9/6/10 Preschooler (3-6 Years Old) Associative Play Group play in similar or identical activities but without rigid

d organization or rules. Magical Thinking-because of their egocentrism and transductive reasoning, they believe all thoughts are all powerful. Such thinking places them in the vulnerable position of feeling guilty and responsible for bad thoughts that may coincide with the occurrence of a wished event. Thoughts and wishes can come true Stuttering-also known as stammering, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the stutterer is unable to produce sound. Bruxismis a condition in which you grind, gnash, or clench your teeth together during the night. Oedipus Complex-strong or emotional attachment of boy to mother, boy wishes his father dead so he could marry his mother. Electra complex-attachment of girl to father, girls have similar wishes to marry their father and kill their mother. Castration complex-unconscious fear of having ones genitals removed by wishing to have sex with ones parent Intuitive thought-children apply mental activities to solve problems or attain goals but are unaware and how they came to those conclusions. Telegraphic speech-is defined as a form of communication consisting of simple two word, noun-verb sentences that adhere to the grammatical standards of the cultures language. Biologic Development Physique -slimmer, taller and much more childlike proportions -future body type becomes apparent whether ectomorphic (slim body) or endomorphic (large body build Proportional changes Weight -avg gain is only about 4.5lbs (2kg) a year Height -avg height gain is 2 to 3.5 inches (6-8 cm) a year Head Circumference -not routinely measured at physical assessment on children over 2 years of age Maturation of Systems Immune System -lymphatic tissues particularly the tonsils begins to increase in size -IgG and IgA antibody levels increase causing preschool illness more localized Cardiovascular System -physiologic splitting of heart sounds may be present on auscultation -innocent heart murmurs may also be heard for the first time -pulse rate decreases to about 85 bpm -BP holds at about 100/60mmhg Urinary System -bladder is easily palpable above the symphis pubis -voiding is frequent enough (9 to 10 times a day) Musculoskeletal System

-demonstrates a well formed arch in the foot now -with stronger muscles -at the beginning of the period some children exhibit genu valgum(locked knees or knock knee) but later on disappears with increased skeletal growth at the end of the period Teeth -generally have all deciduous teeth by 3 years of age -eruption of new teeth is rare Developmental Milestones 3 yr old-walking, running, climbing, and jumping are well established -there is a refinement in eye hand coordination -rides a tricycle, walks on tiptoes, balances on one foot for a few seconds and broad jumps -can build a 9-10 block tower, can construct a 3 block bridges -4 yr olds-skip and hops proficiently on one foot and catch a ball reliably. Gross & Fine Motor Behavior -3 years old- walking, running, climbing and jumping and well established -there is refinement in the eye hand coordination -rides a tricycle, walks on tiptoes, balances on one foot for a few seconds and broad jumps -can build a 9-10 block tower, can construct 3 block bridges -4 year old skips and hops proficiently on one foot and catches ball reliably -can do simple buttons 5 years old, skips on alternate feet, jumps rope and begins to skate and swim; can tie shoe lace Drawing -shows advancement in perception of shape and development of fine muscle coordination -3 years old copes a circle and imitates a cross and vertical and horizontal lines; writing instrument is held with fingers rather than in the fist; scribbles or scrawls but names what has been drawn; not able to draw a complete stick figure but draws a round circle; then later adds facial features -4-5 year old can trace and copy a square -5-6 year olds can draw several body parts (arms, legs and facial features) Psychosocial Development, Erickson = Initiative versus guilt (3-6 Years old) -developmental task: to achieve sense of initiative -if sense of initiative is well developed learning new things is fun -if children are criticized or punished for attempts at initiative, they develop sense of guilt for wanting to try new activities or have new experiences -to gain a sense of initiative, preschoolers need exposure to wide variety of experiences and play materials so they can learn as much of the world as possible -encourage parents to provide materials such as to encourage creative play as finger paints, splash and blow bubbles, sand to build sand castles, modeling clay Imitation -preschooler need free rein to imitate the roles of the people around them -role playing should be fun and does not have to be accurate -children generally imitate activities they see their parent doing at home Fantasy -preschooler begins to differentiate between fantasy and reality -the become engrossed in a fantasy role which is part of magical thinking or believing thoughts and wishes can come true -parents should support the imitations of fantasy role, knowing that such is age appropriate behavior and a good way of exploring roles, while helping a child maintain the difference between pretend and real

Oedipus and Electra complex -Oedipus complex refers to the strong emotional attachment of a preschool boy to his mother -Electra complex the attachment of a preschool girl to her father -patterns can be assured that this phenomenon f competition and romance in preschoolers is normal -castration complex-fear of punishment of mutilation Gender Roles -preschoolers need exposure to an adult of the opposite gender so they can become familiar with opposite gender roles Cognitive development Preoperational Phase(Piaget) -from 2-7 years -preconceptual phase (2-4 years) -intuitive thought (4-7 years) -preschoolers enter into this second phase but they lack the insight to view themselves as others see them or put themselves in anothers place -they feel that they 100% correct -they are not aware of the property of conservation (eg. to transfer water from a bigger to smaller glass, that the amount of water is the same). Socialization -the individualization-separation process is complete -preschoolers have overcome much of their anxiety regarding strangers and the fear if separation if earlier years -3 year old capable of sharing and playing with other children -4 year old continue to enjoy play groups -5 year olds begin to develop best friendships based on who they walk to school with or who lives closer. Spiritual development -Preschoolers begin to have an elemental concept of God if they have been provided some form of religious raining -they tend to do good out of self-interest rather than because of strong spiritual motivation -they enjoy the security of the religious holidays, religious rituals such as prayer and grace before meals. Body Image -preschoolers recognize that individual have desirable and undesirable appearances -they recognize differences in skin color and racial identity and are vulnerable to learning prejudices and biases -they are aware of the meaning of pretty or ugly and they reflect the opinions of others regarding their own appearance -5 years of age compare their size with their peers and become conscious of large or short Sexuality Development -preschooler form strong attachments to the opposite-sex parents while identifying with the same sex parent -sex-typing the process by which an individual develops the behavior, personality, attitudes, and beliefs appropriate of his or her culture and sex The ways parents dress; hold cuddle, caress, discipline and talk to their child express some aspect of sexually-oriented behavior -sexual orientation may be more pronounced particularly in terms of exploring and manipulating the genitals Questions about sexual reproduction may come to the forefront in the preschoolers search for understanding.

Moral development -a preschooler in the preconventional stage of moral development which extends up to ten years of age -in this phase, conscience emerges and the emphasis is on the external control -can determine right from wrong based on their parents rules -on punishment and obedience orientation at approximately 2-4 years old -on nave instrumental orientation at approximately 4-7 years -actions are directed toward satisfying their needs less commonly, the needs of others -there is a concrete sense of justice -reciprocity or fairness involves the philosophy of you scratch my back and Ill scratch yours with no thought of loyalty or gratitude Language Development -at 3 years has vocabulary of about 900 words -asks questions constantly, up to 400 a day(how and why questions) -3 to 4 years form a sentence of about 3 to 4 words and include only the most essential words to convey meaning -4 years peak age for why questions says 1500 words; tell exaggerated stories sing simple songs. -4 to 5 years continue to ask many questions enjoy in meal time conversations uses longer sentences of 4-5 words; follow simple command such as put the ball on the chair -average 5 year olds says 2100 words know four or more colors; name the days of the week and month of the year Personal Social Behavior -preschoolers demonstrate their sense of autonomy differently -they are able to verbalize request for independence and perform independently because of their much refined physical and cognitive development -4-5 years old need little assistance with dressing, eating, or toileting can be trusted to obey warning of danger -much more sociable and willing to please -have internalized many of the standards and values of the family and culture -by the end of the early childhood, they begin to question parental values and compare them with those of their peer group and other authority figure; less willing to abide by the familys code of conduct. Play -enjoy associative play group play a similar or identical activities but without rigid organization or rules -must provide toys for physical, social and mental development -play activities for physical growth and motor skills refinement include jumping, running, and climbing -tricycles, wagon, gym and sports equipment, sandboxes and wading pools can help develop muscles and coordination -swimming, skating and skiing teach safety develop muscle coordination -manipulative, constructive, creative and educational toys provide for quiet activities, fine motor development and self expression -enjoy crafts with the guidance and assistance of an adult. -Characteristics of activity: imitative, imaginative and dramatic -imaginary playmates are part of this period -reassure parents that childrens fantasy is a sign of health that helps them differentiate between make believe and reality Temperament

-influences social development and interaction -the degree of adaptability to new situations, intensity, or response, distractibility, amount of persistence, mood and activity level may influence a childs chances for success in school -children born with low birth weight highly develop temperament related to behavior problems and lean skills -children who are slow to warm up need a gradual introduction to new situations and may benefit from the parents presence until they have settled in. Preschool and Kindergarten Experience -preschool provides an excellent vehicle for expanding childrens experience with others -it is also an excellent preparation for entrance into elementary school -in preschool day care centers, children are exposed to opportunities for learning group cooperation, adjusting to various sociocultural differences, and faced with frustration and anger -beneficial for children who lack peer group experience, such as an only child --it provides extensive stimulation for language, physical and social development Preparing the Child For Preschool/Kindergarten Experience -parent should present idea f going to school as exciting and pleasurable before the experience begins -parent should talk to their children about activities such as painting, building blocks, or enjoying swings and other outdoor equipment to allow children to fantasize about the forthcoming event in a positive manner -they should introduce the child to the teacher and the facility -parents may wonder whether their child is old enough for school -urge parents to discuss such concern with school officials -parents attitude is essential to preparation for school. -they should instill in their children that leaning is fun and they may not always be able to do the things other children can do, but trying to do their individual best is important. Sex Education -Preschoolers search constantly for explanations and reasons that are logical and reasonable to them Ex. Where did I come from? Two Rules in answering questions about sex: -find out what the child knows and thinks -be honest Masturbation self stimulation of the genitals *another concern for some parents *most common among 4 years old and during adolescence *it is part of sexual curiosity and exploration therefore, it is normal and healthy if not excessive Fears -caused by preschoolers active imagination Fear of the dark -parents are encouraged to monitor the stimuli (television, adult discussions, and frightening stories) their children are exposed to especially around bedtime -keeping a dim light in the childs room may help -children who awake terrified and screaming need assurance they are safe Fear of Mutilation(castration Complex) -intense reaction of preschooler to even a simple injury such as falling and scraping a knee -preschoolers dislike invasive behaviors, such as needlesticks, rectal temperature, assessment etc. -they need good explanation if the limits of health care procedures in order to feel safe. Fear of separation and abandonment

-intensifies because of the preschoolers keen imagination, allowing them to believe they are being deserted when they are not. Speech Problem -stuttering/stammering -in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds -parents are advised to see a speech therapist for further evaluation of the child Gifted Children -can present unique challenge to parents -they often demand increase stimulations as infants and continue to seek a great deal of attention from their parents -their high energy level and persistence can lead to discipline problems -parents may be intimidated by having a child smarter than themselves and would be hesitant to set limits -appropriate parental guidance can be critical to the optimum development and emotional adjustment of children -nurses can help parents in the early identification of gifted child. Aggression behavior that will hurt others -refers to behavior that attempts to hurt a person or destroy property -differs from anger, which is a temporary emotional state, but anger may be expressed through aggression -hyper aggressive behavior is characterized by unprovoked physical attacks on other children and adults, destruction of others property, frequent intense temper tantrums, extreme impulsivity, disrespect, and non compliance -influenced by a complex set of biologic, sociocultural and familial variables -there is evidence that gender differences exist and that males are more aggressive than females. Other Factors that tend to increase aggression -frustration is the thwarting of self-satisfaction by parental disapproval humiliation, punishment and insults; can lead children to act out against others as a means of release -applies to child who is well behaved at home but discipline problem at school or a bully among playmates. Modeling-imitating the behavior of significant others -a powerful influencing force in preschoolers -children who see their parents fighting are observing behavior that they come to know as acceptable -another significant source of modeling television -numerous studies have found a positive correlation between viewing violent TV programs and aggression -thus parents need to be encouraged to supervise their children Reinforcement -children who are ignored by their parents until they hit a sibling learn that such acts are forceful attention mechanisms -parents who permit aggressive behavior by not interfering communicate silent, implicit approval of such acts How children learn socially acceptable behavior -parents can help children by modeling the appropriate behavior and encouraging children to express themselves verbally

-children should not be made to feel guilty or ashamed for being angry frustrated -help children find control through appropriate play situations -the combined use of time out and reinforcement for solitary play is an effective intervention for aggression -minimizing anger and frustration can lead to fewer opportunities for acting out -parents may need professional help, in cases of extreme behaviors. Reaction To Divorce Children in divorced families are more likely than children in nondivorced families to have: -academic problems, -to show externalized problems(acting out and delinquency) -internalized problems (anxiety and depression) -to be less responsible -to have less incompetent relationships -to drop out of school -to become sexually active at an early age -to take drugs -to associate with antisocial peers -to have low self esteem Children who are socially mature and responsible, who show few behavioral problems and who have an easy temperament are better able to cope with parents divorce than children with a difficult temperament. 1. Facing the reality of divorce -children may overcome to accept the fact of the split, some still dream their parents will reunite -transition of marriage 2. Resuming their own daily lives -initially, maybe overwhelmed by what is happening around them. -their school work, their play, and their relationship Promotion of health during preschool period Nutrition -similar to toddler but caloric requirement is decreased to 90 kcal/kg/day -proteins 1.2 g/kg/day -fluids 100 ml/kg/day depending on the childs activity, climatic conditions, and state of health -a moderate reduced-fat diet is recommended -diet should not be deficient in nutrients such as calcium -offering small serving of food is a good idea since a preschool child is not likely to have ravenous appetite -4 years of age seem to enter another period of finicky eating -5 years of age more agreeable to trying new foods; ready for the social side of eating(table conversations and manner) help with meal preparation and clean up. -stress out to mothers that quality of food is taken than quantity Dental Health -still require assistance and supervision brushing and flossing should be formed by parents -professional care and fluoride supplements should be continued -deciduous teeth must be preserved to protect the dental arch Night Grinding -or bruxism -grinding the teeth at night which is a habit of many young children

-may be a way of letting go or releasing tension -children who grind their teeth extensively may have greater-than average anxiety Sleep and Activity -sleeps approximately 12 hours a night -preschoolers need an afternoon nap until age 5 -motor activity levels continue to be high -allow them to explore their environment, begin learning physical games and sports, and interact with others Sleep Problems Experiencing trouble going to sleep due to the following: -so much activity and stimulation during the day -bedtime fears, wake during the night, or have nightmares or sleep terrors -extended bedtime rituals -co-sleeping children are more likely to wake at night and have trouble falling asleep alone Sleep Problem interventions -attention seeking behavior is ignored -keeping the light on in the room -providing transitional objects, eg. Favorite toy -leave drink of water by bed -help children slow down before bedtime -establishing limited rituals that signal readiness for bed, eg. bath or story Injury Prevention Motor vehicle injuries -increased because of activities such as playing in the street riding tricycles, running after balls, or forgetting safety regulations when crossing streets -parents should stress the importance of seat belts -children need safety helmets approved for their age and size -parents must set a good example by wearing helmets as well *drowning, burns, poisoning, falls and bodily damage are also common injuries on this period