.
Health Promotion
of the
Preschooler
Preschooler
Rate of physical growth slows and stabilized during the preschool period.
Average weight at 3 years is 32 lbs (14.6 Kg), at 4 years 36 ¾ lbs (16.7
Kg) and at 5 years 41 ¼ lbs (18.7 Kg). Average gain of about 5 lbs per
year. Height – average yearly increase of 2 ½ - 3” (6.75-7.5 cm),
generally by legs becoming longer rather than trunk. Average height of
3 year old 37 ¼” (95 cm), 4 year old 40 ½” (103 cm) and 5 year old 43
¼” (110 cm).
Preschoolers are slender but sturdy in appearance, graceful, agile and
posturally correct. Little actual differences exist between boys and girls
in physical characteristics except dress and hairstyle.
Most body systems are mature and stable; most children are toilet trained.
Muscles and bone growth still taking place, child needs appropriate
exercise, adequate rest and nutrition for musculoskeletal development.
Gross and Fine Motor
Development of the Preschooler
Gross motor development: By age 3, preschooler can ride
a tricycle, walk on tiptoe, balance on one foot for a few
seconds, go up stairs alternating feet (but come down
stairs placing both feet on same step). By age 4, he can
skip and hop on one foot, catch a ball reliably, throw a
ball overhand, and walk down stairs on alternating feet.
By age 5, preschooler skips on alternate feet, jumps
rope, skates with good balance.
Fine motor development: is evident in child’s ability to
draw, copy a diamond and a triangle, tie shoelaces by 5
years, use scissors by 3 years. Children can completely
dress themselves totally by 5 years, although they may
sometimes need guidance.
Erickson's Stage of Initiative vs. Guilt
Children during this stage work, play and live life to the
fullest, they feel a real sense of accomplishment in
their activities.
Guilt can occur if child oversteps his abilities and does
not act appropriately.
Erikson - Initiative vs. Guilt
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This stage is also characterized by a sense of competition or
rivalry between the child and same sex parent. Child may wish
the parent dead, and if it really happens, child may overwhelmed
with a sense of guilt for having caused the death, since they
believe that wishing for something can make it come true. This
conflict is normally resolved during the school years, when child
identifies with the same sex parent.
Language development
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Language development continues, more complex and sophisticated.
Children have a vocabulary of approximately 2100 words by 5 years of
age. Between 3-4 years, children use telegraphic speech, very brief.
They can ask questions, use plurals, pronouns and past tense of verbs.
They can name familiar objects, parts of the body, names of family and
friends, give and follow simple commands. They enjoy talking
incessantly.
By 5 years they use long sentences and can use adjectives,
prepositions and a variety of verbs correctly unless there is a deviation
from the rule. However, preschoolers are egocentric and believe
everyone thinks the way they do. They may have difficulty with
concepts of time such as next Wednesday, last April, 2 weeks before
Christmas, and concepts such as left and right unless related to
something they know. They do not understand cause and effect.
Religion, body image and sexual identity
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Children exposed to religion have a concrete concept of God with physical characteristics,
they like to memorize short prayers and like representations such as the nativity scene,
Chanukah candles, etc.
During the preschool years children develop body image and recognize individual
differences in skin color, racial identity, and the meaning of words such as “pretty”, “big”,
“little”, etc. They still have poorly defined body boundaries and little or no sense of internal
anatomy.
Sexual identity develops beyond gender recognition. Sex-role imitation and dressing up is
an important activity. Attitudes and responses of others, ex, boys shouldn’t play with dolls”,
can influence a boy’s concept of masculinity. Child may ask questions about reproduction.
Answer only what child is asking! Around 3 years of age, children become aware of the
anatomic differences between boys and girls, but do not understand about the reproductive
function of the genitals. Boys may wonder how girls can “pee” without a penis, and girls
are intrigued by the “thing” they don’t have. They will often investigate on their own.
Parents must answer questions honestly, but geared toward child’s age and understanding.
Social Development
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Socially, preschoolers have mastered stranger anxiety and are
comfortable with unfamiliar people. They still need parental guidance
and approval, reassurance and security when entering school. They
can cope with changes in daily routine and still gain comfort from
familiar objects, toys or pictures of their family.
Many children attend some type of early childhood program or day
care, especially with large number of mothers who work outside the
home. In preschool or day care centers children learn group
cooperation, adjust to various sociocultural differences and cope with
frustration, anger and dissatisfaction. Climate should be supportive
with activities that provide for mastery and success. Especially
beneficial for children who lack a peer group, such as only children and
those from impoverished homes.
Play of preschoolers
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Play – associative play is typical of preschoolers, group play in similar or identical activities
but without rigid organization or rules. Child should have manipulative, constructive,
creative and educational toys for quiet activities, fine motor development and selfexpression. 4 and 5 year olds especially like to imitate adult behavior exactly and enjoy
housekeeping toys, dollhouses, farm animals and equipment, trains, trucks, doctor and
nurse kits.
Imaginary playmates are also a part of this stage, between 2 ½ and 3 ½ years and
relinquished by school age. More intelligent children tend to have more vivid and complex
playmates. Imaginary playmates serve many purposes: friends in times of loneliness,
accomplishment of what child is still attempting and experience what child wants to forget
or remember. Friend may have a variety of faults and be blamed for the child’s
wrongdoing. Parents must recognize this fantasy is a sign of health that helps child
distinguish between pretend and reality. They should acknowledge the imaginary
companion by referring to them by name and even setting an extra place at the table if
child requests. However, child should not be allowed to blame the imaginary companion to
avoid punishment for wrongdoing.
Nutrition requirements
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Calories per Kg continues to decrease slightly, but it is important
that nutrients not be deficient. Requires approximately 1800
calories per day. 3 and 4 year olds may still be finicky eaters
with food fads, but by 5 years they are more agreeable to trying
new foods, especially with a new taste or dish. Amount and
variety of food differs from day to day. 5 year olds can enjoy the
social aspects of a meal with family. Parents sometimes worry
about quantity of food, but quality is more important.
Sleep and health promotion
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Sleep patterns vary but average preschooler sleeps 12
hours/night, infrequently takes naps. High activity level,
readiness to participate in organized sport should be individual.
This is also the age of nightmares and night terrors (know
difference). Consistency about bedtime is essential to avoiding
problems.
Dental care is essential to preserve temporary teeth and
establish good habits.
Injury prevention is still important but preschoolers listen to
parental rules and are less reckless and more aware of potential
dangers.
Immunizations must be maintained up to date.
.
Health Promotion of
the School Age
Child
School Age
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Height and weight gain is slow but steady.
Between 6-12 years, child grows approximately 2 inches (5 cm) per
year. 1-2’ height total
Weight, 4 ½ - 6 ½ lbs/year (2-3 Kg).
Average 6-year old is 45 inches (116 cm) tall and weighs 46 lbs.
(21 Kg).
The average 12-year old is 59 inches (150 cm) and weighs 88 lbs
(40 Kg).
There is an increase in both body weight and % of muscle tissue,
decrease in head circumference, waist circumference and an
increase in leg length in relation to height.
Boys tend to be slightly taller and heavier than girls are. Toward the
end of school age years, girls surpass boys in both height and
weight.
School Age
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Decrease in caloric needs, child does not need to be fed as
frequently or carefully as earlier.
 Heart rate and respiratory rate decrease and BP increases from
6 to 12 years.
 Immune system matures, can localize infections and produce
antibodies in response to antigens.
 Skeletal system – bone growth continues, but bones yield to
muscle pull and pressure, ex. Heavy book bags on one side of
body. Books in backpack are better, more evenly distributed.
There is a wide variety in children at the end of middle childhood
in physical growth and emotional and social maturity.
Prepubescent
Period toward end of middle childhood (ages 10-12) until
13th birthday or 2 year period before puberty.
Girls achieve puberty at least 2 years sooner than boys do.
 Average age for girls is 12 years
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14 years for boys.
Girls experience clear physiologic signals during
preadolescence, while boys experience little visible
sexual maturation during these years.
Erickson - Stage of Industry
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Establishes child’s fundamental attitude toward work.
School-age children are eager to develop skills and
participate in socially meaningful work. Growing
sense of independence. Reinforcement includes
grades, material rewards, additional privileges and
recognition, encouragement. Learning new skills is a
means of achieving success in social activities. Sense
of accomplishment involves ability to cooperate,
compete with others and cope effectively with people,
learning the value of working with others to achieve a
goal. Peer approval is a strong motivator.
School age learning - Erikson
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Child must also accept that he cannot master every skill attempted and that some
children will be better at certain skills than he/she is. Also move from rigid, concrete
thinking to making judgments based on conceptual thinking. Increased ability to
master symbols and use memory, evaluate and interpret events.
Learning involves several important concepts.
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Reversibility of #s (basis for math) ex, 4 + 2 = 6 and 6 – 4 = 2.
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Conservation of matter – concept that shape does not change volume.
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Classification – grouping and sorting objects according to categories, logical
order. Beginning of collections, stamps, coins, etc.
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Relationship of objects – big/small, light/dark
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Reciprocity of roles – brother/sister
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Learning the alphabet leads to structuring letters, words, reading and writing.
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Telling time, history, and geography.
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By age’s 8-9, days of week, months date.
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Fascination with concept of God, Heaven, Hell; prayer and faith become very
important.
Social Development
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Formation of intimate friendships between same-sex peers. Time of “best
friends” who share secrets, jokes, adventures and help in time of trouble.
Child experiences love and closeness for a peer, an important foundation
for adult relationships.
Clubs and Groups – characteristic of middle childhood with rigid rules on
members; exclusive selection criteria for who may join, conformity of
behavior, secret codes, standards. Provide a feeling of security and shared
decision-making, merging with peer identities, move from exclusively family
group to an outside group. Generally, common interests are basis of group.
Same-sex groups in middle years.
Play – increased physical skill for athletics, team and group activities,
Scouts, modifying goals for a group goal. Rituals and chants handed down
for generations. “Step on a crack, break your mother’s back.” Board games
with fanatic adherence to the rules. Odd collections of objects that become
more formal as child gets older.
Development of Self-concept – a conscious awareness of self-perception
with values skills and physical characteristics. Adults can manipulate
environment so child is successful and + self-image emerges.
Relationships – School age
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Peer group identity and relationships are essential. Lack of these
leads to bullying – an attempt to act out anger and resentment by
children who lack academic or social skills. They physically, verbally
or emotionally abuse other children.
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Family, is a major influence in shaping personality, behavior and forming
value system. Children may reject or accept family’s values, but will
incorporate those found to be of worth.
Peer relationships may pull child to spend more time with peers than
with family. They prefer the group to family and can be critical of
parents, discover that parents can be wrong and begin to question
knowledge and authority.
Children need and want restrictions placed on their behavior, feel secure
knowing there is a greater authority even though they may complain
loudly and try to break the rules. Parents must remain adults, not
“peers”, stable, secure and mature, especially in times of illness, failure
and disruption.
School
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School entrance delineates a sharp break with structure of a
child’s former world. Usually, children are eager to go and adapt
to school easily. Parents must accept the separation and not
cling to the child. Teachers perform many roles formerly
assumed by parents, supportive statements and reassurances
contribute to + self-image. Teachers of young children should be
warm, loving and guide intellectual development, attitudes and
values.
Latchkey Issues
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“Latchkey children” – describes children in elementary school
who are left to care for themselves before or after school without
supervision of an adult, because of single parent, working
mothers. Child may feel isolated, lonely or fearful – higher % of
injuries and delinquent behavior. Stressors for children can
come from home, school, and community. High % of parents
divorcing; violence at home or in community may result in
physical symptoms.
.
Promoting Health
during the School
Age Years
Nutrition
Likes and dislikes established earlier continue, however, because
children eat what their families eat, child’s diet depends on family
pattern of eating. Often fill up on “empty” calories ex. junk food,
sugar, fats, starches. Parent may pack a nutritious lunch, but
child may trade it, sell it or throw it away. Nutrition can be
included in school curriculum.
Sleep and Rest
Amount of sleep needed is highly individualized, depends on child’s
activity level and state of health. They sleep approximately 9 ½
hours per night. Children are often unaware that they are tired
and will be sleepy the next day. As they get older, children no
longer resist going to bed, but may retire early to read or listen to
music, etc.
Exercise & Activity
Increasingly strenuous play and motor activity
without exhaustion. All need regular exercise,
and physical activity should be encouraged.
Jumping rope, roller skating ice skating,
running swimming and bicycle riding are
appropriate activities that promote coordination
and development.
Dental Health
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First permanent (secondary) teeth erupt at about 6 years of age.
Permanent dentition is more advanced in girls than boys are.
Good dental hygiene needed and regular dental care. Brushing
should be done after meals and snacking.
Parents should floss child’s teeth until 8-9 years, when child has
manual dexterity to do it himself.
Malocclusion occurs when teeth from upper and lower jaw do not
meet properly. Orthodontic treatment is best accomplished in
later school years.
Sex Education
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Child’s attitude toward sex is acquired at a very early age. Initial
curiosity about differences between boys and girls and children
and adults arises during preschool years.
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Middle childhood is an ideal time for formal sex education.
Information about sexual maturation and reproduction help to
minimize child’s feelings of uncertainty and embarrassment
during puberty. Questions should be answered honestly, matterof-factly and to the child’s level of understanding. They need to
know what will happen to their bodies, as they grow older. Also,
information on HIV, STDs, etc.
Injury Prevention
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The most common cause of severe injury and
death is motor vehicle accidents, either as
pedestrian or passenger.
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Emphasize importance of booster seats and seat
belts.
Bicycle, skateboards, in-line skates and other sports
equipment can also lead to serious injuries. Child
should always wear helmet and protective gear.