Chapter 27 Growth & Development of Preschooler

What statement by parent cause be a hint for iron defiency?

"He loves milk and drinks it every time he is thirsty." This is likely to result in a very high intake of milk. Excess milk drinking may lead to iron deficiency since the calcium in milk blocks iron absorption. The nurse needs to emphasize this fact and suggest an appropriate daily milk intake.

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child?

"Look! I am a nurse, and I am helping people feel better!" Erikson's stage of initiative vs. guilt is prevalent in children between 3 and 6 years of age. This includes activities in which they act out the roles of other people (real or imaginary). Being competitive, learning sports and comparing skills are important in the industry vs. inferiority stage (6 to 12 years of age) as seen in a child comparing speed of running a race or playing a game. Staying true to a predefined set of values, such as not cheating in a game, would be typical of a child in the identity vs. role confusion stage (12 to 19 years of age).

Preschooler

3-6 yrs Physical growth continues much more slowly compared to earlier years. Gains in cognitive, language, and psychosocial development are substantial throughout the preschool period. Many tasks that began during the toddler years are mastered and perfected during the preschool years. The child has learned to tolerate separation from parents, has a longer attention span, and continues to learn skills that will lead to later success in the school-age period. Preparation for success in school continues during the preschool period because most children enter elementary school by the end of the preschool period. *Good at absorbing concepts

Best time to teach kids different languages?

A major step for the preschooler is the ability to learn extended language, which is achieved through cognitive development. For this reason, preschoolers exposed to more than one language or who live in a bilingual family have a unique opportunity to master two languages with relative ease. Learning additional languages can be accomplished at any age, but it tends to be more difficult when the person is already immersed in their primary language. Translations and pronunciations are harder. The preschooler is just learning all the words so there are no bad habits to break or translations to make.

Psychosocial Development

According to Erik Erikson, the psychosocial task of the preschool years is establishing a sense of initiative versus guilt Preschoolers feel a sense of accomplishment when succeeding in activities and feeling pride in one's accomplishment helps the child to use initiative. However, when the child extends himself or herself further than current capabilities allow, he or she may feel a sense of guilt

Preschoolers playing groups of 4 work better?

Although 4-year-olds continue to enjoy play groups, they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. This development, like so many others, may make parents worry a child is regressing. However, it is really forward movement, involving some testing and identification of their group role. Because 3-year-olds are capable of sharing, they play with other children their age much more agreeably than do toddlers, which makes the preschool period become a sensitive and critical time for socialization. The elementary rule that an odd number of children will have difficulty playing well together generally pertains to children at this age: two or four will play, but three or five will quarrel.

Toys for preschoolers

Blocks, simple jigsaw puzzles (four to six large pieces), pegboards, wooden bead with string • Supplies for creativity: chalk, large crayons, finger paint, Play-Doh or clay, washable markers, paper, paint and paintbrush, scissors, paste, or glue • Puppets, dress-up clothes, and props for dramatic play • Bucket, plastic shovel, and other containers for sand and water play • Play kitchen with accessories and pretend food (empty food boxes can be recycled for kitchen play) • Squeaking, floating, squirting toys for the bath • Sandbox with shovel and various toys for building • Dolls that can be dressed and undressed (large buttons, zippers, and snaps), doll care accessories (diapers, bottles, carriage, crib) • Gross motor toys: tricycle or big wheel (with helmet), jungle gym or swing set (with supervision), Hula-Hoop, tunnel, wagon • Blocks, Legos, cars and trucks, plastic animals, trains, plastic figures (family, community helpers), stuffed animals, balls, sewing cards • Tape or CD players for music, various musical instruments • Simple card and board games (older preschooler) • Dollhouse with furniture and accessories, people, and animals expensive toys that claim to teach the young child are not necessary. Toys that require interactive rather than passive play, and that may include the involvement of the parent, are recommended

Freud - Phallic stage Age: 3-7 years

Child's pleasure centers on genitalia and masturbation. Superego is developing, and conscience is emerging Oedipal stage occurs: jealousy and rivalry toward same-sex parent, with love of the opposite-sex parent. This usually resolves by the end of the preschool years, when the child develops a strong identification with the same-sex parent

gross motor preschool

Dressing and undressing without assistance is an expected motor skill in a 5-year-old. Four-year-olds should be able to use scissors without assistance. Hopping on one foot is an expected motor skill for a 4-year-old. Learning to skate and swim are normal motor skills for 5-year-olds.

Bedtime Routines

Establish a bedtime as well as morning wake-up time. • Avoid sugar or caffeine consumption in the evening. • Avoid stimulating activities such as roughhousing before bedtime. • Do not allow television watching in bed. • Make the child's bedroom an inviting and comfortable area of the home. • Provide a nightlight in the child's bedroom if he or she is afraid of the dark. • Conform to a nightly routine: • Television off at a certain time. • Bath. • Quiet game or story reading/telling. • Bedtime prayer or song. • Maintain quiet in the bedroom and nearby to increase the child's ability to fall asleep.

Physical Growth

Gains 4-5 lbs per year, Avg 3 year old is 32 lbs The loss of baby fat and the growth of muscle during the preschool years give the child a stronger and more mature appearance. The length of the skull also increases slightly, with the lower jaw becoming more pronounced. The upper jaw widens through the preschool years in preparation for the emergence of permanent teeth, usually starting around age 6.

Sensory Development

Hearing is intact at birth and should remain so throughout the preschool years. The senses of smell and touch continue to develop throughout the preschool years. The young preschooler may have a less discriminating sense of taste than the older child, putting him or her at increased risk for accidental ingestion. Visual acuity continues to progress and should be equal bilaterally. The typical 5-year-old has visual acuity of 20/40 or 20/30. Color Vision Intact

Physiologic Changes of PreSchooler

Heart rate decreases and blood pressure increases slightly during the preschool years. the musculoskeletal system is still not fully mature, making the preschooler susceptible to injury, particularly with overexertion or excess activity.

Communication

Initially, the child may exhibit dysfluency or stuttering. Speech may sound choppy, or the child may say repeated consonants or "um." Stuttering usually has its onset in the preschool years and will resolve in 80% of children by age 8 years (Carter & Feigelman, 2020). Parents should slow down their speech and should give the child time to speak without rushing or interrupting. Some sounds remain difficult for the preschooler to enunciate properly: "f," "v," "s," and "z" sounds are usually mastered by age 5 years, but some children do not master the sounds of "sh," "l," "th," and "r" until age 6 or later. 4 yrs Speaks in complete sentences using adult like grammar • Tells a story that is easy to follow • 75% of speech understood by others outside of family • Asks questions with "who," "how," "how many" • Stays on topic in a conversation • Understands the concepts of "same" and "different" • Asks many questions • Knows names of familiar animals • Names common objects in books and magazines • Knows at least one color • Uses language to engage in make-believe • Follows a three-part command • Can count a few numbers • Vocabulary of 1500 words 5yrs • Persons outside of the family can understand most of the child's speech • Explains how an item is used • Participates in long, detailed conversations • Talks about past, future, and imaginary events • Answers questions that use "why" and "when" • Can count to 10 • Recalls part of a story • Speech should be completely intelligible, even if the child has articulation difficulties • Speech is generally grammatically correct • Vocabulary of 2100 words • Says name and address

Piaget - Preoperational substage: preconceptual phase Age: 2-4 years

Learns through observing and imitating Displays animism- attributes life like qualities to inanimate objects Forms concepts that are not as complete or as logical as the adult's Is able to make simple classifications By age 4, understands the concept of opposites (hot/cold, soft/hard) Reasoning is that of specific to specific Has an active imagination

Eriksons- Initiative versus guilt Age: 3-6 years

Likes to please parents Begins to plan activities, make up games Initiates activities with others Acts out the roles of other people (real and imaginary) Develops sexual identity Develops conscience May take frustrations out on siblings Likes exploring new things Enjoys sports, shopping, cooking, working Feels remorse when makes wrong choice or behaves badly Cooperates with other children Negotiates solutions to conflicts

Teeth

Preschooler should have 20 deciduous teeth

Health Promotion Teaching

Preschoolers are becoming more independent and need to be allowed to pick out their own clothing, brush their teeth with adult supervision, and take care of their own toileting. If the child has an accident, treat it in a matter-of-fact manner and do not make a big deal out of it. Helmets are worn every time the child rides a bicycle, regardless of distance.

Emotional and Social Development

Preschoolers are developing a sense of identity. They recognize that they are boys or girls. They know that they belong to a particular family, community, or culture. They take pride in using self-control rather than giving in to their impulses. Establishing a few simple rules and enforcing them consistently gives preschoolers the structure and security they need while promoting moral development. Parents or caregivers can help the child give a name to the emotion that is being experienced. Fears are very real to preschoolers because of their active imaginations and may result in a variety of emotions. Parents should validate the feeling or emotion, then discuss with the child alternatives for dealing with the emotion Use simple answers for curiosity

Play

Preschoolers begin to play cooperatively with one another. Play may be focused around a distinct theme. They define roles, make up rules, and assign jobs. They are able to work together toward a common goal such as building a house or fort with discarded boxes. Cooperative play encourages the preschool child to learn to share, take turns and compromise, listen to others' opinions, consider the feelings of others, and use self-control and overcome fears. They may play house or school he preschooler should be limited to no more than 1 hour per day of quality television or other digital media programming (such as computer or iPad) Three-year-olds may not realize that they are pretending. They run from scary creatures, make plans, and pack their backpacks (never intending to actually leave). Four-year-olds are more sophisticated with dramatic or pretend play: they know they are pretending, and they use dress-up clothes and props to act out more complex roles and scenarios

Skipping & Standing on one foot for 10 secs are 5 yrs old tasks

Skipping and standing on one foot for up to 10 seconds are motor skills that are expected from a 5-year-old, not a 3-year-old; therefore, the best response is letting the mother know that her child is not behind in motor development. *Also, 5 yrs old should be able to state name and address

Nutritional Facts for preschoolers

The 3- to 5-year-old requires 700 to 1000 mg calcium. Allowing preschoolers controlled choices of foods fosters good eating habits as the child grows. Fruit juice should be limited to 4 to 6 ounces per day, as excess consumption can lead to excess weight gain and dental caries due to the sugar content. Nutrient-poor, high-calorie foods such as sweets and typical fast foods should be offered only in limited amounts.

Fine Motor Skills

The 3-year-old can move each finger independently and is capable of grasping utensils and crayons in adult fashion, with the thumb on one side and the fingers on the other. He or she can also scribble freely, copy a circle, trace a square, and feed himself or herself without spilling much. These skills become refined over the next 2 years, and by 5 years of age, the child can write letters, cut with scissors more accurately, and tie shoelaces

Pre School Anxiety?

The nurse is observing a 4-year-old child in the play room of the medical unit of the hospital. The child uses the toy medical equipment and proceeds to change the bandage on a doll, pretends to give the doll medication, and talks elaborately to the doll. How does the nurse accurately interpret this play Preschool-aged children often use dramatic play to express anxiety, try out negative feelings, or conquer their fears. This child, at 4 years of age, is demonstrating behavior that is developmentally appropriate. Parallel play involves children playing adjacent to each other but not engaging in interaction or affecting each other's play. Pretend play, such as acting like the pediatrician, is more common among toddlers.

Child Says clock smiles at him?

The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child.

Nutrition for preschoolers

The preschool period is not a time of rapid growth, so children do not need large quantities of food. Protein needs are high to provide for muscle growth. Portions are smaller than adult-sized portions, so the child may need to have meals supplemented with nutritious snacks. The preschool child needs 2 to 3 cups of milk each day.

Slow Growth during preschool years

The preschool period is one of slow growth. The child gains about 3 to 5 lb each year (1.4 to 2.3 kg) and grows about 2.5 inches (6.3 cm). The child's weight is above the expected gain and the height is what would be expected. The average preschool child will grow 2.5 to 3 inches (6.35 to 7.62 cm) per year. Thus, the nurse would expect that the child's height would have increased 2.5 to 3 inches (6.35 to 7.62 cm) since last year's well-child examination.

Friendships

The preschooler is more likely to agree to rules and wants to please friends and be like them. The preschooler loves to sing, dance, and act and will enjoy these activities with friends. Are important to pre schoolers

Piaget - Preoperational substage: intuitive phase Age: 4-7 years

Tolerates others' differences but does not understand them Is very curious about facts Knows acceptable cultural rules Uses words appropriately but often without true understanding of their meaning Has a more realistic sense of causality May begin to question parents' values

Pre Schoolers thoughts

Transduction. Because the 4-year-old recently received an injection from a nurse in a flowered uniform, the girl believes that all nurses who wear flowered uniforms give shots. Transduction is reasoning by viewing one situation as the basis for another situation even though the two may or may not be causally linked. Magical thinking involves believing that one's thoughts are all-powerful. Animism is attributing life-like characteristics to inanimate objects. Empathy is the understanding of others' feelings.

Enhancing Family Function

Use puppets or dramatic play with the child to elicit the preschooler's feelings about the current situation. Encourage family visitation and provide for sleeping arrangements for a parent or caregiver to stay in the hospital with the preschooler; this contributes to family's sense of control in the situation. Involve family members in preschooler's care, giving them a feeling of control and connectedness. A sense of guilt will contribute to low self-esteem, whereas a child who is rewarded for his or her initiative will have increased self-confidence. The parent who provides a loving and nurturing environment for the preschooler builds upon the earlier foundation.

4 yr old cant throw ball?

While at 4 years of age a child typically cannot throw a ball overhand, they are developmentally able to throw a ball by other means, such as underhand or side-handed. It is necessary to address this as a possible developmental delay and be sure the pediatrician is aware of the issue.

Promoting Appropriate Growth PreSchooler

rovide only nutrient-rich foods without high sugar content for meals and snacks; even if the preschooler is a picky eater, it is inappropriate to provide high-calorie junk food just so the child eats something. Teach parents to role model appropriate eating (nutrient-rich, varied diet) to encourage child to try/accept new foods, as well as become familiar with a variety of foods. Severely limit the intake of fast foods and foods with high sugar and fat content to decrease intake of nutrient-poor, high-calorie foods. Ensure adequate physical activity to stimulate development of motor skills and provide appropriate caloric expenditure. This also sets the stage for forming the life-long habit of appropriate physical activity. Teach parents to limit entertainment screen time to 1 hour per day to encourage participation in physical activities.

Cognitive Development Piaget

the preschool-age child continues in the preoperational stage. Preoperational thought dominates during this stage and is based on a self-centered understanding of the world. In the preconceptual phase of preoperational thought, the child remains egocentric and is able to approach a problem from a single point of view only. The young preschooler may understand the concept of counting and begins to engage in fantasy play. The preschooler often has an imaginary friend as well and have magical thinking