletal (Physiologic Changes)

Bones increase in length and muscles strengthen and mature.

Communication Skills 5 yrs

Can explain how to use something, talks about past, future and imaginary events, answers why and when questions, vocab of 2,100 words.

Signs of Developmental Delay 4yrs

Cannot jump in place or ride a tricycle, doesn't grasp crayon with thumb and fingers, cant use the words me and you appropriately, doesn't engage in fantasy play.

Erikson Preschooler

Initiative versus guilt (3 to 6 years).

The nurse is caring for a 4-year-old child following an appendectomy. The child becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the child says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of: Animism. Transduction. Beginning empathy. Magical thinking.

Transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the child believes that all nurses who wear flowered uniforms give shots.

The parents of a 5-year-old call the nurse for advice about night terrors. The child has had them nightly for almost 2 weeks. What is the most appropriate intervention?

Wake the child up nightly 30 to 45 minutes after going to sleep. Awakening children early in their sleep cycle often interrupts the night terror events and should be continued nightly for about 7 days.

The nurse is assessing a 3-year-old for gross motor skill development. Which of the following would the nurse expect this preschooler to have accomplished? a. bend over without falling b. standing on one foot for 10 seconds c. skipping d. swimming

a.bend over without falling. The 3-year-old should be able to bend over without falling. Rationale: At age 4, the preschooler hops on one foot and stands on one foot up to 5 seconds. At 5 years old the preschooler stands on one foot for 10 seconds, may skip, and may learn to skate and swim.

The nurse is assessing a 5-year-old child for signs of developmental delay. Which of the following would alert the nurse to a potential problem? a. the child can build a tower of six blocks b. the child does not play with other children c. the child engages in fantasy play d. the child separates from parent easily

b. the child does not play with other children. This is a sign of a potential developmental delay. Rationale: Signs of developmental delay in preschool-age children include not playing with other children, not being able to build a block tower of six to eight blocks, not engaging in fantasy play, and not separating from the parent without major protest.

The parents of a 6-year-old tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable responses by the nurse? (Select all that apply.) A. "There are rental agencies that rent these type of devices. Would that be a possibility financially?" B. "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." C. "I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." D. "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and Play-Doh? These are the types of toys suggested for preschoolers." E. "Could you possibly save a little money each paycheck in order to be able to purchase such items."

B, C, D