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  • Give an example of how a preschool child’s appearance differs from a toddler’s. In what ways has a preschool child refined his/her motor, social, and cognitive skills compared to a toddler?
  • Give an example of cooperative play and how this prepares the child for elementary school. How does the preschool child’s memory and attention span differ from that of a toddler?
  • Give an example of how old skills become natural for the preschool child. Audience Response Question #1 If a child weighs 22 pounds at 1 year of age then the nurse would expect him or her to weigh approximately ________ at 5 years of age. 1. 33 pounds 2. 44 pounds 3. 55 pounds 4. 66 pounds
  • Give an example of symbolic functioning. Discuss the typical vocabulary for a preschool child. Audience Response Question #2 A preschool child tells the nurse that at night her toys dance. This is an example of: 1. animism. 2. artificialism. 3. ritualism. 4. centering.
  • Discuss prelogical thinking. What is centering? Give an example of how the preschool child will exclude other features of an object while focusing on one outstanding aspect of that object.
  • Give an example of how culture affects one’s sense of initiative. How is a preschool child’s language development affected by those in the family?
  • Give an example of physiological, psychological, and environmental factors that can cause developmental delays.
  • Ask students to give other examples of what a parent or family member might say for each of the following classifications: Articulation Expressive language delay Global language delay Language disorder Language loss
  • Give an example of how play can increase a preschooler’s complexities. Discuss a scenario in which a child might mimic a role to display emotions. How might a nurse provide a magical concept to assist in communicating with a preschooler?
  • Give examples of religious practices a preschool child might participate in at home. What is an example of an abstract concept a preschool child would not comprehend? Discuss how routine, which could include religious traditions, would assist the hospitalized child.
  • Give an example of how the nurse could assist the parents in discussing sexual education for their child.
  • Give an example of an honest and accurate conversation between a nurse and preschool child that is appropriate for the child’s level. Provide an example of terminology a nurse might use when discussing sexual curiosity with the preschool child. In what situation might a preschool child ask questions regarding his or her anatomical differences?
  • Give an example of how a nurse or parent might distract a preschool child who is constantly touching his or her private parts. How can the nurse help parents understand and deal with this milestone in their child’s development?
  • What is an example of a social developmental lag in the preschool child?
  • Give examples of how the preschool child can assist the parent in the household. How can this age group function independently or assist in daily activities?
  • Give examples of a 3-year-old’s vocabulary. Discuss how the 3-year-old’s imagination is different from the school-age child’s. How might a 3-year-old display an identification with a parent of the same sex?
  • Describe a situation in which the nurse might have to manage the hurt feelings of a 3-year-old. Discuss how the nurse could help decrease the 3-year-old child’s fear of bodily harm while hospitalized.
  • Give an example of how a 4-year-old child might be more aggressive than a 3-year-old. What education could the nurse provide to parents in dealing with an aggressive 4-year-old who picks on other children? Give an example of how a 4-year-old might display superiority over peers.
  • Give examples of the typical vocabulary of a 4-year-old. Discuss types of achievements a 4-year-old might accomplish.
  • Discuss how 4-year-old children play scenarios in which death is a concept. Discuss how a parent might encourage or stimulate discussion so this child can discuss death or the fear of it.
  • What actions would indicate how a 5-year-old child is more responsible than a 4-year-old? Discuss how the 5-year-old is very talkative and how parents can deal with the constant chatter.
  • Give an example of how a 5-year-old might react to rules of a game versus a 4-year-old child. In what ways is this age group less fearful of the environment?
  • Give examples of other skills a 5-year-old might be encouraged to accomplish. How might a parent discuss the failure of a desired skill attempted by a 5-year-old?
  • Limits make children feel secure, protect them from danger, and relieve them from decisions that they are too young to make. How do limits make children feel secure? Discuss how limits and self-discipline differ from each other and the parent’s role in each. How do rewards differ from bribes? Discuss how modeling by the parent affects the child. Parents should establish a general style for discipline. Audience Response Question #3 The best time to offer a reward for good behavior is: 1. during poor behavior. 2. following an episode of poor behavior. 3. when the child finishes a time-out episode. 4. before the poor behavior occurs.
  • How would a child display jealousy? Discuss how a parent might address a preschool child who is displaying jealousy. Audience Response Question #4 Encouraging a 4-year-old child to assist with the care of his newborn brother will assist in his adjustment to having a sibling. 1. True 2. False
  • Discuss regression. How can a parent effectively discourage thumb-sucking?
  • What organic causes can bring about enuresis?
  • Discuss information the nurse would collect regarding family history, stress, medications, and developmental milestones.
  • What might the child contribute to manage his or her enuresis? Discuss behavior modification and bladder training exercises. Discuss medications that can help with enuresis.
  • Discuss types of group activities that would promote cooperation among preschool children. What are examples of a positive or negative program and how it can affect a child’s self-esteem?
  • Discuss how a nurse or parent can provide education at a preschool child’s level so the child understands the importance of hygiene on a daily basis. Provide examples of restrictive versus nonrestrictive clothing.
  • Discuss methods parents or caregivers could institute to minimize accidents for this population. In what situations could children become victims of predators? Give an example of indirect supervision.
  • Give examples of situations in which the child might not visit the playroom or interact with others while in the hospital environment. What are appropriate toys for the preschool-age child?
  • Discuss education for parents or methods the nurse can institute so play is not competitive between children. In what ways is play important to the physical, psychosocial, and emotional development of the preschool child?
  • Give examples of how the nurse might interact with a preschool child who is interacting with his or her playmate.
  • Discuss why the handicapped child requires more stimulation through play versus a nonimpaired child. Give examples of situations in which mental age differs from chronological age and how the nurse can manage these children. How does repetitive play affect the handicapped child?
  • Give situations and examples of how therapeutic play can help rehabilitate or enhance development in the child. How can the nurse incorporate play therapy into the plan of care?
  • Discuss the stages of separation anxiety and how the nurse can assist the child to transition through anxiety. How can the nurse address and inform the child’s parents about management of separation anxiety?
  • Discuss the nurse’s rationale for obtaining information about how the preschool child interacts socially.

Chapter 018 lo Chapter 018 lo Presentation Transcript

  • Chapter 18Chapter 18The Preschool ChildThe Preschool Child
  • ObjectivesObjectives• List the major developmental tasks of thepreschool-age child.• Describe the physical, psychosocial, andspiritual development of children from age 3to 5 years, listing age-specific events andguidance when appropriate.• Discuss the development of positive bedtimehabits.2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • ObjectivesObjectives (cont.)(cont.)• Discuss one method of introducing theconcept of death to a preschool child.• Describe the development of the preschoolchild in relation to Piaget’s, Erikson’s, andKohlberg’s theories of development.• Discuss the characteristics of a goodpreschool.• Discuss the value of play in the life of apreschool child.3Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • ObjectivesObjectives (cont.)(cont.)• Designate two toys suitable for the preschoolchild, and provide the rationale for eachchoice.• Describe the speech development of thepreschool child.• Discuss the value of the following: time-outperiods, consistency, role modeling, rewards.4Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • ObjectivesObjectives (cont.)(cont.)• Discuss the approach to problems such asenuresis, thumb-sucking, and sexual curiosityin the preschool child.• Describe the developmental characteristicsthat predispose the preschool child to certainaccidents, and suggest methods ofprevention for each type of accident.• Explain the use of therapeutic play with ahandicapped child.5Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • General CharacteristicsGeneral Characteristics• Preschool child is age 3 to 5 years• Marked by– Slowing of physical growth– Mastering and refining of motor, social, andcognitive abilities6Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • General CharacteristicsGeneral Characteristics (cont.)(cont.)• Major tasks of preschool-age child– Preparation to enter school– Development of a cooperative-type play– Control of body functions– Acceptance of separation– Increase in communication skills– Memory– Attention span7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Physical DevelopmentPhysical Development• Doubles the 1-year-old weight by 5 years ofage• Between 3 and 6 years of age, grows tallerand loses chubbiness from toddler age• All 20 primary teeth have erupted• Has good control of muscles• Hand preference develops by 3 years of age• More adept at using old skills as each yearpasses8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Cognitive DevelopmentCognitive Development• Piaget calls this preoperational phase– Has two phases• Preconceptual occurs in the 2- to 4-year-old child• Intuitive thought occurs in 5- to 7-year-old child– Increasing development of language andsymbolic functioning– Egocentric, as they have difficulty seeing anypoint of view other than their own– Animism and artificialism9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Cognitive DevelopmentCognitive Development (cont.)(cont.)• Piaget’s intuitive thought stage– Occurs in the 4- to 7-year-old child– Prelogical thinking– Experience and logic are based on outsideappearance– Distinct characteristic is centeringcentering– Tendency to concentrate on a singleoutstanding characteristic of an object andexclude other features10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Effects of Cultural PracticesEffects of Cultural Practices• Can influence the development of a sense ofinitiative• Parents and older siblings model languagedevelopment11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Language DevelopmentLanguage Development• Delays or problems can be caused by– Physiological– Psychological– Environmental stressors• Includes both the understanding of languageand the expressing of oneself in language12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Not Talking: A ClinicalNot Talking: A ClinicalClassificationClassification13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.WHEN PARENTS SAYCLASSIFY THESYMPTOMS AS“I’m the only one who understands what shesays.”Articulation disorder“She’ll do what I say, but when she wantssomething, she just points.”Expressive languagedelay“He can’t play ‘show me your nose,’ and the onlyword he says is ‘mama’.”Global language delay“He never made those funny baby sounds or said‘mama’ and ‘dada,’ and now he just repeatseverything I say.”Language disorder“He used to say things like ‘Joey go bye-bye,’ butnow he doesn’t talk at all.”Language loss
  • Development of PlayDevelopment of Play• Play activities increase in complexity• Enables child to experience multiple rolesand emotional outlets• Appealing to child’s magical thinking is bestapproach to communicating with apreschooler14Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Spiritual DevelopmentSpiritual Development• Learn religious beliefs and practices at home• Cannot understand abstract concepts• In the hospitalized preschooler, observingreligious traditions practiced in the home maybe calming for the child15Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Sexual CuriositySexual Curiosity• Nurses should use the following principles ofteaching and learning common to otherpatients16Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Sexual CuriositySexual Curiosity (cont.)(cont.)• Assess knowledgebase of child• Assess what specificinformation the childis seeking• Be honest andaccurate• Use correctterminology• Provide sex educationat the time the childasks the questions• Parents mustunderstand thatsexual curiosity startsas an inquiry intoanatomicaldifferences17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Sexual CuriositySexual Curiosity (cont.)(cont.)• Preschool childrenare as matter-of-factabout sexualinvestigation as theyare about any otherleaning experienceand are easilydistracted by otheractivities• May be displayed inthe form ofmasturbation– Considered harmless ifthe child is outgoing,sociable, and notpreoccupied with theactivity– Assure parents thatthis behavior is normal18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Physical, Mental, Emotional, andPhysical, Mental, Emotional, andSocial DevelopmentSocial Development19Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 3-Year-OldThe 3-Year-Old• Helpful and can assist in household chores• Temper tantrums less frequent• Better able to direct primitive instincts• Can help dress themselves, use the toilet,wash their hands, and eat independently• Talk in longer sentences• Able to express thoughts and ask questions20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 3-Year-OldThe 3-Year-Old (cont.)(cont.)• Play in loosely associated groups• Highly imaginative play• Begin to lose interest in mother and prestigeof the father begins• Develop romantic attachment to parent ofopposite gender• Identify themselves with parent of samegenderElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21
  • The 3-Year-OldThe 3-Year-Old (cont.)(cont.)• Become angry when someone tries to taketheir possessions• Resent being disturbed during play• Are sensitive and feelings are easily hurt• Has fear of bodily harm22Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 4-Year-OldThe 4-Year-Old• More aggressive• Eager to let others know they are superior• Pick on playmates• Boisterous, tattle on others• Can use scissors with success• Can tie their shoes23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 4-Year-OldThe 4-Year-Old (cont.)(cont.)• Vocabulary has increased to about 1500words• Many feats done for a purpose• Begin to prefer playing with friends of samegender24Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 4-Year-OldThe 4-Year-Old (cont.)(cont.)• Concept of death– Begin to wonder about death and dying– Realize others die, but do not relate death tothemselves– Parents should reassure child that people donot generally die until they have lived a reallylong time– Parents should encourage questions as theyappear and help the child accept the truthabout death without fear25Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 5-Year-OldThe 5-Year-Old• More responsible• Enjoys doing what is expected of them• Have more patience• Tend to want to finish what they have started• Talk constantly• Inquisitive26Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 5-Year-OldThe 5-Year-Old (cont.)(cont.)• Play games governed by rules• Less fearful of environment• Worries less profound• May begin losing deciduous teeth27Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • The 5-Year-OldThe 5-Year-Old (cont.)(cont.)• Should be encouraged to develop motorskills, such as hammering a nail• Should not be scorned for failure to meetadult standards• Must learn to do tasks themselves for theexperience to be satisfying28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • GuidanceGuidance29Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Discipline and Limit-SettingDiscipline and Limit-Setting• Children need limitsfor their behavior• Teach and graduallyshift control fromparents to child• Self-discipline orself-control• Timing the time-out– 1 minute per year ofage, no interaction oreye contact during• Reward– Don’t confuse withbribes– Encourage positivebehavior• Consistency andmodeling30Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • JealousyJealousy• Normal response toactual, supposed, orthreatened loss ofaffection• Jealousy of a newsibling strongest inchildren under 5 years• May revert tobehaviors seen at anearlier age• May be aggressive,bite, or pinch• Tends to be seen lessin an “only” child• Children should feelthey are helping withthe care of theirsibling31Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Thumb-suckingThumb-sucking• Instinctual behavioral pattern• Finger- or thumb-sucking will not have adetrimental effect on the teeth as long as thehabit is discontinued before the permanentteeth erupt• The child who is trying to stop thumb-suckingis given praise and encouragement– May regress during periods of stress or fatigue32Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Enuresis (Bedwetting)Enuresis (Bedwetting)• Primary– The child has neverbeen dry• Secondary– Bedwetting recurrencein a child who has beendry for a period of 1year or more• More common in boysthan girls• Organic causes– Urinary tract infection– Diabetes mellitus– Diabetes insipidus– Seizures– Obstructive uropathy– Abnormalities ofurinary tract– Sleep disorders33Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Enuresis (Bedwetting)Enuresis (Bedwetting) (cont.)(cont.)• Treatment and nursing care• Data collection• Pattern of wetting• Number of times per night or week• Number of daytime voidings• Type of stream• Dysuria• Amount of fluid taken between dinner and bedtime• Family history• Stress• Medications• Developmental landmarks, including toilet trainingElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34
  • Enuresis (Bedwetting)Enuresis (Bedwetting) (cont.)(cont.)• Child needs to becenter ofmanagementprogram• Liquids should belimited after dinner• Child should voidbefore going to bed• Treatment options– Counseling– Hypnosis– Behavior modification– Pharmacotherapy– Bladder trainingexercises to stretchand increase thebladder size35Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Nursery SchoolNursery School• Preschool programs– Structured activities– Foster group cooperation– The development of coping skills• Child gains– Self-confidence– Positive self-esteem if in a good program36Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Daily CareDaily Care• Does not require extensive physical care butstill needs to bathe each day and shampoohair at least twice a week• Clothing should be loose enough to preventrestriction of movement, washable; sturdyand supportive shoes37Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Accident PreventionAccident Prevention• Accidents are a major threat for 3- to 5-year-olds• Car safety is essential• Burns occur due to child’s experimentation• Poisoning can occur due to increased freedomand access to items within the environment• Child should be taught about the dangers oftalking to or getting in the car with strangers, aswell as the dangers of playing in secluded areas• Indirect supervision necessary due to poorjudgmentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38
  • Play in Health and IllnessPlay in Health and Illness• Value of Play– Important to physical,mental, emotional, andsocial development– Increasescommunication withother children• The Nurse’s Role– Important to include inthe child’s plan of care• Factors to consider– State of health– Overstimulation andfatigue– Diagnosis should beconsidered whenchoosing toys for thechildElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39
  • Value of PlayValue of Play• Should be noncompetitive• Helps the child adjust to an expanding worldand increased independence40Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Nursing TipNursing Tip• Imaginary playmates are common andnormal during the preschool period and servemany purposes, such as relief fromloneliness, mastery of feats, and a“scapegoat”41Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Play and the Handicapped ChildPlay and the Handicapped Child• Mentally disabled child needs morestimulation through play than the child who isnot impaired• Consider mental and not chronological age• Play needs to be supervised due to poorerjudgment and potential for aggressivebehavior• Repetition of play experiences is necessary42Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • PlayPlay• Therapeutic play– Retrain muscles– Improve eye-handcoordination– Help children tocrawl and walk• Other types of play– Play therapy• Used when child isunder stress– Art therapy• Child can expressfeelings andcommunicate withothers throughdrawings43Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Nursing Implications of PreschoolNursing Implications of PreschoolGrowth and DevelopmentGrowth and Development• Provide parentalguidance concerningthe changingbehavior patterns ofthe preschool-agechild• The use of time-outsand alternativemethods of disciplineshould be stressed• Hospitalization can befrightening– May perceivehospitalization as a formof punishment– Child may feel abandoned– Separation anxiety ismanifested by• Stages of protest, despair,detachment, and regressionto earlier behaviors44Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Nursing Implications of PreschoolNursing Implications of PreschoolGrowth and DevelopmentGrowth and Development (cont.)(cont.)• Important nursing assessment includesobserving the child– What is the child’s approach to play?– Does the child join in freely or linger outsidethe group?– Does the child prefer active or quiet activities?– Can the child talk with his or her playmatesand convey ideas?– What type of attention span does the childhave?45Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • Question for ReviewQuestion for Review• What kind of therapeutic play would beappropriate for a postoperative preschoolchild?46Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
  • ReviewReview• Objectives• Key Terms• Key Points• Online Resources• Critical Thinking Question• Review Questions47Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.