The Preschool and School-Aged Child

Enabling Learning Objective

• Identify the development of a preschool child in a classroom environment, given PPTX, handouts, and scenarios.
• The standard is to identify the growth and development of a preschool child without error.

Key Terms

• Animism is attributing lifelike qualities to inanimate objects.
• Artificialism is the belief that everything is created by people.
• Centering is concentrating on a single aspect of an object, neglecting other features.
• Egocentrism is viewing everything in reference to oneself.
• Enuresis is involuntary urination after the age of bladder control.
• Stuttering is a disorder in the rhythm of speech.

The Preschool Child

• The child from age 3 to 5 years is often referred to as the preschool child.
• Physical growth slows down at this age.
• The preschooler refines motor, social and cognitive skills.
• Major developmental tasks for a preschooler include:
  • Preparation to enter school.
  • Development of cooperative play and body function control.
  • Acceptance of separation from parents.
  • Increased communication skills, memory, and attention span.
• Physical Development:
  • Weight: A 20 lbs. 1 year old will be about 40 lbs. by their fifth birthday.
  • Height: Grow about 3 inches per year, mainly in the legs.
  • Visual Acuity: Develops from 20/40 at 3 years to 20/20 by 5 years.
  • Teeth: All 20 primary teeth erupt.
  • Hand Preference: Develops by 3 years, forcing a change can cause frustration.
  • Appetite: Fluctuates widely.
  • Pulse rate: 90-110 bpm.
  • Rate of Respirations: About 20.
  • Blood pressure: Systolic 85-90, Diastolic 60.
  • Muscle Control: Good control for vigorous play (swinging, jumping, steady gait).
• Cognitive Development:
  • Preoperational Phase (2 to 7 years):
    • Preconceptual Stage (2 to 4 years):
      • Increased development of language and symbolic functioning.
      • Children pretend, for example, an empty box is a fort.
      • Egocentrism: Difficulty seeing other viewpoints.
      • Animism: Attributing life to inanimate objects.
      • Artificialism: Belief that people created the world.
    • Intuitive Thought Stage (4 to 7 years):
      • Prelogical thinking, children don't understand equal volume in different size glasses.
      • Children ask "Why?" and "How come?"
      • Centering: Focus on a single characteristic, neglecting others (e.g. focusing on color during block sorting).
• Cultural Practices:
  • Can influence a sense of initiative depending on parenting styles (authoritarian, emphasizing obedience and conformity).
  • Bilingual environments and cultural practices are easily adapted to by young children.
  • Dietary practices are discussed in Chapter 15.
• Language Development:
  • Depends on vision, hearing, comprehension, memory, social interaction, and oral motor skills.
  • Stuttering: Often improves by school age, speech therapy can help.
  • Language development is crucial for school success.
  • Stressors can cause delays or problems.
  • Between 2 and 5 years, the number of words in a child’s sentence should roughly equal their age.
• Development of Play:
  • 2-3 years: Imitate daily activities (hammering, shaving, feeding dolls).
  • 4 years: Develop broader themes in play.
  • 5 years: Imaginary play demonstrates creativity (e.g., a trip to the moon).
  • Play allows role-playing and emotional expression.
  • Limit non-educational screen time to 1 hour per day of high-quality programming with parents.
• Spiritual Development:
  • Preschoolers understand God concretely, often as an invisible friend.
  • They can memorize stories and rituals, but don't fully grasp the concepts.
• Sexual Curiosity:
  • Guide parents on sexual education for young children.
  • Use correct terminology and be honest.
  • Provide information when the child asks, indicating their readiness to learn.
  • Start with basic anatomical differences, explaining urination and where babies come from, before moving to more complex concepts.
  • Treat sexual exploration (masturbation, "playing doctor") in a matter-of-fact way, focusing on acceptable behavior through guidance, not discipline.
• Masturbation:
  • Common in both genders during preschool years.
  • Harmless if the child is outgoing, sociable, and not preoccupied with the activity.
  • Educate parents to see it as normal sexual curiosity.
  • Avoid punishment, distract the child with other activities.
  • Explain that masturbation is not acceptable in public in a non-threatening manner.
• Bedtime Habits:
  • Develop and reinforce optimal bedtime habits.
  • Quiet activities before bedtime are important (story time, bedtime rituals).
  • Cultural bedtime practices are essential for creating a teaching plan.
• Physical, Mental, Emotional, and Social Development:
  • Three-Year-Old:
    • Helpful, can assist with chores.
    • Dresses and undresses independently.
    • Talks in longer sentences, expresses thoughts, and asks questions.
    • Engages in parallel play and associative play.
    • Finds enjoyment away from parents, but wants them nearby.
    • Has more fears due to increased intelligence, memory, and independence.
    • Fears bodily harm, particularly loss of body parts.
    • Becomes angry when possessions are taken.
    • Sensitive, feelings are easily hurt.
  • Four-Year-Old:
    • More aggressive, shows off motor skills, likes to be superior.
    • Boisterous, tattle on others, may swear.
    • Interested in relationships.
    • Vocabulary of about 1500 words.
    • Imaginative, pretends to be different roles.
    • Prefers playing with same-sex friends.
    • Enjoys absorbing materials that stimulate imagination.
    • Likes music to march to, music videos, and simple instruments.
  • Concept of Death:
    • Wonder about death between 3 and 4.
    • Play-pretend death scenarios or witness animal death.
    • Ask direct questions about death.
    • Family's view on death is important.
  • Five-Year-Old:
    • More responsible, enjoys fulfilling expectations, has patience, sees tasks through.
    • Serious about what they can and cannot do.
    • Talkative and inquisitive.
    • Seeks answers to questions from those they believe know.
    • Physical growth less noticeable.
    • May lose deciduous teeth.
    • Learn to do tasks themselves for a sense of accomplishment.
    • Greater comprehension of TV/computer screens than younger children. Screen time should not interfere with healthy habits, sleep, meals, and physical activity.

Guidance

• Discipline and Limit Setting:
  • Purpose: To teach and shift control from parents to the child.
  • Children need limits for their behavior.
  • Benefits of limits: Security, protection from danger, relief from making age-inappropriate decisions.
  • Encourage consistency, mixed messages are confusing.
  • Modeling good behavior leads to more friends and self-esteem.
• Timing the Time-Out:
  • Effective discipline technique.
  • Lasts 1 minute for each year of age.
  • Child sits in a straight chair facing a corner.
  • Too many warnings without follow-up lead to ineffectiveness, one warning before time-out.
  • Spankings are damaging and ineffective.
  • Preserve the child's self-worth.
  • Consistency is key to learning acceptable behavior.
• Reward:
  • Positive and effective discipline method.
  • Examples include hugs, smiles, praise, and tone of voice..
  • Bribes are not desirable, they reinforce bad behavior.
• Consistency and Role Modeling:
  • Consistency is important between parents and within each parent.
  • Modeling: Children identify and imitate adult behavior (verbal and nonverbal).
  • Modeling teaches self-sufficiency and responsibility.
  • Chores (setting the table, sorting laundry, picking up toys) help children feel good about themselves and learn about consequences.
• Jealousy:
  • Normal response to perceived loss of affection.
  • Stronger in children under 5.
  • Jealousy of siblings, parents, and other children.
  • Reduce jealousy through early management: involve the child in caring for the infant, separate children if fighting occurs, assure all children that they are loved.
• Thumb Sucking:
  • Instinctual and normal.
  • Purpose is comfort and satisfaction.
  • Benefits of non-nutritive sucking: increased weight gain, decreased crying, self-consoling, behavioral organization.
  • Pacifiers cause fewer dental problems than fingers, and are easier to give up.
  • Ensure pacifiers are clean.
  • Stop thumb sucking before permanent teeth erupt to prevent dental problems.
  • Praise and encourage children trying to stop.
• Enuresis:
  • Pathophysiology: Involuntary urination after age of bladder control.
    • Primary Enuresis: Never been dry.
    • Secondary Enuresis: Recurrence after being dry for a year.
    • Diurnal (daytime): Less common than nocturnal (nighttime).
    • More common in boys, genetic influence possible.
    • Organic Causes: UTIs, diabetes, seizures, obstructive uropathy, urinary tract abnormalities, sleep disorders.
    • Inappropriate toilet training can cause enuresis.
    • Stressful events can trigger bedwetting.
  • Treatment and Nursing Care:
    • Detailed physical and psychological history needed.
    • Assess medications.
    • Educate the family to prevent emotional problems.
    • Reassurance and support from the nurse are helpful.

Enuresis Management

• Focus on the child's needs when creating a management program
• Alternative techniques for enuresis when routine management fails:
  • Counseling
  • Hypnosis
  • Behavior modification
  • Pharmacotherapy
• Desmopressin hydroacetate:
  • Synthetic antidiuretic hormone that reduces nighttime urine production
  • Taken before bedtime
  • Can be tapered and withdrawn after about 6 months
• Imipramine hydrochloride (Tofranil):
  • Reduces enuresis
  • Administered before bedtime
  • Side effects include mood and sleep disturbances, gastrointestinal upset
  • Overdose can lead to cardiac dysrhythmias

Preschool

• Transition from home to nursery school or preschool is a big step towards independence
• Nurses can provide guidance to parents on selecting the right preschool
• Preschool programs offer structured activities promoting:
  • Group cooperation
  • Development of coping skills
  • Self-confidence
  • Positive self-esteem
• Factors to consider when choosing a preschool:
  • State licensing
  • Accreditation by National Association for the Education of Young Children
  • Early childhood education qualifications for teachers
  • Staff-to-student ratios
  • Philosophy, discipline procedures, environmental safety, sanitary provisions, fees, facilities for snacks, meals, and rest time
  • Schedule and facilities for active and passive play, both indoors and outdoors
  • Requirement for personal and health history before admission
  • Parent visits and communication with other parents
• Daily care:
  • Bathing daily, shampoo at least twice a week
  • Simple hairstyles
  • Dental hygiene and nutrition reinforcement
• Clothing:
  • Loose, washable clothing for active play
  • Encourage self-dressing and undressing
  • Sturdy, supportive shoes
  • Protective gear for play activities
• Accident prevention:
  • Accidents remain a significant risk at this age
  • Supervise activities that could be dangerous (e.g., carrying sharp objects)
  • Teach fire safety (matches and lighters)
  • Poisoning prevention
  • Teach stranger safety
• Play during health and illness:
  • Play is essential for physical, mental, emotional, and social development
  • Play therapy is an important part of pediatric nursing care
  • Play can relieve stress and provide enjoyment
  • Consider overstimulation when children are severely ill
  • Safety is paramount when selecting toys
  • Simple toys (e.g., crayons, blocks, dolls) are beneficial across age groups
  • Provide entertainment during procedures (e.g., nursery rhymes, stories, songs, finger play)
  • Encourage scrapbook making
  • Nurses can contribute to enrichment programs
• Types of Play:
  • Need for playmates to promote social development
  • Transition from parallel and associative play to cooperative play
  • Non-competitive play
  • Active play (climbing, sliding, running)
  • Imaginary playmates are common and serve various functions (loneliness, mastery, scapegoat)
  • Children with neurodevelopmental, sensory, or motor disorders need more play stimulation
    • Consider mental age and motor abilities when selecting toys
    • Supervised play
    • Adequate space for active play
    • Repetition of play experiences
    • Adapt games and songs to their specific needs
  • Therapeutic play:
    • Muscle retraining, eye-hand coordination, crawling, walking
    • Blowing out a flashlight (postoperative)
  • Play therapy:
    • For children under stress
    • Well-equipped playroom
    • Observation of behavior by a counselor
  • Art therapy:
    • Communication through drawing, clay, and other media
• Nursing implications of preschool growth and development:
  • Anticipate parental concern regarding nutritional fluctuations in preschoolers
  • Prioritize safety (childproofing, safety equipment)
  • Reassure children with unfounded fears
  • Guide parents on handling behavior changes
  • Provide consistent care and age-appropriate activities for hospitalized preschoolers
  • Emphasize time-out and alternative discipline methods over corporal punishment
  • Chart observations for better understanding and interventions

The School-Aged Child

• School-age children (6-12 years) are more interested in facts than fantasy and have more sophisticated reasoning abilities
• They need to pay attention for extended periods (45 minutes), understand language, and move beyond writing and reading to comprehension
• School-age have a strong desire for knowledge and accomplishment:
  • Master activities they enjoy (music, sports, art)
  • Erikson: "Stage of Industry" - unsuccessful adaptation can lead to inferiority
    • Influence from others on development
    • Leadership and popularity depend on environment control
    • Positive self-concept through productivity, self-direction, and social acceptance
  • Freud: "Sexual latency" - diminished romantic love for parents and identification with same-sex parent
    • Repression of sexuality enables same-sex friendships
    • Influence from parents and teachers on self-image and sexuality
  • Piaget: "Concrete operations" - logical thinking, understanding of cause and effect, ability to focus on multiple aspects of situations, abstract reasoning limited to personal experience
  • Transition from egocentricity to understanding others’ perspectives
  • By age 10, understanding the uncontrollable nature of certain events (death, spirituality, origins)
  • Preference for friends of the same sex
• Physical growth:
  • Slow until the pre-puberty spurt
  • Weight gains exceed height increases (2.5-3.2 kg/year, 5 cm/year)
  • Head circumference growth slows to 20-21 inches by age 12, brain reaches adult size
  • Improved muscular coordination, suppleness, and rapid skeletal growth leading to a "gangling" appearance
  • Facial structure changes (jaw lengthens)
  • Sinus infections are common
  • First permanent teeth (6-year molars) erupt, primary teeth begin to fall out (4 permanent teeth/year)
  • Gastrointestinal maturity, less frequent stomach upset
  • Stomach capacity increases, lower caloric needs than in preschool years
  • Slower heart growth, smaller in proportion to body size
  • Developed senses (eyes, ears) are crucial for learning
  • Vital signs approach adult levels
  • Boys are taller and heavier until puberty
  • Body proportions prepare for school activities
  • Sedentary habits increase obesity and cardiovascular disease risk
• Sexual development:
  • Sex organs remain immature but interest in gender differences increases
  • Gender role development influenced by parental treatment and identification
  • Influence of societal factors (e.g., color-coded blankets, toys, television)
  • Androgynous: gender role combining masculine and feminine qualities
  • Importance of incorporating both masculine and feminine positive traits for healthy relationships
  • Sex education:
    • Answer questions simply and age-appropriately
    • Prepare boys for erections and nocturnal emissions
    • Prepare girls for menstruation and provide supplies
    • Acknowledge masturbation as normal and prevalent
    • Factual knowledge about sex and drugs is essential
    • School nurses can assist in developing programs, but parent involvement is valuable
    • SIECUS (Sexuality Information and Education Council of the United States) emphasizes six aspects of sex education: biological, social, health, personal adjustment and attitudes, interpersonal associations, and values
• Sexually Transmitted Infections (STIs):
  • Simple explanation of STIs, including HIV
  • Emphasize refusing sexual intercourse and drugs

Influences from the Wider World on School-Aged Children

• Holistic child care:
  • Focus on intellectual achievement, artistic expression, creativity, joy, cooperation, responsibility, industry, and love
• Nurses can affirm children's individuality and encourage parent pride
• Impact of different environments:
  • Home, school, neighborhood, daycare, summer programs
• Schools have a significant influence on socialization:
  • Children bring home experiences and learning to school
  • Acknowledge diverse family backgrounds (intact, financially secure, challenging)
• Moral development:
  • Develops through experience with rules and fairness
  • Understanding right and wrong, value formation
• School-related tasks:
  • Adapting to different teacher expectations
  • Competition for adult attention
  • Accepting criticism without losing self-esteem
  • Integrating peer values with family values
  • Finding satisfaction in school achievements
  • Participation in group activities
  • Self-control and handling prejudice positively
• Patient teaching:
  • Review normal development of 5-6 year olds
  • Anticipate regression (thumb sucking, clinging, soiling)### Preparing for School
• Encourage children to share their thoughts about what school will be like.
• Arrange for children to meet other students entering school with them.
• Take the child on a school tour.
• Teach safety rules for crossing the street, strangers, and blue star homes - community-established safe houses for children in crisis, identified by a blue star or symbol.
• Leave ample time in the mornings for preparation for school.
• Provide a cheerful send-off.
• Teach your child where to go in case of an emergency at home, such as to a neighbor or relative.
• Walk with your child to school until they understand the route, or designate a bus stop.
• Listen to your child at the end of the day, take an interest in their school life.
• Get to know your child’s teacher and take an interest in the school.
• Inform the teacher of sudden or unusual stress in your child’s life.

Play and Development for School-Age Children

• Play for school-age children involves increased physical and intellectual skills and some fantasy.
• School-age children's culture involves being part of a group.
• Play helps children feel powerful and in control.
• Mastering new skills helps children develop a sense of accomplishment; important for achieving Erikson’s stage of industry successfully.
• Participation in organized sports can develop skills, teamwork, and fitness, but excessive pressure and unrealistic expectations can have negative effects.

Assessing Play

• Play is essential for growth and development in children.
• Play connects the spontaneity of childhood with the more mature activities of adulthood.
• Important elements of play to assess include:
  • Motivation and engagement intensity
  • Whether the child initiated the play or joined a group
  • Reality versus creativity in the play
  • The element of choice when playing
  • Self-control in play
  • Following or changing rules
  • Sharing – giving and receiving cues from others
  • Skills used in the play activity

Latchkey Children

• Latchkey children are unsupervised after school when parents are at work and extended family is not available to care for them.
• These children often do not participate in after-school social and sports activities and may be slower to identify themselves as belonging to a group.
• The school nurse can be a source of information regarding the needs of school-age children and quality after-school care programs that may be available in the community.

### Physical, Mental, Emotional, and Social Development of School-Age Children

The Six-Year-Old

• Six-year-olds have lots of energy and are constantly on the go.
• They like to start tasks but may not always finish them due to short attention spans.
• They tend to be bossy, sometimes rude, and experiment with language, but they are very sensitive to criticism.
• Their conscience is active.
• One of the most obvious physical changes at this age is the loss of baby teeth. The permanent 6-year molars also erupt.
• Their use of language has matured and it is purposeful. They have a vocabulary of about 2500 words.
• They require 11 to 13 hours of sleep a night.
• Boys and girls play together but begin to prefer associating with children of their own gender. Most children enjoy collecting items.

The Seven-Year-Old

• Seven-year-olds are quieter and some educators have noted that second-graders are the easiest to teach.
• These children set high standards for themselves and their families.
• They have a good sense of humor.
• Second-graders may have a “crush” on a friend of the opposite sex.
• Active play is still important to both sexes.
• Children at this age are becoming increasingly independent and imagine themselves accomplishing feats more adventurous than their parents.

The Eight-Year-Old

• Eight-year-olds want to do everything and can play alone for longer periods than seven-year-olds.
• These children enjoy group activities such as Brownies and Cub Scouts and prefer companions of the same sex.
• They become interested in group fads.
• They may behave better when around other people than they do with their family.
• Hero worship is evident at this age.
• The arms and hands of eight-year-olds seem to grow faster than the rest of the body. Large and small muscles are better developed, and movements are smoother and more graceful.
• They can write, rather than print, and understand the number of days that must pass before special events, such as Christmas, birthdays, and discharge from hospital.

The Nine-Year-Old

• Nine-year-olds are dependable, show more interest in family activities, assume more responsibility for their belongings and younger siblings, and are more likely to complete tasks.
• They may resist adult authority if it does not align with the opinions or ideals of their peers. But they are more able to accept criticism for their actions.
• Individual differences are more pronounced.
• Worries and mild compulsions are common. Nervous habits, sometimes referred to as tics, may appear and vary widely.
• Hand-eye coordination is well-developed, and manual activities are managed with skill.
• These children work and play hard and can become overly tired. They need about 10 hours of sleep each night.
• The permanent teeth are still erupting at this age
• Children enjoy competitive sports, reading, listening to music, watching television, playing online games, and texting.
• Boys develop more muscle mass than girls as puberty approaches, so competitive contact sports should have separate teams for boys and girls.

Preadolescence

The Ten-Year-Old

• Age 10 marks the beginning of preadolescence. Girls develop physically faster than boys.
• The child is becoming self-directed, courteous to adults, and thinks clearly about social problems and prejudices.
• Ten-year-olds want to be independent, resent being given orders but are receptive to suggestions.
• They value the ideas of their group more than their own individual ideas. They're interested in sex and sexual curiosity continues.
• In general, girls are more poised than boys. Boys and girls begin to identify with skills related to their gender roles, and may be intolerant of the opposite sex.
• Children of this age take more interest in their appearance and texting friends is important.

Eleven- and Twelve-Year-Olds

• These ages can be described as intense, observant, all-knowing, energetic, meddlesome, and argumentative.
• This period before puberty is one of complete disorganization. The onset and rate of physical maturity vary greatly. Hormones start to influence physical growth. Posture is often poor.
• Children have 24 to 26 permanent teeth at this age.
• They have a lot of energy and are constantly on the go. Girls may become more “tomboyish” in their actions.
• Preadolescents are interested in their bodies and watch for signs of growing up.
• Guiding preadolescents can be difficult. They need freedom within limits and recognition that they are no longer infants.
• They need clear explanations when parents make decisions.

Chores as Teaching Tools

• Chores help children do a job, take responsibility, feel like an important part of the family, and develop self-esteem.
• Age-appropriate chores for preschoolers may include:
  • Setting the table
  • Sorting laundry
  • Making beds
  • Watering plants
• Age-appropriate chores for school-age children may include:
  • Loading the washer or dryer
  • Taking out the garbage
  • Caring for pets
• Teens can mow or rake the lawn for their family or others.
• The nurse can refer parents to various websites for suggestions on age-appropriate chores.

Guidance

Health Exams

• A physical exam is given in the spring preceding school admission.
• Booster immunizations are provided as needed.
• Child’s teeth are examined, and dental work is completed. Good dental hygiene and regular professional dental care are essential as the permanent set of teeth erupts.

#### School Health Programs

• School health programs aim to maintain and promote health and are provided in most school systems.
• Nurses and other professionals in such programs can play an important role in counseling parents.
• They help to meet the needs of disabled children enrolled in their schools.
• A carefully obtained health history provides valuable information for the school nurse.
• The eating habits for a school-age child should be sound
  • Offer a variety of nutritious foods.
  • Food preferences are common in this age group.
  • A nutritious breakfast is important; the federal government has established a school breakfast program in many areas.
  • The National School Lunch Program has been ongoing.
  • Summer lunch programs are also available; these lunches must meet certain nutritional standards, aiming to provide one-third of the recommended daily allowance of foods.
• Active play with family members is important for school-age children.
• Divorce, separation, domestic violence, and neighborhood gangs can negatively affect the development of these children.
• The school nurse can initiate appropriate referrals to community agencies.

Pet Ownership

• Owning a pet is common in families with children.
• After 7 years of age, children can be responsible for caring for the needs of a family pet.
• Pets that have close contact with children have the potential to transmit disease.
• Children with compromised immune systems are at risk of contracting illnesses that can be spread by some animals.
• Studies have documented the positive influence of pet ownership on improving medical and psychological outcomes after illness or surgery.
• Children with disabilities benefit from interaction with pets, which can lower blood pressure and heart rate, reduce loneliness and feelings of isolation, improve communication, foster trust, and motivate participation in physical therapy.
• Pets can provide companionship and acceptance for an ill child who feels separated from other people.
• Shy children often find pet ownership helps them socialize with others.
• Birds, rodents, turtles, and reptiles are not recommended as pets because they can’t be screened for potential pathogens, have few vaccines, and are more likely to transmit diseases.

Enabling Learning Objective

• Identify the development of a preschool child in a classroom environment, using PPTX, handouts, and scenarios.
• This objective requires students to be able to identify the growth and development of a preschool child without error.

Key Terms

• Animism: Attributing lifelike qualities to inanimate objects.
• Artificialism: Belief that everything is created by people.
• Centering: Concentrating on a single aspect of an object.
• Egocentrism: Viewing everything in reference to oneself.
• Enuresis: Involuntary urination after the age at which bladder control should have been established.
• Stuttering: A disorder in the rhythm of speech.

The Preschool Child

• The child from age 3 to 5 years is often referred to as the preschool child.
• This period is marked by slowing physical growth and mastery of motor, social, and cognitive skills.
• Major developmental tasks include:
  • Preparation for school.
  • Development of cooperative play and control of body functions.
  • Acceptance of separation.
  • Increased communication skills, memory, and attention span.

Physical Development

• Weight: Infants triple their weight by age 1 and double their 1-year weight by age 5 (e.g., a 20 lb 1-year-old will be about 40 lbs by their fifth birthday).
• Height: Between 3 to 6 years old, children grow taller and lose their toddler "chubbiness," with an increase in height of about 3 inches, primarily in their legs.
• Visual acuity: Around 3 years old, visual acuity is typically 20/40 but may develop to 20/20 by 5 years.
• Teeth development: All 20 primary teeth have erupted by this stage.
• Hand preference: Hand preference develops by 3 years old, and trying to change a child's hand preference can cause frustration.
• Appetite: Appetite fluctuates widely during this period.
• Pulse rate: Normal pulse rate is 90-110 bpm.
• Respirations: Respirations are about 20.
• Blood pressure: Systolic blood pressure is about 85-90, and diastolic is about 60.
• Muscle control: Good muscle control allows preschoolers to participate in vigorous play, swinging, jumping, and walking with a steadier gait.

Cognitive Development

• Preoperational Phase (2 to 7 years): This phase is divided into two stages.
  • Preconceptual Stage (2 to 4 years):
    • Increasing language and symbolic functioning.
    • Children engage in pretend play (e.g., using a box as a fort).
    • Egocentrism: Children have difficulty understanding perspectives other than their own.
    • Animism: Attributing life to inanimate objects.
    • Artificialism: The belief that people created the world and everything in it.
  • Intuitive Thought Stage (4 to 7 years):
    • Prelogical thinking: Children may not understand that a wide glass and a tall glass can both contain 4 ounces of juice.
    • Children learn by asking questions like "Why?" and "How come?"
    • Centering: The tendency to focus on one outstanding characteristic of an object while excluding others.

Cultural Practices

• Cultural practices can influence the development of a sense of initiative, especially in families that practice authoritarian parenting styles emphasizing obedience and conformity.
• Bilingual environments, where parents speak both English and a native language, can be beneficial as young children quickly adapt to such environments.
• Cultural preferences related to dietary practices are discussed in Chapter 15 (Table 15.6).

Language Development

• Normal speech and language development rely on the ability to see, hear, understand, remember, socially interact, and possess oral motor skills.
• Stuttering: A disorder in the rhythm of speech can lead to anxiety and social phobia, but often improves by school age.
• Preschool therapy with a speech pathologist is often helpful.
• Language development is essential for school success.
• Stressors can lead to delays or problems in language expression.
• Between 2 to 5 years, the number of words in a child's sentence should generally align with their age (e.g., at 2 years old, "my doll").

Development of Play

• Children at 2 to 3 years old imitate daily activities of their parents (e.g., hammering, shaving, feeding a doll).
• By 4 years old, play develops broader themes.
• By 5 years old, children demonstrate imaginary abilities in their play (e.g., a trip to the moon).
• Play allows children to experience multiple roles and emotional outlets.
• Noneducational screen time should be limited to 1 hour per day with high-quality programs and parental involvement.

Spiritual Development

• Preschoolers struggle to understand abstract concepts, including the concept of God, often viewing it as an invisible friend.
• Children can memorize Bible stories and rituals, but their understanding of the concepts is limited.

Sexual Curiosity

• Nurses should guide parents on providing age-appropriate sexual education.
• Key principles of teaching children about sex:
  • First, assess the child's existing knowledge and the specific information they are seeking.
  • Be honest and accurate when providing information at the child's level of understanding.
  • Use correct terminology to avoid misinformation.
  • Provide sex education when the child asks questions, as this often indicates readiness to learn.
  • Parents should understand that sexual curiosity starts with curiosity about anatomical differences, progressing to how urination occurs.

Masturbation

• Masturbation is common in both genders during the preschool years.
• It is considered harmless if the child is outgoing, sociable, and not preoccupied with the activity.
• Education of parents should focus on reassuring them that this behavior is a normal form of curiosity and not harmful to the child, who is exploring sexuality.
• Punitive reactions should be avoided.
• Parents should ignore the behavior and distract the child with other activities.
• Children should understand that masturbation is not acceptable in public but should be explained in a non-threatening manner.

Bedtime Habits

• Establishing optimal bedtime habits during this age range is crucial.
• Guide parents to engage children in quiet activities before bedtime.
• Implement specific rituals that signal "bedtime readiness" (e.g., storytelling).
• Cultural bedtime rituals are essential to consider before developing a teaching plan.

Physical, Mental, Emotional, and Social Development

• Three-year-olds:
  • Often exhibit desired characteristics like helpfulness, assisting with chores, dressing themselves, and expressing thoughts through longer sentences.
  • Engage in both parallel play and associative play.
  • Enjoy being away from parents while still needing their proximity.
  • Develop more fears than infants or older children due to increased intelligence, memory development, and independence.
  • Common fears include bodily harm, particularly the loss of body parts.
  • Become angry when others take their possessions.
  • Their feelings are easily hurt.
• Four-year-olds (pg. 432):
  • Often exhibit more aggression, enjoying showing off newly refined motor skills and eagerness to demonstrate superiority.
  • Can be boisterous, tattle on others, and may start swearing if exposed to profanity.
  • Show interest in the relationships between people.
  • Vocabulary increases to approximately 1500 words.
  • Enjoy imaginative pretend play (e.g., doctor, firefighter).
  • Start preferring play with same-sex friends.
  • Enjoy music they can march to, music videos, and simple musical instruments.
• Concept of Death:
  • Children between 3 and 4 years old begin to wonder about death and dying.
  • They may pretend to be heroic figures, witness animals being killed, and have direct questions about death.
  • The family's view of death influences the child's understanding.
• Five-year-olds:
  • Often considered a more comfortable age, with children becoming more responsible, patient, and focused on finishing tasks.
  • Talk constantly and are inquisitive about their environment.
  • Want to do things correctly and seek answers to their questions.
  • Physical growth is not as notable as in previous years.
  • May begin to lose their deciduous teeth.
  • Should not be criticized for failing to meet adult standards and overdirection can be damaging.
  • Show better comprehension of television or computer screens than younger children.

Guidance

• Discipline and Limit Setting:
  • The goal of discipline is to teach and gradually shift control from parents to the child, fostering self-discipline.
  • Children need behavioral limits. Setting limits:
    • Provides security.
    • Protects children from danger.
    • Relieves them from making decisions they may be too young for.
  • Consistency in discipline is crucial.
• Timing the Time-Out:
  • Time-outs (lasting 1 minute per year of age with the child facing a corner) are considered effective discipline techniques.
  • Too many warnings without follow-up lead to ineffectiveness.
  • Spankings are not productive and can be damaging.

Reward

• Rewarding positive behavior is a positive and effective discipline method.
• Examples include hugs, smiles, praise, and a kind tone of voice.
• Rewards should not be confused with bribes. Bribes offered after an incident reinforce negative behavior.

Consistency and Role Modeling

• Consistency must be demonstrated by both parents.
• Parents should establish a clear style for disciplining misconduct.
• Modeling good behavior (both verbal and nonverbal) is important.
• Children imitate adult behavior.
• Modeling teaches children to be self-sufficient.

Jealousy

• Jealousy is a normal response to perceived loss of affection.
• Jealousy of a new sibling is strongest in children under 5 years old.
• Parents can minimize jealousy by involving the older child in caring for the infant.

Thumb Sucking

• Thumb sucking is an instinctual behavior and considered normal.
• It provides comfort to infants.
• Pacifiers can lead to fewer dental problems than fingers or thumbs.
• Parents should be educated on the safe use of pacifiers (e.g., cleanliness).
• Thumb sucking before the permanent teeth erupt does not significantly impact dental health.

Enuresis

• Pathophysiology:
  • Involuntary urination after the age at which bladder control should have been established.
  • Primary enuresis: Bed wetting in a child who has never been dry.
  • Secondary enuresis: Recurrence of bed wetting in a child who has been dry for at least a year.
  • Diurnal enuresis (daytime wetting): Less common than nighttime wetting.
  • More common in boys than girls, and there may be a genetic link.
  • Organic causes of nocturnal (nighttime) enuresis include:
    • Urinary tract infections.
    • Diabetes mellitus.
    • Diabetes insipidus.
    • Seizure disorders.
    • Obstructive uropathy.
    • Urinary tract abnormalities.
    • Sleep disorders.
  • Early, inappropriate toilet training can contribute to enuresis.
  • Stressful events can trigger bed wetting.
• Treatment and Nursing Care:
  • Obtain detailed physical and psychological history.
  • Investigate any medications the child is taking.
  • Educate the family to prevent secondary emotional problems.
  • Reassurance and support from the nurse are vital.

Enuresis Management

• Enuresis management should focus on the child.
• Alternative management techniques include counseling, hypnosis, behavior modification, and pharmacotherapy.
• Desmopressin hydroacetate, a synthesized antidiuretic hormone, reduces nighttime urination.
• Imipramine hydrochloride (Tofranil) can reduce enuresis, but can cause mood, sleep, and gastrointestinal disturbances.
• Overdose could lead to cardiac dysrhythmias.

Preschool Growth and Development

• Preschoolers are transitioning from home to a larger world, with the added adjustments of a new sibling.
• Preschool programs provide structured activities, fostering cooperation and coping skills.
• Nurses can guide parents in selecting appropriate preschools.
• Daily care for preschoolers includes bathing/shampooing, simple hairstyles, and emphasizing dental hygiene.
• Clothing should allow for movement and easy dressing.
• Preschoolers are at risk for accidents, including poisoning, burns, and stranger danger.
• Play is crucial to a preschooler's development, both physically and mentally.
• Nurses play a significant role in facilitating play for hospitalized children, considering safety and avoiding overstimulation.
• Preschoolers engage in parallel, associative, and cooperative play.
• Imaginary friends are normal and serve various purposes.
• Children with neurodevelopmental, sensory, or motor disorders require extra stimulation and supervised play.
• Therapeutic play can help with muscle retraining, eye-hand coordination, and mobility.
• Play therapy offers children an outlet to process emotions and fears.
• Art therapy helps children express themselves creatively.
• Preschoolers experience fluctuating appetites, but their weekly eating patterns usually meet their growth needs.
• Parental guidance regarding changing behavior patterns is important, focusing on time-out techniques.
• Hospitalized preschoolers require age-appropriate activities and consistent caregivers.

School-Aged Child Growth and Development

• School-aged children (6-12 years old) transition from fantasy to fact-based thinking, demonstrating more reasoning abilities.
• They develop an ardent thirst for knowledge and accomplishment, aiming to master skills.
• Erikson identifies this stage as "industry," with potential for inferiority if not successful.
• Peers and family exert significant influence on the child's development.
• Romantic feelings toward the opposite-sex parent diminish.
• Piaget describes this period as "concrete operations," marked by logical thinking and understanding cause and effect.
• School-aged children develop empathy and can understand the viewpoint of others.
• By 10 years old, children grasp the unpredictability of events, like death and spiritual concepts.
• Physical growth is slow until puberty, with weight gaining more rapidly than height.
• Muscular coordination improves, but skeletal growth can be faster than muscle and ligament development.
• Facial structures change as the jaw lengthens.
• The first permanent teeth erupt, and primary teeth loss begins.
• The gastrointestinal system matures, and stomach upset lessens.
• The heart grows slowly, but the sense organs, like eyes and ears, play a key role in learning.
• The vital signs of school-aged children resemble adults.
• Boys are taller and heavier than girls until puberty.
• Sedentary habits increase the risk for childhood obesity and cardiovascular issues later in life.
• Sexual development is influenced by parents and societal cues.
• Sex education should be provided in age-appropriate terms, covering puberty and STIs.

School-Aged Child Influences

• A holistic approach to child care emphasizes not only intellectual achievements but also creativity, cooperation, responsibility, and emotional attributes.
• Home, school, and community environments all shape a child's development.
• Schools influence children's socialization, reflecting the values learned at home.
• Nurses must be aware of the diverse backgrounds and challenges children face.
• Moral development stems from experiences with rules and fairness.
• School-related tasks include adapting to teacher expectations, competing with peers, and navigating peer and family values.
• Patient teaching for school-aged children should acknowledge potential regression in behavior.

Preparing Children for School

• Encourage children to express their expectations about school.
• Arrange for children to meet other children who will be starting school with them.
• Take a tour of the school with the child.
• Teach safety precautions regarding street crossing, strangers, and blue star homes (community-established safe havens for children during emergencies).
• Allow ample time in the mornings for the child to get ready for school.
• Explain to the child what to do in case of an emergency at home.
• Walk with the child to school until they understand the route or designate a bus stop.
• Listen to the child at the end of each school day and show interest in their school life.
• Form a relationship with the child’s teacher and take an interest in the school.
• Inform the teacher about any sudden or unusual stress the child is experiencing.

Play

• Play activities for school-age children involve increased physical and intellectual skills, as well as some fantasy elements.

• The sense of belonging to a group is crucial for this age group, and conforming to be "like their friends" is essential.

• Play allows children to feel powerful and in control.

• Mastering new skills brings a sense of accomplishment, which is important for successful development in Erikson's stage of industry.

• Organized sports promote skill, teamwork, and fitness, but excessive pressure and unrealistic expectations can have negative outcomes.

• Assessing play: Factors to consider:

  • Motivation and intensity of engagement
  • Whether the child initiated the play or joined an existing group
  • The level of reality or creativity in the play
  • The child's ability to make choices about how they play
  • The child's level of self-control
  • Their ability to follow or change rules
  • Their capacity to share and exchange cues with others
  • The skills employed in the play activity

• Factors limiting play effectiveness: Adult intervention, limited space, a dominant older player, or younger players interfering with the action.

Latchkey Children

• Latchkey children are unsupervised after school due to parents being away at work or extended family's unavailability.
• Many latchkey children don't participate in after-school activities and might struggle to identify with a group.
• The school nurse can provide information about quality after-school care programs in the community.

Physical, Mental, Emotional, and Social Development

• Six-Year-Old:

  • High energy levels and constant activity.
  • They like to start tasks but often have difficulty finishing them due to short attention spans.
  • They can exhibit bossiness, rudeness, and experimentation with language, but are also sensitive to criticism.
  • Their conscience is developing, and they find decision-making difficult.
  • They lose their baby teeth, and permanent teeth, including the important six-year molars, erupt.
  • Their language usage is more purposeful compared to preschoolers.
  • They have a vocabulary of around 2,500 words.
  • They require 11 to 13 hours of sleep per night.
  • Boys and girls still play together but start preferring to associate with same-sex peers.
  • They enjoy collecting objects like shells, leaves, or stones.

• Seven-Year-Old:

  • Calmer than six-year-olds, often considered easier to teach.
  • Set high standards for themselves and their families.
  • Possess a good sense of humor.
  • May develop crushes on friends of the opposite sex.
  • Active play remains important for both sexes.
  • They are increasingly independent and imagine themselves accomplishing remarkable feats.

• Eight-Year-Old:

  • Eager to try everything and can play alone longer than seven-year-olds.
  • They enjoy group activities like Brownies and Cub Scouts, and prefer same-sex companionship.
  • They become interested in group trends and fads.
  • May behave better in company than around family.
  • They display hero worship.
  • Their arms and hands grow faster than the rest of their body.
  • Their motor skills are more developed, leading to smoother and more graceful movements.
  • They can write instead of print and understand the time needed for special events, like Christmas, birthdays, and hospital discharge.

• Nine-Year-Old:

  • Dependable, more interested in family activities, take more responsibility for their belongings and younger siblings, and are more likely to finish tasks.
  • They challenge adult authority that contradicts their group's opinions or ideals.
  • They are more receptive to criticism for their actions.
  • Individual differences are more pronounced.
  • Worries and mild compulsions are common, and they might develop nervous habits (tics).
  • Hand-eye coordination is well-developed, and they perform manual tasks skillfully.
  • They work and play hard and can become easily tired.
  • They require about 10 hours of sleep per night.
  • Permanent teeth continue to erupt.
  • They enjoy competitive sports, reading, music, television, online computer games, and texting.
  • Boys develop more muscle mass than girls as they approach puberty.

• Preadolescence:

  • Ten-Year-Old:

    • Marks the start of preadolescence, with girls being more physically mature than boys.
    • They display self-direction, are courteous to adults, and think critically about social issues and prejudice.
    • They seek independence and resent being told what to do but are receptive to suggestions.
    • Group ideas are more important to them than individual ones.
    • There is a continued interest in sex and sexual curiosity.
    • Girls are generally more poised than boys, and both sexes are reliable in household duties.
    • Both genders start to identify with skills related to their gender roles and often become intolerant of the opposite sex.
    • They take more interest in their appearance and enjoy texting with friends.

  • Eleven- and Twelve-Year-Olds:

    • Characterized by intensity, observation, a sense of knowing everything, energy levels, interfering tendencies, and arguments.
    • The period before puberty is one of disorganization, with varying onset and rates of physical maturity.
    • Hormonal changes influence physical growth and lead to poor posture.
    • They have 24 to 26 permanent teeth.
    • Have abundant energy and are constantly on the move.
    • Girls exhibit "tomboyish" characteristics.
    • They are curious about their bodies and observe signs of growing up.
    • Girls look forward to menstruation and wearing a bra, while both genders tend to "ignore" the opposite sex while still being aware of them.
    • They often tease each other.
    • Preadolescents need freedom within limits and acknowledgement that they are not infants anymore.
    • They need clear explanations for parental decisions.

Chores as Teaching Tools

• Chores help children develop a sense of responsibility, feel valued within the family, and build self-esteem.
• Preschool:
  • Setting the table
  • Sorting laundry by color
  • Making their beds
  • Watering Plants
• School-Age:
  • Loading the washing machine or dryer
  • Taking out the trash
  • Caring for pets

Guidance

• Health Examinations:

  • School entry usually involves a physical examination in the spring beforehand to allow time for addressing any issues.
  • Booster immunizations are given as needed.
  • The child's teeth are examined, and any dental work is completed. Good dental hygiene is essential during the permanent teeth eruption phase.

• School Health Programs:

  • Most school systems offer health programs aimed at maintaining and promoting health.
  • Nurses and other professionals play an important role in counseling parents.
  • They provide support to meet the needs of disabled children in their schools.
  • A thorough health history provides valuable information for the nurse.
  • Nutrition:
    • Encourage a variety of nutritious foods.
    • Food preferences develop at this age.
    • A nutritious breakfast is important.
    • National school lunch and breakfast programs are available in many areas.
    • Summer lunch programs are also available and must meet certain nutritional standards.

• Physical Activity:

  • Active play with family members is crucial for school-age children.

• Social Challenges:

  • Divorce, separation, domestic violence, and gang involvement can negatively impact a child's development.
  • The school nurse can initiate appropriate referrals to community agencies.

Pet Ownership

• Pets are common in families with children.
• Children over the age of seven can take responsibility for caring for a family pet.
• Pets can transmit diseases to children, especially those with weakened immune systems.
• Studies show that pet ownership positively impacts medical and psychological outcomes after illness or surgery.
• Disabled children benefit significantly from interactions with pets.
• Pets provide companionship and acceptance for children who feel isolated from other people, especially those with illnesses.
• Shy children often find it easier to socialize through their pets.
• Birds, rodents, turtles, and reptiles are not recommended as pets because they cannot be screened for pathogens and are more likely to spread diseases.

Check on Learning Questions

1. Question: Which describes the cognitive abilities of school-age children?

   • Answer: Able to classify, to group and sore, and to hold a concept in their minds while making decisions based on that concept.
   • Rationale: During concrete operations, children can group and sort information and make decisions based on concepts. Abstract and logical reasoning develops later in adolescence.

2. Question: A group of boys ages 9 and 10 years have formed a “boys-only” club that is open to neighborhood and school friends who have skateboards.This should be interpreted as:

   • Answer: Characteristic of social development at this age.
   • Rationale: Group formation and affiliation with peers are common during middle childhood. While it can contribute to bullying, a "boys-only" club doesn't directly correlate with future gang involvement.

3. Question: The school nurse has been asked to begin teaching sex education in the fifth grade.The nurse should recognize that:

   • Answer: Sex can be presented as a normal part of growth and development.
   • Rationale: Children in fifth grade (around 10-11 years old) are ready for age-appropriate sex education presented as a natural part of growing up. They should be encouraged to ask questions, and precise and concrete information is appropriate.

4. Question: The nurse is teaching a group of 10- to 12-year-old children about physical development during the school-age years.Which statement made by a participant, indicates the correct understanding of the teaching?

   • Answer: “I will grow an average of 2 inches per year from this point on.”
   • Rationale: Children in middle childhood grow 2 inches per year on average. Weight almost doubles, and they become slimmer with longer legs.

5. Question: A nurse is planning care for a 7-year-old child hospitalized with osteomyelitis.Which activities should the nurse plan to bring from the playroom for the child?(Select all that apply)

   • Answer: Paper and some paints, Board games, Computer games
   • Rationale: School-age children enjoy complex board games, card games, computer games, painting, sewing, cooking, carpentry, gardening, and other creative activities.

6. Question: When teaching injury prevention during the school-age years, what should the nurse include?

   • Answer: Teach basic rules of water safety.
   • Rationale: Water safety education is crucial for this age group, including supervised swimming, swimming with a buddy, checking water depth, and using flotation devices. It's important to teach about stranger safety, safe cooking, and caution regarding hazardous sports.

Test your knowledge about preschool development, including physical growth, emotional tasks, and social behaviors of children aged 3 to 5. Explore concepts such as artificialism and the appropriate responses to childhood behaviors. This quiz is perfect for parents and educators wanting to understand early childhood development.