Ch11

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 11
The Preschooler: Basic
Assessment and Health Promotion

PreschoolerPreschooler
 Considered age 3-5
 Emerges as a social being
 Physical growth is slowing
 Becomes acquainted with the environment
 Can identify with play group and control
impulses
 Being to be self-critical

Parenting StylesParenting Styles
 Types
– Authoritarian
– Permissive
– Neglectful
– Intimidated
– Secure
 Must be adapted to child’s temperament

Relationship with ParentsRelationship with Parents
 Stage where Oedipal or Electra complex
develops
 Secondary identification
– Child imitates the parents
– Child internalizes attitudes, feelings, and
values
 Psychoanalytic, Behavioral, and Social
Learning theories apply
 Attachment continues to develop

One-parent or Stepparent FamilyOne-parent or Stepparent Family
 Achieving identification may be more
difficult
 Child’s needs in stepparent family
– Expressing feelings
– Loving interaction with adults of same and
opposite sex
– Involvement with the divorced parents
– Help in dealing with stepparent and sense of
history

Relationship with New BabyRelationship with New Baby
 Parents should
– Share the anticipation in discussions and
planning
– Educate child about reproduction or birth
– Include child in preparation
– Accept that the preschooler may act out
(jealousy)
– Prepare whether the child should be with
mother during birth

Relationship with Older SiblingsRelationship with Older Siblings
 Older siblings may feel cause for envy and
frustration with attention-seeking
preschooler
 Older siblings are important to the
preschooler and can affect preschooler’s
development
 Quality time, reassurance, and firm rules
reduce sibling rivalry

Relationship with GrandparentsRelationship with Grandparents
 Relationship has emotional power and
influence
– Oral historian
– Mentor
– Spiritual guidance
 Grandparents increasingly seeking legal
means to ensure visitation

Other Significant Adults andOther Significant Adults and
Non-Family MembersNon-Family Members
 Examples include aunts, uncles, cousins,
peers, teachers, babysitters, neighbors, or
pets
 Educate parents
– Various types of day-care agencies
– Differences between agencies
– Criteria for selection
 Assist with primary prevention and
consultation in agencies

Early Childhood EducationEarly Childhood Education
 Increasing emphasis on accountability and
measurable outcomes
 Types
– Montessori programs and Follow Through
Projects
– Compensatory programs (Head Start)
– Nursery school, pre-kindergarten, and
kindergarten
 Help parents understand benefits of
education and prepare for the separation

Family Developmental TasksFamily Developmental Tasks
 Supply adequate housing, space,
equipment, and other materials
 Encourage and accept child’s skills
 Plan for predicated and unexpected costs
 Maintain some personal privacy and outlet
for tension
 Share household and child-care
responsibility

Family Developmental Tasks cont.Family Developmental Tasks cont.
 Strengthen partnership with mate
 Learn to accept failures, mistakes, and
blunders; rework codes and values
 Nourish common interests and friendships
 Create and maintain effective
communication
 Cultivate relationships with extended
family
 Tap resources and serve others

Growth PatternsGrowth Patterns
 Limb growth is greater in proportion to
trunk growth
 Child grows more proportionately in height
than in weight
 Head circumference growth is slowing

Vital SignsVital Signs
 Body temperature: 98-99 degrees
 Pulse rate: 70-110
 Respiratory rate: 25 per minute
 Blood pressure: 101-115 mmHg systolic
and 57-68 mmHg diastolic

Other CharacteristicsOther Characteristics
 Appearance changes
 Knees and legs change
 Vision is farsighted
 Eye-hand coordination improves
 Bladder and bowel control improves;
internal organs are larger
 Precise fine muscle movements are
demonstrated

AssessmentAssessment
 Should consider more than chronological
age
 Whole and unique child must be
considered
 Denver II—Revision and
Restandardization of the Denver
Developmental Screening Test (DDST)

Assessment contAssessment cont
Figure 9-2
Denver II Revision and
Restandardization of
the Denver
Development
Screening Test

Assessment contAssessment cont
Figure 9-2 (cont)
Denver II Revision and
Restandardization of
the Denver
Development
Screening Test

Cognitive DevelopmentCognitive Development
 Brain undergoes rapid spurts
developmentally
– Most rapid growth is in frontal lobe
 Child learns by
– Interacting with more knowledgeable people
– Being confronted with others’ opinions
– Being actively involved with objects and
processes

Cognitive Development cont.Cognitive Development cont.
 Help parents understand
– Concept formation
– How to stimulate intellectual growth
– Influences on cognitive development
 Concepts of relationships
– Time concept
– Spatial concepts
– Quantitative concepts
– Concepts of causality

Preoperational StagePreoperational Stage
 Literal thinking with absence of reference
system
 Intermingling of fantasy, intuition, and
reality
 Absolute thought and centering
 Difficulty remembering conversation topic
 Inability to state cause-effect relationships,
categories, or abstraction

Preoperational Stage contPreoperational Stage cont
 Preoperational Stage is divided into 2
parts
– Preconceptual Stage (2-4 years)
– Intuitive Stage (4-7 years)
 Another approach used is Vygotsky’s
Sociocultural Theory
– Cognitive growth occurs in sociocultural
context and evolves out of child’s social
interactions

Preschooler CommunicationPreschooler Communication
 Use somatic or physical symptoms, action,
and verbal expression
 Learn new words quickly, flexibly, and
efficiently
– Connected to familiar words, experiences, or
themselves
 Participate in private speech, social
speech, and later inner speech

Preschooler Communication cont.Preschooler Communication cont.
 Inform parents how child uses language
 Help parents choose books that foster
development
 Share effective ways of talking with a
preschooler
 Educate about possible reasons for
speech problems

Preschooler PlayPreschooler Play
 Intrusive in play
 Pregang stage
 Purposes include learning cooperation,
expressing imagination, and building self-
esteem
 Play materials should be stimulating and
encourage different types of play
 Inform parents of their role in play

Emotional DevelopmentEmotional Development
 Child appears more self-confident and
relaxed
 Child ready for prosocial behavior
 Encourage parents to be role models for
standards of behavior
 Encourage parents to choose stories,
songs, games and videos that promote
prosocial behavior

Nutritional NeedsNutritional Needs
 Use food pyramid adjusted for
preschoolers
 Guide for caloric intake is 1000 calorie
baseline with 100 calories each year
 Protein, fat, and vitamins needed daily
 Eating assumes social significance
 Eating habits may include overeating or
not wanting to eat

Nutritional Needs cont.Nutritional Needs cont.
 Food should be attractive, mildly-flavored,
and separated and distinctly identifiable in
flavor
 New food should be introduced gradually
 Review with parents
– Reasons a child may not eat
– Differences between 3-, 4-, and 5-year-old
eating patterns
– Recommended supplements and sources of
information

ExerciseExercise
 Needs at least 60 minutes of active
exercise daily
 Needs time and space for physical
exercise
 Needs comfortable shoes and clothing
 Needs adult-initiated rest periods

SleepSleep
 Bedtime routines important
 Sleep time decreases from 10-12 hours
for younger preschooler to 9-11 hours for
older preschooler
 Dreams and nightmares occur
 Emphasize that parents should teach
sleep strategies and set limits
 Help parents understand how to deal with
night terrors and sleepwalking

ImmunizationsImmunizations
 Counsel about the benefit of state law
 Ensure the following before giving
immunization
– Parent’s consent
– Need for vaccination
– Knowledge of contraindication or past history
– Education to parents about administration,
benefits, and risks
– Proper storage and date of expiration

Dental CareDental Care
 Dental carries begin at this age
 Deciduous teeth guide in the permanent
ones
 Fluoride is important to dental health
 Teeth should be brushed after eating
 Refined sugar intake should be limited
 Child required to have physical and dental
examination before school

SafetySafety
 Teach parents
– Developmental characteristics that may cause
hazardous risk
– Measures for teaching safety to the child
– Measures parents can institute for child’s
safety
– Measures to avoid falls and related injury
– Measures for parents to teach child related to
abduction, running away, or getting lost
– Why child may continually fail to listen or obey

AccidentsAccidents
 Teach parents about prevention
 Educate about minor head injuries and
how to assess preschooler
 Inform parents how to prevent and watch
for signs of infection
 Teach parents different types of burn and
guidelines for accidental ingestion
poisonings

Common Health RisksCommon Health Risks
 Respiratory asthma
– Inform about dangers of smoking
 Bites from animals or children
– Ensure dog does not have rabies
 Lead
– Watch for signs of lead poisoning

Child MaltreatmentChild Maltreatment
 Abuse can be physical, psychological, or
sexual
 Abuse can be intrafamilial or extrafamilial
 Sexual abuse can be contact or
noncontact
 Abuse can be ritualistic
 Abuse can be neglect
 Abuse can cause autonomic or
hyperarousal response

Assessment for AbuseAssessment for Abuse
 TRIADS Checklist
– Type of abuse
– Role of relationship with victim to offender
– Intensity of abuse
– Autonomic response to child
– Duration of abuse
– Style techniques or access of offender

InterventionIntervention
 Report abuse to appropriate professionals
and agencies
 Tell parents of your concern for the child
 Give idea on how to help child work
through feelings and trauma
 Use interventions such as counseling
techniques, relaxation techniques, and
play
 Carefully document all interaction

Administering CareAdministering Care
 Preschooler is particularly vulnerable to
fears about body damage, including
dental, medical, and surgical procedures
 Feeling can influence personality and
development into childhood
 Teach parents many of these negative
feelings can be averted
 Emphasize that parents should lead by
example

SexualitySexuality
 Preschooler
– Identifies self as girl or boy
– Adopts gender-appropriate behavior through
identification
– Interested in function and appearance of body
 Teach parents that they foster gender
roles
 Encourage importance of variety of play
activities and experiences

Teaching SexualityTeaching Sexuality
 Recognize importance of parents’ showing
love and respect for self and others
 Acknowledge importance of parent-child
open communication
 Answer questions correctly in a relaxed
manner
 Teach atomic names for body parts
 Observe child’s play to determine needs

Teaching a ChildTeaching a Child
 Most critical factor is loving caretaker
 Learning occurs from
– Motor activity, play, and language games
– Talking with adults and peers
– Paying attention to both trivial and important
aspects of environment
 Avoid too much television or aggressive,
fast-paced shows, videotapes, and
videogames

Self-ConceptSelf-Concept
 Learning about the body is important at
this stage
 Child should learn some control over
feelings and behavior
 Child feels great self-esteem when a
problem is faced and handled
 Teach parents ways to increase the child’s
self-esteem and self-concept and develop
concept of body image

Moral and Spiritual DevelopmentMoral and Spiritual Development
 Child learns by example
 Child needs simple explanation matched
with daily practices to learn religion
 Child develops superego at this stage
 Child needs to learn about consequences
of behavior on others
 Teach parents importance of superego
development and beginning moral
development

Guidance and DisciplineGuidance and Discipline
 Teach parents
– Set consistent, fair, and kind limits that
preserve parent’s and child’s respect
– Stop immediately behavior that hurts others
– Explain reasons for limits
– Avoid spanking
– Use time-out and reward to help guide
behavior
 Encourage parents to use age and
developmentally appropriate discipline

Development TasksDevelopment Tasks
 Settle into healthy daily routine of eating,
exercising, resting, and following health
promotion
 Master large- and small-muscle
coordination and movement
 Participate in life and activities of family
 Identify with parents of the same gender
 Conform somewhat to other’s
expectations
 Express emotions healthfully

Developmental Tasks cont.Developmental Tasks cont.
 Become more realistic
 Learn to communicate effectively with a
number of people
 Learn to use initiative tempered by a
conscience
 Develop ability to handle potentially
dangerous situations
 Lay foundation of beliefs, values, and
ideas

Initiative versus GuiltInitiative versus Guilt
 Initiative is enjoyed of energy displayed in
action, assertiveness, learning, increasing
dependability, and ability to plan
 Guilt is sense of defeatism, anger, and
feeling shameful or deserving of punishment
 Guilt can come from excessive expectations,
sibling rivalry, lack of opportunity, and lack of
guidance

Developing Initiative in PreschoolerDeveloping Initiative in Preschooler
 Encourage use of child’s imagination,
planning, and creativity
 Limit punishment to acts that are truly
dangerous or wrong
 Reinforce appropriate behavior
 Affirm emotional experiences and set
aside time each day to review them
 Help preschooler learn about different
feelings and how to express and cope

Adaptive MechanismsAdaptive Mechanisms
 Fear is common
 Frustration arises in response to self- and
other’s expectations
 Emotional regulation is a task
 Mechanisms include introjection,
secondary identification, fantasy,
repression, and suppression

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