Chapter 12

HEALTH PROMOTION OF THE

PRESCHOOLER AND FAMILY
Promoting Growth and Development

 The preschool period lasts from age 3 to 5 years

 Preparation for the most significant lifestyle change: going to
school
 Has an increased attention span and memory
Biologic Development

 Physical growth slows and stabilizes

 Average weight gain remains about 5 pounds per year
 Average height increases 2½ to 3 inches per year
 Body systems mature and stabilize; can adjust to moderate
stress and change
 Gross Motor Skills

 Gross motor skills should be well-established

 Walking
 Running
 Climbing
 Jumping
 Fine Motor Skills

 Fine motor skills include refinement in eye–hand and muscle coordination

 Drawing, dressing, artwork, skillful manipulation
Psychosocial Development

 Erikson: Developing a sense of initiative

 Chief psychosocial task of the preschool period
 Feelings of guilt, anxiety, and fear may result from thoughts that
differ from expected behavior
 Development of superego (conscience)
 Learning right from wrong; moral development
Cognitive Development

 Readiness for school

 Readiness for scholastic learning
 Successful achievement of cognitive goals at this stage is
needed for learning, which is among the reasons children
enter school at 5 to 6 years old they cannot learn it sooner
except in very unique cases
Cognitive Development

Piaget: Preoperational phase spans age 2 to 7 years

Divided into two stages
 Preconceptual phase at 2 to 4 years
 Intuitive thought phase at 4 to 7 years
Shifts from egocentric thought to social awareness
Able to consider other viewpoints
Egocentricity is still evident
Cognitive Development

 Language continues to develop

 Concept of causality is beginning to develop
 Concept of time is incompletely understood
 They do not know how to tell time, so it can cause them
anxiety; use tasks to tell time ( ie after school we will go to
park)
 Uses magical thinking frequently
 Question 1

In terms of cognitive development, the 5-year-old child would be expected to do which

of the following?

A. Use magical thinking.

B. Think abstractly.
C. Understand conservation of matter.
D. Comprehend another person’s perspective.
 Question 1Answer

A. Use magical thinking.

Magical thinking is believing that thoughts can cause events. An example

would be that thinking of the death of a parent might cause it to happen.
Abstract thought does not develop until the school-age years. The concept of
conservation is the cognitive task of children age 5 to 7 years. A 5-year-old
cannot understand another person’s perspective.
Kohlberg: Moral Development

 Basic level of moral judgment

 Punishment and obedience orientation
 Naive instrumental orientation: Actions to satisfy one’s own
needs and less concern about the needs of others
 Concrete sense of justice and fairness
Spiritual Development

 Knowledge of faith and religion is learned from significant

others and religious practices
 Development of conscience is strongly linked to spiritual
development
 May misinterpret illness as punishment from God
Development of Body Image

 Increasing comprehension of “desirable” appearances

 Aware of racial identity, differences in appearances, and biases
 Poorly defined body boundaries
 Fear that if the skin is “broken,” all one’s blood and “insides”
can leak out
 Frightened by intrusive experiences
Development of Sexuality

 Forms a strong attachment to the opposite-sex parent while

identifying with the same-sex parent
 Becomes concerned with modesty
 Sex role limitation; “dressing up like Mommy or Daddy”
 Sexual exploration is more pronounced
 Questions arise about sexual reproduction
Social Development

 Individuation–separation process is completed

 Overcomes stranger anxiety and fear of separation from the
parents
 Still needs parental security and guidance
 Security from familiar objects
 Play is beneficial for working through fears, anxieties, and
fantasies
Language

 Major mode of communication and social interaction

 Vocabulary increases dramatically between age 2 and 5 years
 Complexity of language use increases between age 2 and 5
years
Personal and Social Behavior

 Minimal help with toileting, eating, or dressing

 Is willing to please
 Has internalized values and standards of family and culture
 May begin to challenge parental values
Play

 Associative play- play together in group but no define roles;

most common type of play
 Imitative play
 Imaginative play and imaginative playmates
 Dramatic play
Coping with Concerns Related to Normal
Growth and Development

 Preschool and kindergarten

 Developmental screening tool to assess readiness for school
 Importance of infection control in school setting
 Introduction of child to school
 5 R’s of school readiness p. 369
Sex Education

 Find out what children know and think

 Be honest
 Avoid “overanswering” the question
 Sexual exploration and sexual curiosity
Fears

 Dark
 Being left alone
 Animals (e.g., snakes, large dogs)
 Ghosts
 Objects or persons associated with pain
 Technique of desensitization to overcome fears
Stress

 Minimum amounts of stress can be beneficial

 Parental awareness of signs of stress in the child’s life
 Prevention of stress
 Schedule adequate rest
 Prepare the child for upcoming changes to maximize coping
strategies
Aggression

 Behavior that attempts to hurt another person or destroy

property
 May be influenced by biologic, sociocultural, and familial
variables
 Factors that increase aggressive behavior include gender,
frustration, modeling, and reinforcement
Speech Problems

 Most critical period ages 2 to 4 years

 Stuttering
 Stammering
 Articulation problems (dyslalia)
Promoting Health During the
Preschool Years

 Nutrition
 Caloric requirements are approximately
90 kcal/kg
 1,000-1,800 calories each day
 Fluid requirements are approximately
100 ml/kg, depending on activity and climate
 Food fads and strong tastes are common
Sleep and Activity

 Sleeps for 12 hours per night; infrequent naps

 Free play is encouraged
 Emphasis is on fun and safety
Sleep Problems

 Thorough assessment of sleep problems

 Nightmares
 Sleep terrors
 Encourage consistent bedtime routine
 Case Study

During a well-child physical assessment, parents of a 4-year-old say that their child
resists going to bed every night and cries until they allow the child to get into bed with
them. This has now become a nightly habit. What guidance should the nurse give to the
parents?
 Case Study Answers

The nurse should explain several factors:

The preschool years are a prime time for sleep disturbances. Such disturbances
are usually related to increased autonomy of the child and the child’s nighttime
fears, inconsistent bedtime routines, and a lack of limit setting.
First, complete a thorough health history, including a cultural assessment.
How the problem is presented will determine guidance.
If a child delays going to bed, have a consistent bedtime; do not allow the child to
get into bed with the parents; leave a light on in the room; give the child a favorite
toy; and leave a drink of water by the bed. Parental consistency is important (i.e.,
both parents need to make sure they are doing the same thing).
Have rituals that allow the child to slow down before bedtime, such as taking a
warm bath or reading a bedtime story.
Minimize television watching at bedtime because it may cause the child to resist
going to bed.
Dental Health

 Eruption of primary(deciduous) teeth is complete

 Professional care and prophylaxis
 Fluoride supplements
Injury Prevention

 Safety education
 Development of long-term safety behaviors
 Bike helmets
Anticipatory Guidance: Care of
Families

 Childcare focus shifts from protection to education

 Children begin questioning previous teachings of parents
 Children begin to prefer the companionship of peers
 Guidance for parents during preschool years