Preschool Life Stage

Preschool Life Stage
(3-5 years)
Fall 2018
Jacey Mitchell, RDH, MS
COPYRIGHT © 2018, ELSEVIER INC. ALL RIGHTS RESERVED.

Biology and Genetics
▪ Growth
– 2 kg (4 lb) and 7 cm (2 in) per year
– <2 cm head circumference change
▪ Selected system changes
– Kidneys/GI: full maturity; voluntary control
– Heart/lungs: increased capacity
– Ears: change shape, less otitis media
– Tonsils/adenoids: large
– Immune: boosted immune response
– Musculoskeletal/neuro: advances fine/gross motor skills
▪ Increase in size of cardiovascular system to meet demands of larger body size
– Average pulse: 90-100 beats per minute compared to 60-100 for adult
– Average Blood Pressure: 100/60 compared to 120/80 for adult
– Respirations: 22-25 compared to 12-18 for adults
COPYRIGHT © 2018, ELSEVIER INC. ALL RIGHTS RESERVED. 2

Biology and Genetics (Cont.)
▪ Gender
– Boys: more illnesses; more accidents
▪ Race influences
– Health care
– Cultural preferences
– Dietary choices
– Health-promoting behaviors
▪ Genetics: most commonly diagnosed
– Cystic fibrosis, Duchenne muscular dystrophy, fragile X
syndrome, Williams’ syndrome

Gordon’s Functional Health Patterns
▪ Health perception–health management pattern
▪ Nutritional-metabolic pattern
▪ Elimination pattern
▪ Activity-exercise pattern
▪ Sleep-rest pattern
▪ Cognitive-perceptual pattern
▪ Self-perception–self-concept pattern
▪ Roles-relationships pattern
▪ Sexuality-reproductive pattern
▪ Coping–stress tolerance pattern
▪ Values-beliefs pattern
4COPYRIGHT © 2018, ELSEVIER INC. ALL RIGHTS RESERVED.

Health Perception–Health Management Pattern
▪ Body concepts
– Curious about body of opposite sex
– Vague/inaccurate ideas of internal body
– Anxiety: Fear of mutilation, death
▪ Health beliefs and health management
– Family influence—context for health beliefs
– Upset over minor injuries; pain/illness is viewed as punishment
– Contribute to health management (brushing teeth)
▪ Health promotion
– Help families promote healthy lifestyle

Nutritional-Metabolic Pattern
▪ Nutritional guidelines
– Variety of foods; follow MyPyramid
– Attention to iron, calcium intake
– Limit fat and sugar
– basic requirements are daily caloric needs of 1800 calories
▪ most children do best with 3 meals and three snacks
– Advertised foods in commercials and fast food could become problematic
▪ Presweetened cereals, McDonald’s meals with toys
▪ Behavioral/motor aspects
– Food preferences/refusals
– Learning utensil use
– Helping with meal preparation
▪ Meals away from home
– Preschool/child care center requirements

Nutritional-Metabolic Pattern (Cont.)
▪ Oral health
– Prevention: fluoride toothpaste, water fluoridation, dental
sealants
– Self-care, population-based, and professional care needed
▪ Food allergies: increasing prevalence
– Most develop before age 2
– High-risk allergens: milk, eggs, peanuts
– Allergy prevention, exposure prevention, action plan

Elimination Pattern
▪ Physical ability
– Independent toileting—developmental achievement
▪ Guidance
– Supervise washing hands, flushing toilet
– Soiling
▪ Handle in gentle/encouraging way
▪ Preschooler responsible for changing clothes

Activity-Exercise Pattern
▪ Play
– “Work” of the child
– Important role social/psychological development
– Mimic others (adults)
▪ Play kitchens, workshops, cars, telephones
– Play reveals child’s reality and perceptions
– Toys chosen for age-appropriateness
▪ Imitation play
– Window into social competency
– Fantasy (imaginary companion, imaginary scenario)
▪ It is important for the people in the child’s life to be good
role models because they are who the preschooler will
imitate and learn from

Activity-Exercise Pattern (Cont.)
▪ Time orientation
– Idea past/future
– Enjoy planning for family activities
▪ Television
– Limit time
– Disengages mind
– Less learning
– Less active lifestyle
▪ Socialization via group activities

Sleep-Rest Pattern
▪ 8-12 hours/night; nap or “quiet time”
▪ Bedtime ritual
– Prolonged bedtime routines
– Honor reasonable rituals
– Be firm and consistent
▪ Sleep disturbances
– Night terrors vs nightmares (anxiety dreams)
– Helping child understand “real” vs “pretend” stories/ideas—
lessen nightmares

Cognitive-Perceptual Pattern
▪ Can internalize family rules; sense of time
▪ Piaget: Preoperational stage
– Ability to function symbolically with language
– Concrete thought process
▪ Egocentrism—own perspective
▪ Irreversibility
▪ Transductive reasoning
– Imaginary friends
▪ Controlled by child; not a threat
▪ Way to practice social interactions

Vision
▪ Amblyopia (infancy to age 4)
▪ Refractive errors
– Myopia (near-sighted)—elongated eyeball
– Glasses always indicated
▪ Strabismus (crossed-eyes)—cover test
▪ Color blindness
▪ Detection vision problems: screening
– Denver Eye Screening Test—visual defects
– Snellen E Screening Test—visual acuity
– Ishihara’s Test—color-blindedness
– Pupillary light reflex—heterotropia

▪ Hearing
– Audiometry: screening; speech delays
▪ Language
– Receptive/expressive skill development
– Speech maturation: issues of speech rhythm, fluency
– Vocabulary consists of about 2000-24000 words by age 5
▪ Memory
– Affects language development, learning
– Enhanced by grouping items, verbally naming items, rehearsal

Testing of Developmental Level
▪ Assess Readiness for School
– Ages and States Questionnaire (ASQ-3)
– Battelle Developmental Inventory Screening Tool
– Parent’s Evaluation of Developmental Status (PEDS)

Autism Spectrum Disorder
▪ CDC identifies 1 in 68 children on spectrum
▪ More common in boys (4-5 times)
▪ Prevalence increasing (NOT caused by vaccines)
▪ Genetically determined disorders—only rarely nongenetic
factors
▪ Risk factors:
– Atypical birth weight, low Apgar, hemolytic disease, jaundice,
respiratory distress, advanced parental age
▪ Screening tests available
– Modified checklist for Autism in Toddlers (M-CHAT)
– Childhood Asperger Syndrome Test (CAST)

Self-Perception–Self-Concept Pattern
▪ Self-concept: emerges from struggle for autonomy
– Refined through task-oriented and societally oriented
experiences
▪ Erikson: initiative vs guilt
– Sense of initiative: vigorous activity and active imagination
– Parental role: promote initiative; nurture ideas, encourage
behaviors for positive self-concept

Roles-Relationships Pattern
▪ Expanding influences
– Peers
– Gender expectations
– Older siblings
▪ Social interaction
– Preparation for school
– Social competency
▪ Compared over time, in context
▪ Family drawings and discussion
▪ Vineland Social Maturity Scale

Roles-Relationships Pattern (Cont.)
▪ Parental divorce
– Disruption in family relationships
– Regression, confusion, irritability common response
– Need for closeness, patience, consistency
▪ Child abuse
– Complex contributory factors
– Family stressors important trigger
– Primary and secondary prevention
– Recognize signs—mandatory reporting

Sexuality-Reproductive Pattern
▪ Gender identification
▪ Body image
– Perception of sex organs
– Curiosity about bodies/sexual functioning
– Encourage addressing questions simply/factually
– Resources: preschool recommended books
▪ Many good children’s books available as resource

Coping–Stress Tolerance Pattern
▪ Play
– Doll or puppet play
– Mutual storytelling
▪ Coping
– Similar coping mechanisms to toddler
– Maturing coping skills: fewer tantrums
– More problem-solving abilities
– Use of projection/fantasy
– Controlling behavior
– Gentle, consistent adult direction recommended

Values-Beliefs Pattern
▪ Lack fully developed consciences
– Age 4-5: some internal controls
▪ Modeling and inductive explanations
– Moving from specific to general
– Modeling from many sources—not all positive
▪ Preschool typical behavior
– Control behavior to retain parental love/approval
– Express likes/dislikes, ask endless questions
▪ Death
– Fascinated by life beginning/death concepts
– Needs support, possible counseling, to cope with loss

Environmental Processes
▪ Injuries: leading cause of death
– MVA: car seats; ride in back seat
– Household furniture/tools/equipment
– Firearm safety: child access protection
▪ Burns
– Scald/direct flame burns
– Teach danger of matches, open flames, hot objects
▪ Drowning: swimming pool risk
– Fencing, flotation device, water survival, supervision

Mechanical Forces
▪ Bicycle
– Age-appropriate limits needed
– Helmet: with transition from tricycle to bicycle
▪ Automobile-related risk
– Teach proper street-crossing techniques
– Supervision when crossing street
– Consistent and proper use of restraint devices in car

Biological Agents
▪ Boosters
– DTaP: fourth year
– MMR: between 4 and 6 years old
▪ Immunization concerns
– Religious
– Safety of immunizations
– Importance of accurate information
▪ Additional considerations
– New and combined vaccines
– Under-vaccination; “catch-up” schedules

Chemical Agents
▪ Factors impacting risk exposure
▪ Lead: folk remedies, old paint, pottery
▪ Poisonings: poison control number
– More than half occur in children <6 years old
– Teach children about poisons
– Solids: pills, vitamins, aspirin, lipstick
– Liquids: cleaning products, fuel, alcohol
– Sprays: furniture polish, oven cleaner
– Invisibles: carbon monoxide, space heater fumes

Cancers in Preschool Children
▪ Acute lymphocytic leukemia
– Most common; incidence rises ages 2-5
▪ Wilms’ tumor < age 5
– Correlated with congenital malformations
▪ Retinoblastoma: <age 5; genetic mutations
▪ Neuroblastoma <age 2
– Sympathetic nervous system; half of cases in children

Asthma
▪ Incidence
– More rapid rate increase than other ages
– Higher in Black and Hispanic populations
▪ Causes
– Genetic predisposition, allergens
– Precipitants: infections, exercise, weather, stress
▪ Exacerbation factors
– Tobacco smoke, pollutants, allergens
– Poverty contributes significantly to disability and death
– Dust mite, pet/rodent dander, cockroach particles

Determinants of Health
▪ Social factors and environment
– Variance in degree, type of outside contact
– Preschool: wider social contacts; skill development for group
interaction
▪ Culture and ethnicity
– Notice differences in cultural practices
– Socialization to ethnic differences: follow family presumptions
▪ Legislation
– Safety legislation
– Financial social programs: significantly affect preschoolers
– CHIP
– Water fluoridation
– Sealant and varnish programs

Determinants of Health (Cont.)
▪ Economics
– More aware of resource limitations
– Beginning concepts of earning/spending
▪ Health care delivery system
– Recommendations for preventive care
▪ American Academy of Pediatrics
– EPSDT
▪ Medicaid program for yearly screening
▪ Assesses physical status and developmental milestones

References:
▪ Edelman, C., Kudzma, E. (2018). Health promotion throughout the life span.
(9th ed.). St. Louis: Elsevier.

Preschool Life Stage

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