Competency Appraisal (Pedia)

Case #3: Daniel, Enrique and Joshua

Submitted by:

ROMERO, Abbey Rochelle

TOLENTINO, Jyle Kristine

TORRES, Vince Ronald

UY, Sergio Miguel

4 NUR 2

Submitted to:

Assoc. Prof. Rouena S. Villarama, MAEd., RN.,

Case # 3

In the orphanage are three brothers, Daniel aged 2 ½ and the twins Enrique and Joshua, both age
5. They were all playing in the playroom when Nurse Angela heard Joshua, one of the twins who
is younger by 5 minutes, scream. She hurriedly went to check and she saw the three of them
fighting over a toy car. The brothers became dear to Nurse Angela as she was with their parents
when they had an accident a year ago where both parents died. Nurse Angela herself was slightly
injured. She took it to herself to be like the brothers’ own mother. She saw them in their best and
worst behavior. Daniel, the toddler is noticed to be the most aggressive of the three boys. He is
the one who would not share his toy and seems to be the most hard-headed as he would refuse to
do most things requested from him. He also gets upset easily when he did not get what he wanted
and would throw fits on occasions. He prefers to be by himself when he plays and would have a
particular way of doing things like he will not sleep without a tattered blanket that he always
keep with him.

As for the twins, though identical, there are obvious differences between the two. Enrique is a
very active boy with lots of adventure stories to tell. He is often seen playing while wearing his
bath towel like a cape around his shoulder. He would say to anyone who ask him that he is
“Superman”. Nurse Angela loves talking with him although she finds it very tiring sometimes
because of the so many questions he asks. He is popular with most of the volunteers because he
wants to participate in all activities happening in the playroom.

Joshua on the other hand is a timid boy who would just look and not say anything even is people
talks to him. He has always been smaller by size than his older twin. He is oftentimes very quiet
except when he goes into tantrums which happens every so often especially if the caretaker
failed to notice him when he urinates while playing and if made to eat foods he does not like. He
is seen always holding his tattered blue blanket which he sleeps with too.
A. TODDLER

1. Biological Growth and Development

- Period of 12-36 months of age, although in some sources, some consider it from 1 – 4 years
old.

- Growth slows considerably in childhood:

• Average weight at 2 years old: 12 kg (26.5 lbs)

• Average weight gain: 1.8-2.7 kg (4-6 lbs) per year

• Average height at 2 years old: 34 inches (86.6 cm)

- In general, adult height is about twice the child’s height at 2 years old.
Note: Accurate measurement of height and weight during toddler years should reveal a steady
growth curve that is steplike rather than linear.

- Chest circumference continues to increase and exceeds head circumference during the toddler
years. Its shape changes as the transverse (or lateral) diameter exceeds the anteroposterior
diameter.

- After the second year, the chest circumference exceeds the abdominal measurement which
gives the child a taller, leaner appearance. However, the toddler retains a squat, “potbellied”
appearance because of the less well-developed abdominal muscles and short legs.

- Legs retain a slightly bowed or curved appearance during the second year from the weight of
the relatively large trunk.

- Sense of sight, hearing, smell, touch and taste develop:

• Visual acuity of 20/40 in toddler years
• Full binocular vision is well developed: developed vision using two eyes with
overlapping fields of view

• Depth perception continues to develop, but because of the child’s lack of motor
coordination, falls from heights remain a persistent danger
 • There is integrated function of the senses. Senses of hearing, smell, taste, and tough
become increasingly well-developed, coordinated with one another and associated with
other experiences. Toddlers use all senses to explore the environment.

• Descending development of the spinal tract is evidenced by increased sensations in the

lower extremities, such as ticklish feet.

• Pleasant sensations soothe and comfort the toddler, especially in times of stress or
fatigue.

- Development of the Brain and Spinal Cord:

• By the end of the first year, all the brain cells are present but continue to increase in size.
• Myelination of the spinal cord is almost complete by 2 years of age, which parallels the
completion of most of the gross motor skills associated with locomotion.

• Although the myelination of the spinal cord advances, the immaturity of this control,
combined with the child’s limited experiences and lack of visual perception, makes it
difficult to do simple acts (such as seating in a chair or climbing down the stairs).

• Brain growth is 75% completed by the end of 2 years old.

• Development of various areas of the brain correspond to the child’s progressive
intellectual capacity. As development progresses, specific changes take place in various
areas of the cerebral cortex, such as the Broca’s area for speech and cortical areas for
control of the legs, hands, feet and sphincters. The child is limited to attend to any one
aspect of behavior for more than a few minutes due to the intricacy and complexity of
this neuromotor organization.

- Internal structures of the ear and throat continue to be short and straight and the lymphoid
tissues of the tonsils and adenoids continues to be large. As a result, otitis media, tonsillitis and
respiratory tract infections are common.

- Respirations continue to be abdominal.

- Digestive Processes is fairly complete by the beginning of toddlerhood. Acidity of gastric
contents continue to increase. It provides a protective function since it destroys many types of
bacteria that may enter.

- Stomach capacity increases to allow for the usual schedule of 3 meals per day.
- Epidermis and dermis are more tightly bound together, increasing the resistance from infection
and irritation and creating a more effective barrier against fluid loss. Sebum production is
minimal. This contributes to the development of dry skin

- Eccrine glands: functional and reacts to changes in temperature but produces minimum
amounts of sweat.

- Fine hair is evident on the lower arms and legs

- Production of adipose tissue declines as hyperplasia of the muscle cells increases.
- The capillaries are able to conserve core temperature by constricting in response to cold and
dilating in response to heat. Shivering: involuntary act that results in rhythmic muscle
contractions, which increases cellular metabolism and produces heat.

2. Psychosexual Development (Freud)

Anal Stage (18 months to three years)

- The child’s focus of pleasure in this stage is on eliminating and retaining feces. Through
society’s pressure, mainly via parents, the child has to learn to control anal stimulation. In
terms of personality, after effects of an anal fixation during this stage can result in an
obsession with cleanliness, perfection, and control (anal retentive). On the opposite end of the
spectrum, they may become messy and disorganized (anal expulsive).

3. Cognitive Development (Piaget)

Sensorimotor

- The child uses active experimentation to achieve previously un- attainable goals. The child
incorporates the old learning of the secondary circular reactions and applies the combined
knowledge to new situations and applications. Awareness of a casual relationship between two
events is apparent. Reasoning skills are still primitive and need to be understood to effectively
deal with the typical behaviors of the toddlers. The main cognitive achievement of early
childhood is the acquisition of language, which represents mental symbolism. Spatial
relationship is where the toddler is able to recognize different shapes and their relationship to
one another. Object permanence is when the toddler learns that an object continues to exist
even though they cannot see it.
Preoperative

- Egocentrism: inability to envision situations from perspectives other than one’s own.
- Transductive: when a child fails to understand the true relationships between cause and effect
or reasoning from the particular to the particular.

- Global organization: belief that changes in any one part of the whole changes the entire world.
- Centration: focusing on one aspect rather than considering all possible alternatives.
- Animism: attributing lifelike qualities to inanimate objects.
- Irreversibility: inability to undo or reverse the actions initiated physically.
- Magical thinking: believing that thoughts are all-powerful and can cause events.
- Inability to conserve: inability to understand the idea that a mass can be changed in size,
shape, volume, or length without losing or adding mass.

4. Psychosocial Development (Erikson)

Autonomy vs. Shame and Doubt

- This stage occurs between the ages of 18 months to around age 2 or 3 years.
- According to Erikson, children at this stage are focused on developing a greater sense of self-
control. It is at this point in development that young children begin to express a greater need
for independence and control over themselves and the world around them.

- Children who successfully complete this stage feel secure and confident, while those who do
not are left with a sense of inadequacy and self-doubt.

- In the psychosocial development, toddlers are faced with the mastery of several tasks. If he
need for basic trust has been satisfied, they are ready to give up dependence for control,
independence and autonomy. Some specific tasks include:

• Differentiation of self from others, particularly the mother or primary caregiver

• Toleration of separation from parents (Separation anxiety)
• Ability to withstand delayed gratification
• Control over bodily functions (Toilet training)
 • Acquisition of socially acceptable behavior
• Verbal means of communication
• Ability to interact with others in a less egocentric manner

5. Social Development

Separation and Individuation

- Separation is the children’s emergence from a symbiotic fusion with the mother while
Individuation are those achievements that mark children’s assumption of their individual
characteristics in the environment.

- Toddlers also show less fear of strangers, but only when their parents are present.
- They begin to lose some of their resistance to separation, yet appear even more concerned
about parent’s whereabouts.

- They have learned from experience that parents exist when physically absent. Repetition of
events such as going to bed without parents but waking up to find them again reinforces the
reliability of such brief separations.

- A major task of toddler period is differentiation of self from significant others, usually the
mother.

- Transitional objects, such as favorite blanket or toy, provide security for young children,
especially when they are separated from parents, are dealing with new stress, or are just
fatigued.

Personal-Social Development

- Toddlers begin to develop the skill of independence as evidenced by their behaviors such as:
being able to drink from a lidded cup, able to zip and unzip, being able to remove clothing
items, using utensils such as spoon and fork during meals although they may lack table
manners.

Play

- Parallel play is normal for toddlers. This means they enjoy to play alongside others, but not
with other children.
- Toddlers also enjoy “reading” stories from a picture book and imitating the sounds of animals.
They usually cannot distinguish “sex-stereotypes toys”.

- Active play time should also be encouraged over the use of computer or video games, which
are more passive. Remember that toys are never substitutes for the attention of devoted
caregivers, but toys can enhance these interactions.

6. Behavioral Concerns and How to Cope

Tantrums- an uncontrolled outburst of anger and frustration, typically in a young child.

- Temper tantrums are most common in toddlers and preschoolers but they can extend into
grade school if they aren’t addressed swiftly. A tantrum, temper tantrum, meltdown or hissy fit
is an emotional outburst, usually associated with children or those in emotional distress that is
typically characterized by stubbornness, crying, etc.

- What to do: Don't lose your cool. You may be tempted to stomp out of the room, but that can
make your child feel abandoned.

- Identify tantrum triggers. For example, your child might have tantrums when you’re shopping.
You might be able to plan ahead or change the environment to avoid tantrums. For example, it
might help to go shopping after your child has had a nap and a snack.

- Talk about emotions with your child. When your child struggles with a difficult feeling,
encourage him to name the feeling and what caused it. For example, ‘Did you throw your toy
because you were cross that it wasn’t working? What else could you have done?

Negativism - As your child grows they will go through a normal developmental stage of being
negative. Most children go through a period of time, typically around 14 months, or until age 3,
when they seem to resist everything their parents want them to do; their favorite word seems to
be no.

- Frustration is at the root of many temper tantrums. Being unable to put her own hair in a
ponytail, tie his shoes or tearfully watching a carefully built block tower come tumbling down
can all trigger negativism in toddlers.

What to do:

- Don’t ask questions that will require a “yes” or “no” answer. Toddlers will undoubtedly say
NO. for example instead of “would you like cereal for breakfast?” say, “Would you like hot or
cold cereal?”
- Offer lots of choices. When toddlers have been given lots of choices, they are more likely to
accept those times when there is no choice.

Ritualism - Maintaining routines provides a sense of comfort for toddlers as they begin to
explore the environment beyond those most familiar to them. For example toddlers often like to
have the same dish, cup or spoon for each meal, and prefer the same dining hours.

- Rituals create order for children as they grow and try to make sense of the world around them.
For example, a bath, story time, and cuddles every night before bed give children structure and
a sense of security. They feel safe; they know what to expect. Everything is as it should be.
Here, rituals are a good thing.

What to do:

- Provide a sense of comfort. A child has a short attention span and still takes naps. The toddler
has poorly developed body boundaries, and any intrusion produces anxiety.

Bowel and Bladder Control “Holding on and Letting Go”- Voluntary control of the anal and
urethral sphincters is achieved sometime after the child is walking, probably between 18 and 24
months. However, psycho-physiologic factors are required for readiness. The child must be able
to must be able to recognize the urge to let go and hold on and be able to communicate this
sensation to the parent. Five Markers signal a child readiness to toilet train: bladder readiness,
bowel readiness, cognitive readiness, motor readiness, and psychologic readiness (Schmitt,
2004).

- Bowel training is usually accomplished first before bladder training because of its greater
regularity and predictability. The sensation for defecation is stronger than that for urination
and easier for children to recognize. A well balance diet that includes dietary fiber help keeps
stool soft and supports the development and maintenance of regular bowel movement.

How to toilet train?

- Parent should begin the readiness phase of toilet training by teaching the child about how the
body functions in relation to voiding and having a stool.

- Make toilet training as easy as possible:

• Selection of the child’s clothing (dress should be easily removed by the child)
• Use of free standing potty chair (allows children feeling of security) or use of the toilet
• Practice session should only be limited to 5 to 8 minutes
 • Parents should always stay with the child during toilet training
• Children should be praised for cooperative behavior and successful evacuation
• Use of “pull-on” diapers or underwear on children
• Frequent reminder and trips to the toilet are necessary
- As the child masters each step of toileting (discussion, undressing, going, wiping, dressing,
flushing and hand-washing), he or she gains a sense of accomplishment that parents should
reinforce. Parents who utilize praise and rewards for using the toilet at the appropriate time
encourage positive outcomes and help children feel capable and productive. Freud believed
that positive experiences during this stage served as the basis for people to become competent,
productive, and creative adults.

REMEMBER: Ensuring consistency in care of the toddler and ensuring healthy practices in a
sanitary environment allow for a safe and effective toilet practices in all setting.

7. Care for Toddlers

Nutrition

- Usually require three (3) meals and two (2) snacks per day with an increase in the intake of
sweets, snacks and soda. A phenomenon called “Physiologic Anorexia” is manifested during
this age and this is decreased nutritional need with a decreased appetite because their own
physiologic body is stating that they do not need much food in order for them to grow due to
the fact that it is normal for them to grow slowly.

- They become picky and fussy eaters with strong taste preference and they eat large amounts
one day and almost nothing the next. Likewise, they are influenced by factors other than taste
when choosing food such as:

• if a family member refuses to eat, they are likely to imitate

• if plate is overfilled, they are likely to push away overwhelmed by its size
• if food does not appear or smell appetizing, they will not agree to try it
Accident prevention for toddlers:

- Keep floors free of toys and obstructions.

- Exercise close supervision when toddler learns to walk.
- Never leave babies unattended on raised surfaces.
- Check constantly floor surface for wear and tear.
- Windows and doors must be locked to avoid misadventure by children.
- Choose toys appropriate to the age of children. Avoid toys with detachable small parts.
- Ensure small objects are kept out of reach of children.
- Keep medicines and chemicals out of sight and reach of children, preferably in an isolated,
locked cabinet.

Sleep and Activity

- Normally, toddlers sleeping hours average about 11 to 12 hours at night and they take one nap
a day. Moreover, they are prone to bedtime resistance or refusal to go to bed, have frequent
night waking and express fears about monsters. Lastly, they might take a light snack before
bedtime because heavy meal may interfere with sleep.

Role of the nurse in the care of a healthy/ill toddler:

• Nurse as a Coordinator and Collaborator- the nurse plays an extremely important role
with the combination of health care team members. Nurse maintains good interpersonal
communication with the child, family and health team members. The nurse coordinates
nursing care with other services for meeting the needs of child.

• Nurse Advocate- the pediatric nurse acts as an advocate to safeguard the child’s right, to
assist and to provide best care from the health care team. Nurse acts as a representative
for the child, family and other health care providers. Example it can range from
consulting dietary department for special foods to arrange team meeting to discuss plan
of care with other health team members.

• Health Educator- The nurse’s goal of health teaching is to provide information to the
child parents and significant other about prevention of illness, promotion or health
maintenance.
B. PRESCHOOLER

1. Biological Growth and Development

- Preschoolers are 3-5 years of age

- The rate of growth slows and stabilizes during the preschool years
• Average weight: 14.5 kg (32 lbs) at 3 years, 16.5 kg (36.5 lb) at 4 years and 18.5 kg (41
lb) at 5 years.

• Average weight gain remains approximately 2-3 kg (4.5 -6.5 lb) per year
• Growth in height also remains steady at a yearly increase of 2.5-3.5 inches (6.5 to 9 cm)
• The legs of a preschooler, rather than the trunk, increases in length
• Average height is 37.5 inches (95 cm) at 3 years old, 40.5 inches (103 cm) at 4 years old,
and 43.5 inches (110 cm) at 5 years

- Physical proportions no longer resemble those of the squat, pot-bellied toddler. The
preschooler is slender but sturdy, graceful, agile and posturally erect. There is little difference
in physical characteristics according to sex, except in factors such as dress and hairstyle.

- Most organ systems can adjust to moderate stress and change. Most children are toilet trained
during this period. Most muscle development and bone growth are still far from mature.
Excessive activity and overexertion can injure delicate tissues. Good posture, appropriate
exercise and adequate nutrition and rest are essential for optimum development of the
musculoskeletal system.

- 3 to 4 year- olds continue to refine their eating skills and can use utensils like forks and
spoons. Young children at this age can also use larger writing instruments, like fat crayons, in
a writing hold rather than just grasping them with their fist. They can also use a twisting
motion with their hands, useful for opening door knobs or twisting lids off containers. Because
children can now open containers with lids, caregivers should make certain that harmful
substances such as cleaners and medications are stored out of reach in a locked area to prevent
accidental poisonings.

- During ages 4 to 5 years, children continue to refine fine motor skills and build upon earlier
skills. For instance, they can now button and unbutton their clothes by themselves. Their
 artistic skills improve, and they can draw simple stick figures and copy shapes such as circles,
squares, and large letters. Drawing more complex shapes, however, may take longer.

Types of Twins (Fraternal and Identical)

- There are two types of twins – identical (monozygotic) and fraternal (dizygotic).
- To form identical twins, one fertilised egg (ovum) splits and develops two babies with exactly
the same genetic information. This differs from fraternal twins, where two eggs (ova) are
fertilised by two sperm and produce two genetically unique children, who are no more alike
than individual siblings born at different times.

- Approximately one quarter of identical twins are mirror images of each other, which means
the right side of one child matches the left side of their twin. Meanwhile, fraternal twin babies
will be no more alike than siblings born at separate times, they can be either the same sex or
different sexes, with the odds roughly equal for each.

2. Psychosexual Development (Freud)

Phallic

- Sensitivity now becomes concentrated in the genitals and masturbation (in both sexes)
becomes a new source of pleasure.

- Oedipus complex:

• Envy and Jealous is aimed at the father, the object of the mother's affection and attention.
These feelings for the mother and rivalry toward the father lead to fantasies of getting rid
of his father and taking his place with the mother.

• The hostile feelings towards the father lead to castration anxiety, an irrational fear that
the father will castrate (remove his penis) him as punishment.

• To cope with this anxiety, the son identifies with the father. This means the son adopts /
internalizes the attitudes, characteristics and values that his father holds (personality,
gender role, masculine dad-type behaviors etc.)

• The father becomes a role model rather than a rival. Through this identification with the
aggressor, boys acquire their superego and the male sex role. The boy substitutes his
desire for his mother with the desire for other women.

- Electra complex:
 • Electra complex begins with the belief that she’s already been castrated. She blames her
mother for this and experiences penis envy. For girls to develop their superego and
female sex role, they need to identify with the mother.

• But the girl’s motivation for giving up her father as a love-object in order to move back
to her mother is much less obvious than the boy’s for identifying with his father.

• As a consequence, girls’ identification with their mothers is less complete than boys’
with their fathers. In turn, this makes the female superego weaker and their identity as
separate, independent persons is less well developed.

3. Cognitive Development (Piaget)

Preoperative

- Piaget cognitive theory does not include a period specifically for children ages 3-5. However
egocentricity is still evident.

- They can also verbalize in their mental process without having to act out their thinking. They
can think of only one idea at a time.

- Preschoolers thinking is usually described as magical thinking because of their egocentrism

and transductive reasoning.

4. Psychosocial Development (Erikson)

Initiative vs. Guilt

- Preschoolers are in a stage of energetic learning; they play, work, and live to the fullest and
feel a real sense of accomplishment and satisfaction of their activities.

- Development of the superego is a major task for preschoolers.

- Learning right from wrong and good from bad is the beginning of morality. Children in this
age group are generally unable to understand why something is acceptable or unacceptable.
They are aware of appropriate behavior primarily through punishment or reward and rely
almost completely on parental principles for developing their own moral judgment.
- Conflict arises when children overstep the limits of their ability and inquiry and experience
guilt for not having behaved appropriately. Feelings of guilt, anxiety and fear may also result
from thoughts that differ from expected behavior.

5. Social Development

Development of Gender Identity

- Just as preschoolers explore their environment, they also explore their bodies and find that
touching certain body parts is pleasurable.

- Genital fondling (masturbation) can occur and involves manual stimulation and posturing
movements. Other demonstrations of pleasurable activities include rocking, swinging, and
hugging people and toys.

- Parental reactions to children’s behavior influence their own attitudes and should be accepting
rather than critical. If such acts are performed in public, parents should not condone or bring
attention to the behavior but should teach the child that it is more acceptable to perform the
behavior in private.

Personal-Social Development

- Preschoolers have overcome their anxiety associated with strangers and the fear of separation
of earlier years. They can cope with changes in daily routine much better than toddlers but
may develop more imaginary fears. They gain security and comfort from familiar objects like
toys and dolls and photographs of family members.

Language

- Vocabulary increases dramatically. Preschoolers use longer sentences of 4 or 5 words and use
more words to convey a message. They follow simple directional commands.

Play

- Preschoolers enjoy associative play, group play, in similar or identical activities but without
rigid organization or rules. They can also play easy construction set, large blocks of various
sizes, alphabet number flash cards, and clay and other suitable toys. Although their attention
span. Probably the most characteristic and pervasive preschooler activity is imitative,
imaginative and dramatic play.
6. Behavioral Concerns and How to Cope

• Imaginary Fears
• Security Items
• School Readiness
• Aggressions
• Curiosity

Preparing the child for school - “School readiness” refers to the academic knowledge,
independence, communication, and social skills children need to do well in school.

- Academic readiness:
• Read to your child daily and talk about what you’ve read.
• Visit the library. Check out books and attend story times.
• Sing rhyming songs and do finger plays.
• Put your child’s name on their clothing and toys to help him or her recognize their name
in print.

• Encourage your child to write his or her name.

• Help your child learn basic colors by pointing and naming objects like “green trees,” “red
apples,” or “blue coats.”

• Give your child puzzles and games that require counting and problem solving. Let your
child scribble, draw, write, and cut and paste.

• Sing the alphabet song with your child and provide letter magnets or other toys that will
help him/her begin to recognize the letters of the alphabet.

• Take your child to the zoo, park, grocery store, post office, and pet shop. Talk about the
sights and sounds of your day.

• Make time for your child to sing, dance, climb, jump, run, and ride tricycles or bikes.
• Choose child care that promotes learning with well planned, fun, and interesting
activities.
Social readiness:

- Set rules and give consequences for breaking them.

- Have regular routines for mealtime and bedtime.
- Encourage your child to play with and talk to other children.
- Encourage your child to take turns and share with other children.
- Encourage your child to finish difficult or frustrating tasks once they have begun them.
- Encourage your child to consider the feelings of others.
- Model and discuss positive ways for your child to express his or her feelings.
- Discourage hitting, biting, screaming, and other negative behaviors.
- Kiss and hug your child several times a day.
Independence:

- Buy shoes and clothing that are easy for children to buckle, zip, and fasten on their own.
- Let your child get dressed and put on shoes by him or herself.
- Encourage your child to take turns and share with other children.
- Let your child do simple chores like setting the table at mealtimes or cleaning up toys after
playing.

- Encourage independent toileting and hand washing.

- Let your child work independently on activities such as completing puzzles.
- Communication skills:
- Have regular conversations with your child.
- Encourage your child to listen and respond to others when they speak.
- Answer your child’s questions, even if the answer is “no.”
- Help your child learn and use new words.
- Explore language through singing, rhyming, songs, and chants.
- Model the language you want your child to use.
- Write notes to your child.
- Help your child dictate letters to family and friends.
Sibling Rivalry/Jealousy

- This usually happens when the parents compare her to any of her siblings. As a result, it brings
her self-confidence down and makes her feel jealous of her siblings.

- How to deal with it:

• Model and teach respect
• Compliment good behavior
• Minimize stress
• Create healthy competition
• Avoid comparisons
• Encourage siblings to develop friendships with each other
Sex awareness/sex education

Children Ages 3 to 4 may:

• Become increasingly curious about their bodies. Knowing that touching their genitals
feels good, they may begin to masturbate by stimulating themselves with their hand or
rocking against a stuffed animal, which may or may not lead to orgasm.

• Establish that they are a boy or a girl. However, while playing they may pretend to be the
other gender.

• Be inquisitive about body differences and voluntarily play house, doctor, or explore other
forms of sexual play with friends or siblings that are close in age and developmental
level. If they play alone, they might undress their dolls to see their genitals.

• Express interest in words associated with bathroom behaviors, show curiosity about how
males and females use the toilet, repeat "curse" words that they hear, and start to ask
sexuality-related questions like "Where did I come from?"

How to deal with it:

- Explain in a calm tone that while touching the genitals can feel good, it is to be done in a
private place like their bedroom.
- When finding a child engaged in sex play with another child, gently ask them what they are
doing so that the scenario can be understood from the child's perspective. It is important to
remove the adult lens and see the behavior from the child's point of view. This will help
parents understand that more often than not, the behavior is not erotically focused but
motivated by curiosity.

- Parents can then explain that one's penis/vulva/buttocks etc. are considered to be private, and
that no one should touch their "private parts" except for health reasons or to clean them.

- Give the child anatomically correct dolls to help them understand that girls and boys have
many body parts that are the same and some that are different.

- Read age-appropriate sexuality books with the child to help lay the foundation for them to
grow up sexually healthy.

- Continue to model appropriate behavior and share positive messages about gender and other
aspects of sexuality that arise.

- Use proper terms to name body parts, including the genitals.

- Follow up children's questions age-appropriately by asking questions like "What do you
think?" This will give parents an idea of what they are really asking and help give an
indication of what they are ready to learn.

Role of the nurse in the care of a healthy/ ill preschooler

• Assessing their needs

• Planning for care
• Implementing the plan
• Evaluating children’s condition
• Providing health teaching to children