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Dinoy BSN II-D

Preschooler (3-5 Years)

20 of all their deciduous teeth are present

Assessment: at 3 years of age

 Physical Growth and Development  Cognitive

Slimmer, taller and much more childlike Falls to the preoperational stage
according to Piaget
Learns extended language
They have intuitional thought but they
Lymphatic tissues begin to increase in lack insight to view themselves as others
size e.g. tonsils see them or put themselves in another’s
place
IgG and IgA levels increase
Vocabulary is about 900 words
Physiologic splitting of heart sounds may
be present Imaginations are keener than they will be
at any other time in their lives
Anteroposterior and transverse diameters
of the chest reach adult proportions The child with a well-developed sense of
initiative discovers that learning about
Pulse rate decreases to about 85 bpm
new things is fun
Blood pressure: 100/60 mmHg
Developmental task: Initiative versus
Muscles are noticeably stronger Guilt

Exhibits genu valgus(knock-knees) To gain a sense of initiative, they need

exposure to a wide variety of
Weight gain: slight at 4.5 lbs (2 kg) a year experiences and play materials

Appetite remains as it was during They are interested in seeing new places
toddlerhood and enjoy going with the family on
vacation- these activities lead to
Height gain: minimal at 2 - 3.5 inches (6-8 increased vocabulary and learn words
cm) a year in average which they transfer from abstract
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concepts to the objects to which they Frequently asks how and why questions
relate that needs simple answers

They have such active imaginations that Words with multiple meaning s are
they need little guidance confounding to them

Imitation: they need free rein to imitate Enjoys participating in mealtime

the roles of the people around them conversation and describes something
from their day in great detail
Fantasy: they believe that their
thoughts and wishes come true  Emotional

 Personality-Temperament They have a great deal in their ability to

Egocentric-defines something in relation
to themselves
If children are criticized or punished for
attempts at initiative, they develop a
sense of guilt for wanting to try new
activities or have new experiences
They need exposure to an adult of the
opposite sex so they can become familiar
with opposite gender roles
Because 3-years olds are capable of
sharing, they play with other children
agreeably than do toddlers , which is why
preschool age is sensitive and critical
time for socialization
They can determine right from wrong
based on their parent’s rules
 Communication
understand the world and how they relate
to people
Oedipus Complex: strong emotional
attachment of a preschool boy to his
mother
Electra Complex: attachment of a
preschool girl to his mother
Each child competes with the same-sex
parent for the love and attention of the
other parent
 Play
Do not need many toys
They enjoy games that use IMITATION e.g.
playing house
They imitate what they see their parents
are doing
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Many have imaginary friends as a normal
part of having active imagination
4 and 5 years old divide their time
between rough housing and imitative
plays
Also interested in group games
Begin to develop best-friendships
Diagnosis:
 Wellness oriented:
Health-seeking behaviors related
developmental expectations
 Other Nursing Diagnosis:
Risk for injury related to increased
independence outside the home
Delayed growth and development related
to frequent illnesses
Risk for poisoning related to maturational
age of child
Risk for injury to teeth related
developmental age and play activities
Risk for Impaired Urinary Elimination
related to parental knowledge deficit of
toilet-training techniques
E. A. Dinoy BSN II-D
Planning/Implementation for Health
Promotion:
 Preschooler safety
As preschoolers broaden their horizons,
safety issues increase
By age 4, they may project an attitude of
independence and the ability to take care
of their own needs(PSEUDO-
INDEPENDENCE)
They still need supervision to be certain
they do not injure themselves or other
children and to ensure they do not stray
to too far from home
They must be reminded repeatedly of
automobile safety
They may imitate taking medicine so
adults should never take them in front of
children
Warn a child never to talk with or accept
gifts from strangers
Teach a child how to call for emergency
to Describe what police officers look like
Explain the importance of telling secrets
to adult when they feel uncomfortable
Explain not to tolerate bullying behaviors
from other children
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Make sure that parents buckle
preschoolers in into car seats in the
backseat
Promote bicycle safety
 Nutritional Health
The preschool years are not a time of fast
growth so the child is less likely to have a
ravenous appetite
Offering small servings of food is still a
good idea
Most children are hungry after preschool
and enjoy a snack when they arrive home
Teach parents to make mealtime a happy
and enjoyable part of the day for
everyone
Initiative or learning how to do new things
can be strengthened by allowing a child
to prepare simple foods e.g. sandwiches
or spreading jelly on toast
Parents should select foods based on the
food pyramid, making sure to offer a
variety
Caution parents not to give vitamins more
than recommended amount
Vitamins should be out of reach
A vegetarian diet should appear colorful
E. A. Dinoy BSN II-D
 Preschooler development on daily activities
Preschoolers have often mastered the
basic skills needed for most self-care
activities including feeding, dressing,
washing and tooth brushing
DRESSING: mot of them can dress
themselves except for difficult buttons,
although there may be a conflict with
what the child would wear
SLEEP: they are aware of their heeds,
when they are tired, they often curl up on
the sofa or bed and fall asleep
EXERCISE: this period is an active phase
so they make a great deal of exercise
BATHING: they can wash and dry their
hands perfectly adequately if the faucet is
regulated for them
CARE OF TEETH: the child should
continue drinking fluorinated water or
receive a prescribed oral fluoride
supplement if fluoride is not provided in
the water supply; one good tooth
brushing session a day is more often
effective than more frequent half-hearted
brushings
 Healthy Family functioning
Parents should encourage vocabulary
development
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Answering a preschooler’s question is
often difficult because the questions are
philosophical
It is important for parents to guide a child
through struggles without discouraging
the child’s right to have an opinion
 Behavioral Variations
Time-out is a good technique to correct
behaviors for parents to continue through
the preschool years
Parental Concerns r/t normal
development:
 Fears
Because preschoolers imagination is so
active, it can lead to a number of fears
FEAR OF THE DARK: an example of fear
heightened by a child’s vivid imagination:
a stuffed toy by daylight becomes a
threatening monster in the dark
… They may be reluctant to go to bed
or to go back to sleep by
themselves unless a light is left on
FEAR OF SEPARATION OR
ABANDONMENT: their keen imagination
allows them to believe that they are
being deserted when they are not
E. A. Dinoy BSN II-D
… sense of time is still distorted so
that they are not comforted by
assurances
… sense of distance is also still
limited
A combination of keen imagination and
immature reasoning results in common
behavior variations in preschooler
TELLING TALL TALES: stretching stories
to make them seem more interesting is a
phenomenon frequently encountered
IMAGINARY FRIENDS: many have
imaginary friend that plays with them
DIFFICULTY SHARING: sharing is a
concept that first comes to be understood
around the age of 3 years then around
three years of age, children begin to think
understand that some things are theirs,
some belong to others and some belong
to both
… They must have experience in
property rights
REGRESSION: some, generally in
relation to stress, revert to behavior they
previously outgrew such as thumb
sucking, negativism, loss of bladder
control and inability to separate from
their parents
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SIBLING RIVALRY: jealousy f a brother
or sister may first become evident during
this period, partly because they have
enough vocabulary to express how they
feel
 Preparing for a new sibling
Introduction of a new sibling is a major
happening that parents need to take
special steps to be certain their
preschooler will be prepared. There is no
rule when to begin, but it should be
before the time when the child begins to
feel the difference the new baby will
make
 Sex education
Children in this period become accurately
aware of the difference between boys and
girls possibly because this may be the
first time in their lives they are exposed
to genitalia of the opposite sex
 Choosing a Preschool/Child Care Center
The main purpose of a childcare center is
to provide childcare while parents work or
are otherwise occupied
These centers are dedicated to
stimulating the children’s sense of
creativity and initiative and introducing
them to new experiences and social
contacts they would not ordinarily receive
at home
E. A. Dinoy BSN II-D
 Preparing Child for School
Essential to this preparation is the
parent’s attitude. If school is always
discussed as something to look forward
to, as an adventure that will be satisfying
and rewarding, then the child view it from
early on as a positive experience
 Broken fluency
Developing language is such a
complicated process that children from 2-
6 years of age are typically having speech
difficulty that parents may interpret as
stuttering
 Bathroom Language
Many preschoolers imitate the
vocabularies of their parents or older
children in the family so well during this
time that they incorporate swear words
into their vocabularies. Parents may have
to be reminded that a child does not
understand what the words mean; he/she
has simply heard them, just as he or she
has decided to use them.
Correction should be unemotional; for
example, “That’s not a word we like to
hear you use. When you’re angry, why
don’t you say ‘fudge’ (or whatever)?
The correcting is no different from that
involvement when a child uses poor
grammar.
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If parents become emotional, a child
realizes the value of such words and may
continue using them for the attention
they create.

Source:

Pilitterri, A., 2003. Maternal and Child Health

Nursing: Care of the Childbearing and Childrearing
family. Philippines: Lippicott Williams and Wilkins.