Preschooler

(3-5 years)
Learning Guide - 5

Text Book
Kozier & Erbs Fundamentals of Nursing
concepts, process and practice. 8th edition.
Chapter 21
Pages: 377 - 380.

The preschool years are full of curiosity, discovery

and the development of the social behavior. The
child interacts more with the environment and
becomes a social being. Their world gets larger as
they meet relatives, friends and neighbors.
Promotion of growth and development at this stage
focuses on psychological and emotional support as
the tasks of toileting, independence and self care
have been mastered during toddlerhood. The
preschooler develops initiative which is reinforced
through parental praise and guidance.

1. Physiological changes
Physical growth is slow but control of the body and
coordination increases greatly.
General appearance: Thinner than toddlers
because the height gain is more compared to the
weight gain. The pelvis gradually straightens and
their abdominal muscles become stronger. Child
looks slender with erect posture. The extremities
grow more quickly than their body trunk, making
them appear somewhat out of proportion.

Physical growth
Weight: Slow gain in weight. By 5 years the weight is
18-20Kg.
Height: Height gain is about 5-6.25 cm each year. By
4 years the birth height is doubled and measure 102
cm.
Brain: Brain size reaches almost adult size by 5
years.

Sense organs
Vision: Hyperopia (far-sighted). As the eye ball grows in
length they become emmetropic (normal vision). If the
eye balls grow longer myopia (short sightedness) can
occur. Normal vision for 5 year old is 20/30. They should
be able to identify alphabets with Snellen chart.
Hearing: Optimal level. Can listen and comprehend.
Taste: Well developed and shows taste preferences.
yummy (good), yuckie (bad).

Vital signs
Respiration: 255 per minute
Pulse: 10515 beats/mt.
BP: 100/67 mm of Hg.

Motor development 3 years

Gross motor

Fine motor

Self Care

Walks in straight line

Walks back
Walks on tip toe
Runs well
Catches a ball
Kicks a ball
Jumps from a height
Rides tricycle

Builds tower of 910 blocks

Copies a circle
Uses blunt
scissors
Puts beads on a
string
Helps with
simple house hold
tasks.

Puts on coat
Undress self
Pulls pants up
and down
Goes to toilet
alone
Brushes teeth
with help.

Motor development 4 years

Gross motor

Fine motor

Self Care

Balances on one
foot 3-5 sec.
Hops on one foot
climbs ladders or
trees

Copies square
Draws simple
face
Cuts around
pictures

Manages spoon
Eats with fork
Puts buttons for
shirt
Puts on socks
with help
Puts on shoes
May bath self

Motor development 5 years

Gross motor

Fine motor

Self Care

Skips
Alternates feet
Jumps ropes
Jumps over
objects
Imitates dance
steps
Roller skates

Copies a triangle
Crosses vertical
lines
Copies letters
Prints own name
Draws a man with
3 parts

Selects fork over

spoon
Ties shoe laces
Manages zippers
in back
Wipes self
Flushes toilet
Bathes self
Combs hair

Language development - 3 years

Uses 4 word sentences why questions

Gives sex and full name.
Names figures in a picture.
Vocabulary 800-1000 words.

Language development - 4 years

Understands directives on, under, back, in
front
Names one or more colours.
Counts to 5.
Uses 3-7 word sentences.
Vocabulary 1500 words.

Language development - 5 years

Carries out instructions with 3 suggestions.

Names primary colours.
Asks meaning of words.
Names dinar, fills
Counts to 10.
Vocabulary 2100 words.

Psycho-sexual development (Freud)

Phallic stage.
Operates on the basis of super ego. Learn social values
and try to control instincts. E.g. Controls temper tantrum,
can control the feeling to beat another child.
Sexual pleasure is concentrated around genitalia.
Play with genitalia ( masturbation ).
Interested in the anatomic differences of different sexes.
Curious to see the body parts.
Peeping through to see how others look like.
Oedipal complex Boys get attached to their mothers.
Electra complex Girls feel attached to their fathers.
Children usually hide the feelings of oedipal and electra
complexes by using the mental mechanism of repression.

Psycho-Social development - Erikson

Developmental task Initiative versus guilt.
The child is curious and explores the
environment. Asks probing questions to others. If
discouraged or punished the child becomes shy
and afraid to do anything. Lack self confidence in
later life.

Intellectual / cognitive development

Piaget Preoperational stage

Precoceptual phase ( 2-4 years )

Intuitive phase ( 4-7 years )
Give reasons for their beliefs and rationale for
actions.

Characteristics of thought

Free association Thinks stuffed toys are real.

Fantasies Imaginary play mates. Eg. Play with
superman.
Illogical meanings Reasoning on causal relationship.
Eg. Sleep because there is no Sun.
Symbolism A mental event can stand for something in
the real world. Eg. May take a pillow for a horse and ride
it.
Animism Belief that objects have life.
Realism Take dreams for real.
Artificialism Thinks everything in the world is for them.
Eg. The Sun shines for the children to play.

Moral development (Kohlberg)

Stage 2 ( 4-7 years )
Pre-conventional morality : Ego centric. Act
out to satisfy their own needs. You do
something for me and Ill do something for
you. An eye for an eye.
They follow rules strictly for the purpose of
self interest. i.e. To avoid punishments or for
favors returned.

Spiritual development (Fowler)

Intuitive-projective faith
Follow the religion and rituals by the parents.
Can attend to religion classes. Pray to God
when they are sick.

Health promotion
Physical health
Balanced diet
Adequate rest. 12 hours sleep at night and
a nap during the day.
Exercise / play
Positive reinforcement for skills.

Nutrition :
The nutrional requirement is Carbohydrates - 1300-1700 cal / day.
Proteins 30 gm / day.
Water 1500-2000 ml / day (90-100 ml / kg
/day)
Accident prevention
Health supervision : Check up every 6 months 1
year. Give vaccinations on time. Check up and
correction of any visual or hearing defects.

Needs of preschoolers
A

Emotional and social needs

Love and security
Guidance Suggestions, not commands.
Independence Independent self care
activities.
Socialization Nursery school /
kindergarten.
Separation from parents for short periods.

Separation from parents

Allow the child to stay with parental

families.

Send to play school.

Encourage the child to sit with baby

sitter when parents go for outing.

Influence of family
Children of working mothers
Young children of working mothers are not adversely affected
by the mothers absence.
Many of them are superior in cognitive and social
development to the children of nonworking mothers.
Working mothers compensate for their absence by interacting
more with their children when they are at home.
In such families fathers also involve more in child care and
children show less attitude of sex stereotypes.
Maternal employment play as an incentive for the children to
set higher occupational or educational goals for themselves.

Influence of family
Parental divorce
Many children respond to divorce with anger and
fear.
They feel guilty or responsible for the divorce.
They may be withdrawn or depressed.
Girls are better able to cope with divorce than boys.
Following divorce boys usually have a higher rate of
behavioral disorders and more problems in relating
to others.

Influence of family
Single parent families
Children brought up by mothers alone tend to
perform more poorly on intelligence and
achievement tests.
They showed up to 14 points less in IQ tests and
two and a half years behind in achievement tests.
They show cognitive deficits.

Enhance attention & concentration

Ask the child to do simple things at a

time.

Encourage to listen to stories.

Teach simple rhymes and counting.

Preparation for school (good manners)

Teach the child to take a queue.

Teach him to take turns.

Teach table manners.

Send the child to play school.

Teach good manners.

Hand-eye coordination skills

Start writing.
Give coloring books.
Drawing.

Prevention of accidents
Motor vehicles
Using seat belts.
Avoid playing on road.
Road rules for crossing.

Prevention of accidents
Falls
Remind the safety rules.
Avoid heights.
Restrict rough play.
Safety precautions to prevents falls side
rails for bed.

Prevention of accidents
Suffocation
Not to put anything in the mouth or nose.
Avoid playing with broken balloons and
plastic bags.
Avoid talking, laughing, crying or running
with food in the mouth.
Avoid hiding in closed spaces
cupboards, refrigerator.
Not to use charcoal for heating closed
rooms.

Prevention of accidents
Burns
Avoid playing with fire, crackers.
Keep gas cylinders off after use.
Teach fire safety.
Teach them to roll on ground if their dress
catches fire.

Prevention of accidents
Drowning
Swimming lessons under supervision.
Tub bath under supervision.
Teach them to use life jackets while
swimming.

Prevention of accidents
Bodily injury
Not to use sharps.
Restrict use of knives, pins needles and
breakables.
Proper selection of toys.
Supervise playing with pets.
Teach child to keep himself away from
strangers.

Prevention of accidents
Ingestion / inhalation
Not to put anything in the mouth.
Not to take any medicines by themselves.
Not to accept food from strangers.
Keep medicines and domestic chemicals
out of reach of children.

Play behavior of children

Types of play
Unoccupied play : No play activity. E.g. Child crawls
under a table.
Solitary independent play : Child plays alone. Playing
alone with a doll.
Onlooker play : Watching others playing.
Parallel play : Independent play. One child plays with
toys similar to those used by another child.
Associative play : Children playing with one another.
Giving and taking, playing wagon.
Cooperative play : Group play with a target. E.g.
Cricket.

Safety in selecting toys

Spaces between moving parts should be wide enough not
to catch / pinch toes or fingers.
Swing seats should be smooth and with belts; Strong
chain; Hooks with close ends.
All sharp and protruding ends covered with plastic caps.
All exposed edges should be rounded.
Frequent inspection of toys for tear and wear.
Tricycles of proper size, wide wheels and low seats.
Avoid toys producing loud sounds (impact on hearing) and
propelled objects (injure eyes).
Teach the child the proper use of toys and storage.

Developmental problems
Bedtime problems Sleep pattern to be changed to early to
bed and early to rise for school. Forcefully put the child to
sleep.
Selfishness Encourage group play to overcome this.
Hurting others Should be supervised by adults. Give
proper attention to the child. Dont hurt them back with the
same injury. Make them apologize.

Developmental problems
Destructiveness Breaking things. Intentional destruction
shows the child is unhappy. Give proper attention to the
child.
Enuresis Bedwetting. Look for physical causes like UTI.
Treat the cause. Limit fluid intake in the evening and night.
Make them pass urine before going to bed. Counseling for
psychological problems.
Encopresis Uncontrolled passing of stool. If no
physiological causes counseling for emotional problems.