Chapter 13: Health Promotion of the Preschooler and Family

Gross and Fine Motor Behavior

• 36 months, preschoolers are walking,

running, climbing, and jumping well.
• 3 years, the preschooler rides a tricycle,
walks on tiptoe, balances on one foot for a
few seconds, and broad jumps.
• 4 years, the child skips and hops proficiently
on one foot
• 5 years, the child skips on alternate feet,
jumps rope, and begins to skate and swim

• Scribbling and drawing also help develop

the fine muscle skills and eye-hand
coordination
• Drawing is also a tool used for assessing
intelligence, personality development, and
psychosocial adjustment.

Developing a Sense of Initiative (Erikson)

• superego, or conscience, starts toward the

end of the toddler years and is a major task
for preschoolers.

Oedipal Stage (Freud)

• Subconsciously, he wishes that his father

were dead so he could marry his mother
(Oedipus complex).
• Girls have similar wishes to marry their
father and kill their mother (Electra
complex).
instrumental orientation
Preoperational Phase (Piaget)
- in which actions are directed toward satisfying their
needs and, less commonly, the needs of others.
• preconceptual phase (2 to 4 years)
• intuitive thought (4 to 7 years)
Sex typing
- or the process by which an individual develops the
• Preschoolers’ thinking is often described as behavior, personality, attitudes, and beliefs
magical thinking. appropriate for his or her culture and sex, occurs
through several mechanisms during this period.
MORAL DEVELOPMENT (KOHLBERG)
Gender identification
 three major levels: - is a result of complex prenatal and postnatal
▪ preconventional psychologic factors, as well as biologic, social, and
▪ conventional genetic influences.
▪ postconventional
important activities
▪ Sex-role imitation
▪ dressing up

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 Relational aggression
Language - is exhibited at similar rates in boys and girls
- becomes a major mode of communication and social of this age-group
interaction
Sociocultural factors that are associated with
Vocabulary increases dramatically childhood aggression
▪ 300 words at age 2 years
• community violence
▪ 2100 words at the end of age 5 years
• Media violence
Such speech Familial variables
- is often termed telegraphic because of its brevity. • maternal depression
• low level of maternal education
4 to 5 years, preschoolers use longer sentences of four or • low socioeconomic status
five words and use more words to convey a message
Modeling
6 years, children can use all parts of speech correctly, - or imitating the behavior of significant
except for deviations from the rule. others, is a powerful influencing force in
preschoolers.
Play activities for physical growth and the refinement of
motor time-out and solitary play
• Jumping - are effective disciplinary measures in the
• Running preschool years.
• Climbing
most critical period for speech development
occurs
Play is so much a part of the young child’s life that reality
and fantasy become blurred.
- between 2 and 4 years of age.
Types of play developmental stuttering
• Imitative play - disfluency in speech pattern
• Imaginative play - common during language development in
• dramatic play children ages 2 to 5 years

Behavioral Style Questionnaire Sources of Stress in Preschoolers

- helps identify temperamental characteristics in
children from 3 to 7 years old Age 3 Years
- Stubbornness
giftedness - Belongings
- is commonly recognized as a minimum intelligence - Jealousy
quotient (IQ) of 130 - Separation anxiety
- Stranger anxiety
gifted-talented - Confusion
- considers signs of giftedness to include specific - Fears
academic aptitudes, advanced memory skills, creative - Speech
thinking, ability in the visual or performing arts, and - Activity level
psychomotor ability, either individually or in - Mealtime
combination. - Nap
- Destructiveness
aggression - Questions
- refers to behavior that attempts to hurt a person or
destroy property.

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Age 4 Years
- Insecurity
- Companionship
- Belongings
- Sex
- Activity level
- Fears
- Attention

Age 5 Years
- Approval
- School
- Separation anxiety
- Worrying
- Belongings
- Procrastination
- Name calling

Preschoolers may fear

• the dark,
• being left alone
• animals
• Ghosts
• sexual matters
• objects

Estimated daily caloric requirement ranges from

1200 to 1400 calories

Fluid requirements 13 to 19 g/day

Milk and dairy products

- provide a major source of calcium.

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Chapter 14: Health Problems of Early Childhood

Media Nonpoisonous Plants

- use can also contribute to sleep • African violet
disturbances • Aluminum plant
• Asparagus fern
Nightmares and sleep terrors • Begonia
- Two major sleep problems • Boston fern
• Christmas cactus
Nightmares • Coleus
- A scary dream; takes place during REM • Gardenia
sleep and is followed by full waking • Grape ivy
- After dream is over, child wakes and cries • Jade plant
or calls; not during nightmare itself
Selected Poisonings in Children
Sleep Terrors
- A partial arousal from very deep sleep • Corrosives (Strong Acids or Alkalis)
(stage IV, non-REM) sleep → Treatment:
- During terror itself, as child screams and ▪ Administer analgesics.
thrashes; afterward is calm ▪ Give oral fluids when tolerated

The most frequently ingested poisons for EMERGENCY TREATMENT Poisoning

children under age 6 include the following:
1. Assess the victim
• Cosmetics 2. Terminate exposure
• Household cleaning products 3. Identify the poison
• Medications 4. Prevent poison absorption
• Foreign bodies, toys,
• Topical preparations The first and most important principle in dealing
• Vitamins with a poisoning is to treat the child first, not the
• Antihistamines poison.
• Pesticides
• Dietary supplements shock
- is a complication of several types of
Advise parents to call the poison control center household poisons, particularly corrosives,
(PCC) before initiating any intervention. measures to reduce the effects of shock are
important, beginning with circulation,
Poisonous Plants (Toxic Parts) airway, and breathing support measures—
the CABs of resuscitation.
• Apple (leaves, seeds)
• Apple (leaves, seeds) gastrointestinal decontamination (GID)
• Azalea (all parts) - only after careful evaluation of the
• Buttercup (all parts) potential toxicity of the poison and the
• Castor oil plant (bean or seeds—extremely risks versus benefits.
toxic)
• Cherry (wild or cultivated) (twigs, seeds, GID
foliage) - is not routinely recommended for most
• Daffodil (bulbs) childhood poisonings.
• Dumb cane (dieffenbachia) (all parts)
• Elephant ear (all parts)
• Foxglove (leaves, seeds, flowers)
• Holly (berries)
• Hyacinth (bulbs)
• Hyacinth (bulbs)

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 Sources of mercury toxicity:
Activated charcoal may be considered in the
following situations: • predator fish (king mackerel, shark, swordfish,
tilefish)
• Child may have ingested large amounts of • broken thermometers or thermostats
carbamazepine, dapsone, phenobarbital, • broken fluorescent light bulbs
quinine, or theophylline. • disk batteries
• Time to activated charcoal administration is • topical medications
within 1 hour after the poison ingestion. • gas regulators
• Child has an intact or protected airway • Cathartics
• interior latex house paint
Activated charcoal
- is mixed with water or a saline cathartic to Elemental mercury
form a slurry. - (also called metallic mercury or quicksilver) is
nontoxic if ingested and if the gastrointestinal tract
N-acetylcysteine is healthy (e.g., has no fistulas).
- for acetaminophen poisoning, oxygen for
carbon monoxide inhalation, acrodynia (painful extremities)
- classic form of mercury poisoning
naloxone
- for opioid overdose Chelation
- Treatment for metal poisoning
flumazenil (Romazicon) - use of a chemical compound that combines with
- for benzodiazepine the metal for rapid and safe excretion

midazolam [Versed]) Sources of Lead:

- overdose
• Lead-based paint in deteriorating condition
digoxin immune fab (Digibind) • Lead solder
- for digoxin toxicity • Lead crystal
• Battery casings
amyl nitrate • Lead fishing sinkers
- for cyanide, • Lead curtain weights
• Lead bullets
antivenin
- for certain poisonous bites Some of these may contain lead:
• Ceramic ware
Passive measures • Water
- (those that do not require active • Pottery
participation) have been the most successful • Pewter
in preventing poisoning and include using • Dyes
child-resistant closures and limiting the • Industrial factories
number of tablets in one container. • Vinyl miniblinds
• Playground equipment
active measures • Collectible toys
- (those that require participation) are • Some imported toys or children’s metal jewelry
essential. • Artists’ paints
• Pool cue chalk
Lead
- Most common heavy metal poisoning Sources of Lead (CULTURAL CONSIDERATIONS)
• Azarcon (Mexico)
Mercury toxicity • Greta (Mexico):
- a rare form of heavy metal poisoning, has • Paylooah (Southeast Asia)
occurred in children from a variety of • Surma (India and Pakistan):
sources • Unknown ayurvedic (Tibet)
• Tamarind jellied, fruit candy (Mexico)
• Lozeena (Iraq)

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Chelation Therapy
Chelation
- is the term used for removing lead from circulating
blood and, theoretically, some lead from organs
and tissues. It is unclear whether chelation affects
lead stores in bones.
three chelating agents have been used consistently:
- calcium disodium edetate (calcium EDTA)
• British antilewisite
• meso2,3-dimercaptosuccinic acid (DMSA)
child maltreatment
- includes intentional physical abuse or neglect,
emotional abuse or neglect, and sexual abuse of
children, usually by adults. It is one of the most
significant social problems affecting children.
Child neglect
- is the most common form of maltreatment, and
74.8% of reported neglect cases involve children 3
years old or younger
Neglect
- is generally defined as the failure of a parent or
other person legally responsible for the child’s
welfare to provide for the child’s basic needs and
an adequate level of care
factors for child neglect:
- lack of knowledge of child’s needs
- lack of resources
- caregiver substance abuse
Types of Neglect
• Physical neglect
- involves the deprivation of necessities, such
as food, clothing, shelter, supervision,
medical care, and education
• Emotional neglect
- generally refers to failure to meet the child’s
needs for affection, attention, and
emotional nurturance.
Emotional abuse or psychologic maltreatment
- an even more difficult aspect of maltreatment to
define, refers to the deliberate attempt to destroy
or significantly impair a child’s self-esteem or
competence.
physical abuse
- deliberate infliction of physical injury on a child,
usually by the child’s caregiver
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Minor physical injury
- is responsible for more reported cases of
maltreatment than major physical injury
major physical abuse
- causes more deaths
Abusive head trauma (AHT)
- is a serious form of physical abuse caused by
violent shaking of infants and young children.
Munchausen syndrome by proxy (MSBP)
- also known as medical child abuse or factitious
disorder by proxy, is a rare but serious form of
child abuse in which caregivers deliberately
exaggerate or fabricate histories and symptoms
or induce symptoms.
- include physical, emotional, and psychologic
abuse for the gratification of the caregiver.
Factors Predisposing to Physical Abuse
• parental characteristics
• characteristics of the child
• environmental characteristics
Sexual abuse
- is one of the most devastating types of child
maltreatment, and estimates indicate that it
has increased significantly during the past
decade
Types of sexual abuse:
• Incest: Any physical sexual activity between
family members
• Molestation: A vague term that includes
“indecent liberties,” such as touching, fondling,
kissing, single or mutual masturbation, or
oralgenital contact
• Exhibitionism: Indecent exposure, usually
exposure of the genitalia by an adult man to
children or women
• Child pornography: Arranging and
photographing, in any media, sexual acts
involving children,
• Child prostitution: Involving children in sex acts
for profit and usually with changing partners
• Pedophilia: Literally means “love of child”