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 The preschool years are a time of new
initiative and independence. Language
skills are well developed and the child is
able to understand and speak clearly.
 Preschoolers grow slowly and steadily, with
most growth taking place in long bones of
the arms and the legs. The short chubby
toddler gradually gives way to a slender,
long-legged preschooler.
Physical Growth and
Development Milestones
 Physical Growth: Gains 1.5 - 2.5 kg (3-5 kg)/year;
grows 4-6cm (1 ½ - 2 ½ in)/year
 Gross Motor Ability: Throws a ball overhand; rides
bicycle; climbs well
 Sensory Ability: Visual acuity continues to improve;
can focus and learn letters and numbers
 Fine Motor Ability: Eats 3 meals with snacks; uses
spoon, fork and knife; uses scissors; draws circle,
square and cross; draws at least a 6 part person; enjoys
projects such as pasting, stringing beads and using clay;
learns to tie shoes at the end of the preschool years;
buttons; brushes teeth
 The preschooler exhibits characteristics of
the preoperational thought. Symbols or
words are used to represent objects and
people and enabling the young child to
think about them. This is a milestone n
intellectual development; however, the
preschooler still has some limitations in
Characteristics of
Preoperational Thought
 Egocentrism: Ability to see things from
only one’s point of view.
 Transductive Reasoning: Connecting two
events in a cause-effect relationship simply
because they occur together in the same
 Centration: Focusing on only one
particular aspect of a situation.
 Animism: Giving lifelike qualities to non-
living things.
 The preschooler has begun playing in a new way.
Toddlers simply play side by side with friends, each
engaging in his or her own activities. One child cuts
out colored paper for example, while her friend glues
it on paper in a design. This is a new type of
interaction called associative play.

 The materials provided for play can be simple but

should guide activities in which the child engages.

 Because fantasy of life is so powerful at this age, the

preschooler readily uses his props to engage in
dramatic play, that is the living out of drama of
human life.
Psychosocial Development
During the Preschool
 Associative Play: Facilitated by simple
games, puzzles, nursery rhymes and
 Dramatic Play: Fostered by dolls and doll
clothes, play houses and hospitals, dress-
up cloths and puppets.
 Stress: Relieved by pens, pencils, scissors
and glue
 Cognitive Growth: Fostered by
educational television shows, music,
stories and books
 Characteristics of personality observed in
infancy tend to persist over time. The
preschooler may need assistance as these
characteristics are expressed in new
situations of preschool or nursery school.
An excessively active child for example, will
need gentle, consistent handling to adjust
to the structure of a classroom. Encourage
parents to visit preschool programs to
choose the one that would best foster
growth in their child.
 Language skills blossom during the preschool years. The
vocabulary grows to over 2,000 words, and children speak in
complete sentences of several words and use all parts of
speech. Hey practice these new found language skills by
endlessly taking and asking questions.

 The child may have difficulty focusing in the content of a

conversation. The preschooler is egocentric and may be
unable to move from individual thoughts to those the nurse is
proposing in a teaching situation.

 Concrete visual aids such as pictures of a child under-

going the same procedure or a book to read together
enhance teaching by meeting the child’s developmental
needs. Handling medical equipments such as intravenous
bags and stethoscopes increase interest and help the child
to focus. Teachings may be done in several long sessions
rather that in long session.
 School age is the last period in which girls and
boys are close in size and body proportions. As
long bones continue to grow, leg length increases.
Fat gives way to muscles and children appear to
be leaner. Jaw proportions change as the 1st
deciduous tooth is lost at 6 years and permanent
teeth begin to erupt. Physical skills are also refined
as children begin to play sports, and fine motor
skills are well developed through school activities.
 The school age child should be closer and
monitored during brushing teeth to ensure that
flossing and brushing is adequate.
 The child enters the stage of Concrete Pre-
operational thought at about 7 years old. This stage
considers school age children to consider alternative
solutions and solve problems. However, school age
children continue to rely on concrete experiences
and materials to form their thought content.

 During the school age years, the child learns the

thought of conservation (that matter is not changed
when its form is altered). At earlier ages a child
believes that when water is poured from a short,
wide glass into a tall, thin glass, there is no more
water in the taller glass. The school age child
recognizes that although it may look like the taller
glass holds more water , the quantity is the same.
The concept of conservation is very helpful.
 The characteristic of play exhibited by school age
children are cooperation with other’s ability to play
a part in order to contribute a unified whole. This
type of play is called cooperative play. The
concrete nature of cognitive thoughts lead to a
reliance on rules to provide structure and security.
Children have increasing desire to spend much of
play time with friends which demonstrates the
social component of play.
 The enduring aspects of temperament continue to
be manifested during the school years. The child
classified as “difficult” at an earlier age may now
have trouble in the classroom. Advise parents to
provide a quiet setting for homework and reward the
child for concentration. Creative efforts and
alternative methods of learning should be valued.
Encourage the parents to see their children as
individuals who may not all learn in the same way.
The “slow-to-warm-up” child may need
encouragement to try new activities to share
experiences with others, while the “easy” sill readily
adapt to new schools, people and experiences.
 Early school age covers approximately ages five, six,
and seven.
 Children become more aware of gender differences,
and tend to choose same-sex friends and
playmates, even disparaging the opposite sex.
Children may drop their close attachment to their
opposite-sex parent and become more attached to
their same-sex parent.
 During this time children, especially girls, show
increased awareness of social norms regarding sex,
nudity, and privacy. Children may use sexual terms
to test adult reaction. "Bathroom humor" (jokes and
conversation relating to excretory functions), present
in earlier stages, continues.
 Masturbation continues to be common.
Definition of Terms
 Psychosocial development as articulated by Erik Erikson
explain eight stages through which a healthily developing human
should pass from infancy to late adulthood.
 Super-ego - controls our sense of right and wrong and guilt, it
aims for perfection
 Fundamentalism refers to a belief in a strict adherence to a set
of basic principles (often religious in nature), sometimes as a
reaction to perceived doctrinal compromises with modern social
and political life.
 Culpability describes the degree of one's blameworthiness in the
commission of a crime or offense.
 Gonad is the organ that makes gametes.
 Vas deferens transport sperm from the epididymis in anticipation
of ejaculation.
Health Promotion during
 establishing health habits of daily living in relation to
personal care, such as posture, hearing, vision, body-
piercing and sun-tanning
 education in stress-reducing techniques
 providing information on nutritional requirements and eating
habits and behaviors
 accident prevention in relation to vehicle-related injuries and
sports injuries
 immunization
 exercise and activity
 education about sexuality and guidance on avoiding STIs
and unplanned pregnancies
 substance abuse
Adolescent Health Concern
 Accidents

Health Promotion
 Provide information on proper use of sports
 Emphasize proper pedestrian behavior
 Promote proper behavior while a passenger in a
 Use of seatbelts
 Encourage attendance at driver education
course, reinforce dangers of drugs when driving
 Teach basic rules of water safety
 Promote use of safe sports and recreational
 Instruct in safe use and respect for firearms
Adolescent Health Concern
 Suicide

Health Promotion
 Be alert for signs of depression
 Offer suicide prevention education
 Teach methods to cope with a suicidal peer
 Promote alternatives to suicide
Adolescent Health Concern
 Substance Abuse

Health Promotion
 Educate about the risks of tobacco, alcohol
and drug use
 Screen for substance abuse
Adolescent Health Concern
 Sexually transmitted infections

Health Promotion
 Provide information about mode of
transmission and symptoms
 Encourage use of condoms, abstinence
from sexual activity
 Educate about consequences of sexual
 Adolescent Health Concern
 Nutrition

 Health Promotion
 Provide information about nutritional
requirements during adolescence
 Educate about the risks of snacking and
irregular mealtimes
 Promote regular consumption of
breakfast and balance diet
 According to Erikson
 Teenage: Identity vs. Role Confusion (12 to 20 years)
 Psychosocial Crisis: Identity vs. Role Confusion
 Main Question: "Who am I?"
 Ego quality: Fidelity
 The adolescent is newly concerned with how he or she
appears to others. Superego identity is the accrued
confidence that the outer sameness and continuity prepared
in the future are matched by the sameness and continuity of
one's meaning for oneself, as evidenced in the promise of a
career. The ability to settle on a school or occupational
identity is pleasant. In later stages of Adolescence, the child
develops a sense of sexual identity.
Moral Development
 According to Kohlberg
 Conventional
 Stage Four (authority and social order obedience driven), it is
important to obey laws, dictums and social conventions because
of their importance in maintaining a functioning society. Moral
reasoning in stage four is thus beyond the need for individual
approval exhibited in stage three; society must learn to
transcend individual needs. A central ideal or ideals often
prescribe what is right and wrong, such as in the case of
fundamentalism. If one person violates a law, perhaps everyone
would—thus there is an obligation and a duty to uphold laws and
rules. When someone does violate a law, it is morally wrong;
culpability is thus a significant factor in this stage as it separates
the bad domains from the good ones. Most active members of
society remain at stage four, where morality is still predominantly
dictated by an outside force.
Physical Changes during
Adolescent Period
 Increase in height and weight is associated with
redistribution of fat in the body and an increase
in the proportion of bone and muscle tissues.
 The growth spurt: in boys generally begins
about two years later than it does
 in girls, but, continues for a longer period.
 There are also changes in body proportions:
 Girls generally broaden in the hips
 Boys mostly in the shoulders. The waist line
proportionately drops.
 There are also major changes in the secretion of
hormones by the various glands in the body. The
gonads, or the sex glands begin to function bringing
about sexual development. Both boys and girls
develop sex characteristics, which are broadly
classified as

 primary, and
 secondary.
Primary Sex
 Primary sex characteristics in boys refer to the
growth of the main male sex organs which include
the Penis, scrotum, testes and vas deferens.
 For girls the primary sex characteristics refer to the
growth of sex organs like uterus, fallopian tubes
and breasts, acquisition of body hair, change of
voice change in" skin texture etc.
 These sex characteristics are acquired over a
span of time. The period during the bodily changes
occur is called puberty.
Stages of Puberty
 Prepubescent Stage
 Pubescent Stage
 Post-pubescent Stage

 During the pre-pubescent stage, the secondary sex

characteristics begin to develop in the child. These are
followed by development of the primary sex characteristics
 In the pubescent stage the hall mark of this stage in girls ia the
commencement of menstruation or menarche and in boys the
beginning of wet dreams or nocturnal emissions.
 The post pubescent stage is the one when both boys and girls
come to full reproductive maturity. Thus puberty itself is a long
sequential process which actually launches the child into
Needs and Tasks
 As children get closer to the teen years, they become more
independent. It’s important that parents should:
 Allow them to make some choices and take part in family decision
 Help decide the chores they’ll be responsible for completing
 Support their children’s growing need for more freedom.

 Friendships become important to older school age children.

Friends may use secret codes, made-up languages, and
passwords to feel closer to each other. Having friends provides
children the:
 Security they need to begin separating from their parents and
 Children’s thinking also changes at this time.
Children can think about and understand why
certain things happen. This ability helps them
predict what might happen in similar situations in
the future. Their new way of thinking also affects
their behavior.
 For example, older school age children are
capable of playing more complex games.
 They are better able to understand the relation of
rules to games.
 As children continue to improve their motor skills,
they may be more willing to try new activities.
 School age children also need to feel they’re
valued members of the family.
 Provide opportunities DO?
for older school-ages to help out with real skills.
Cooking, sewing, and designing dramatic play props are useful ways to
use their skills.
 Provide time and space for an older child to be alone. Time to read,
daydream, or do school work uninterrupted will be appreciated.
 Encourage your child to make a call to a school friend.
 Encourage your child to participate in an organized club or youth group.
Many groups encourage skill development with projects or activities that
can be worked on at home.
 Encourage your older child to help with a younger one but avoid
burdening older children with too many adult responsibilities.
 Allow time for play and relaxation.
 Provide opportunities for older children to play games of strategy.
Checkers, chess, and Monopoly are favorites.
 Remember to provide plenty of food. Older children have larger
appetites than younger children and will need to eat more.
 Provide phone privileges to call a friend or classmate.
 Provide time to participate in an organized club or youth group. Many
groups encourage skill and leadership development.
Problems Arising during
Adolescence Stage
 Drug and Alcohol Abuse: The 1960s and 1970s marked a sharp
increase in drug use that accompanied the social and political unrest of
the time. After a slight decrease in the 80s and early 90s, the use of
drugs is rising again. Drugs used include marijuana, stimulants, LSD,
inhalants and cocaine, but by far alcohol is the most commonly abused

 Juvenile Delinquency: Juvenile delinquency refers to a variety of

behaviors, ranging from socially unacceptable behavior (such as acting
out in school) to status offenses (such as running away) to criminal acts
(such as burglary). For some, these criminal behaviors become
acts of violence.

 Adolescent Pregnancy: Adolescent pregnancy has become a national

dilemma. 4 out of 5 of the 1 million teens who become pregnant are
unmarried. 30,000 of them are under the age of 15. Overall, 1 of every
10 adolescent females becomes pregnant each year. Consequences
include the increased possibility of health risks, and the mother usually
drops out of school, fails to gain employment, and becomes dependent
on welfare.
 Depression and Suicide: Suicide is a growing problem. Suicide
accounts for about 12% of deaths among adolescents and young
adults. Worse, for every successful suicide, 6 to 10 attempts are

 Factors that can trigger suicide include:

 High stress, loss of a boyfriend or girlfriend
 School problem such as: poor grades, missing classes, truancy
 An unwanted pregnancy
 Early experiences such as family instability and unhappiness
 Loss of appetite
 Withdrawal from peers and friends
 An explicit announcement of thoughts of suicide

 Eating Disorders: Two types of eating disorders are anorexia

nervosa and bulimia. Anorexia nervosa is an eating disorder that
involves the relentless pursuit of thinness through starvation.
Bulimia involves a binge-and-purge sequence on a regular basis.
These are primarily female disorders caused by societal,
psychological, and physiological factors.