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Physical Growth Developments of the Preschooler
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Average growth of 2.5 to 3 in per year
Average weight gain around 5 lb per year
Loss of baby fat and growth of muscle
Length of skull increases slightly; lower jaw more pronounced; upper jaw widens
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Motor Skill Development
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Question
The nurse is assessing a 4-year-old for gross motor skill development. Which would
the nurse expect this preschooler to have accomplished?
a. hopping on one foot
b. standing on one foot for 10 seconds
c. skipping
d. swimming
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Answer
a. hopping on one foot
The 4-year-old should be able to hop on one foot.
At age 4, the preschooler hops on one foot and stands on one foot up to 5 seconds.
At 5 years old the preschooler stands on one foot for 10 seconds, may skip, and may
learn to skate and swim.
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Maturation of the Organ System (Preschooler)
• Myelination of the spinal cord allows for bowel and bladder control to be complete;
small intestine grows in length.
• Respiratory structures continue to grow in size; number of alveoli increase.
• Eustachian tubes remain short and straight.
• Heart rate decreases; blood pressure increases slightly; innocent heart murmur may
be heard.
• 20 deciduous teeth should be present.
• Urethra remains short in children, making them susceptible to urinary tract infections.
• Bones increase in length and muscles strengthen and mature.
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Psychosocial Development of the Preschooler
• In Erikson’s stage of development: initiative versus guilt
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– Preschooler is an inquisitive and enthusiastic learner
– Feels sense of accomplishment by succeeding in activities
– Feeling pride in accomplishment stimulates initiative
– Overextending self can result in sense of guilt
• Superego (conscious development) is completed and is basis for moral development
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Social Skills Developed by the Preschooler
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Cooperation
Sharing (of things and feelings)
Kindness
Generosity
Affection display
Conversation
Expression of feelings
Helping others
Making friends
Emotional and Social Development of the Preschooler
• Friendships
– Preschoolers learn how to make and keep a friend
• Temperament
– Indicator of parent’s expectation of child’s behavior
– Determines child’s task orientation, social flexibility, and reactivity
• Fears
– Preschoolers exhibit variety of fears
– Parents should acknowledge child’s fears
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Cognitive Development of the Preschooler
• Piaget’s theory
– Preoperational stage
• Magical thinking
– Believes thoughts are all-powerful
• Imaginary friend
– Creative way to sample activities and behaviors and practice conversation skills
• Transduction
– Extrapolates from one situation to another
• Animism
– Attributes life-like qualities to inanimate objects
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Psychosocial Preschool-Aged Child
• Kohlberg’s theory
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– Preconventional stage
– Punishment and obedience orientation
• Religion
– Diet
– Mode of discipline
– View of children
– Prayer or meditation
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Language Development
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Sample Nursing Diagnoses for Issues Related to Growth and Development
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Delayed growth and development
Imbalanced nutrition, less than body requirements
Interrupted family processes
Readiness for enhanced parenting
Risk for caregiver role strain
Risk for delayed development
Risk for disproportionate growth
Risk for injury
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Issues Involved in Promoting Growth and Development of the Preschooler
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Symbolic thought
Do not understand the concept of death
Acquisition of language allows for child to express thoughts and creativity
Transition in this period from the use of telegraphic speech at age 3 years to the
adult-like structure of sentences at age 5 years
Building self-esteem
Maintaining routine and ritual
Setting limits and remaining consistent with them
Knowing signs of developmental delay
Question
The nurse is assessing a 5-year-old child for signs of developmental delay. Which
would alert the nurse to a potential problem?
a. the child can build a tower of six blocks
b. the child does not play with other children
c. the child engages in fantasy play
d. the child separates from parent easily
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Answer
b. the child does not play with other children
This is a sign of a potential developmental delay.
Signs of developmental delay in preschool-aged children include not playing with
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other children, not being able to build a block tower of six to eight blocks, not
engaging in fantasy play, and not separating from the parent without major protest.
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Focus of Nursing Care Plan to Promote Growth and Development of Preschooler
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Promoting growth through play
Promoting early learning
Promoting language development
Choosing a preschool/starting kindergarten
Promoting safety
Promoting nutrition
Promoting healthy sleep and rest
Promoting appropriate discipline
Question
Is the following statement True or False?
The nurse should recommend that parents of a 3- to 5-year-old receive 500- to 800mg calcium and 10-mg iron daily.
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Answer
True.
The preschool child needs 500- to 800-mg calcium and 10-mg iron daily.
Preschool children need 500- to 800-mg calcium and 10-mg iron daily. Parents should
be aware that drinking excess amounts of milk may lead to iron deficiency as the
calcium in milk blocks iron absorption.
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Daily Nutritional Requirements of the Preschooler
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500- to 800-mg calcium
10-mg iron
19-mg fiber
Fat intake no less than 20% and no more than 30% daily calories
Saturated fats less than 10%
Diet high in nutrient-rich foods
Limited amounts of poor, high-calorie foods
Risks of Overweight and Obesity
• Hypertension
• Hyperlipidemia
• Insulin resistance
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Developmental Issues for Preschoolers
• Lying
• Sex education
• Masturbation
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Question
Tell whether the following statement is True or False.
The nurse is counseling parents of a 5-year-old who are concerned that their child is
masturbating. The recommended intervention for this situation is to advise parents to
discourage their child from this practice using firm discipline.
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Answer
False.
The recommended intervention for a 5-year-old child who is masturbating is to treat it
in a matter-of-fact way, making sure the child knows nudity and masturbation are not
acceptable in public.
If parents overreact to this behavior, it may occur more frequently. The child should
also be taught that no other person can touch his or her private parts.
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Focus of Health Care Visits Throughout Childhood
• Expected growth and development
• Anticipatory guidance
• Preparation for school entry
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Hospitalization
• Explore the environment
• Engage in make-believe play
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