Preschool Development PDF

7589_Ch08_115-130 29/08/17 12:02 PM Page 115 CHAPTER 8 Preschool Key Words Chapter Outline adducted centration conscience cooperative play enuresis initiative night terrors reversibility Physical Characteristics Height and Weight Body Proportions Muscle and Bone Development Teeth Sensory Devel...

7589_Ch08_115-130 29/08/17 12:02 PM Page 115 CHAPTER 8 Preschool Key Words Chapter Outline adducted centration conscience cooperative play enuresis initiative night terrors reversibility Physical Characteristics Height and Weight Body Proportions Muscle and Bone Development Teeth Sensory Development Vital Signs Developmental Milestones Motor Development Gross Motor Skills Fine Motor Skills Sexual Development Psychosocial Development Initiative Discipline Special Psychosocial Concerns Preschool Education Cognitive Development Moral Development Communication Nutrition Obesity Sleep and Rest Play Safety Health Promotion Common Preschool Concerns Thumb-Sucking Bed-Wetting Fears Summary Critical Thinking Multiple-Choice Questions Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • • • • • • Describe the physical changes that commonly occur during the preschool years. List two gross motor skills characteristic of preschoolers. Describe the psychosocial task of the preschooler as outlined by Erikson. List the important guidelines useful in assessing a nursery school program. Describe the stage of cognitive development for the preschool child as presented by Piaget. List three appropriate snack foods for preschool children. Describe the type of play characteristic of preschoolers. List the safety concerns important to the preschool stage of development. Name two common behavioral concerns affecting preschoolers. 115 7589_Ch08_115-130 29/08/17 12:02 PM Page 116 116 Journey Across the Life Span The preschool period generally refers to ages 3 to 6 years. The rate of growth during the preschool period is slow and steady. Preschoolers are focusing on refining their gross and fine motor skills, improving their vocabularies, and increasing their knowledge of the environment. Characteristically, children by this stage have mastered some autonomy and are moving toward a creative exploration of their potential. Preschool children are usually ready to spend more time away from their homes and caregivers and often attend preschool or nursery school. PHYSICAL CHARACTERISTICS Height and Weight The trunk and body lengthen, giving the child a taller appearance. On average, preschool children gain 5 to 7 pounds (2.3 to 3.2 kg) a year. Most children grow 21/2 to 3 inches (6.75 to 7.5 cm) per year. Body Proportions During the preschool period, children lose some subcutaneous or adipose tissue, which accounts for their more slender look. Growth patterns vary with each child. The rate of growth for the extremities is faster than for the trunk, resulting in more adultlike proportions. The protuberant abdomen and exaggerated lumbar curvature (lordosis) of toddlerhood disappear. The head and neck decrease in size in proportion to that of the rest of the body. Muscle and Bone Development Rapid growth in the muscles accounts for approximately 75% of the weight gain during this period. Heredity, nutrition, and actual muscle use play a role in stimulating muscle growth and increasing muscle strength. The hips gradually rotate inward, causing a more adducted foot position. The adducted movement causes the foot to move toward the center of the body, resulting in a more erect posture and steady gait and making the child appear less awkward and clumsy. During this stage of development, fat replaces the red marrow in the long bones. From this time on, marrow is found in the flat bones of the body such as the skull, sternum or breastbone, vertebrae, and pelvic bones. Red marrow helps the body to produce blood cells. Teeth Deciduous teeth are important for nutrition and because they help prepare for the child’s permanent teeth. During the preschool years, many children develop dental decay and plaque buildup. Care of the teeth should include daily brushing, flossing, and visits to the dentist at least every 6 months. Proper care and dietary practices may help to avoid excessive tooth destruction. Recommendations for promoting dental health are listed in Box 8.1. Preschool children should be encouraged to eat snacks that are low in carbohydrates, such as apples, celery, carrots, and cheese. These snacks are nutritious and help prevent tooth decay. Sensory Development Visual acuity improves to 20/20 at about 3 years of age. The lack of depth perception contributes to some of the clumsiness that is still characteristic of the early preschool years. Depth perception and color detection are fully established by age 5. Maximum visual ability is achieved by the end of the preschool period. Hearing matures at an earlier age. Children at this stage are better able to listen and to interpret and distinguish different sounds. Preschoolers, like toddlers, frequently develop ear infections. By the preschool years, the child may be capable of verbalizing and pinpointing ear discomfort. A simple ear examination followed by the prescribed course of antibiotics will treat an ear infection and prevent permanent hearing loss. B O 8.1 X P ro mo ting Dental Health Daily dental hygiene: • Provide a small, soft toothbrush for the child. • Provide toothpaste with fluoride. Teach the child not to swallow fluoride toothpaste. • Ensure the child brushes daily in the morning and before bedtime. • Show the child how to use a back-and-forth motion while the brush is against the teeth and gum line. Foods: • Limit the child’s intake of high-sugar foods. • Offer fresh fruits and vegetables daily. Health supervision: • Schedule dental visits for the preschooler every 6 months. 7589_Ch08_115-130 29/08/17 12:02 PM Page 117 Preschool 117 VITAL SIGNS The preschool child’s cardiovascular system enlarges to meet the general demands of the body. The average pulse rate for this age ranges from 90 to 100 beats per minute. The average blood pressure is 100/60 mm Hg. Hypertension may develop during the preschool period; therefore, blood pressure should be monitored during routine annual health assessments. The normal range for the respiratory rate is 22 to 25 breaths per minute at rest. This decrease in the rate of respirations from that of a younger age is related to growth of the lungs that permits better efficiency. DEVELOPMENTAL MILESTONES Motor Development Gross Motor Skills Four-year-old children are capable of walking and running on their tiptoes. They can hop and balance on one foot for 3 to 5 seconds and use alternating feet while descending stairs. Their development improves to the point where they can pedal a tricycle and begin to quickly navigate corners and turns. A 4-year-old child likes to climb and jump from heights without demonstrating much fear, making constant supervision necessary (Fig. 8.1). A child of this age can catch a ball with extended arms and hands. By 5 years of age muscle coordination and strength increase, permitting the child to jump rope, skip on alternating feet, walk on a balance beam, and catch a ball with both hands. Preschoolers’ movements are now smoother and more efficient, and they can begin to play certain sports, including soccer, skating, and baseball. Five-year-old children are also capable of imitating and learning simple dance steps or other similar routines. Fine Motor Skills Four-year-old children are able to manage many of their self-care activities, including bathing, dressing, feeding, and toileting. These skills, which began in the toddler years, can now be performed with greater ease and dexterity. Although preschool children can wash and dry their hands without supervision, they still require supervision and some assistance with the task of bathing. FIGURE 8.1 Gross motor skills improve during the preschool stage. Children at this age can manipulate their clothing, including buttons, zippers, and snaps. Children of 4 and 5 years can readily recognize the front and back of their clothing. They still need help with tying shoelaces. Preschool children can handle a spoon without inverting it, and many prefer to use a fork rather than a spoon. Many children are able to use a knife to spread butter or jelly. They still need help cutting up their food but like making their own sandwiches or pouring their own drinks. They are able to sit at the table for longer periods of time. Children of this age can learn about table manners. Preschool children usually can sit at meals for longer periods than toddlers. Whenever possible, families should eat together. Mealtime can be a time for family interaction, communication, and sharing of daily accomplishments. At 4 years of age children are able to recognize their need to use the toilet but may require some assistance in manipulating their clothing and carrying out the necessary hygiene measures. By 5 years of age toileting has become a more independent practice. However, it is wise for parents to still supervise toileting to make certain that the child is washing his or her hands, wiping properly, and remembering to flush. Fine motor development improves at 4 years of age to the point of allowing the child to draw a simple 7589_Ch08_115-130 29/08/17 12:02 PM Page 118 118 Journey Across the Life Span face and use scissors to cut along a line. Five-yearold children can control their drawing to permit copying letters and printing their names (Fig. 8.2). Their drawings are more detailed and include not only a face, but also other body parts. The 5-year-old child also has better control of scissors. Sexual Development During the preschool period children become aware of their genital organs and their sexual identity. As discussed in Chapter 5, children may become strongly attached to the parent of the opposite sex. They later identify with the parent of the same sex. Single-parent families should try to plan for the child to spend time with aunts, uncles, and other relatives or adult friends of the opposite sex during the preschool years. Children at this stage are also curious about the differences between the male and female bodies. Parents should respond simply and at the level of the child’s understanding. For example, a preschool girl may ask why her baby brother looks different. Usually this age group is not looking for a detailed explanation, so the parents should simply explain that boys look different. The child should be told that her brother has a penis. Using the correct terms and encouraging questions about sex helps keep the lines of communication open between parents and children. Masturbation is a common activity in both sexes, although it is usually a concern to parents. It is normal behavior, and caregivers must respond in a matter-of-fact manner to prevent instilling feelings of guilt in the child. As children mature and grow, they will develop mechanisms to channel sexual feelings, and this behavior will decrease. Psychosocial Development Initiative According to Erikson, by preschool age the child has learned to trust those in the environment and has FIGURE 8.2 Progression of fine motor development from (A) 3 years to (B) 5 years. developed a sense of independence. Preschoolers pretend, explore, and try out new roles. Erikson referred to exploration as the task of initiative. Children enjoy playing and pretending to be many different people in their environment. It is important that young preschool children have good role models whom they may imitate and from whom they may learn. Although parents are the primary role models, other adults in the community, such as teachers, health providers, and clergy, may also serve as role models. Caregivers must allow children freedom to explore and try out roles they desire, regardless of gender or stereotype. If not, children can develop feelings of guilt that may thwart their ability to grow and develop. Discipline Parents need to continue to set limits to protect children and property. Preschool children must not go into the street or hit others. As preschoolers develop a sense of initiative and guilt, they strive to follow rules and please parents. Discipline teaches children impulse control. If a child hits another child, the parents need to help the child learn to channel emotions into words. For example, a parent might say, “Stop it. You are very angry. Tell me why.” This encourages the child to talk about his or her feelings. Parents can also limit undesirable behavior by using positive reinforcement. In other words, parents can give a privilege or remove it, as the behavior warrants. Discipline should be of short duration because the child still has a limited concept of time. Time-out, as discussed in Chapter 7, can be useful in disciplining the preschooler. Special Psychosocial Concerns Jealousy Jealousy, or sibling rivalry as discussed in Chapter 7, is a normal, inevitable behavior pattern seen at various stages of development. During the preschool stage, children need affection, attention, and recognition. Unlike the toddler, the child of this age is better able to share and understand that he or she is not the only person in need of the caregivers’ attention. Preschoolers who are involved with nursery school and other activities outside the home seem less threatened by a new baby or younger child at home. To help minimize sibling rivalry, parents should try to understand the preschooler’s feelings, set aside special time for him or her, and provide a designated space for toys and other meaningful items. Even busy parents must always try to meet the preschooler’s needs. Taking time out to tell the child 7589_Ch08_115-130 29/08/17 12:02 PM Page 119 Preschool H E L P F U L H I N T S Sibling Rivalry • Do not react to all sibling disputes unless there is the threat of immediate harm. • Allow children to resolve crises themselves. • Avoid placing blame or taking sides. • Separate children until they are calm. • Have children suggest resolutions to their conflicts. • Use family meetings to resolve major conflicts. • Seek professional help when behavior persists without improvement. a story or offer a special hug may be just enough to help the child adjust to a new baby. The child of this age can also be given little “jobs” to help assist the parent with the care of other siblings. For example, the preschool child may be able to hold the diaper bag, get the powder, or hand the parent what is needed during diaper changes. Allowing the preschooler to do these jobs helps strengthen his or her growing self-esteem. Responses to Divorce Divorce is one of the common stresses affecting children during the preschool period. At this age, children may interpret the failing marriage as their fault. They usually have a strong wish to reunite their parents and may fantasize about this. Parents need to try to privately resolve their conflicts and spare the child undue emotional pain. Important measures include making the child feel loved and protected by both parties. The degree of emotional fallout from divorce can be minimized by having the noncustodial parent establish consistent and orderly visiting patterns. Children should feel that they have their own space in both parents’ homes. Allowing the child to leave toys and clothing at the “other home” helps to reinforce a sense of belonging. See Box 8.2 for hints for divorced parents. Preschool Education Preschool is rapidly becoming the norm in the United States today. The purpose of preschool education is to promote cognitive, motor, and social development. Preschool provides a place where children can form friendships and begin to learn to get along with peers. Starting school is a new experience for young children (Fig. 8.3). The first day should be brief, and the parent should stay with the child until he or she appears to be acclimated to the B O 8.2 119 X Hints fo r Div o rced P arents • Only a firm and final decision should be presented to the children. • Avoid casting blame or criticizing the other parent. • Avoid involving the children in any divorce-related matters (financial, legal, and so forth). • Continue routines as much as possible. • Reassure the children that they are not to blame for the divorce. • Offer love and support to the children. • Encourage open expression of feelings. • Create a space for the children’s belongings in the noncustodial parent’s home. • Avoid interrogating the children after visits with the other parent. • Seek supportive services for both parent and children, as needed. FIGURE 8.3 Preschoolers like being with peers. surroundings. For some children acclimation is especially difficult and requires special understanding and patience from the parent. No activity should be forced on a child. If a child is not ready for preschool, socialization skills such as forming friendships and getting along with peers are unlikely to develop. Parents and school staff can work together to assess the readiness of the child. Signs of preschool readiness include mastery of toilet training, ability to tolerate brief periods of separation from parents, and increased communication skills. Children eventually gain confidence in themselves and become interested in participating with peers. To better prepare the child for preschool, parents can begin by familiarizing the child with the school 7589_Ch08_115-130 29/08/17 12:02 PM Page 120 120 Journey Across the Life Span location and teachers, visiting the school before the first day, and offering the child ample opportunity to discuss feelings. Parents should consider several factors when selecting a preschool for a child. First, the parents should consider the location, cost, and schedule to make certain that the school fulfills the family’s needs. Next, parents should determine what philosophy forms the basis of the preschool program. It is recommended that the program and curriculum be driven by student needs, interests, and learning styles, not teacher desires. This type of program places the children at the center of activities. Each child should be considered unique and given diverse play experiences tailored to his or her individual needs. The philosophy must appreciate the physical, cultural, cognitive, and emotional differences among the children. To best indicate its appreciation for these differences, the school should recognize and discuss holidays, introduce foods from different cultures, and value and celebrate diversity. The National Association for the Education of Young Children (NAEYC) recommends that at least one teacher hold a degree in early childhood education. NAEYC recommends a teacher-child ratio of one adult for every four to six 2-year-old toddlers, with a maximum group size of 12, or one adult for every eight to ten 3- to 4-year-old children, with a maximum group size of 20. The school should allow parents to visit at any time, and parents should make at least one unannounced visit. Play is very important to the development of preschool-aged children. The school should have adequate play space to allow freedom of movement. The supplies at the preschool should include blocks of various sizes and shapes and other hands-on materials such as clay, sand, wood, water, and puzzles. The entire classroom area should be clean, but it should not be an environment that is prohibitive to exploration and play. Bathroom facilities must be close by and accessible for preschoolers. Box 8.3 provides a preschool safety checklist. Types of Preschool Parents have many choices for preschool programs, including public, private, or homeschooling. Homeschooling education is typically run by parents or tutors rather than in formal settings. There are several reasons for selecting this form of education, including religious or moral instruction. Often it is the choice of parents who find themselves dissatisfied with public education and the school social environment. B O 8.3 X P rescho o l Safety Check list • Playgrounds should be secured with a fence. • Equipment must be free of sharp edges, in a good state of repair, and routinely inspected. • Fire alarms and fire extinguishers must be present and working. • Emergency exits and evacuation plans must be clearly posted. • Toys must be appropriate for children’s ages and in good condition. • Staff should be trained in first aid and cardiopulmonary resuscitation. • Bathrooms must be kept clean and easily accessible for young children. • Water temperature in faucets must be no higher than 110ºF (43ºC) to prevent accidental burns. • The sites for picking up and dropping off children should be safely secured. • Children must be allowed to leave only with authorized caregivers. Cognitive Development According to Piaget, the preoperational stage of development begins in the toddler period and extends through the school-age years. It is limited in several ways. First, the preschooler is unable to focus on several aspects of a stimulus. For example, if someone is wearing a mask, preschool children do not recognize the person and instead become frightened. Piaget called this centration and described it as the child focusing or centering attention on only one cue. Piaget further believed that preschoolers lack reversibility, or the understanding of how two actions may be related to each other. For example, preschoolers may watch liquid being poured from a short, fat beaker into a tall, thin beaker but maintain that the tall beaker contains more fluid. Preschoolers are unable to understand that the physical attributes of an item remain the same despite superficial changes in its appearance. This is easily demonstrated by asking a preschooler to tell you if the amount of play clay has changed when you simply change its shape. At this stage the child continues to develop language and memory. The preschooler is still somewhat egocentric but is now able to share, take turns, and follow rules. Preschoolers can form general concepts but cannot reason formally. Their reasoning appears to be based on their earlier experiences. For example, preschoolers, like toddlers, become concerned when they see their mother dressing up in her 7589_Ch08_115-130 29/08/17 12:02 PM Page 121 Preschool “going out” clothes, knowing that this means that she is leaving. If trust and autonomy have developed sufficiently, however, the preschooler is able to tolerate separation and understand that Mommy will come back. Limited reasoning is also evident in the preschooler’s concept and understanding of time. During the preschool years children often pretend and are highly creative (Fig. 8.4). When 4- or 5-year-old children tell a story, they may use their overactive imaginations to embellish or enhance parts of the story. Their thinking style is still egotistical and also magical. They may believe that they are the center of the world and that they are all-powerful. Sometimes they develop feelings of guilt over their “bad” thoughts, which they believe may have caused an accident or other adverse happening. It is also common for preschoolers to believe that if they become ill or injured, they are being punished for their wrongdoings. Parents and health care workers need to explore preschool children’s feelings to minimize their guilt and misunderstandings. Preschoolers have longer attention spans than toddlers. This permits the preschool child to perform an activity for longer periods than a toddler can. Toddlers may have difficulty sitting still and listening to an entire story, whereas preschoolers listen attentively, often memorize the story, and do not let the reader skip even a word. FIGURE 8.4 Preschoolers are highly creative. 121 Moral Development According to Kohlberg, the preconventional stage of moral development begins at about age 4 and continues to about age 10 (see Chapter 5). Moral development is a process in which children learn by modeling and imitating adult behaviors. For this reason it is imperative that parents set good examples and have consistent patterns of interaction. According to Freud, children at this stage begin to develop a superego, or conscience. The conscience gives them the capacity for self-evaluation and criticism. The superego becomes the moral dimension of the child’s personality. It is at this stage that children begin to emulate beliefs, values, and ideals based on what is learned in their homes and immediate environments. Caregivers must help children understand the cause and effect that certain behaviors may have on others. Preschool children should be reminded that if they take a toy from a playmate, the action will cause an unfavorable response. The vivid imagination of preschoolers can make it difficult for them to distinguish fantasy from reality. They often tell stories that have threads of truth woven together with untruths. Preschoolers are just beginning to recognize that deliberate lying is a bad thing to do. Communication A child’s language and speech become more sophisticated during the preschool period. Whereas toddlers make their needs known by gestures and the use of a few words, preschoolers can use nouns, verbs, and adjectives in their sentences. At 4 years of age children can form sentences using three to four words and understand who, what, and where questions. Most 5-year-old children can form sentences containing five or more words. The 5-yearold child’s vocabulary contains between 2,000 and 2,400 words. Preschool children may exhibit some difficulty with the pronunciation of certain words. This is to be expected and should be treated by the adult by gently correcting the child’s mispronunciation without criticism. Putting undue stress on the child’s ability to speak clearly may lead to stuttering and hesitancy. Some hesitancy is a normal pattern of speech development. Children who are 3, 4, or 5 years old are usually very talkative. They like monopolizing the conversation and will talk even if no one is listening or answers them. Preschoolers ask questions even when 7589_Ch08_115-130 29/08/17 12:02 PM Page 122 122 Journey Across the Life Span H E L P F U L H I N T S Strategies to Stimulate Language Development Read to your child. Encourage storytelling. Play naming games. Gently correct mispronunciations. they know the answer. They can express past, present, and future with an improved understanding of time. For example, if a preschooler is riding in a car and asks for a drink, you can tell him or her that in just a few minutes you will be able to get the drink. Unlike toddlers, preschoolers can understand basic time concepts and delay their gratification. Children in this age group also enjoy talking on the telephone. At 3 years of age, children’s phone skills are limited to talking without interactive conversation. In other words, the 3-year-old can tell about a happening but is not able to answer questions asked by someone on the phone. By 5 years of age, the child can converse on the telephone. Preschool children can be taught their full name, address, and telephone number. This is the time for parents and teachers to instruct children about how to respond to emergencies. This age group can be taught how to dial 911 to initiate the emergency help system if needed. Preschoolers learn by imitating others in their environments. Their vocabularies increase through repetition and practice. It is important that adult role models use appropriate words to instill positive H E L P F U L H I N T S Red Flags for Language and Speech Problems (Birth to Preschool) 0–3 months 4–6 months 7–12 months 1–2 years 2–3 years 3–4 years Does not listen to sounds or does not coo or make throaty sounds Does not notice noisy items such as vacuums Does not babble or respond to name Does not use one- to two-word sentences Does not use two- to threeword sentences Does not understand or answer who, what, and why questions influences on a growing child. As a preschooler thinks about the right word to use, he or she may hesitate or stutter. This mannerism usually disappears within a few months. Parents should be patient and listen without hurrying or labeling the child a stutterer. When the child repeats an unacceptable or bad word, simple correction without a fuss is needed. Drawing attention to the “bad” words serves only to reinforce the child’s negative behavior. NUTRITION The nutritional requirements for the preschool years are similar to those for the toddler years. The child will need all of the basic nutrients outlined in the food pyramid and MyPlate. See Chapter 1 for the MyPlate chart. The average daily caloric needs for this age are approximately 1,800 calories, divided over the course of the day. Like toddlers, most preschool children do best when they have three meals and three snacks daily. Certain issues may be a concern during this stage, including food fads carried over from the toddler years, rebellious behavior, and periods of diminished appetite. Many parents become concerned about the amount of food consumed by their child. Parents should not expect the preschooler to eat an adult-size portion of food. Some children develop strong food preferences that may limit the type of foods that they will eat. By age 5 many children begin to develop food habits similar to those of their peers. Fast foods and highly advertised foods are known favorites for this age group. Parents must exercise caution when planning meals from fast-food restaurants because many of these food choices are very high in calories and fat. The best diet for young children includes foods containing proteins, carbohydrates, vitamins and minerals, and limited fats. Milk is still an important food because of its calcium content. Preschoolers need at least 1 pint of milk per day to meet their daily calcium requirements. It is also important that snack foods be selected for their nutritional value and appeal. Good food choices for snacks may include fresh or dried fruits, vegetables in bite-size pieces, cheese, or yogurt. It is best not to offer candy or other excessively sweet foods as snacks. These foods are not good for the health of the teeth and have a tendency to spoil the child’s appetite for regular meals. See Table 8.1 for a typical preschool diet. 7589_Ch08_115-130 29/08/17 12:02 PM Page 123 Preschool T A B L E 8.1 Samp l e Dai l y Di et f or P r es c h ool er s Type of Food Dairy foods Milk Cheese Yogurt Protein foods Meat, fish, or poultry Eggs Peanut butter Legumes, dried peas, beans, cooked Vegetables and fruits Vegetables, cooked Vegetables, raw Fruits, raw Fruits, canned Amount per Day 4 oz. 1 ⁄2–3⁄4 oz. 1 ⁄2 cup Two servings, 1–2 oz. 3 eggs per week 1–2 tablespoons 1 ⁄4–1⁄2 cup Four servings, 2–4 tablespoons Include 1 green or yellow vegetable Several pieces 4–8 tablespoons Grains Bread, enriched or Whole wheat bread Multigrain crackers Cereal, cooked or dry Pasta, rice 1–2 slices 3–4 crackers 1 ⁄4–1⁄2 cup 1 ⁄2 cup Fats Bacon Butter 1 slice 1 teaspoon 1–2 slices Mealtimes should be pleasant and allow family interaction. If the mealtime is very long, the preschooler may not be able to sit through it without getting restless and fidgety. Obesity Obesity is more accurately measured in infants, toddlers, and preschoolers using the weight for height chart. Any reading over the 85th percentile is considered obesity. Obesity places children at risk for cardiovascular disease, hypertension, type 2 diabetes, liver and gallbladder disease, and asthma. Researchers believe that a person can have a genetic predisposition for obesity, although other factors that can contribute to obesity include medications, consumption of fast food, and a sedentary lifestyle (such as more than 2 hours a day spent watching TV). To counteract obesity in children, the whole family must H E L P F U L 123 H I N T S Fostering Good Eating Habits Set good examples. Never force eating. Do not use food as a bribe or reward. Eat with the child. Provide a relaxed atmosphere. Encourage the child’s help in preparation and cleanup. Provide positive reinforcement. Allow the child to eat foods in any order. be involved in making better food choices and becoming more physically active. The adults must demonstrate healthy eating, and children should be involved in meal planning and preparation. SLEEP AND REST The average preschool child requires about 10 to 12 hours of sleep each night. Children in this age group are usually very active and busily engaged in some activity or game. Many are too busy and active to have time for a nap, even though they still need to rest and replenish their energy. Some children in this age group take only one nap per day, and many do not nap on a daily basis. The average nap at this age lasts 30 to 60 minutes. By evening the child is generally overtired and very much in need of an early bedtime. Many children during this stage have difficulty falling asleep at bedtime. Following a consistent bedtime routine helps minimize the conflict or debate over bedtime practices. Each child should be expected to follow the bedtime routine regardless of the day of the week or other distractions. Sometimes, however, it is necessary to limit the routine if a child tries to lengthen it as a means of putting off the inevitable. Preschool children often wake up during the night with nightmares. Parents should gently reassure the child that he or she is safe and not alone. After sitting with the child until he or she is relaxed, the parent should then proceed with the bedtime routine and encourage the child to go back to sleep. Some children experience a more extreme form of nightmare called night terrors. When these occur, the child suddenly sits up screaming but is not fully awake. The child’s appearance may be very frightening to the parents. The screaming may be accompanied by rapid breathing, a rapid heart rate, and profuse perspiration. The 7589_Ch08_115-130 29/08/17 12:02 PM Page 124 124 Journey Across the Life Span child may be inconsolable for a brief period. These episodes are usually followed by the child relaxing and falling back into a quiet sleep. The child is unable to recall the event in the morning. Night terrors are not thought to represent any emotional stress and disappear without intervention. PLAY Preschool children engage in cooperative play, also called associative play. Such play requires that children be able to understand limited rules. By this age children usually have developed some social skills that permit them to begin to share and take turns. Their mastery of basic communication skills enables them to express their desires. They enjoy being with peers and interacting with them during play. When observing preschool children at play, one can clearly see different personality traits emerge. For example, some children are dominant; others are passive and follow another child’s lead. Some children are more cautious and timid when trying new activities, whereas others aggressively attack any new activity without regard for danger. Still others may not interact well with peers or may even be excluded from peer activity. Unless the child is victimized or appears unhappy, he or she should be allowed to socialize at his or her own pace. Caregivers should understand that children have different personalities and different social needs. For example, some children need to be in the center of all activities, whereas some prefer to be observers or to play alone. The preschool child uses toys such as jungle gyms, tricycles, and big wheels, and these activities help further develop gross motor skills such as jumping, running, climbing, and pedaling. See Figure 8.5. It is possible to teach a preschooler to swim, skate, and play soccer and other sporting FIGURE 8.5 Play helps improve gross motor skills. activities. It is important, however, that parents not force their own competitive needs on their children. Just as growth patterns vary with each child, so do gross motor skills and innate abilities. Some children are more coordinated and skillful than others. Fine motor skills are enhanced through the use of playthings such as puzzles, construction sets, and computer programs. These activities help children at this age learn to manipulate and coordinate their small motor movements. Computer programs and other interactive games also help stimulate the preschooler’s thinking skills, reasoning, and memory. The preschool years are a time for building confidence. Children at this stage frequently say, “Look at my tall tower” or “Listen to me sing the ABCs.” “Watch me” is a common demand. At this age they seek approval and recognition from adults. Child-size kitchens and tool corners permit children to use their imagination, try on roles, and pretend to be grown up. Regardless of the type of plaything used, it is important that children be taught to clean up their play areas and take care of their toys. This helps to teach children responsibility and initiative, both of which can later be transferred to other situations. Preschoolers still use symbolic play, as described in Chapter 7. A great amount of play time is spent FIGURE 8.6 Preschoolers like to try on different roles. 7589_Ch08_115-130 29/08/17 12:02 PM Page 125 Preschool in activities that use their imaginations. Dramatic play may involve dressing up in different clothes, exploring roles, and imitating adults (Fig. 8.6). Common activities may also include playing with dolls or tools. Television is sometimes used as a time filler and for entertainment. Parents should screen the types of programs that their children view. Many programs have educational value, whereas others may have little or none. Educational programs can foster good social relationships and help enhance the child’s imagination. Television shows involving puppets have been shown to be useful in stimulating the imagination and creativity of preschool children. Preschool children may benefit from an introduction to music and instruments during this stage. This can enhance their sense of rhythm and concentration (Fig. 8.7). SAFETY The more coordinated preschool child is less likely to fall than the awkward toddler. This age group is also more aware of certain dangers and limitations. Most of them can recite a long list of “Nos” or things they cannot touch or do. Even so, they still need adult supervision and continual reminders about potential environmental hazards. The safety precautions outlined in Chapter 7 for the toddler also apply to the preschool child. See Box 8.4 for an overview of the recommended safety precautions for preschoolers. 125 Clothing items must be carefully inspected to make certain that they are safe for the active child. Clothing must allow freedom of movement and be nonrestrictive. Strangulation deaths have occurred as a result of clothing strings, belts, or loops catching on playground items. It is the responsibility of both the clothing manufacturers and caregivers to help look for these potential dangers to prevent accidents. Federal regulations now require that children’s nightclothes be flame-resistant as an additional means of providing for child safety in the home. Motor vehicle accidents are the major cause of accidental death in preschool children, as they are in toddlers. Preschool children must always be restrained in proper car safety seats. Some preschool children may be big enough to use an adult safety restraint, depending on the type of car and the state in which they live. It is best to check with the car manufacturer for guidelines about use. Because preschoolers like to imitate adult behaviors, adults must always use their own car safety restraints. As children become more active and involved in various games and activities, the number of injuries they sustain often increases. Preschool children are less likely to drown in the bathtub but more likely to get into danger outdoors near pools or other bodies of water. Preschool children should be given swimming lessons and instructions about water safety regulations. Parents must begin to educate their children about the dangers of talking to strangers or accepting candy, rides, or money from strangers. It is also necessary to teach children about their private body parts, including the rule that no one should be allowed to touch them. The environment in the home must permit children access and freedom to discuss their concerns and worries without shame or ridicule. Many communities have enacted safety programs that fingerprint and create photographic identification of children as a preventive measure in case of abduction or for help in searching for a missing person. Parents may contact their local police department for information on or help in establishing these types of programs. HEALTH PROMOTION FIGURE 8.7 Children connect with both music and one another. Preschool children need to receive booster shots for diphtheria, pertussis, and tetanus (DTaP) and the polio vaccine (TOPV); the measles, mumps, and 7589_Ch08_115-130 29/08/17 12:02 PM Page 126 126 B O 8.4 Journey Across the Life Span X S a fe t y Pr ec au t i on s f or P r es c h oo lers Motor Vehicles: Choking or Aspiration: • Car safety seats and restraints must be used at all times. • Windows and door handles should be off-limits to all young children or locked. • Never leave children alone or unattended in a motor vehicle. • Children should not play near roads or in active driveways. • Children should be actively supervised whenever near roads or motor vehicles. • Avoid known choking hazards, including foods like hard candies, popcorn, fruit pits or seeds, and large pieces of meat. • Avoid toys with small removable parts that can be placed in the child’s mouth and either swallowed or aspirated. • Suffocation is another safety concern. Keep all plastic coverings and bags away from children. • Do not let children blow up balloons, as this poses an aspiration risk. Poisoning: • Store household cleaning agents, garden products, car products, and prescription and nonprescription drugs safely away from children (for example, on a high shelf or in a locked cabinet). • Never refer to medicine as candy, and avoid taking medication in front of children to avoid their imitation of parental behavior. • Keep the national poison control number (800-222-1222) readily available in the event of accidental poisoning. Drowning: • Drowning can happen in just a few inches of water. Always supervise children while in the bathtub, swimming pool, or another body of water. Safe Clothing: • Avoid clothing that has loops, strings, or belts that could pose a strangulation risk. • Purchase fire-resistant sleepwear. Burns: Strangers: • Keep the stove safe by removing stove knobs and turning pot handles toward the back of the stove to prevent spills. • Educate children about the dangers of talking to strangers or accepting candy, rides, or money from strangers. • Teach children about body parts that are private and that no one should be allowed to touch. Cover Electrical Sockets: • Prevent burns from hot liquids, including bath water. • Keep matches and lighters away from young children. rubella vaccine (MMR); the varicella vaccine (VAR); and an annual influenza vaccine (Hib) to ensure immunity and protection against these diseases. Children at this age need yearly preventive health care visits to supervise their physical and social growth and development. See Box 8.5 for a sample of preschool health-screening assessments. Because preschoolers have increased exposure to other children, they are more likely to spread simple infections such as the common cold. They should be taught the importance of hygiene principles such as handwashing, using tissues, or sneezing or coughing into one’s elbow if tissues are unavailable. Common Preschool Concerns Thumb-Sucking Thumb-sucking is thought to be a primitive, instinctive behavior that may fulfill the child’s sucking and comfort needs. One concern with prolonged thumbsucking is that it may cause malalignment of the teeth. For this reason, many parents try to discourage this habit, often unsuccessfully. Sometimes other comfort objects such as a teddy bear, soft doll, or blanket can replace the thumb and still provide the child with a sense of security. Usually by school age this behavior lessens and eventually disappears. B O 8.5 X P rescho o l Yearly Health Screening A complete examination should include the following: • • • • • • • • • • Physical examination Health history Physical, nutritional, and psychosocial assessment Vision and hearing testing Cardiac screening Blood screening Urine testing Immunizations Tuberculosis screening Dental supervision 7589_Ch08_115-130 29/08/17 12:02 PM Page 127 Preschool Bed-Wetting Bed-wetting, also known as enuresis, is a problem that is seen more often in boys than in girls. Enuresis is not considered to be a problem until after toilet training is well established. The cause of enuresis is not fully understood. Stress and illness in the child appear to make it worse. If this behavior persists, it is important that the child be given a complete medical examination to help rule out any underlying pathology. The best approach in dealing with the problem of bed-wetting is one that minimizes each episode and avoids making the child feel guilty or ashamed. Parents can sometimes help prevent these accidents by taking the child to the toilet in the evening hours and limiting the child’s fluid intake after 5 p.m. Punishment or ridicule lowers the child’s self-esteem and morale and should be avoided. Fears Preschool children frequently have fears of the dark, mutilation, and abandonment. All childhood fears should be approached in a similar manner. Caregivers must first acknowledge the child’s fears. Reassurance and reality reinforcement are essential in 127 helping children cope with their fears. Some preschoolers experience fear of the dark. This may cause bedtime hassles or interrupt sleep. Having a simple nightlight in the child’s room or in a hallway may lessen the fear. Fear of mutilation often becomes evident at the time of injury or during hospitalization. Bleeding from a small scrape seems particularly frightening to this age group. Bandages can help cover the site of an injury, making the child feel better. Fear of abandonment frequently occurs at this age. Preschoolers may get hysterical if a parent is a few minutes late in picking them up at school. They respond as though the parent is never coming back. However, they show increased independence by thinking nothing of walking away from their parents in a store or on the playground. They think it is all right if they wander out of sight, but their response is different if the parent walks away. Parents may help allay the fears of abandonment by being honest with their child. For example, if parents/caregivers are going out for the evening, they should tell the child that they are leaving and when they will be back. Parents should never sneak out or lie to their child. SUMMARY 1. The rate of growth for the preschool period is slow and steady. 2. Children grow 21/2 inches per year. The average weight gain is 5 to 7 pounds a year. The trunk and body lengthen, giving the child a taller appearance and a more erect posture. 7. The focus during the preschool years is on increasing motor skills, improving vocabulary, and increasing knowledge about the environment. 3. Care of the teeth during the preschool stage is important to promote healthy teeth in future years. 8. Four-year-old children are capable of walking and running on their tiptoes, hopping, and balancing on one foot. Preschoolers can pedal a tricycle and like to climb and jump. By age 5, they can skip, walk on a balance beam, and catch a ball. 4. Visual acuity improves and hearing matures during this stage. 9. Improved fine motor development allows 4year-old children to accomplish self-care. 5. The structural makeup of the preschool child’s ears continues to account for the high incidence of middle-ear infections in this age group. 6. The normal pulse rate is between 90 and 100 beats per minute, and blood pressure is about 100/60 mm Hg. The normal respiratory rate is 22 to 25 breaths per minute at rest. 10. Preschoolers find pleasure in examining and exploring their bodies. They are now very curious about the differences between male and female bodies. 11. Masturbation is common for both sexes during this stage. Parents should respond in a matterof-fact manner and not instill feelings of guilt in their child. 7589_Ch08_115-130 29/08/17 12:02 PM Page 128 128 Journey Across the Life Span 12. The psychosocial task of the preschool period is the development of initiative. 13. Preschool children need discipline to learn impulse control. 14. Preschools should be selected on the basis of philosophy, location, schedule, and cost. 15. Jealousy is a normal pattern of behavior seen at various stages of development. 16. Divorce is one of the common stresses that affect children. Preschool children often blame themselves and have a strong wish to reunite the parents. 17. Cognitive development is at the preoperational stage. The child continues to develop language and memory. The thinking style of the preschool stage is often described as magical, giving the child the feeling that he or she is all-powerful. 18. Preschool children are developing their consciences and have a beginning capacity for moral reasoning. Moral reasoning is learned mainly by imitating parents and other adults. It is therefore important that the adult role model use appropriate words and set good examples for the child. 19. Communication is more sophisticated during this period of development. Children are very talkative and can be taught their full names and addresses and how to respond to emergencies. 20. The average daily caloric need for this age is 1,800 calories, divided over the course of the day. By age 5 many children have developed food habits similar to those of their peers. The diet for this age group should include foods containing proteins, carbohydrates, vitamins, minerals, and limited fats. 21. Children at this stage are very active and require an average of 10 to 12 hours of sleep each night. All preschool children need consistency with their night rituals. Nightmares and night terrors are common during this stage of development. 22. Preschool play style is known as cooperative, or associative. Children are able to share, take turns, and follow simple rules. 23. Toys should be selected to help stimulate fine and gross motor development. Just as growth patterns vary with each child, so do motor skills and innate abilities, making some children more coordinated than others. 24. Safety continues to be a major concern for preschool children, and they still need adult supervision and constant reminders about potential environmental hazards. 25. During the preschool years, children need to be given booster shots for DTaP and TOPV to help ensure immunity and protection against these diseases. Children at this stage need yearly preventive health care visits and screening to supervise their physical, emotional, and social development. 26. Thumb-sucking is thought to be a primitive and instinctive behavior. If it becomes a prolonged habit, it may cause malalignment of the child’s teeth. 27. Bed-wetting, also known as enuresis, is a problem seen more often in boys than in girls. Stress and illness in the child seem to make it worse. 7589_Ch08_115-130 29/08/17 12:02 PM Page 129 Preschool 129 CRITICAL THINKING Exercise #1 Mrs. Hyatt attends a local community support group supervised by the pediatric nurse practitioner for new and working mothers. Mrs. Hyatt verbalizes her concern about her 41/2-year-old son. He appears to be slow in mastering language. He is presently enrolled in a preschool program. Although his speech has improved since he began school, he demonstrates marked stuttering. Mrs. Hyatt also reports that her son repeatedly uses bad language. She is very upset and admits that she doesn’t know how to handle this. Mrs. Hyatt assures the nurse that neither she nor her husband uses this type of language in the home. 1. What reason would you give Mrs. Hyatt for her son’s: a. Bad language? b. Stuttering? 2. How would you instruct Mrs. Hyatt to respond to her son when he: a. Uses bad language? b. Stutters? Exercise #2 You are assigned to a playroom. Explain what play activities would be appropriate for several 4- to 5-year-old children. Select activities that will stimulate their growth and development. MULTIPLE-CHOICE QUESTIONS 1. The purpose of preschool education is to foster which of the following? (Select all that apply) a. Cognitive development b. Physical development c. Social development d. Psychological development 2. Preschool focuses on which of the following? (Select all that apply) a. Medical care b. Interests c. Learning style d. Rest 3. The erect posture and steady gait seen in preschool children may be a result of: a. Movement of the foot away from the center of the body b. Exaggerated lumbar curvature of the spine c. Movement of the foot toward the center of the body d. Increased fusion of the spinal bones 4. Ear infections are more commonly seen in children because of: a. Their increased exposure to infection b. Their earlobes, which are smaller than those of adults c. Their short eustachian tubes d. A decrease in the number of white blood cells 5. The type of play seen at the preschool age is: a. Parallel play b. Associative play c. Solitary play d. Isolated play 6. Occasional periods of masturbation in a 4-year-old child suggest: a. Pathology in the child’s personality b. A normal pattern of development c. History of sexual abuse d. Impaired cognitive development 7589_Ch08_115-130 29/08/17 12:02 PM Page 130 130 Journey Across the Life Span 7. According to Erikson, a sense of initiative is best explained as: a. Finishing tasks started b. Establishing trust c. The ability to express one’s needs d. Trying new roles without feelings of guilt 8. Preschoolers learn to handle frustration in a positive manner by: a. Becoming ambivalent b. Learning self-control c. Developing apathy d. Becoming manipulative 9. The average daily caloric intake recommended during the preschool years is: a. 1,000 calories b. 2,500 calories c. 1,800 calories d. 500 calories 11. Sibling rivalry is best resolved by: a. Blaming both parties b. Separating both children c. Immediately determining the instigator d. Supporting the weaker child 12. According to Piaget, preschoolers lack the concept of reversibility. This can be demonstrated by: a. Believing that if the item is out of sight, then it doesn’t exist b. Having the ability to solve problems abstractly c. Not recognizing that changing the shape of something, such as clay, does not change the amount d. Having the ability to learn through their senses 10. Nightmares and night terrors differ in the following way: a. With nightmares, the child remains inconsolable for a long period. b. With night terrors, the child remembers the event in detail. c. Nightmares are usually accompanied by rapid respirations and rapid heart rate. d. With night terrors, the child has no recall of the event. Visit www.DavisPlus.com for Student Resources.