chapter 018 lo

Chapter 18Chapter 18

The Preschool ChildThe Preschool Child

ObjectivesObjectives

• List the major developmental tasks of the preschool-age child.

• Describe the physical, psychosocial, and spiritual development of children from age 3 to 5 years, listing age-specific events and guidance when appropriate.

• Discuss the development of positive bedtime habits.

2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Objectives Objectives (cont.)(cont.)

• Discuss one method of introducing the concept of death to a preschool child.

• Describe the development of the preschool child in relation to Piaget’s, Erikson’s, and Kohlberg’s theories of development.

• Discuss the characteristics of a good preschool.

• Discuss the value of play in the life of a preschool child.



• Designate two toys suitable for the preschool child, and provide the rationale for each choice.

• Describe the speech development of the preschool child.

• Discuss the value of the following: time-out periods, consistency, role modeling, rewards.



• Discuss the approach to problems such as enuresis, thumb-sucking, and sexual curiosity in the preschool child.

• Describe the developmental characteristics that predispose the preschool child to certain accidents, and suggest methods of prevention for each type of accident.

• Explain the use of therapeutic play with a handicapped child.


General CharacteristicsGeneral Characteristics

• Preschool child is age 3 to 5 years

• Marked by – Slowing of physical growth– Mastering and refining of motor, social, and

cognitive abilities


General Characteristics General Characteristics (cont.)(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


Physical DevelopmentPhysical 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


Cognitive DevelopmentCognitive 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 Cognitive Development (cont.)(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 centeringcentering– Tendency to concentrate on a single

outstanding characteristic of an object and exclude other features


Effects of Cultural PracticesEffects of Cultural Practices

• Can influence the development of a sense of initiative

• Parents and older siblings model language development


Language DevelopmentLanguage 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


Not Talking: A Clinical Not Talking: A Clinical ClassificationClassification


WHEN PARENTS SAY CLASSIFY THE SYMPTOMS AS

“I’m the only one who understands what she says.”

Articulation disorder

“She’ll do what I say, but when she wants something, she just points.”

Expressive language delay

“He can’t play ‘show me your nose,’ and the only word he says is ‘mama’.”

Global language delay

“He never made those funny baby sounds or said ‘mama’ and ‘dada,’ and now he just repeats everything I say.”

Language disorder

“He used to say things like ‘Joey go bye-bye,’ but now he doesn’t talk at all.”

Language loss

Development of PlayDevelopment 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


Spiritual DevelopmentSpiritual 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


Sexual CuriositySexual Curiosity

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


Sexual Curiosity Sexual Curiosity (cont.)(cont.)

• Assess knowledge base of child

• Assess what specific information the child is seeking

• Be honest and accurate

• Use correct terminology

• Provide sex education at the time the child asks the questions

• Parents must understand that sexual curiosity starts as an inquiry into anatomical differences


Sexual Curiosity Sexual Curiosity (cont.)(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


Physical, Mental, Emotional, and Physical, Mental, Emotional, and Social DevelopmentSocial Development


The 3-Year-OldThe 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


The 3-Year-Old The 3-Year-Old (cont.)(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

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21


• 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



• 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



• Vocabulary has increased to about 1500 words

• Many feats done for a purpose

• Begin to prefer playing with friends of same gender



• 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



• More responsible

• Enjoys doing what is expected of them

• Have more patience

• Tend to want to finish what they have started

• Talk constantly

• Inquisitive



• Play games governed by rules

• Less fearful of environment

• Worries less profound

• May begin losing deciduous teeth



• 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


GuidanceGuidance


Discipline and Limit-SettingDiscipline 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 and modeling


JealousyJealousy

• 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


Thumb-suckingThumb-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


Enuresis (Bedwetting)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


Enuresis (Bedwetting) Enuresis (Bedwetting) (cont.)(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


Enuresis (Bedwetting) Enuresis (Bedwetting) (cont.)(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


Nursery SchoolNursery 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


Daily CareDaily 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


Accident PreventionAccident 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


Play in Health and IllnessPlay 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


Value of PlayValue of Play

• Should be noncompetitive

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


Nursing TipNursing 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”


Play and the Handicapped ChildPlay and the Handicapped Child

• Mentally 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


Play 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


Nursing Implications of Preschool Nursing Implications of Preschool Growth and DevelopmentGrowth 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


Nursing Implications of Preschool Nursing Implications of Preschool Growth and Development Growth and Development (cont.)(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?45Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Question for ReviewQuestion for Review

• What kind of therapeutic play would be appropriate for a postoperative preschool child?


ReviewReview

• Objectives

• Key Terms

• Key Points

• Online Resources

• Critical Thinking Question

• Review Questions


chapter 018 lo

Self Improvement