Chapter 17
Care of the Preschooler
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Preschool Stage
From 3 to 6 years of age.
Gross motor skills become more coordinated.
Fine motor skills develop exponentially.
Preschoolers take initiative and try new things.
Imagination and creativity are key.
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Health Assessment of Preschoolers
 Begin to involve child in health history.
 Allow the choice of sitting on the examination table or in the parent’s
lap.
 Give choices throughout examination.
 Allow the preschooler to play with safe medical equipment.
 Perform most invasive parts last.
 Implement visual acuity testing at age 4.
 Assess hearing with optoacoustic emissions test.
 To inspect the pinna of the ear at age 3, pull it up and back.
 Can incorporate more formal assessments and screenings.
 Play games to illicit cooperation.
 Can use radial pulses for heart rate assessments.
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Physical Variants in Preschoolers
Visual acuity reaches 20/20 at 4 to 5 years of age.
Thoracic breathing begins at age 5.
May experience stool holding during toilet training.
Full daytime bladder control around 3 years of age.
Nighttime bladder control around 4 to 5 years of
age.
Genu valgum (knock-knees) in early preschool
period.
Body is more slender and abdominal muscles are
stronger.
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Pain Assessment of Preschoolers
 Are able to point to location of pain.
 Not able to describe the quality of pain.
 Able to use developmentally-appropriate self-report tools.
 Oucher scale:
o Six points with corresponding photos of children’s faces
depicting different levels of pain.
o Scale of 0 to 100, with higher number indicating more
pain.
 FACES scale:
o Six cartoon faces with different expressions.
o Scale of 0 to 10, with higher number indicating more
pain.
 Also use observation and caregiver report to assess pain.
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Physical Growth of Preschoolers
 Height:
o Grow 2.5 to 3 in (6.1 to 7.6 cm) per year.
o Average 4 year old height is 40 in (3.3 ft).
 Weight:
o Gain 5 lb (2.3 kg) per year from ages 3 to 6.
o Average 4 year old weighs 40 lb (18.1 kg).
 Head circumference:
o Brain growth slows.
o Only 1.9 to 2.4 in (5 to 6 cm) increase from 3 to 18
years of age.
 Document all physical growth data points on growth
charts to assess trends and averages.
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Developmental Theories #1
 Psychosocial:
o Erikson stage of initiative vs. guilt.
o Asserts self more and wants to please parents.
o Plans and initiates activities.
 Cognitive:
o Preoperational stage until 4 years of age.
o Remains egocentric and focuses only on one aspect.
o Transductive reasoning: connecting unrelated events.
o Intuitive thinking after 4 years of age.
o Develops logical thought based on perception.
o Irreversibility: unable to reverse sequence of events.
o Magical thinking: fantasy and vivid imaginations.
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Developmental Theories #2
 Moral:
o Preconventional stage.
o Right and wrong is interpreted through
punishment and reward.
o Rules are seen as absolute.
 Psychosexual:
o Phallic stage.
o Genitals become area of interest.
o Identifies more with parents of the same sex.
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Gross Motor Development of Preschoolers
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Fine Motor Development of Preschoolers
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Communication and Speech of Preschoolers #1
 Rapid language acquisition.
 Uses concrete language.
 Children living in poverty are at increased risk of language
delay.
 Language is learned through exposure to words.
 Screen for language delays at each well-child visit.
 Underlying causes of language delay include:
o Autism
o Cognitive impairment
o Emotional delays
o Low socioeconomic status or neglect
o Underlying neurological disorders
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Communication and Speech of Preschoolers #2
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Social and Emotional Development #1
Learn to cope with emotions.
Use imaginary play and imaginary friends to explore
communication and emotions.
Interested in basic sexuality by the age of 5 to 6.
Develop their own identity and independence.
Cooperation is more common.
Learn to share and take turns.
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Social and Emotional Development #2
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Safety Considerations for Preschoolers
 Like new experiences.
 Don’t comprehend risks.
 Role model safe behaviors.
 Stranger safety and street safety are most important.
 Teach home address and phone number.
 Natural curiosity can create harmful situations such as:
o Improper handling of firearms
o Poisoning
o Choking
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School Readiness
 Read to children:
o Use picture books.
o Books with a few words per page.
 Carry on conversations:
o Ask open-ended questions.
 Provide structured environments with choices.
 Encourage social interactions with peers.
 Implement Head Start or other preschool services for
low-income families.
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Play Considerations for Preschoolers
 Engage in imaginary and creative play.
 Allow to work through frustration and anxiety.
 Use arts and crafts for fine motor skills such as:
o Modeling clay
o Crayons
 Learn to share and take turns:
o Simple board games
 Outdoor activities:
o Playgrounds, bicycles, tricycles
o Unstructured physical activity
 Toys to avoid:
o Toys with small parts, small magnets, or lead paint.
o Excessive electronics.
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Sleep Considerations for Preschoolers
 Hours of sleep are consolidated into one long block.
 Require 10 to 13 hours per day of sleep.
 Naps typically end around 4 years of age.
 Establish bedtime routines and remain consistent.
 Nightmares:
o Child wakes up scared and wants comfort from parents.
o Talk about nightmare and assist the child back to sleep.
 Night terrors:
o Child is not awake when they occur and does not remember
episodes.
o May scream, kick, thrash, or push parents away.
o Do not try to wake the child.
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Discipline for Preschoolers
Preschoolers behave better if given opportunities for
independence with set limits.
Incorporate daily routines for consistency.
Explain consequences for rule-breaking.
Time-outs:
o Used to remove child from environment.
o 1 min per year of age.
Avoid yelling and spanking:
o Leads to aggression and physical struggles.
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Nutrition for Preschoolers
Focus on a healthy, well-rounded diet.
Incorporate fruits, vegetables, whole grains, and
lean proteins.
Requires 1,200 to 1,400 calories per day.
Avoid foods high in fat and sugar.
Three meals and one to two snacks per day.
Involve child in meal preparation and offer choices
when possible.
Do not fix separate meals; this encourages picky
eating.
Do not force intake if child is not hungry.
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Lying
Stems from overactive imaginations or to avoid
punishment.
Reasons for lying change as preschoolers get older.
Teach children that lying is never okay.
Role model positive behaviors.
Punishment should be based on severity of the
transgression and lie.
Praise preschoolers for telling the truth.
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Fifth Disease
Also known as erythema infectiosum.
Caused by parvovirus B19.
Peaks in late winter and spring.
Bright red cheeks with “slapped” appearance.
Lacy rash on trunk and upper extremities.
Benign and self-limiting.
Offer supportive treatment if prodromal symptoms.
Avoid pregnant women because virus can harm
fetus.
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Hand-Foot-and-Mouth Disease
Caused by coxsackie virus.
Spread through fecal-oral route.
Prevented with proper hand washing.
Vesicular and/or pustular lesions occur on the
oropharynx, palms of hands, and soles of feet.
May have mild fever and moderate pain.
Self-limiting condition; usually resolves after 1
week.
Supportive care for symptomatic management.
Monitor for dehydration.
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Conjunctivitis
Inflammation of conjunctiva.
Also known as “pink-eye.”
Can be bacterial, viral, or allergic.
Typically associated with thick drainage, pruritus,
and/or vision changes.
Very contagious.
Treat based on cause (antibiotics, symptomatic
management, antihistamines).
Viral is self-limiting.
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