DEVELOPMENTAL MILESTONES OFTHE PRESCHOOLER The preschool period traditionallyincludes ages 3, 4, and 5 years. Although physical growth slowsconsiderably during this period,personality and cognitive growthare substantial.
A.PHYSICAL DEVELOPMENT The preschoolers are able to independentlydress including buttoning and zippering. Brushing teeth still requires some assistance. Around the age of 5 the child will be able towalk steadily both forward and backward.He/she walk up and down stairs one foot at atime, as well skip, jump and climb. At this time he also learns to throw and catcha ball and to ride a tricycle independently.
B. SOCIAL, PLAY AND LANGUAGE DEVELOPMENTSocial Between the ages of 3 and 5, preschooler is becoming a more socialcreature. He is now learning to share and cooperate.Play Preschoolers do not need many toys. Play is more focused on make-believe than on toys or games. Many preschoolers have imaginary friends as a normal part of having anactive imagination. Four and five year olds divide their time between rough-housing andimitative play. Five-year-olds are also interested in group games or songs they havelearned in kindergarten or preschool.
Language Three-year-olds have acquired about 900 to 1,000words. They easily can produce three-wordsentences. At four years of age, vocabulary consists of about4,000 to 6,000 words, and they are typicallyspeaking in five- to six-word sentences. Five-year-olds’ language continues to grow, andtheir vocabularies are expanding to 5,000 to 8,000words. The number of words in sentences isincreasing, and sentence structure is becomingmore complex.
C. EMOTIONAL DEVELOPMENT At three, their emotions are usually extreme and short-lived.They need to be encouraged to express their feelings withwords. They begin to learn to share. At four, they tend to brag and be bossy. They need to feelimportant and worthwhile. They need opportunities to feelmore freedom and independence. They are learning to taketurns and to share. The phase of 5-year-old development is fraught withemotional extremes and contradictions. A 5-year-old may beable to exhibit much more self-control, such as sitting forperiods of time in a classroom and listening to a teachersinstructions.
D. COGNITIVE DEVELOPMENT The preschool years are important andvibrant time for learning. Preschoolers learn best by doing. Along with learning new words, preschoolerswill learn colors, shapes, and some basicabstract concepts (which helps them begin tounderstand consequences).
AT 3 YEARS OLD, PRESCHOOLERS: Have a word for almost everything. Are understood by others about 75 percent of the time. Know the colors red, blue, and yellow. May talk more often and for longer periods of time. Like to use nonsense (and sometimes "naughty")words, rhymes and songs with actions. Ask questions to get information - "Why?", "Wheres thepuppy?", or "What is that?"
AT 4 YEARS OLD, PRESCHOOLERS: Describes pictures in detail. Identify and names primary colors. Understands concepts of grouping and matching. Recognizes own name in print. Increased concentration. Draw a person adding much detail to the body. Count to at least to 10. Tell you their physical address and often their hometelephone number. Make their own rhyming words, mimic sounds or evencreate their own sounds or words. Understand that events have a cause and effect reaction(e.g. if you drop a glass then it will break). Begins to learn rules of behavior and reasons behind them.
AT 5 YEARS OLD, PRESCHOOLERS: Identify and name secondary colors. Can count 10 or more objects. Actively seeks information through “why” and “how”questions. Learns through observations and socialinteractions. Understands order and process. Recognizes most letters of the alphabet. Understands basic concept of time. Knows what common objects are used for.
E. MORAL AND SPIRITUAL DEVELOPMENT Children of preschool age determine right from wrong basedon their parents’ rules. Preschoolers begin to have an elemental concept of God ifthey have been provided some form of religious training. Preschoolers tend to do good out of self-interest rather thanbecause of strong spiritual motivation. Preschoolers enjoy the security of religious holidays, andreligious rituals such as prayer and grace before mealsbecause these rituals offer them the same reassurance andsecurity as a familiar nursery rhyme read over and over.
F. PROMOTING DEVELOPMENT OF THEPRESCHOOLER IN DAILY ACTIVITIESDRESSING Many preschoolers can dress themselves exceptfor difficult buttons. Preschoolers prefer bright colors or prints and mayselect items that do not match.
SLEEP Preschoolers are aware of their needs; when theyare tired, they often curl up on a couch and fallasleep. Children in this age group may also refuse to go tosleep because of fear of the dark. Preschoolers may need a night light. A helpful suggestion for parents is to screen outfrightening stories or TV watching just prior tobedtime.
EXERCISE The preschool period is an active phase, sochildren receive a great deal of exercise. Preschoolers love time-honored games such asring-around-the-rosy, or other more structuredgames which can help them develop motor skills aswell as prevent childhood obesity.
BATHING Preschoolers can wash and dry their hands perfectlyadequately. Preschoolers should not be left unsupervised at bathtime to prevent accidents such as scalding, drowning inthe bathtub and slipping on wet floors. Preschoolers do not clean their fingernails or ears well,so these areas often need “touching up” by a parent orolder sibling. Hair washing can be a problem. They cannot close theireyes well enough or long enough to keep soap out.Parents can hang a mobile over the tub so they have areason to look up for rinsing and they can use anonirritating shampoo.
CARE OF TEETH If independent toothbrushing was not started as adaily practice during the infant or toddler years, itshould be started during the preschool years. Encourage them to eat fruits and vegetables forsnacks rather than candy or sweets to preventtooth decay. Children should have made a first visit to a dentistby 2.5 years of age for evaluation of toothformation.
G. PARENTAL CONCERNS ASSOCIATEDWITH THE PRESCHOOL PERIOD1. COMMON HEALTH PROBLEMS OF THEPRESCHOOLER The mortality of children during preschool years is lowand becoming lower every year as more infectiousdiseases are preventable. The major cause of death is automobile accidents,followed by poisoning and falls. In contrast, the number of minor illnesses, such ascolds, ear infections, and flu symptoms areexceptionally high.
2. COMMON FEARS OF THE PRESCHOOLERa. Fear of the Dark Parents should monitor the stimuli their children areexposed to which trigger their fear, especiallyaround bedtime. This includes televisions, adultdiscussion and frightening stories. Burning a dim night light can solve the problem andcosts only pennies. Children who awake terrified and screaming needreassurance they are safe. They may require anunderstanding adult to sit on their bed until they canfall back to sleep again.
b. Fear of Mutilation Fear of mutilation is revealed by the intensereaction of a preschooler to even a simple injurysuch as falling and scraping a knee. They dislike invasive procedures, such asneedlesticks, rectal temperature assessment,otoscopic examination. They need good explanations of the limits ofhealth care procedures (e.g., a tympanicthermometer does not hurt, a finger prick healsquickly) in order to feel safe.c. Fear of Separation or Abandonment Fear of separation intensifies because their keenimagination allows them to believe they are beingdeserted when they are not.
3. BEHAVIOR VARIATIONSa. Telling Tall Tales Stretching stories to make them seem moreinteresting is a phenomenon frequentlyencountered in this age group. Parents should not encourage this kind ofstorytelling, but instead help a child separate factfrom fiction by saying, “That’s a good story, but nowtell me what really happened.” This conveys theidea a child has not told the truth, yet does notsquash imagination or initiative.
b. Imaginary Friends Imaginary friends are a normal, creative part of the preschoolyears and can be invented by children who are surrounded byreal playmates. Parents can help their preschooler separate fact from fantasyabout their imaginary friend by saying, “I know Eric isn’t real, but ifyou want to pretend, I’ll set a place for him.” This helps a childunderstand what is real and what is fantasy without restricting achild’s imagination or creativity.c. Difficulty Sharing Sharing is a concept that first comes to be understood around theage of 3 years. Preschoolers begin to understand that some things are theirs,some belong to others, and some can belong to both. As with most skills, preschoolers need practice to understand andlearn it.
d. Regression Some preschoolers, generally in relation to stress, revert tobehavior they previously outgrew, such as thumb sucking,loss of bladder control, and inability to separate from theirparents. Stress is usually the result of such things as a new baby inthe family, a new school experience, seeing frighteningtelevision news, marital and financial difficulties, orseparation caused by hospitalization. Regression in these circumstances is normal. Manifestations of stress are best ignored; calling them to achild’s attention merely causes more stress, because itmakes a child aware that he or she is not pleasing parents.
e. Sibling Rivalry Jealousy of a brother or sister may first become evidentduring the preschool period, partly because this is the firsttime that children have enough vocabulary to express howthey feel and partly because they are more aware of familyroles and how responsibilities at home are divided. For many children, this is also the time when a new brotheror sister is born. Because preschooler can sense that a younger sibling isbeing allowed behavior that was not tolerated in them, thiscan lead to sibling rivalry.
4. PREPARING FOR A NEW SIBLING Introduction of a new sibling is such a major happening thatparents need to take special steps to be certain their preschoolerwill be prepared . If the preschooler has been sleeping in a crib that is to be usedfor the baby, it is usually best if he or she is moved to a bed about3 months in advance of the birth. Explaining that it is time to sleepin a new bed because he is growing up. If children are to start preschool or childcare, they should do soeither before the baby is born or 2 or 3 months afterward, ifpossible. That way, children can perceive starting school as aresult of maturity and not of being pushed out of the house by thenew child. If the mother will be hospitalized for the birth, she should becertain her child is prepared for this separation in advance. Mother should maintain contact with their preschooler during theshort time they are hospitalized for the birth.
5. SEX EDUCATION Preschoolers’ questions about genital organs are simpleand fact-finding. It is important for parents not to convey thatthese body parts are never to be talked about to leave anopen line of communication for sexual questions. It is common for preschoolers to engage in masturbation.Calling unnecessary attention to the act can increaseanxiety and cause increased, not decreased activity. An important part of sex education is teaching them to avoidsexual abuse, such as not allowing anyone to touch theirbody unless they agree it is all right. Because children havebeen taught this, remember to ask permission before givingnursing care that involves touching.
6. CHOOSING A PRESCHOOL OR CHILDCARECENTER Be sure to investigate preschools orchildcare centers carefully before enrolling tobe certain that the child will be safe and havean enjoyable experience.
7. BROKEN FLUENCY Broken fluency is the repetition and prolongation ofsounds, syllables and words. It is often referred to as secondary stutteringbecause a child begins to speak without thisproblem and then, during the preschool years,develops it. It is a part of normal development and, if acceptedas such, will pass.
H. NURSING CARE OF THE HOSPITALIZEDPRESCHOOLER
DEVELOPMENTAL MILESTONES OFTHE SCHOOL AGE School-age child developmentdescribes the expected physical,emotional, and mental abilities ofchildren ages 6-12. The school-age years are a time ofsteady growth and development.
A.PHYSICAL DEVELOPMENT School-age children usually have smooth and strong motorskills. However, their coordination (especially eye-hand),endurance, balance, and physical abilities vary. Fine motor skills may also vary widely. These skills canaffect a childs ability to write neatly, dress appropriately, andperform certain chores, such as making beds or doingdishes. There will be big differences in height, weight, and buildamong children of this age range. A sense of body image begins developing around age 6.Sedentary habits in school-aged children are linked to a riskof obesity and heart disease in adults. Children in this agegroup should get 1 hour of physical activity per day.
There can also be a big difference in the age at which childrenbegin to develop secondary sexual characteristics.For girls, secondary sex characteristics include: Breast development Underarm and pubic hair growthFor boys, they include: Growth of underarm, chest, and pubic hair Growth of testicles and penis
B. PSYCHOMOTOR DEVELOPMENTGross Motor Development At the age of 6, children endlessly jump, tumble, skip andhop. They have enough coordination to walk a straight line.Many can ride a bicycle. They can skip rope with practice. A 7-year-old appears quiet compared with a rough-and-tumble 6-year-old. Gender difference usually begin tomanifest in play: there are “girl games,” such as dressingdolls, and “boy games,” such as pretending to be pirates. The movements of 8-year-olds are more graceful. They ridea bicycle well and enjoy sports.
Nine-year-olds are on the go constantly. They have enougheye-hand coordination to enjoy baseball, basketball andvolleyball. By 10, they are more interested in perfecting their athleticskills than they were previously. At age 11, they feel awkward because of their growth spurtand drop out of sports activities. They may channel theirenergy into constant motion such as drumming fingers andtapping pencils and feet. Twelve-year-olds plunge into activities with intensity andconcentration. They often enjoy participating in sportsevents for charities (walk-a-thons). They are cooperativearound the house.
Fine Motor Development Six-year-olds can easily tie their shoelaces. They can cutand paste well and draw a person with good detail. For seven-year-olds this has been called the “eraser year”because they are never quite content with what they havedone. By 8 years of age, children’s eyes are developed enough sothey can read regular-size type. They learn to write scriptrather than print. By 9, their writing begins to look mature and less awkward. Older school children begin to evaluate their teacher’s abilityand may perform at varying levels, depending on eachteacher’s expectations.
C. PLAY AND LANGUAGE DEVELOPMENTPlay Play continues to be rough at age 6 years; however, whenthey discover reading as an enjoyable activity, they canbegin to spend quiet time with books. Many children spend hours playing video games, an activitythat can either foster a healthy sense of competition orcreate isolation from others. By 7 years of age, children require more props for play. Thisis the start of a decline in imaginative play. Girls begin to prefer teenage dolls.
Around 7, children also develop an interest in collectingitems such as cards, dolls, rocks, or marbles. Eight-year-olds like table games but hate to lose, so theytend to avoid competitive games. Many children of 8 or 9 enter a phase of reading comicbooks. Many 10-year-olds spend most of their time playing videogames. Boys and girls plays separately at age 10, althoughinterest in the opposite sex is apparent. Eleven and 12-year-old enjoy dancing to popular music andplaying table games and are accommodating enough to beable to play with younger siblings.
Language Development Early school-age children should be able to use simple, butcomplete sentences that average five to seven words. Language delays may be due to hearing or intelligenceproblems. A 6-year-old child normally can follow a series of threecommands in a row. By age 10, most children can follow five commands in a row.
D. EMOTIONAL DEVELOPMENT Children who enter the school-age period have the ability totrust others and a sense of respect for their own worth. They can accomplish small tasks independently becausethey have gained a sense of autonomy. They have learned to share, and discovered that doingthings is more important and rewarding than watching thingsbeing done (a sense of initiative).
E. COGNITIVE DEVELOPMENTThe period from 5 to 7 years of age is a transitional stage wherechildren undergo a shift from the preoperational thought to concreteoperational thought or the ability to reason through any problem theycan actually visualize.Children can use concrete operational thought because they learnseveral new concepts, such as: Decentering, the ability to project one’s self into other people’ssituation and see the world from their viewpoint rather than focusingonly on their own view. Accommodation, the ability to adapt through processes to fit what isperceived (i.e. understanding that there can be more than onereason for other peoples’ action). Conservation, the ability to appreciate that a change in shape doesnot necessarily mean a change in size. Class inclusion, the ability to understand that objects can belong tomore than one classification
F. PROMOTING DEVELOPMENT OF A SCHOOLAGE CHILD IN DAILY ACTIVITIESDRESSING School-age children have definite opinions about clothingstyles, based on the likes of their friends or a popular iconrather than the preference of their parents. Parents must be aware that a child who wears differentclothing than others may become the object of exclusionfrom a school club or group. Many schools require school uniforms to avoid this problem
SLEEP Younger school-age children typically require 10-12hours of sleep, older ones require about 8-10hours. During early school years, many children enjoy aquiet talk or a reading time at bedtime. At about age 9, when friends become moreimportant, children generally give up theseactivities.
EXERCISE School-age children need daily exercise becauseschool is basically a sit-down activity. Exercise need not involve organized sports. It cancome from neighborhood games, walking withparents, or bicycle riding. School-age children must participate in some dailyexercises, or else obesity, or osteoporosis later inlife can result.
HYGIENE Six or 7 years of age still need help in regulatingthe bath water temperature and in cleaning theirears and fingernails. By age 8, they are generally capable of bathingthemselves. Both boys and girls become interested in showeringas they approach their teens.
CARE OF TEETH School-age children should visit a dentist at leasttwice yearly for a checkup, cleaning, and possibly afluoride treatment. School-age children have to be reminded to brushtheir teeth daily. Snacks are best limited to high-protein foods ratherthan candy.
G. COMMON HEALTH PROBLEMS OF THESCHOOL-AGE PERIOD Children in their early school years have one of thelowest rates of death and serious illness of any agegroup. The two leading causes of death are accidents andcancer. Minor illnesses are largely due to dentalcaries, gastrointestinal disturbances, and upperrespiratory infections.
DENTAL CARIES Caries (cavities) are progressive, destructivelesions or decalcification of the tooth enamel anddentin. Neglected caries result in poor chewing andtherefore poor digestion, abscess and pain, andsometimes osteomyelitis (bone infection). Dental caries are largely preventable with properbrushing and fluoride application.
MALOCCLUSION Children with malocclusion of the teeth (a deviationfrom normal) should be evaluated by anorthodontist to see if orthodontic braces or othertherapy is necessary. Braces and retainers, once thought of asimplements to be made fun of, have become sucha common feature of life for school children today. Some even view them as a mark of pride or badgeof courage.
H. CONCERNS AND PROBLEMS OF THE SCHOOL-AGE PERIOD One of the most important disorders of the school-age period is attention deficit hyperactivity disorder(ADHD) because it interferes so dramatically withschool progress. Other problems concernlanguage, fears, and responsibility.
1.Problems Associated With LanguageDevelopment The most common speech problem of a school-agechild is articulation. The child has difficultypronouncing s, z, th, l, r, and w or substitutes w for r(“westroom” instead of “restroom”). This is most noticeable during the first and secondgrades; it usually disappears by the third grade.
2. Common Fears and Anxieties of a School-AgeChildAnxiety Related to Beginning School Preschool learning was carried out through fun activities;whereas part of every day in grade school involves obviouswork.School Phobia School phobia is fear of attending school. Children may develop signs of illness such as vomiting,diarrhea, headache, or abdominal pain on school days. A particular child may be reacting to a situation such asharsh teacher or facing a class bully every day. Counselingmay help the child manage the situation better.
3. Home Schooling Because of religious or personal preference orbecause of disillusionment with the school system,a growing number of children are home schooledtoday. It is important to identify these children at a healthcare visit because with their less extensiveexperience with peers, they may not be comfortablewith peer interaction.
4. Latchkey Children Latchkey children are schoolchildren who arewithout adult supervision for part of each weekdaybecause both parents work outside the home. A major concern of latchkey children is that they willdevelop an increased tendency to accidents,delinquent behavior, alcohol, or beginning drugabuse, or decreased school performance for lack ofadult supervision. Many communities offer special after-schoolprograms so children do not have to be homealone.
5. Sex EducationSex education should be incorporated into health educationthroughout the school years in a manner that is appropriate toage and development. Topics include: Reproductive organ function Secondary sexual characteristics, so children will know whatis going on with their bodies Physiology of reproduction, so they understand whatmenstruation is and why it occurs Male sexual functioning, including why the production ofincreased amounts of seminal fluid leads to nocturnalemissions Explanation of the physiology of pregnancy and thepossibility that comes with sexual maturity for unplanned orunwanted pregnancies Birth control measures and the principles of safe sex Social and moral implications of sexual maturity
6. Stealing Stealing usually happens at around 7 years of age,when children discover the importance of money. A parent should tell the importance of propertyrights. Youngsters who continue to steal past 9years of age may require counseling.
7. Violence or Terrorism Children basically view their world as safe, so it is ashock when violence such as school shooting orreports of international terrorists enter their lives. A number of organizations have proposedguidelines on how to help children deal withviolence and terrorism.
8. BullyingTo avoid bullying school personnel should: Supervise recreation periods closely Intervene immediately to stop bullying Insist that if such behavior does not stop, bothschool and parents will become involved Therapy may be needed to correct bullyingbehavior Advise parents to discuss bullying with their school-age child and tell them how it should be reported,so that adults can intervene
9. Recreational Drug Use Once considered a college or high school problem, illegaldrugs are now available to children as early as elementaryschool. Alcohol is available in so many homes and can bepurchased in small stores without proof of age. Inhalants that are easily available such as airplane glue(toluene) and aerosolized cooking oil may be abused byschool age children. Parents should suspect glue sniffing if their child regularlyappears irritable, inattentive or drowsy. School health personnel should be aware of this and lookfor warning signs. Cigarette smoking also begins in school-age children. Todiscourage use of tobacco, health care professionals andparents need to be role models of excellent health
10. Children of Alcoholic Parents Children of alcoholic parents are at greater risk from havingemotional problems because of the frequent disruption intheir lives. Alcoholism may have a genetic cause, so children ofalcoholics are more likely to become alcoholics. Manifestations of these children are: failing marks in school,withdrawal from friends or social activities, and delinquentbehavior such as stealing. School nurses are in excellent position to identify suchchildren, monitor their school progress and refer them toorganizations such as Al-Anon for support.
11. Obesity Many families rely on fast food meals, and suchfoods tend to be high in calories and fat and canlead to obesity Children of obese parents are also inclined toobesity. Obese children begin to develop many ofthe same health problems as obese adults such ashypertension, type 2 diabetes, and an elevatedcholesterol. They also may be ridiculed for their size and beunable to participate on sports teams.
Such programs should contain three aspects: Intake of about 1,200 calories An active exercise program A counseling program to discuss self-image andmotivation to reduce weight