PRESCHOOL AGE

Christine B. Mamaril-Fiel, RN MN LPT MAED

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 • Slimmer, taller, and much more childlike proportions.
Growth and • Ectomorphic (slim) or endomorphic (large)—
becomes apparent
• Handedness
Development of a • Major step = ability to learn extended language

• Lymphatic tissue begins to increase in size = tonsils

Preschooler • Levels of IgG and IgA antibodies increase
• Physiologic splitting of heart sounds may be present for the
Physical Growth first time on auscultation; innocent heart murmurs may also
be heard for the first time.
• PR : 85 beats b/m; BP 100/60 mmHg.

• Bladder is easily palpable above the symphysis pubis;

voiding: frequent (9 or 10 times a day)
• Muscles are noticeably stronger
• Many children at the beginning of the period exhibit
GENU VALGUS (KNOCK-KNEES) disappears with
increased skeletal growth at the end of the preschool
period
 Language Development
Growth and • 3-year-old child has a vocabulary of about 900 words
• Four- and 5-year-old children continue to ask many
Development of a questions.
• Imitate language exactly
Preschooler • Egocentric, so they define objects in relation to themselves

B Developmental Milestone
Play
• Enjoy games that use imitation such as pretending to be
teachers, cowboys, firefighters, and police etc.
• They imitate exactly what they see parents doing
• Imaginary friends as a normal part of having an active
imagination (Goldson & Reynolds, 2008).
• Four- and 5-year-olds : roughhousing and imitative play.
• Five-year-olds : group games or songs they have learned
in kindergarten or preschool.
 Emotional Development
Developmental Task: Initiative Versus Guilt
Sense if initiative and Sense of Guilt
INITIATIVE
• A child with a well-developed sense of initiative has discovered that learning new things is fun.
• Need exposure to a wide variety of experiences and play materials so they can learn as much about
the world as possible.
GUILT
• If children are criticized or punished for attempts at initiative.

Imitation
• Preschoolers need free rein to imitate the roles of the people around them.
• Role playing should be fun and does not have to be accurate.
Fantasy
•. Preschoolers begin to make differentiation between fantasy and reality.
• They may become so engrossed in a fantasy role, however, they become afraid they have
lost their own identity or have become “stuck” in their fantasies. Such intense involvement
in play is part of “magical thinking,” or believing thoughts and wishes can come true.
 Emotional Development
Oedipus and Electra Complexes

Oedipus

• the strong emotional attachment a preschool boy demonstrates toward his

mother.

Electra

• is the attachment of a preschool girl to her father.

Note: Parents can be reassured that this phenomenon of competition and

romance in preschoolers is normal.
 Emotional Development
Gender Roles

• Preschoolers need exposure to an adult of the opposite gender so they can become familiar
with opposite gender roles.

• Children’s gender-typical actions are strengthened by parents, strangers, preschool teachers,

other family members, and other children.
 Emotional Development
Socialization - Preschool period is a sensitive and critical time for socialization.
3 years old
• capable of sharing, they play with other children their age much more agree
ably than do toddlers
• Children who are exposed to other playmates have an easier time learning
to relate to people than those raised in an environment where they never
see other children of the same age.
4 years old
• they may become involved in arguments more than they did at age 3, especi
ally as they become more certain of their role in the group.
5 years old
• begin to develop “best” friendships, perhaps on the basis of who they walk to
school with or who lives closest to them.

“The elementary rule that an odd number of children will have difficulty playing
well together pertains to children at this age: two or four will play, but three or fi
ve will quarrel.”
Cognitive Development Moral and Spiritual Development

3 years = according to Piaget is

still PREOPERATIONAL (Piaget, 1969). Determines right from wrong based on their
parents’ rules. They have little understandin
Although children during this period do enter a g of the rationale for these rules or even whe
second phase called INTUITIONAL ther the rules are consistent.
THOUGHT, they lack the insight to view
themselves as other see them or put Preschoolers begin to have an elemental con
themselves in another’s place (termed
cept of God if they have been provided som
CENTERING). Because preschoolers cannot
e form of religious training. Belief in an outsid
make this kind of mental substitution, they feel
they are always right. e force aids in the development of conscienc
e; however, preschoolers tend to do good out
Are not yet aware of the property of of self-interest rather than because of strong
conservation. spiritual motivation (Kohlberg,1984).
 As preschoolers broaden their horizons, safety issues increase.
By age 4, children may project an attitude of independence and the
ability to take care of their own needs.

Health I

Promotion For Keeping Children Safe, Strong, and Free

A Preschooler  Educate children about the potential threat of harm from strangers or
even how to address bullying behavior from people
And Family • Warning a child never to talk with or accept a ride from a Stranger

A • Teaching a child how to call for help in an emergency (yelling or running to

a designated neighbor’s house if outside, or dialing 911 if near a telephone)

Promoting • Describing what police officers look like and explaining that police officers
can help in an emergency situation
Preschooler
• Explaining that if children or adults ask them to keep secrets about
Safety anything that has made them uncomfortable, they should tell their parents o
r another trusted adult, even if they have promised to keep the secret

• Explaining that bullying behavior from other children is not to be tolerated a

nd should be reported so they can receive help managing it
 II

General
• Know whereabouts of preschooler at all times.
• Be aware that frequency of accidents is increased when parents are under stress.
Special precautions must be taken at these times.
• Some children are more active, curious, and impulsive and therefore more
Health vulnerable to accidents than others.

Promotion For Motor Vehicle and Bicycle Safety

•
A Preschooler •
Teach safety with tricycle (look before crossing driveways; do not cross streets).
Teach child to always hold hands with a grownup before crossing a street.
• Teach parking lot safety (hold hands with grownup; do not run behind cars that
And Family •
are backing up).
Children should wear helmets when riding bicycles. Encourage parents who
ride bicycles to demonstrate safe riding habits by wearing helmets as well.
A
Promoting Poisoning
• Never present medication as a candy.
Preschooler • Never take medication in front of a child.
• Never store food or substances in containers other than their own.
Safety • Post telephone number of local poison control center by the telephone.
• Teach child that medication is a serious substance and not for play.
 Falls
• Supervise preschooler at playgrounds.
• Remove drawstrings from hooded clothing.
• Help child to judge safe distances for jumping or safe heights for climbing.
Health
Promotion For Drowning
• Teach beginning swimming
A Preschooler
And Family
Animal bites
A • Do not allow child to approach strange dogs. Supervise child’s play with
family pets.
Promoting
Preschooler Burns
• Store matches in closed containers.
Safety • Do not allow preschooler to help light birthday candles, fireplaces, etc. (fire is
not fun or a “treat”).
 III

General
• Know whereabouts of preschooler at all times.
• Be aware that frequency of accidents is increased when parents are under stress.
Special precautions must be taken at these times.
• Some children are more active, curious, and impulsive and therefore more
Health vulnerable to accidents than others.

Promotion For Motor Vehicle and Bicycle Safety

•
A Preschooler •
Teach safety with tricycle (look before crossing driveways; do not cross streets).
Teach child to always hold hands with a grownup before crossing a street.
• Teach parking lot safety (hold hands with grownup; do not run behind cars that
And Family •
are backing up).
Children should wear helmets when riding bicycles. Encourage parents who
ride bicycles to demonstrate safe riding habits by wearing helmets as well.
A
Promoting Poisoning
• Never present medication as a candy.
Preschooler • Never take medication in front of a child.
• Never store food or substances in containers other than their own.
Safety • Post telephone number of local poison control center by the telephone.
• Teach child that medication is a serious substance and not for play.
 Falls
• Supervise preschooler at playgrounds.
• Remove drawstrings from hooded clothing.
• Help child to judge safe distances for jumping or safe heights for climbing.
Health
Promotion For Drowning
• Teach beginning swimming
A Preschooler
And Family
Animal bites
A • Do not allow child to approach strange dogs. Supervise child’s play with
family pets.
Promoting
Preschooler Burns
• Store matches in closed containers.
Safety • Do not allow preschooler to help light birthday candles, fireplaces, etc. (fire is
not fun or a “treat”).
 • Offer small servings of food
• Parents need to check that children are not snacking so
frequently that they miss out on planned meals to be
certain children receive a complete range of nutrients
(Gable, Chang, & Krull, 2007)
• Urge parents to offer foods such as fruit, cheese, or milk
Health rather than cookies and a soft drink (Rolfes, Pinna, &
Whitney, 2009).
Promotion For • Teach parents to make mealtime a happy and enjoyable
part of the day for everyone by allowing the child to
A Preschooler prepare simple food (e.t. sandwich)

And Family Recommended Dietary Reference Intakes

A • Foods selected for preschoolers should be based on food pyramid groups
, making sure to offer a variety.
Promoting • Caution parents not to give more vitamins than the recommended daily
amount, because poisoning from high doses of fat-soluble vitamins or iron
Nutritional Health can result.
of the Preschooler
 Dressing
• Preschoolers prefer bright colors or prints and so may select items
that do not match.
• Children need the experience of choosing their own clothes. One
way for parents to solve the problem of mismatching is to fold t
Health ogether matching shirts and pants so a child sees them as a s
et rather than individual pieces.
Promotion For
A Preschooler Sleep
And Family • Preschoolers are more aware of their needs; when they a
re tired, they often curl up on a couch or soft chair and fall
B asleep.
• Children in this age group, however, may refuse to go to sl
Promoting eep because of fear of the dark. Night waking from nightm
Development of the ares or night terrors reaches its peak (Hiscock et al., 2
Preschooler in 007).
Daily Activities • Parents should screen out frightening stories or television
watching and give night light
 Exercise
• Preschool period is an active phase, so children receive a great
deal of exercise.
• Time-honored games such as ring-around-the-rosy, London Brid
ge, or other more structured games.
Health • Rough-housing
Promotion For Promoting this type of active game and reducing television / gadget
A Preschooler s can help children develop motor skills as well as be a step towar
d preventing childhood obesity (Kline, 2008).
And Family
Hygiene
B • Preschoolers do not clean their fingernails very well, so these o
ften need “touching up” by a parent or older sibling.
Promoting • Caution parents about not using bubble bath with preschoolers
Development of the as some girls develop vulvar irritation (and perhaps bladder inf
Preschooler in ections)
• Assist in cleaning the ears.
Daily Activities
 Care of Teeth
• Independent tooth brushing should be started but checked.
Health • Flossing with assistance from parents
• A child should continue to drink fluoridated water or prescribed or
Promotion For al fluoride supplement if fluoride is not provided in the water supp
ly (Armfield & Spencer, 2007).
A Preschooler • Encouraging children to eat apples, carrots, celery, chicken, or c
heese for snacks rather than candy or sweets.
And Family • Visit the dentist. Deciduous teeth must be preserved to protect th
e dental arch.
B • Night grinding (Bruxism) grinding the teeth at night (usually durin
g sleep), is a habit of many young children (Goddard, 2008).
Promoting • Teeth grinding may be a way of “letting go,” similar to body rocki
Development of the ng, that children do for a short time each night to release tension
Preschooler in and allow themselves to fall asleep.

Daily Activities
 • A major parental role during this time is to encourag
e vocabulary development. One way to do this is to r
ead aloud to a child; another is to answer questions
so a child sees language as an organized system of
Health communication.
Promotion For
Discipline
A Preschooler
And Family “Timeout” is a good technique to correct behavior for p
B
C arents throughout the preschool years. This technique
allows parents to discipline without using physical puni
Promoting Healthy shment and allows a child to learn a new way of beha
Family Functioning vior without extreme stress.
Parental Concerns Associated
With the Preschool Period
Common Health Problems

• Minor illnesses, such as colds, ear infections, and flu sympt

oms

• Children who attend child care or preschool programs also

have an increased incidence of gastrointestinal disturba
nces (such as vomiting and diarrhea) from the exposure to
other children
(Butterton & Calderwood, 2008).
 Parental Concerns Associated With the Preschool Period

Common Fears
Fear of the Dark. Fear heightened by a child’s vivid imagination. Monitor the stimuli the
children are exposed to, especially around bedtime.
• It may be a reaction to undue stress. In these instances, the source of the stress
needs to be investigated.
Fear of Mutilation. falling and scraping a knee or having an injection. Because they do
not know which body parts are essential and which ones can be easily replaced.
• Boys develop a fear of castration
Fear of Separation or Abandonment. It intensifies because their keen imagination
allows them to believe they have been deserted when they are safe.
 Parental Concerns Associated
With the Preschool Period
Behavior Variations
Telling Tall Tales

Imaginary Friends. Many preschoolers have an imaginary friend who plays with them (Goldson & Reynolds, 2008).

Difficulty Sharing. Sharing is a concept first understood at 3 years of age. Children begin to understand that some
things are theirs, some belong to others, and some can belong to both.
• Teach about = mine, yours, ours

Regression. = stress, exhibits thumb sucking, negativism, loss of bladder control, and inability to separate from their
parents.
• Help parents understand that regression in these circumstances is normal.
• Removing the stress is the best way to help a child discontinue this behavior.
Sibling Rivalry. To help them feel secure and promote self-esteem, supplying them with a private drawer or box for
their things.
Parental Concerns Associated
With the Preschool Period
Preparing for a New Sibling
• There is no rule as to when this preparation should begin, but it should be before the
time the child begins to feel the difference the new baby will make.
• Help parents not to underestimate the significance of a bed to a preschool child.
 Bed = security, consistency and “Home”. Transfer child at least 3 mos. prior to birth.
 The fact that he is growing up is a better reason for such a move than because a new
brother or sister wants the old bed.
• Start Preschool or child care prior to birth or two to thee months after birth.
• During birth of the new baby, when the mother is hospitalized, they should make sue
the preschool is prepared.
• Encourage women to maintain contact with their preschooler during the short time th
ey are hospitalized for the new birth.
 Parental Concerns Associated
With the Preschool Period
Sex Education
• It is important for parents not to convey that these body parts are never to be talked about to
leave an open line of communication for sexual questions.
• Masturbation common while watching television or being read to or before they fall asleep at
night. The frequency of this may increase under stress, as does thumb-sucking.
• Teach them to avoid sexual abuse, such as not allowing anyone to touch their body unless they
agree it is all right. Always ask permission before giving nursing care to them that involves
touching.
• “Where do babies come from?” factual answer to this type of question is best: “Babies grow in
a special place in a mother’s body called a uterus.”
• Many new books for children explain where babies come from, including descriptions of sexual
relations and orgasm.
 Parental Concerns Associated
With the Preschool Period
Preparing a Child for School
• Essential to this preparation is the parents’ attitude.
• If a child was not attending preschool, some parents may have to change their child’s daily
routine a few months in advance
• If a child is to ride a bus to school, a parent might take a child on a municipal bus as an
introduction to this form of transportation. If a child is to walk, a trial walk is in order.
• If a child will be required to take a lunch to school, a parent can introduce this new experience
by preparing a bagged lunch at home some noon.
• For children to do well in a formal school setting, they must be able to follow instructions and sit
at a table and chair for a short work period.
• Going to school is a form of separation so parents must make preparations for this.
 Parental Concerns Associated
With the Preschool Period
Broken Fluency
Repetition and prolongation of sounds, syllables, and words. Often referred to as
Secondary Stuttering
• It is a part of normal development and, if accepted as such, will pass.
• It is associated with rapid speech patterns that may also be present in the parent (Savelkoul et al., 2007).
• Do not discuss in a child’s presence the difficulty they are having with speech. Do not label them a “stutterer.”
• Listen with patience to what a child is saying. Do not interrupt or fill in a word for her.

• Talk to her in a calm, simple way.

• Protect space for her to talk if there are other children in the family.
• Do not force a child to speak if she does not want to.
• Do not reward her for fluent speech or punish her for nonfluent speech. Broken fluency is a developmental
stage in language formation, not an indication of regression or a chronic speech pattern.