1. Chapter 18Chapter 18
The Preschool ChildThe Preschool Child

2. ObjectivesObjectives
• List the major developmental tasks of the
preschool-age child.
• Describe the physical, psychosocial, and
spiritual development of children from age 3
to 5 years, listing age-specific events and
guidance when appropriate.
• Discuss the development of positive bedtime
habits.
2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

3. ObjectivesObjectives (cont.)(cont.)
• Discuss one method of introducing the
concept of death to a preschool child.
• Describe the development of the preschool
child in relation to Piaget’s, Erikson’s, and
Kohlberg’s theories of development.
• Discuss the characteristics of a good
preschool.
• Discuss the value of play in the life of a
preschool child.
3Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

4. ObjectivesObjectives (cont.)(cont.)
• Designate two toys suitable for the preschool
child, and provide the rationale for each
choice.
• Describe the speech development of the
preschool child.
• Discuss the value of the following: time-out
periods, consistency, role modeling, rewards.
4Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

5. ObjectivesObjectives (cont.)(cont.)
• Discuss the approach to problems such as
enuresis, thumb-sucking, and sexual curiosity
in the preschool child.
• Describe the developmental characteristics
that predispose the preschool child to certain
accidents, and suggest methods of
prevention for each type of accident.
• Explain the use of therapeutic play with a
handicapped child.
5Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

6. General CharacteristicsGeneral Characteristics
• Preschool child is age 3 to 5 years
• Marked by
– Slowing of physical growth
– Mastering and refining of motor, social, and
cognitive abilities
6Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

7. 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 span
7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

8. Physical DevelopmentPhysical Development
• Doubles the 1-year-old weight by 5 years of
age
• Between 3 and 6 years of age, grows taller
and 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 year
passes
8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

9. 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 and
symbolic functioning
– Egocentric, as they have difficulty seeing any
point of view other than their own
– Animism and artificialism
9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

10. 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 outside
appearance
– Distinct characteristic is centeringcentering
– Tendency to concentrate on a single
outstanding characteristic of an object and
exclude other features
10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

11. Effects of Cultural PracticesEffects of Cultural Practices
• Can influence the development of a sense of
initiative
• Parents and older siblings model language
development
11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

12. Language DevelopmentLanguage Development
• Delays or problems can be caused by
– Physiological
– Psychological
– Environmental stressors
• Includes both the understanding of language
and the expressing of oneself in language
12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

13. Not Talking: A ClinicalNot Talking: A Clinical
ClassificationClassification
13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
WHEN PARENTS SAY
CLASSIFY THE
SYMPTOMS AS
“I’m the only one who understands what she
says.”
Articulation disorder
“She’ll do what I say, but when she wants
something, she just points.”
Expressive language
delay
“He can’t play ‘show me your nose,’ and the only
word he says is ‘mama’.”
Global language delay
“He never made those funny baby sounds or said
‘mama’ and ‘dada,’ and now he just repeats
everything I say.”
Language disorder
“He used to say things like ‘Joey go bye-bye,’ but
now he doesn’t talk at all.”
Language loss

14. Development of PlayDevelopment of Play
• Play activities increase in complexity
• Enables child to experience multiple roles
and emotional outlets
• Appealing to child’s magical thinking is best
approach to communicating with a
preschooler
14Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

15. Spiritual DevelopmentSpiritual Development
• Learn religious beliefs and practices at home
• Cannot understand abstract concepts
• In the hospitalized preschooler, observing
religious traditions practiced in the home may
be calming for the child
15Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

16. Sexual CuriositySexual Curiosity
• Nurses should use the following principles of
teaching and learning common to other
patients
16Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

17. Sexual CuriositySexual Curiosity (cont.)(cont.)
• Assess knowledge
base of child
• Assess what specific
information the child
is seeking
• Be honest and
accurate
• Use correct
terminology
• Provide sex education
at the time the child
asks the questions
• Parents must
understand that
sexual curiosity starts
as an inquiry into
anatomical
differences
17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

18. Sexual CuriositySexual Curiosity (cont.)(cont.)
• Preschool children
are as matter-of-fact
about sexual
investigation as they
are about any other
leaning experience
and are easily
distracted by other
activities
• May be displayed in
the form of
masturbation
– Considered harmless if
the child is outgoing,
sociable, and not
preoccupied with the
activity
– Assure parents that
this behavior is normal
18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

19. Physical, Mental, Emotional, andPhysical, Mental, Emotional, and
Social DevelopmentSocial Development
19Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

20. 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 questions
20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21. The 3-Year-OldThe 3-Year-Old (cont.)(cont.)
• Play in loosely associated groups
• Highly imaginative play
• Begin to lose interest in mother and prestige
of the father begins
• Develop romantic attachment to parent of
opposite gender
• Identify themselves with parent of same
gender
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21

22. The 3-Year-OldThe 3-Year-Old (cont.)(cont.)
• Become angry when someone tries to take
their possessions
• Resent being disturbed during play
• Are sensitive and feelings are easily hurt
• Has fear of bodily harm
22Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

23. 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 shoes
23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

24. The 4-Year-OldThe 4-Year-Old (cont.)(cont.)
• Vocabulary has increased to about 1500
words
• Many feats done for a purpose
• Begin to prefer playing with friends of same
gender
24Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

25. 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 to
themselves
– Parents should reassure child that people do
not generally die until they have lived a really
long time
– Parents should encourage questions as they
appear and help the child accept the truth
about death without fear
25Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

26. 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
• Inquisitive
26Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

27. 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 teeth
27Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

28. The 5-Year-OldThe 5-Year-Old (cont.)(cont.)
• Should be encouraged to develop motor
skills, such as hammering a nail
• Should not be scorned for failure to meet
adult standards
• Must learn to do tasks themselves for the
experience to be satisfying
28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

29. GuidanceGuidance
29Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

30. Discipline and Limit-SettingDiscipline and Limit-Setting
• Children need limits
for their behavior
• Teach and gradually
shift control from
parents to child
• Self-discipline or
self-control
• Timing the time-out
– 1 minute per year of
age, no interaction or
eye contact during
• Reward
– Don’t confuse with
bribes
– Encourage positive
behavior
• Consistency and
modeling
30Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

31. JealousyJealousy
• Normal response to
actual, supposed, or
threatened loss of
affection
• Jealousy of a new
sibling strongest in
children under 5 years
• May revert to
behaviors seen at an
earlier age
• May be aggressive,
bite, or pinch
• Tends to be seen less
in an “only” child
• Children should feel
they are helping with
the care of their
sibling
31Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

32. Thumb-suckingThumb-sucking
• Instinctual behavioral pattern
• Finger- or thumb-sucking will not have a
detrimental effect on the teeth as long as the
habit is discontinued before the permanent
teeth erupt
• The child who is trying to stop thumb-sucking
is given praise and encouragement
– May regress during periods of stress or fatigue
32Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

33. Enuresis (Bedwetting)Enuresis (Bedwetting)
• Primary
– The child has never
been dry
• Secondary
– Bedwetting recurrence
in a child who has been
dry for a period of 1
year or more
• More common in boys
than girls
• Organic causes
– Urinary tract infection
– Diabetes mellitus
– Diabetes insipidus
– Seizures
– Obstructive uropathy
– Abnormalities of
urinary tract
– Sleep disorders
33Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

34. 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 training
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34

35. Enuresis (Bedwetting)Enuresis (Bedwetting) (cont.)(cont.)
• Child needs to be
center of
management
program
• Liquids should be
limited after dinner
• Child should void
before going to bed
• Treatment options
– Counseling
– Hypnosis
– Behavior modification
– Pharmacotherapy
– Bladder training
exercises to stretch
and increase the
bladder size
35Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

36. 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 program
36Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

37. Daily CareDaily Care
• Does not require extensive physical care but
still needs to bathe each day and shampoo
hair at least twice a week
• Clothing should be loose enough to prevent
restriction of movement, washable; sturdy
and supportive shoes
37Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

38. 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 freedom
and access to items within the environment
• Child should be taught about the dangers of
talking to or getting in the car with strangers, as
well as the dangers of playing in secluded areas
• Indirect supervision necessary due to poor
judgment
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38

39. Play in Health and IllnessPlay in Health and Illness
• Value of Play
– Important to physical,
mental, emotional, and
social development
– Increases
communication with
other children
• The Nurse’s Role
– Important to include in
the child’s plan of care
• Factors to consider
– State of health
– Overstimulation and
fatigue
– Diagnosis should be
considered when
choosing toys for the
child
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39

40. Value of PlayValue of Play
• Should be noncompetitive
• Helps the child adjust to an expanding world
and increased independence
40Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

41. Nursing TipNursing Tip
• Imaginary playmates are common and
normal during the preschool period and serve
many purposes, such as relief from
loneliness, mastery of feats, and a
“scapegoat”
41Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

42. Play and the Handicapped ChildPlay and the Handicapped Child
• Mentally disabled child needs more
stimulation through play than the child who is
not impaired
• Consider mental and not chronological age
• Play needs to be supervised due to poorer
judgment and potential for aggressive
behavior
• Repetition of play experiences is necessary
42Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

43. PlayPlay
• Therapeutic play
– Retrain muscles
– Improve eye-hand
coordination
– Help children to
crawl and walk
• Other types of play
– Play therapy
• Used when child is
under stress
– Art therapy
• Child can express
feelings and
communicate with
others through
drawings
43Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

44. Nursing Implications of PreschoolNursing Implications of Preschool
Growth and DevelopmentGrowth and Development
• Provide parental
guidance concerning
the changing
behavior patterns of
the preschool-age
child
• The use of time-outs
and alternative
methods of discipline
should be stressed
• Hospitalization can be
frightening
– May perceive
hospitalization as a form
of punishment
– Child may feel abandoned
– Separation anxiety is
manifested by
• Stages of protest, despair,
detachment, and regression
to earlier behaviors
44Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

45. Nursing Implications of PreschoolNursing Implications of Preschool
Growth and DevelopmentGrowth and Development (cont.)(cont.)
• Important nursing assessment includes
observing the child
– What is the child’s approach to play?
– Does the child join in freely or linger outside
the group?
– Does the child prefer active or quiet activities?
– Can the child talk with his or her playmates
and convey ideas?
– What type of attention span does the child
have?
45Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

46. Question for ReviewQuestion for Review
• What kind of therapeutic play would be
appropriate for a postoperative preschool
child?
46Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

47. ReviewReview
• Objectives
• Key Terms
• Key Points
• Online Resources
• Critical Thinking Question
• Review Questions
47Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.