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Course: Pediatric Nursing

Topic: Growth and Development of Preschoolers

The Nurses International Community

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Module Goals

Learners will be able to:

Identify normal developmental changes (e.g., physiologic, cognitive, psychosocial) that occur in a preschool-age child.
Examine common developmental theories (Erikson, Freud and Piaget) in relation to the growth of a preschooler.
Understand and explain the nutritional requirements of a preschooler.
Identify common issues related to growth and development in a preschooler.
Discuss nurses’ role in the development of a preschooler.

developmental

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Preschoolers (Early childhood)

Paris, Ricardo, & Rymond, 2019

Three to five years of age
Significant changes occur in the way children:

Look, think, communicate, regulate their emotions, and
Interact with others

A time of pretending, blending fact and fiction, and learning to think of the world using language.

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Physical Development

Paris, Ricardo, & Rymond, 2019

Gains about 4 to 5 pounds per year
Grows about 3 inches per year
The average 6-year-old weighs approximately 46 pounds and is about 46 inches in height.
This growth rate is slower than that of infancy.
Has all 20 primary teeth by age 3
Has 20/20 vision by age 4

growth

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Critical Thinking Question

What hallmarks of growth are present in a 4-year-old?

What behaviors or data might indicate a need for further investigation?

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Gross Motor Skills Development

Paris, Ricardo, & Rymond, 2019

At the age of 3 years:

Runs easily
Pedals a tricycle (3-wheel bike)
Walks up and down stairs, one foot on each step

At the age of 4 years:

Hops and stands on one foot for up to 2 seconds
Catches a bounced ball most of the time

At the age of 5 years:

Stands on one foot for 10 seconds or longer
Hops; may be able to skip
Can do a somersault
Can use the toilet on their own

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Fine Motor Development

Paris, Ricardo, & Rymond, 2019

At the age of 3 years:

Copies a circle with a pencil
Turns book pages one at a time
Builds towers of more than 6 blocks
Screws and unscrews jar lids

At the age of 4 years:

Pours, cuts with supervision, and mashes their own food
Draws an individual with 2 to 4 body parts
Uses scissors
Starts to copy some capital letters

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Fine Motor Development

Paris, Ricardo, & Rymond, 2019

At the age of 5 years:

Can draw an individual with at least 6 body parts
Can print some letters or numbers
Copies a triangle and other geometric shapes
Uses a fork and spoon and sometimes, a table knife

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Cognitive Development

Paris, Ricardo, & Rymond, 2019

At 3 years of age:

Can work toys with buttons, levers, and moving parts
Plays make-believe with dolls, animals, and people
Does puzzles with 3 or 4 pieces

At 4 years of age:

Names some colors and numbers
Understands the idea of counting
Starts to understand time
Remembers parts of a story
Understands the idea of “same” and “different”
Tells what he thinks is going to happen next in a book

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Cognitive Development (Continued):

At age 5 years:

Counts 10 or more objects
Understands commonly used everyday items like money and food

Paris, Ricardo, & Rymond, 2019

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Language Development

Paris, Ricardo, & Rymond, 2019

At the age of 3 years:

Follows instructions with 2 or 3 steps
Can name most familiar things
Understands words like “in,” “on,” and “under”
Says first name, age, and sex
Names a friend
Says words like “I,” “me,” “we,” and “you,” and some plurals
Talks well enough for strangers to understand most of the time
Carries on a conversation using 2 to 3 sentences
This age group enjoys talking, and language becomes their primary method of communication.

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Language Development (Continued)

Paris, Ricardo, & Rymond, 2019

At the age of 4 years:

Tells stories
Can say first and last name
Follow a 3-step command
Name 4 colors
Enjoy rhymes and wordplay

At the age of 5 years:

Tells a simple story using full sentences
Uses future tense; for example, “Grandma will be here.”
Says name and address

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Social-Emotional Development

Paris, Ricardo, & Rymond, 2019

At the age of 3 years:

Copies adults’ and friends’ behaviors
Shows affection for friends without prompting
Takes turns
Shows concern for a crying friend
Understands the idea of “mine” and “his” or “hers”
Shows a wide range of emotions
Separates easily from mom and dad
May get upset with major changes in routine

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Social-Emotional Development (Continued):

Paris, Ricardo, & Rymond, 2019

At the age of 4 years:

Enjoys doing new things
Is much more creative with make-believe play
Would rather play with other children than alone
Cooperates with other children
Plays “mom” or “dad”
Often can’t tell what’s real and what’s make-believe
Talks about what they like and what interests them

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Social-Emotional Development (Continued):

Paris, Ricardo, & Rymond, 2019

At the age of 5 years:

Wants to please friends
Wants to be like friends
More likely to agree with rules
Likes to sing, dance, and act
Is aware of gender
Can tell what’s real and what is make-believe
Shows more independence
Can be very cooperative and/or demanding

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Case Study/Critical Thinking Question/What would the nurse do?

Discuss 2 concepts related to cognitive development in preschool-age children. Give specific examples.

Discuss 2 concepts related to language development in preschool-age children. Give specific examples.

Discuss 2 concepts related to social-emotional development in preschool-age children. Give specific examples.

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Psychosocial Development Theory: Erik Erikson

Paris, Ricardo, & Rymond, 2019

Erikson: Initiative vs. Guilt

When a child is placed in an environment where they can explore, make decisions, and initiate activities, a child will achieve initiative.
On the other hand, if the child is put in an environment where initiation is repressed through criticism and control, they will develop a sense of guilt.

erikson

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Psychosexual Development Theory: Sigmund Freud

Freud (Phallic Stage):

Masculinity and femininity are learned during this stage.
The child develops an attraction to the opposite-sex parent and becomes aware of anatomical sex differences.

Sets in motion the conflict between erotic attraction, resentment, rivalry, jealousy and fear called:

Oedipus complex (in boys)
Electra complex (in girls)

After recognizing that they cannot be romantically involved with the opposite-sex parent, the child learns to model their own behavior after the same-sex parent.

Paris, Ricardo, & Rymond, 2019

Belagavi, 2019

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Cognitive Development Theory: Jean Piaget

Preoperational Stage:

The word “operational” means logical, so children are thought to be illogical.
Learning to use language; see the world symbolically:
Pretend play
Egocentrism (think everyone sees things in the same way)
Syncretism (a tendency to think that if two events occur simultaneously, one caused the other)
Animism (attributing lifelike qualities to objects)
Preoccupied with symbols in language, dreams and fantasy

Paris, Ricardo, & Rymond, 2019

Belagavi, 2019

Contact info: info@nursesinternational.org

Pretend Play:

Pretending is a favorite activity at this time. A toy has qualities beyond the way it was designed to function and can now be used to stand for a character or object unlike anything originally intended. A teddy bear, for example, can be a baby or the queen of a faraway land.

According to Piaget, children’s pretend play helps them solidify new schemes they were developing cognitively.

Egocentrism:

Egocentrism in early childhood refers to the tendency of young children to think that everyone sees things in the same way as the child.

Syncretism:

Syncretism refers to a tendency to think that if two events occur simultaneously, one caused the other. An example of this is a child putting on their bathing suit to turn it into summertime.

Animism:

Attributing lifelike qualities to objects is referred to as animism. The cup is alive, the chair that falls down and hits the child’s ankle is mean, and the toys need to stay home because they are tired.

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Nutritional Requirements for a Preschooler

American Heart Association, April 16, 2018

Calories/ foods	4-8 years
Calories kilocalories per day (kcal/d)	Female: 1200 kcal/d Male: 1400 kcal/d
Fat	25% to 35%
Milk / Dairy	2 cups
Lean Meat and Beans	Female: 3 ounces Male: 4 ounces
Fruits	1.5 cups for both male and female
Vegetables	Female: 1 cup and Male: 1.5 cups
Grains	Female: 4 ounces, Male: 5 ounces

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Nutritional Requirements (Continued)

Breakfast

3/4 cup milk
1/2 cup vegetables, fruit, or both
½ ounce equivalent grains

Lunch or Supper

3/4 cup milk
1½ ounces meat or meat alternative
1/4 cup vegetables
1/4 cup fruits
½ ounce equivalent of grains

Paris, Ricardo, & Rymond (2019)

Snack

Select two of the following:
½ cup of milk
½ ounce meat or meat alternative
½ cup vegetables
½ cup fruit
½ ounce equivalent of grains

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Common Issues in Preschoolers

Paris, Ricardo, & Rymond, 2019

Sleep terrors and nightmare disorders
Elimination Disorders

Enuresis - the repeated voiding of urine into bed or clothes (involuntary or intentional) after age 5
Encopresis - the repeated passage of feces into inappropriate places (involuntary or intentional)

Childhood obesity
Food allergies (Anaphylaxis)

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Case Study/Critical Thinking Question/What would the nurse do?

What is the implication of overeating and obesity in this age group?

What health promotion strategies can be recommended to caregivers to promote good eating habits and an active lifestyle in this age group?

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Common Issues (Continued):

Paris, Ricardo, & Rymond, 2019

Safety:

Falls
Burns
Drowning
Poisoning
Accidents

Oral Health

Tooth decay (cavities)

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Nurses’ Role

Promoter of parental role construction:

Education about growth and development
Guide to stimulate (touching, speaking and playing)
Promote parent-child interaction (emotional and cognitive development)

Guidance and support for the implementation of physical health care:

Perform early detection and treatment of disorders
Teach parents to identify signs of health problems
Health education: feeding, prevention of infectious diseases, hygiene and comfort care

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, 2019

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Nurses’ Role (Continued):

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, 2019

Guidance for promoting a safe environment:

Provide guidance for safe family activities and home safety
(smoke detector, tap water temperature, protection on windows and stairs, safe place to sleep, car seat safety)

Application of theories, principles and methods of maternal and child programs:

Conduct home visits
Supervise child development in a structured program

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Forward-Facing-Only Seats (20-80 pounds)

Forward-facing car seats are designed to protect children from 20 to 80 pounds (about 10 to 36 kilograms) or more, depending on the model.

All kids who have outgrown the rear-facing height or weight limit for their car seat should use a forward-facing car seat with a full harness for as long as possible.

Protect the baby or toddler from airbag injury by following these rules:

Never place a rear-facing infant seat in the front seat of a car that has a passenger-side airbag.
Place child safety seats in the back seat.
If parents have no choice and must place a child in the front (that is, if the car is a two-seater or if the car seat will not fit in the back seat), push the passenger seat as far back as it will go.
All kids under 13 years of age should always ride in the back seat and in the middle of the back seat whenever possible.

https://kidshealth.org/en/parents/auto-baby-toddler.html#:~:text=Forward%2Dfacing%20car%20seats%20are,for%20as%20long%20as%20possible.

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Nurses’ Role (Continued.):

Development of therapeutic relationships:

Trustful relationships with mothers and other family members
Respect the decisions of parental figures

Implementation of maternal and child care management:

Act in complex individual and social situations of families
Assume the role of manager

Promotion of access to support network:

Provide information about community resources that parental figures can use in childcare

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, 2019

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Case Study/Critical Thinking Question/What would the nurse do?

Identify 2 injury prevention strategies for the pre-schooler.

Give specific examples.

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References

American Heart Association ( April 16, 2018). Dietary Recommendations for Healthy Children. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/dietary-recommendations-for-healthy-children

Andrews, M. M., Boyle, J. S. & Collins, J. W. (2020). Transcultural concepts in nursing care (8th Ed.). Wolters Kluwer: Philadelphia, PA.

Belagavi, D. (2019). Theories of growth and development in pediatrics: A review. Disease. J PaediatrNursSci ;2(3):63-6. https://www.innovativepublication.com/media/journals/IJPNS-2-3-63-66.pdf

Paris, J., Ricardo, A. & Rymond, D. (2019). Growth and Development https://docs.google.com/document/d/1wjD-vdmYPhdirIWczCCqEDxqmeMzaA4-/edit

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations

(AHRQ, 2020)

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be okay in some cultures but inappropriate or offensive in others.

(AHRQ, 2020)

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Red Flags

Delays in growth and milestone targets
Food allergies
Obesity
Dental caries
Night terrors
Safety issues, including abuse

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References

Reticena, K. O., Yabuchi, V., Gomes, M., Siqueira, L. D., Abreu, F., & Fracolli, L. A. (2019). Role of nursing professionals for parenting development in early childhood: a systematic review of scope. Revista latino-americana de enfermagem, 27, e3213. https://doi.org/10.1590/1518-8345.3031.3213

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896803/#:~:text=For%20the%20development%20of%20parenting%20in%20early%20childhood%20care%2C%20the,4

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