New Era University

College of Nursing

NCM 107-18 Care of Mother, Child and Adolescent (Well)

S.Y. 2024-2025 | 1st Semester | Final Period
Module 12: Care of a Family with a Pre-school Child

Introduction

This module will provide students with an understanding of the care of the family with a pre-school child
and the physical and psychological changes that occurs during this period. The preschool period traditionally
includes the years 3, 4, and 5. Although physical growth slows considerably during this period, personality and
cognitive growth continue at a rapid rate. Therefore, this is also an important period of growth for parents
because they may be unsure how much independence and responsibility for self-care, they should allow their
rapidly maturing child. Most children of this age want to do things for themselves. As a result, parents may find
their child not properly dressed or untidy, etc. They need reassurance that this behavior is typical because it is
the way children explore and learn about new experiences.

Learning Outcomes

1. Integrate knowledge and principles of pre-schooler growth and development with application of
appropriate nursing care to the child and family.
2. Assess the pre-schooler for normal growth and developmental milestones
3. Formulate nursing diagnosis/es that address related to growth and development

of a pre-schooler and parental concerns.

4. Implement safe and quality nursing interventions related to normal growth and development of a pre-
schooler.
5. Evaluate with the mother and family the health outcomes of nurse-client relationship.

Topic Outline

I. Physiologic Development

II. Motor Development

III. Freud’s Theory of Psychosexual Development

IV. Erikson’s Theory of Psychosocial Development

V. Piaget’s Theory of Cognitive Development

VI. Kohlberg’s Theory of Moral Development

VII. Nutrition of the pre-schooler

VIII. Concerns and Problems Related to Normal Development of pre-schooler

IX. Assessment of a pre-schooler

 X. Nursing diagnosis for a pre-schooler and family

XI. Implementation of safe and quality nursing interventions

XII. Evaluation

I. PHYSIOLOGIC DEVELOPMENT
Physical Growth
A definite change in body contour occurs during the pre-school years. Change to slimmer, taller, more of
child-like proportions. Contour changes are so definite that future body type: ectomorphic (slim body build) and
endomorphic (large body build) becomes apparent. They are more childlike than baby like. As children grow
older, they tend to favor one hand over the other for certain tasks, particularly for writing or drawing. A child's
“handedness” is generally categorized as right, left or mixed, and tends to settle around the same time they
acquire language – about four-years-old.
Weight gain is only about 4.5 lb (2 kg) a year. Appetite remains the same as it was during the toddler years
though parents expect more. Height gain is also minimal: increases only 2 to 3.5 inches ( 6 – 8 cm) a year on
average. Birth length is doubled by 4 years. Head circumference has an increase by 1 inch per year though it is
not routinely measured at physical assessments on children over 2 yrs of age because it changes little after this
time.
Vital signs decrease slightly: Pulse 85 / min; respirations 24-25; BP 85-100 / 60-70

Teeth

Preschoolers have all the 20 deciduous teeth by the end of three years; permanent teeth don’t replace these
until school age. Preserving these teeth is important because they hold the position for the permanent teeth as
the child’s jaw grows larger. If a deciduous tooth has to be removed, children need conscientious follow-up to be
certain a space for a permanent tooth remains. It is rarely for new teeth to erupt during the preschool period.

Body Systems

• Lymphatic tissue begins to increase in size particularly tonsils. Levels of IgG and IgA antibodies increase
making preschool illnesses more localized.

• Physiologic splitting of heart sounds and innocent heart murmurs are heard for the first time. This occurs
owing to the changing heart size in reference to the thorax because the anteroposterior and transverse
diameters of the chest have not yet reached adult proportions. Pulse rate decreases to about 85 bpm,
BP at 100/60 mmHg.

• Bladder is easily palpable above the symphysis pubis, voiding is frequent (9 to 10 times a day), that play
must be interrupted and voiding accidents may occur if a child becomes absorbed in an activity

• Muscles are noticeably stronger, so activities as gymnastics become possible. Many children at the
beginning of the period exhibit genu valgus (knock -knees), this disappears with increased skeletal
growth at the end of the preschool period.
II. MOTOR DEVELOPMENT

Age Fine Motor Skills Gross Motor Skills Play

(in yrs.)
3 Undress self Runs Able to take turns
Stacks tower of Alternates feet on Very imaginative
blocks stairs
Draws a cross Rides tricycle
Stands on one foot

4 Can do simple Constantly in motion Pretending is major activity

buttons Jumps & skips

5 Can draw a six-part Throws overhand Likes games with numbers or

figure letters
Can lace shoes

III. FREUD’S THEORY OF PSYCHOSEXUAL DEVELOPMENT

PHALLIC STAGE

• Activity: The child may show exhibitionism and increased knowledge on both sexes.

• May exhibit masturbation, pleasure through genitals by touching of genitals

• Basic Concept: Super EGO

• Major Conflict: Oedipal and Electra Complex

• Erotic attachment to parent of opposite sex

• Develops fear of punishment (castration anxiety for boys and Penis envy for girls) by parent of same sex

• Usually resolve toward end of this period

• Oedipus complex refers to the strong emotional attachment of a preschool boy to his mother. The
Oedipus complex describes these feelings of wanting to possess the mother and the desire to replace
the father. However, the child also fears that he will be punished by the father for these feelings, a fear
Freud termed castration anxiety

• Electra complex refers to the strong emotional attachment of a preschool girl to her father. It has been
used to describe a similar set of feelings experienced by young girls. Freud believed that girls instead
experience penis envy.

• Each child competes with the same-sex parent for the love and attention of the other parent. This is
normal. Parents feel left out, and need help in handling feelings of jealousy and anger especially if the
child is vocal in expressing feelings: “I hate you! I only love Daddy!”

• Gender Roles
 - Preschoolers begin to be aware of the difference between sexes and so need to be introduced to
both gender to both gender roles. Encourage single parents to plan opportunities for their
children to spend some time with adults other than themselves a grandparent, a friend, or a
relative of the opposite sex for this experience. If a child is hospitalized during the preschool
period, a nurse could readily fill this role. Many parents do not want their child to grow up as
they did, with a fixed gender role as a result of stereotyping. Help them understand that parents
reinforce such attitudes by their actions as well as by their words.

- Preschoolers need exposure to an adult of the opposite sex so they could become familiar with
the opposite gender roles. If a child is hospitalized during the preschool period, a male nurse
could help fill this role. Children’s gender-typical actions are strengthened by parents, strangers,
nursery school teachers, other family members and other children.

IV. SOCIAL AND EMOTIONAL DEVELOPMENT

A. Socialization
Since 3-year-olds are capable of sharing, they play with other children their age much more
agreeably than do toddlers, which is why preschool period is a sensitive and critical time for
socialization. Preschoolers who are exposed to other playmates have an easier time learning to relate
to people than those raised in an environment where they rarely see other children of the same age.
Children at age 4 continue to enjoy play groups, become involved in arguments more than they did at
age 3, especially as they become more certain of their role in the group. This development, like so many
others, may make parents worry that a child is regressing. However, it is really forward movement that
involves some testing and identification of their group role. Five-year-olds begin to develop “best”
friendships perhaps on the basis of who they walk to school with or who lives closest to them. The
elementary rule that an odd number of children will have difficulty playing well together generally
pertains to children at this age: two or four will play, but three or five will quarrel.

Fantasy

o Preschoolers begin to differentiate cartoon characters from real.

o Children are fond of imitating and pretending to be something or someone else, a fantasy role:
like rabbit, batman, superman.

o Parents should be encouraged to support the fantasy but still reassuring the child that she/he is
still herself/himself, the difference between the child and the role.

B. Language Development

The extent of a 3-year-old vocabulary varies depending on how much the child has been encouraged
to ask questions or participate in conversations. A child needs simple answers to questions to encourage
curiosity, vocabulary building, and questioning. Words that sound alike but mean different things can be
confounding to children of this age.
 Four- and five-year old children enjoy participating in mealtime conversation and can describe an
incident from their day in great detail. Preschoolers tend to imitate language exactly, so if they hear less-
than-perfect language, this is the language pattern they adopt. They may imitate and use “bathroom
language” because of the attention from adults this generates. The 3-year-old child has a vocabulary of 900
words. These are used to ask questions constantly, mostly “how”, and “why”. They need simple answers, so
curiosity, vocabulary building, and questioning are encouraged, and also the depth of child’s understanding
is deceptive. They would just follow what has been told to them but then return and ask why it was so. The
4-year-old has a vocabulary of 1,500 words. The 5-year-old has a vocabulary of 2,100 words.

Child has an ability to learn extended language. Children of this age who are exposed to more than one
language or who live in a bilingual family have a unique opportunity to master two languages with relative
ease because of this increased cognitive ability.

C. Erikson’s Theory of Psychosocial Development.

The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt.
Children with a well -developed sense of initiative like to explore because they have discovered that
learning new things is fun. If children are criticized or punished for attempts at initiative, they can
develop a sense of guilt for wanting to try new activities, or to have new experiences. Those who leave
the preschool period with a sense of guilt can carry it with them into school situations. They may even
have difficulty later in life making decisions about everything because they cannot envision that they are
capable of solving the associated problems that will come with change.

To gain a sense of initiative, preschoolers need exposure to a wide variety of experiences and play
materials so they can learn as much about how things work as possible. They are ready to explore
outside their homes. These types of experiences lead to increased vocabulary. Because things they see
around are transferred from abstract concepts to actual. They need exposure to a wide variety of
experiences and play materials so they can learn as much about the world as possible. They need to go
places: zoo, or amusement park where they could learn more vocabularies. Parents should encourage
creative play where they could use their hands: clay, finger paints, soapy water, sand, mud, homemade
dough.

D. PLAY

Urge parents to provide play materials that encourage creative play. Preschoolers tend to have such active
imagination that they need little guidance in this type of play. What they make may not be recognizable; it is the
enjoyment of feeling the material and how they can manipulate it that captures the experiences. Preschoolers
do not need so many toys because their imaginations are keener than it will be at any other time in their life, so
they enjoy games that use imitation such as playing. They imitate what they see parents doing: eating meals,
mowing the lawn, cleaning the house, washing, ironing, arguing, etc. They pretend to be teachers, firefighters,
cowboys, store clerks. They have imaginary friends. These exist until they formally begin schooling. Four and 5-
year-olds divide their time between rough-housing and imaginative/imitative/associative play. Five-year olds
become interested in group games or reciting songs they have learned in kindergarten or preschool
V. PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

According to Piaget, cognitive development is still preoperational by 3 years of age, although children
during this period also enter a second phase called intuitional thought.

During this second phase of development, children learn by asking questions such as “How come?” and
“Why?” Children in the intuitive substage may still demonstrate many advances in cognitive skills. They may
shift from using only magical beliefs to using rational beliefs to explain situations or events that they had not
experienced previously.

Intuitive children show a style of thinking he called “centration.” These children typically are focused on
the characteristic of an object or person, and they base their decisions or judgment on that one characteristic
(example: according to color or to shape only). Centration also means that preschoolers cannot make mental
substitutions and often feel they are always right. They cannot see your side of the situation, they cannot hurry
because you must have something done by 10 o’clock, and they cannot hold still just because you want them to.

Preschoolers are not yet aware of the property of conservation. This means that if they have two balls of
clay of equal size, but one is squashed flatter and wider than the other, they will insist the flatter one is bigger
(because it is wider). They cannot see that only the form, not the amount, has changed. Decentering, combined
with the concept of conservation, appear prior to more sophisticated logical thinking abilities.

Imitating the actions of the people around them peaks during preschool age. Role modeling this way
should be fun and does not have to be accurate. If a parent is concerned that a child should recognize these
roles more accurately, it is usually best to suggest that the parent not to stop the play but rather to explain the
importance of a certain job.

In addition to learning what activities adults carry out at home, preschoolers should also be introduced
to their parent’s work environments, so the child is provided with a visual context for the parent’s job.

Fantasy

Toddlers cannot differentiate between fantasy and reality. Preschoolers, however, begin to make this
differentiation. They may become so engrossed in a fantasy role that they fear they are “stuck” in the fantasy and
are no longer themselves. Such intense involvement in play is part of “magical thinking,” which is active at this
age. Parents sometimes strengthen this feeling without realizing it, so they need to be careful in this regard.
Parents may support the fantasy and yet reassure the child she is still herself.

Egocentrism or perceiving that one’s thoughts and needs are better or more important than those of
others, is also strong during this period. They cannot believe that not everyone knows facts they know. As part of
egocentrism, preschoolers define objects mainly in relation to themselves (a key is not a metal object but “what I
use to open a door”).

VI. KOHLBERG MORAL DEVELOPMENT

According to Kohlberg, preschoolers are at the Pre-Conventional level (Individualism and Exchange).
Children at this stage do the right thing in exchange for something. Rules are obeyed for personal gain with the
ethics of “What’s in it for me?”. For them, obeying rules and exchanging favors are judged in terms of the
benefit to the individual. At this stage, children recognize that there is not just one right view that is handed
down by authorities. Different individuals have different viewpoints. Since everything is relative, each person is
free to pursue his /her own interest. Preschoolers carry out actions to satisfy their own needs rather than
society’s. They will do something for another if that person does something for the child.

Children of preschool age determine right from wrong based on their parents’ rules because they have
little understanding of the rationale for these rules or even whether the rules are consistent.

Preschoolers begin to have an elemental concept of spirituality if they have been provided some form of
religious training. Belief in an outside force aid in the development of conscience; however, preschoolers tend to
do good out of self-interest rather than because of strong spiritual motivation. Children at this age enjoy the
security of religious holidays and religious rituals such as prayer before meals because these rituals offer them
the same reassurance and security as a familiar nursery rhyme

VII. Nutritional health of a Preschooler

Like the toddler period, the preschool years are not a time of fast growth, so preschool children are not
likely to have ravenous appetites. Being certain they get enough daily exercise helps to improve this. A sense of
initiative, or learning how to do things, can be strengthened by allowing a child to prepare simple foods.

Most children are hungry after preschool and enjoy a snack when they arrive home. Because sugary
foods can dull a child’s appetite for dinner and it is not too soon to begin measures to prevent childhood obesity,
urge parents to offer snacks, such as fruit, cheese, or milk rather than cookies and a soft drink or juice.

As with all age groups, food selected for preschoolers should include variety and be based on My Plate
recommendations. Preschoolers do not eat meat so much because it can be hard to chew. As long as a child is
eating foods from all five food groups and meets the criteria for a healthy child like being alert and active with
height and weight within normal averages, additional vitamins are probably unnecessary. If parents do give
vitamins, remind them that a child will view a vitamin as candy rather than a medicine because of the attractive
shapes and colors of preschool vitamins, so they must be stored out of reach. Parents should also be reminded
not to give more than the recommended daily amount or poisoning from high doses of fat-soluble vitamins or
iron can result.

Fruits, vegetable, and grains are healthy snack foods. Check to be sure a child is ingesting a variety of
calcium sources because calcium is very important for bone growth. Vitamin D is found in fortified cereals and
milk. Vitamin B12 is found almost exclusively in animal products, so a child on vegetarian intake may need a
supplemental source.

VII. CONCERNS RELATED TO GROWTH AND DEVELOPMENT

Preschoolers are old enough to begin to take responsibility for their own actions. Children’s safety, nutritional
health, daily activities, and family functioning are all affected by this increased responsibility

A. Promoting preschool safety

As preschoolers broaden their horizon, safety issues must also widen. By age 4 years, children may
project an attitude of independence and the ability to take care of their own needs. However, they still need
supervision to be certain they do not injure themselves or other children while rough housing and to ensure they
do not stray too far from home. Their interest in learning adult roles may lead them to exploring and accidents.
Automobile safety should also be considered.

Preschoolers should be educated also about the potential threat of harm from strangers or how to
address bullying behavior at preschool or at play through such measures as:

o Caution a child never to talk with or accept a ride from a stranger.

o Teach a child how to call for help in an emergency

o Describe what police officers look like and explain that police can help in an emergency situation

o Explain that if children or adults ask them to keep secrets about anything that has made them
uncomfortable, they should tell their parents or another trusted adult, even if they have promised
to keep the secret.

o Explain that bullying behavior from other children is not to be tolerated and should be reported
so they can receive help managing it.

Parents should present this information in a calm and everyday manner so as not to terrify the child
about the world but for them to use it to begin to build safe habits that will help them later when they are old
enough to walk home from school alone or play with their friends unsupervised.

Because of front seat airbags, preschoolers need to be buckled into car seats or booster seats in the back
seat. Urge parents to stress the important role of seat belts in preventing injury and to make a rule that the car
does not move until seat belts are fastened. Many preschoolers outgrow their car seats during this period (when
they reach about 40 lbs) and need to graduate to a booster- type seat. Remind parents to check the position of
the shoulder harness in both types of seat so the belt does not cross a child’s face or throat.

Bicycle safety should also be promoted because falls off bicycles are a major cause of severe head
injuries in this age group. They need to use safety helmet approved for children their age and size. Parents
should also be encouraged to demonstrate safe riding habits by wearing helmets as well.

B. Promoting the development of the Preschooler in daily activities

The preschooler has often mastered the basic skills needed for most self-care activities, including
feeding, dressing, washing (with supervision), and tooth brushing (with supervision)

DRESSING

Many 3- year-olds and most 4-year-olds can dress themselves except for difficult buttons. Preschoolers
prefer bright colors or prints and so may select items that are appealing in color rather than matching.
Preschoolers need the experience of choosing their own clothes. One way for parents to solve the problem of
mismatching is to fold together matching shirts and slacks so a child sees them as a set rather than individual
pieces. If children insist on wearing mismatched clothing, parents should not make no apologies for their
appearance. Anyone who understands preschoolers appreciates that the experience children gain in being able
to select their own clothing is worth more than a perfect appearance by adult standards.

SLEEP
 Preschoolers are more aware of their needs. Those who attend afternoon classes, give up afternoon
naps. If they nap at preschool, they may have some difficulty going to sleep at the usual bedtime established at
home. On some occasions, even though they may be tired, children in this age group may refuse to go to sleep
because of fear of the dark and may wake at night terrified by a bad dream. This means that preschoolers may
need a night light turned on, although they did not need one before. Very helpful is for the parents to screen out
frightening stories or TV watching just prior to bedtime and to be certain when the light in their bedroom is
dimmed, it has a soothing atmosphere.

EXERCISE

The preschool period is an active phase, so preschool play tends to be vigorous. Roughhousing helps
relieve tension and should be allowed as long as it does not become destructive. They also love time-honored
games such as ring- around-the-rosy, London Bridge, or other more structured games they were not ready for as
toddlers. Promoting active games and reducing television watching can be steps toward helping children develop
motor skills as well as prevent childhood obesity.

HYGIENE

Preschoolers can wash and dry their hands adequately if the faucet is regulated for them. Parents should
turn down the temperature of the water heater in their home to help prevent scalds.

Preschoolers are not paragons of neatness and may not clean their hands thoroughly. They do not clean
their fingernails or ears well. Use a nonirritating shampoo and hanging a mobile over the tub so they have a
reason to look up while their hair is rinsed helps make hair washing a fun procedure.

CARE OF TEETH

This is the best time to start independent tooth brushing If it was not started as a daily practice during
toddler period. Parents should check that all tooth surfaces have been cleaned. Parents should also floss the
child’s teeth because this is a skill beyond a preschooler’s motor ability.

Preschoolers should continue to drink fluoridated water or receive a prescribed oral fluoride supplement
if fluoride is not provided in the water supply. Encourage children to eat apples, carrots, chicken or cheese for
snacks rather than candy or sweets to prevent tooth decay. If allowed to chew gums, it should be the sugar-free
variety.

First dentist visit should be arranged no later than 2 years of age for an evaluation of tooth formation
because deciduous (baby) teeth. Must be preserved to protect the dental arch. Dental services can be
performed at 3 years of age. If a tooth has to be pulled for any reason, this can cause the permanent teeth to
drift out of position or the jaw not grow enough to accommodate them.

Teeth grinding (bruxism) may begin at this age as a way of “letting go,” similar to body rocking, which
children do for a short time each night before falling asleep. Children who grind their teeth extensively may have
greater than average anxiety. If grinding is extensive, refer the child to a pediatric dentist so the teeth can be
evaluated, repaired (capped), and conserved because the crowns of the teeth can actually become abraded. This
condition can advance to such an extent that tooth nerves become exposed and painful.

C. Promoting healthy family functioning

 An important role of preschooler parents is to respect creativity and flexibility. Part of encouraging
creativity is encouraging vocabulary building. One way to do this is to read aloud to the child; another is to
answer questions so the child sees language as an organized system of communication. Answering a
preschooler’s questions can be difficult, because the questions are frequently philosophical, not fact finding

DISCIPLINE

Preschoolers have definite opinions on things such as what they want to eat, where they want to go, and
what they want to wear, and these opinions may bring them into opposition with parents. A major responsibility
of parents when this happens is to guide the child through these struggles without discouraging the child’s right
to have an opinion. A “time out” is a useful technique for parents to correct behavior throughout the preschool
years. Time- out periods should be as many minutes long as the child is old, so 3 to 5 minutes is appropriate for
preschoolers.

STRESS

Stress is the body's reaction to a physical or emotional situation that causes imbalance in a person's life.
For preschoolers, negative sources of stress are: physical abuse, separation, rejection, and fights, parent losing a
job, or the death of a parent, grandparent, or sibling. Positive sources of stress are: birthday parties, new pets,
and the birth of new siblings, everyday family obligations, events, and routines. Children show possible signs of
stress by showing the following behaviors: accident proneness, hitting, anger, kicking, Anxiety, Insomnia,
appetite loss, stuttering, baby talk, indigestion, bed-wetting, thumb sucking, biting, pounding heart, crying spells,
grinding teeth, detachment, fingernail biting, excessive aggressiveness, respiratory tract illness, excessive
laziness and tattling. It is recommended that parents do the following interventions for stress:

- Acknowledge their feelings so they understand what they are feeling.

- Promote a positive environment by praising children for the acceptable things that they do.

- Help children through stories.

- Make an effort to cut down on activities when you see signs of stress

- Teach children tricks for calming themselves.

- Plan plenty of time for play to allow them to express their feelings

- Books, art activities, puppetry, play and drawing allow children to think through and label their feelings.

- Give children a lot of cuddles, reassurances, and familiar routines

D. Parental concerns associated with the preschool period

A number of common health problems and fears usually arise during the preschool years.

o Common health problems of the preschooler

The mortality of children during the preschool years is low and becoming lower every year as more
infectious diseases are preventable. Even though the number of major illnesses is few in this age group, the
number of minor illnesses is high. There is higher incidence of ear (otitis media) and respiratory infections in
children who live in homes in which parents smoke. There is increased incidence of gastrointestinal disturbances
(vomiting and diarrhea) and upper respiratory infections for children who attend preschool programs due to
exposure to other children unless frequent handwashing is stressed. Children may demonstrate frequent
whining or clinging behavior because of this parade of constant minor infections.

o Common fears of the preschoolers

Because preschooler’s imaginations are so active, this leads to a number of fears such as fear of the dark,
mutilation, and separation or abandonment. Although most of these fears can be handled by providing comfort
from parents, in some children, fears are so intense that they need therapy such as desensitization in order for
the fear to be conquered.

Fear of the dark

The tendency to fear the dark is an example of a fear heightened by a child’s vivid imagination. Children
awaken screaming because of nightmares. They may be reluctant to go to bed or go back to sleep by themselves
unless a light is left turned on or a parent sits nearby. It is generally helpful if parents monitor the stimuli their
children are exposed to, especially around bedtime. This includes television, adult discussions, and frightening
stories.

Leaving on a dim night-light can solve the problem. Children who awake terrified and screaming need
reassurance that they are safe and that it was only a dream and it is not in their room. If parents take sensible
precautions and still this happens every night, it may be a reaction to undue stress which needs to be
investigated and eliminated.

Fear of mutilation

This is very significant during the preschool age as revealed by the intense reaction of a preschooler to
even a simple injury such as falling and scraping of a knee or having an injection. A child cries afterward not only
from the pain but also from the intrusiveness of the procedure. The preschooler does not know which body
parts are essential and which ones can be easily replaced. They need good explanations of the limits of
healthcare procedures as well as distraction techniques in order to feel safe.

Fear of separation or abandonment

The preschooler’s sense of time is still so distorted that they cannot be comforted by assurances such as
“Mommy will pick you up at noon.” Their sense of distance is also limited, so making a statement such as “I work
only a block away” is not reassuring. Relating time and space to something a child knows better is more
effective. A hospital admission or going to a new school often brings a child’s fear of separation to the forefront

Some fears are a result of concrete experiences but some is due to their developing imagination.
Interventions for preschooler’s fear are:

a. Approach the fear in steps.

b. Explain, expose, and explore.

c. Use love objects. These can offer an anxious child lasting reassurance

d. Problem-solve together.

e. Practice through pretend play

 E. Behavior variations

A combination of a keen imagination and immature reasoning results in a number of other common
behavior variations in preschoolers.

Telling tall tales

Stretching stories to make them seem more interesting is a phenomenon frequently encountered in
preschoolers. If you ask him what happened? The preschooler perceives you want something exciting to have
happened so the child over exaggerates his story. This is not lying but merely supplying an expected answer.
Parents should be cautioned not to encourage this kind of story-telling but instead help the child separate fact
from fiction.to convey the idea that the child has not told the truth, yet does not squash imagination or initiative

Imaginary friends

Many preschoolers have an imaginary friend who plays with them. Although imaginary friends are a
normal, creative part of the preschool years and can be invented by children who are surrounded by real
playmates as well as by those who have few friends, parents may find them disconcerting. For as long as they are
surrounded by real playmates, imaginary playmates do not take center stage in children’s lives or prevent them
from socializing with other children, they should not pose a problem and often leave as quickly as they come. In
the meantime, pretend friends can encourage language development, may provide an outlet for a child to
express innermost feelings, or serve as a handy scapegoat for behavior about which a child has some conflict.

Difficulty sharing

Sharing is a concept that first comes to be understood around the age of 3 years. Before this, children
engage in parallel play. Around 3 years of age, children begin to understand some things are theirs, some belong
to others, and some can belong to both. Preschoolers need practice to understand and learn the concept of
sharing. Defining limits and exposing children to these three categories (mine, yours, ours) helps them
determine which objects belong to which category.

Regression

Some preschoolers, 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. The stress that
causes this is usually the result of so many things. During this time, manifestations of stress are best ignored;
calling the child’s attention merely causes more stress because, in addition to experiencing the primary stress, it
makes children aware they are not pleasing their parents.

Sibling rivalry

Jealousy of a brother or sister may first become evident during the preschool period because this is the
first time children have enough vocabulary to express how they fell and partly because preschoolers are more
aware of family roles and how responsibilities at home are divided. For many children, this is also the time when
a new brother or sister is born. To help preschoolers feel secure and to promote self-esteem during this time,
remind them that these are things they can do that a younger sibling is not allowed to do. Supply them with a
private drawer or box for their things that parents or other children do not touch. This serves as a defense
against younger children who do not yet appreciate property rights.
 Preparing for a new sibling

There is no rule as to when preparation for a new sibling should begin, but it should be before the time
the child begins to feel the difference the new baby will make. Maybe the time when the mother begins to look
pregnant. If the preschooler is sleeping in a crib that will be used for the new baby, it’s usually best if the
preschooler can be moved to a bed about 3 months in advance of the birth. If children are to start preschool,it’s
also best if they can do so before the new baby is born or 2 or 3 months afterward. That way, children can
perceive starting school as a result of maturity and not of being pushed out of the house by the new child.
Prepare the preschooler before mother goes to the hospital and while in the hospital, mother should maintain
contact with the preschooler so that the preschooler will not think that the new baby took her mother from her.

F. Sex education

During the preschool age, children become acutely aware of the difference between boys and girls.
Possibly, this may be the first time they are exposed to the genitalia of the opposite sex. Preschoolers’ questions
about genital organs are simple and fact-finding. Explanations should also be just as simple. Parents should not
convey that these body parts are never to be talked about so they leave an open line of communication for
sexual questions.

It is common for preschoolers to engage in masturbation while watching TV or before they fall asleep at
night. The frequency of this might increase under stress. If parents are bothered observing this, explain to the
child that certain things are done in some places but not in others.

It is so natural for preschoolers to ask about where babies come from. A parent could introduce the
subject by visiting a new baby in the neighborhood who is pregnant or visiting new puppies or kittens. There are
also many books for children that explain the birth process which can be helpful for parents to read to a child to
increase understanding if they feel the child is ready for a longer explanation. Correct terminology should be
used when providing explanation to a child.

Teach them also to avoid sexual maltreatment, such as not allowing anyone to touch their body unless they
and their parents agree that it is alright. Because children have been taught this, remember to ask permission
before giving nursing care that involves touching, especially before procedures such as catheterization, etc.

G. Choosing a Preschool or Child Care Center

A preschool or Child Care experience is helpful for preschoolers because peer exposure seems to have a
positive effect on social development. Child care center’s main purpose is to provide child care while parents
work or are otherwise occupied. A preschool is dedicated to stimulating children’s sense of creativity and
initiative and introducing them to new experiences and social contacts that they would not ordinarily receive at
home. Be certain that the child will noy only be safe there but also will have an enjoyable experience. Make it a
habit to ask children what happened at school, what they learned, and the names of any new friends.

In child care centers, frequent handwashing and covering the cough is very important because children
come from different homes and they are all gathered in one place. Thus, upper respiratory infection and
gastrointestinal diseases are very common.
 Preparing A child for School

As they enter kindergarten. Because school involves a great deal of children’s time and influences their
future greatly, it’s important for parents to take time to prepare preschoolers not only physically but also
emotionally.

a. Immunizations should be up-to-date

b. Parent’s attitude; school should be discussed as something to look forward to as an adventure that
will be satisfying and rewarding as a positive experience

c. If the child is not attending preschool, parents may have to change the child’s daily routine a few
months in advance of beginning school to accustom the child to waking earlier or going to bed
earlier.

d. Safety along the road should always be emphasized and practice going to school either by a trial
walk to school or practice riding a bus going to school.

e. If the child is taking lunch at school, parents can prepare a bagged lunch at home or play “cafeteria”
at home so the child can practice walking from one dish to another to select food.

f. Some suggest that children should know how to tie their shoes, name basic colors, and print their
name before they begin

A better contribution for parents to make toward their children’s achievement in school is to instill in
their children the concept that learning is fun, and that their child may not always be able to do all things other
children can do, but trying to do one’s best is what is important.

For children to do well in a formal setting, they must be able to follow instructions and sit at a table and
chair for a short work period. Going to school is a form of separation and a new experience so parents must
make preparations for this. Caution both parents and children that no matter how hard they try, not everything
can be anticipated; school will bring some new happenings that are not expected. If a child has been led to
believe learning is fun and new experiences are enjoyable (creating a strong sense of initiative), solving these
unpredictable problems is good preparation for the thousands of surprise experiences ahead.

H. Broken fluency

Developing language is such a complicated process that children from 2 to 6 years of age typically have
some speech difficulty. A child may begin to repeat words or syllables saying, “I-I-I want a n-n-new spoon-spoon-
spoon.” This is called broken fluency (repetition and prolongation of sounds, syllables, and words). It is often
referred to secondary stuttering because the child begins to speak without this problem and then, during the
preschool years, develops it. Children are unaware that they are not being fluent unless it is called to their
attention. Few simple rules to resolve the problem quickly

- Do not discuss in the child’s presence that he or she is having difficulty with speech because this
can make the child conscious of speech patterns and compound the problem.

- Listen with patience rather than interrupt or ask the child to speak more slowly or to start over.

- Always talk to the child in a calm, simple way to role model slow speech. If adults talk quickly,
the child imitates this pattern and has difficulty speaking clearly.
 - Protect space for the child to talk if there are other children in the family. Rushing to say
something before a second child interrupts is the same as rushing to conform to adult speech.

- Do not force a child to speak if he or she does not want to. Do not ask preschoolers to recite or
sing for strangers.

- Do not reward a child for fluent speech or punish for non-fluent speech.

- Set limits for watching TV and using electronic media. Use the time for talking and reading
together.

- Reduce child's stress.

- Eat dinner as a family to regularly participate in conversation with adults

I. “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 in their vocabularies if they hear these used. Parents may have to be
reminded that children do not necessarily understand what the word they are using means; they have simply
heard it, just as they have heard hundreds of other words and have decided to use it. Correction should be
unemotional. The correcting is no different from that involved when a child uses poor grammar. If parents
become emotional, a child realizes the value of such a word and may continue using it for the attention it
creates.

VIII. ASSESSMENT OF A PRE-SCHOOL CHILD

Regular assessment of a preschooler includes obtaining a health history and performing both a physical
and developmental evaluation at healthcare visits. Preschoolers may speak very little during a health
assessment; they may even revert to baby talk, or infantile actions when stressed. A history that details their
usual performance level is therefore important for accurate evaluation

Assessment of measurements and general appearance should be based on standards and racial
backgrounds

IX. NURSING DIAGNOSIS

Nursing diagnoses for preschoolers typically center on health promotion or unintentional injury prevention.
Examples include:

- Health-seeking behaviors related to developmental expectations

- Risk for injury related to increased independence outside the home

- Delayed growth and development related to frequent illness

- Risk for imbalanced nutrition more than body requirements, related to fast food choices

- Risk for poisoning related to maturational age of the child

- Parental anxiety related to lack of understanding of childhood development

X. IMPLEMENTATION OF SAFE AND QUALITY NURSING INTERVENTIONS
For many parents, preschool is a difficult time because a child is at an in-between stage – no longer an
infant, although not yet ready for formal school. Planning and establishing expected outcomes for care of
children at this age often begin with establishing a schedule for discussing normal preschool development with
the parents. It is also important to plan opportunities for adventurous activities and interaction with other
children. Parents may find it helpful to be referred to online resources for further information

Preschool children imitate moods as well as actions. An important nursing intervention, therefore is
role-playing a mood or attitude you would like a child to learn. To project an attitude that a health assessment
is an enjoyable activity, you might suggest preschoolers participate by listening to their heart or coloring the
table paper. Unintentional injury prevention is also best taught by role modeling

XI. EVALUATION

An evaluation of expected outcomes needs to be continuous and frequent. Because growth during this
period is more cognitive and emotional than physical, parents may report little growth. Evaluating specific areas
can help them appreciate that progress has occurred. Examples of expected outcomes might include:

- Child states importance of holding parent’s hand while crossing streets

- Parents states realistic expectations of 3-year-old child’s motor ability by next visit

- Mother reports she has prepared her 4-year-old for new baby by next visit

References:
Silbert - Flagg, J. (2022). Maternal and child health nursing: Care of the childbearing and
childbearing family (9thed.). Philadelphia, PA: Wolters Kluwer.