MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
PRESCHOOLER
PHYSICAL GROWTH
E. BODY SYSTEMS
A. BODY CONTOUR
• A definite change in body contour
occurs during the preschool years, and
the changes are so definite that future
body type becomes apparent.
Ectomorphic body build
• slim body build
Endomorphic body build
• large body build
B. HEAD CIRCUMFERENCE
• It is not routinely measured at physical
assessments on children over 2 years
of age, because it changes a little after
F. TEETH
this time
C. HEIGHT
• Height gain is also minimal during this
period: only 2 to 3.5 in. (6-8 cm) a year
on average. During these years,
appetite remains the same as it was
during the toddler years 4.5 lbs (2kg) –
average weight gain
D. WEIGHT
G. GENU VALGUS
• Weight gain is slight during the
preschool years
• During these years, appetite remains
the same as it was during the toddler
years
• 4.5 lbs (2kg) – average weight gain
1. Lympathic Tissue
• begins to increase in size,
particularly the tonsils levels of
immune globulin (Ig)G and IgA
antibodies increases.
• These changes tend to make
preschool illness more localized
2. Heart
• Physiologic splitting of heart
sounds and innocent heart
murmurs may be present for the
first time on auscultation
• Pulse rate decreases to about 85
beats/min
• Blood pressure holds at about
100/60 mmHg
3. Bladder
• Easily palpable above the
symphysis pubis
• Voiding is frequent enough (9 to
10 times a day) that play must be
interrupted
• Voiding accidents may occur if a
child becomes absorbed in an
activity
4. Muscles
• Muscles are noticeably stronger,
so activities such as gymnastics
become possible
• Children generally have all 20 of their
deciduous teeth by 3 years of age,
permanent teeth don’t replace these
until school age.
• Preserving these teeth is important
because they hold the position of the
permanent teeth as the child’s jaw
grows larger
• Knock-knees; disappear with increased
skeletal growth at the end of the
preschool period
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DEVELOPMENTAL MILESTONES
A. LANGUAGE DEVELOPMENT
• The Extend of a 3-year-old child’s
vocabulary varies depending on how
much the child has been encouraged
to ask questions or participate in a
conversations
• A child has a vocabulary of about 900
words and uses it to ask questions
constantly, up to 400 a day
• 4-5 yr. old children enjoy participating
in mealtime conversation and can
describe an incident from their day in
great detail they tend to imitate
language exactly, so if they hear the
less-than-perfect language, this is the
language pattern they adopt
Egocentrism
• perceiving that one’s thought and
needs are better or more important
than those of others; as part of
egocentrism, pre-schoolers defines
object mainly as themselves
B. PLAY
• Preschoolers do not need many toys
because, with an imagination keener
than it will be at any other time in life,
they enjoy games that use imitation
such as pretending they are a teacher,
cowboy or cowgirl, firefighter, or
store clerk.
• Four- and 5-year-olds divide their time
between roughhousing and imitative
play.
• Five-year-olds become interested in
group games or reciting songs they
have learned in kindergarten or
preschool.
EMOTIONAL DEVELOPMENT
A. INITIATIVE
• 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 the school
situation
B. IMITATION
• Imitating the actions of the people
around them peaks during this stage
• Role modeling this way should be fun
and does not have to be accurate
• Children generally imitate those
activities best that they see their
parents performing at home
C. FANTASY
• Preschoolers begin to make a
differentiation between fantasy and
reality; they may become so
engrossed in a fantasy role that they
fear they are “stuck” in the fantasy
and are no longer themselves
D. OEDIPUS AND ELECTRA COMPLEXES
• Occurs in the Phallic Stage of
Psychosexual Development
• Parents who are not prepared for this
behavior may feel hurt and cut off
from family interaction. Parents can be
assured this phenomenon of
competition and romance in
preschoolers is a normal part of
maturing
Oedipus Complex
• refers to the strong emotional
attachment a preschool boy
demonstrates toward his mother
Electra complex
• the attachment of a preschool girl to
her father
E. GENDER ROLES
• Preschoolers begin to be aware of the
difference between sexes and so need
to be introduced to both gender roles.
• If a child is hospitalized during the
preschool period, a nurse could readily
fill this role. Many parents do not want
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their children to grow up as they did,
with a fixed gender role as a result of
stereotyping
F. SOCIALIZATION
• Preschoolers play with other children
their age much more agreeably than
toddlers, which makes the preschool
period a sensitive and critical time for
socialization
• Although 4-year-olds continue to enjoy
play groups, they may become
involved in arguments more than they
did at age
• 3 years, especially as they become
more certain of their role in the group
• 5-year-olds begin to develop “best”
friendships
COGNITIVE DEVELOPMENT
• According to Piaget (1969), 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?”
• Piaget named this stage “intuitive
thought” because he believed that
children tend to be so certain of their
knowledge and understanding that they
are unaware of how they gained this
knowledge initially.
• Preschoolers are not yet of the property
of conversation.
A. CENTRATION
• This is shown as a style of thinking by
intuitive children
• These children typically are focused on
the characteristic of an object or
person, and they base their decisions
or judgment on that one characteristic
(as opposed to considering multiple
characteristics).
• Centration also means that
preschoolers cannot make mental
substitutions and often feel they are
always right
B. CONSERVATION
• Preschoolers are not yet aware of the
property of conservation
• This inability to appreciate
conservation has implications for
nursing care because it means
preschoolers are not able to
comprehend that a procedure
performed two separate ways is the
same procedure. They cannot see that
only the form, not the amount, has
changed
C. DECENTERING
• Combined with the concept of
conservation, appears before more
sophisticated logical thinking abilities.
MORAL AND SPIRITUAL DEVELOPMENT
• 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.
• If preschoolers depend on their parents to
supply rules for them when faced with a
new situation, they may have difficulty
understanding the rules they know. They
begin to have an elemental concept of
spirituality if they have been provided
some form of religious training.
• 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
read over and over
PROMOTING PRESCHOOLER SAFETY
• The preschool years are not too early a
time to educate children about the
potential threat of harm from strangers or
how to address bullying behavior at
preschool or play through such measures
as:
1. Cautioning children never to talk or
accept a ride from a stranger
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2. Teaching children how to call for help
in an emergency
3. Describing what a police officer looks
like and explaining that police can help
in emergencies
4. Explaining that bullying behavior from
other children is not to be tolerated
and should be reported so they can
receive help managing it.
5. Explaining the difference between
appropriate and inappropriate touch
or behavior
• 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.
UNINTENTIONAL INJURIES PREVENTION
MEASURES
A. MOTOR VEHICLES
• Teach safety with tricycles (e.g., look
before crossing driveways, do not
cross streets).
• Teach the child to always hold hands
with an adult before crossing a street.
• Teach parking lot safety (e.g., hold
hands with an adult, do not run behind
cars that could be backing up).
• Teach children to consistently wear
helmets when beginning bicycle
riding.
B. FALLS
• Always supervise a preschooler at a
playground.
• Remove drawstrings from hooded
clothing.
• Help the child to judge safe distances
for jumping or safe heights for
climbing.
C. DROWNING
• Teach beginning swimming.
D. ANIMAL BITES
• Do not allow the child to approach
strange dogs.
• Supervise the child’s play with family
pets.
E. POISONING
• Never present medication as candy.
• Never take the medication in front of a
child.
• Never store food or substances in
containers other than their own.
• Post the telephone number of the
poison control center by telephone or
as a cell phone contact number (1-800-
222-1222).
• Teach the child that medications are a
serious substance and not for play.
F. BURNS
• Store matches in closed containers.
• Do not allow the preschooler to help
light birthday candles, or fi replaces;
them if he is not fun or a “treat”.
G. COMMUNITY SAFETY
• Teach the preschooler that not all
people are friends (e.g., “Do not talk
to strangers or take candy from
strangers”).
• Define a stranger as someone the
child does not know, not someone
odd looking.
• Teach the child to say “no” to people
whose touching he or she does not
enjoy, including family members.
(When a child is sexually maltreated,
the offender is usually a family
member or close family friend.)
H. GENERAL
• Know the whereabouts of the
preschooler at all times.
• Be aware the frequency of
unintentional injuries increases when
parents are under stress.
• Special precautions must be taken at
these times.
• Some children are more active,
curious, and impulsive and therefore
more vulnerable to unintentional
injuries than others.
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MATERNAL AND CHILD HEALTH NURSING
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NUTRITIONAL HEALTH
A VEGETARIAN DIET
• A vegetarian diet is usually colorful
and appealing to preschoolers, and is
usually high in calcium, vitamin B 12,
and vitamin D.
• Check to ensure a child is consuming a
variety of calcium sources, as calcium
is important for bone growth.
• Vitamin B 12 is found almost
exclusively in animal products, so a
child may need a supplemental source.
DEVELOPMENT IN DAILY ACTIVITIES
A. DRESSING
• Most 4-year-olds can dress except for
difficult buttons,
• Preschoolers prefer bright colors or
prints and so may select items that are
appealing in color rather than
matching.
• 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.
B. SLEEP
• Preschoolers are more aware of their
needs than toddlers; when they are
tired, they often curl up on a couch or
soft chair and fall asleep
• If they nap at preschool, they may
have some difficulty going to sleep at
the usual bedtime established at home
C. EXERCISE
• The preschool period is an active
phase, so preschool play tends to be
vigorous
• Roughhousing helps relieve tension
and participate in time-honored games
such as ring-around-the-rosy, London
Bridge, or other more structured
games they were not ready for as
toddlers.
• Promoting these types of active
games and reducing television
watching can be steps toward helping
children develop motor skills as well as
prevent childhood obesity
D. HYGIENE
• Children this age are not paragons of
neatness and may not clean their
hands thoroughly. Preschoolers do
not clean their fingernails or ears well,
either, so these areas often need
“touching up” by a parent or older
sibling
• Parents should turn down the
temperature of the water heater in
their home to under 120°F to help
prevent scalds
• Some girls develop vulvar irritation
(and perhaps bladder infections) from
exposure to bubble baths so parents
shouldn’t add such products to the
water
E. CARE OF TEETH
• Independent toothbrushing should be
started during preschool.
• One good toothbrushing period a day
is often more effective than more
frequent half-hearted attempts.
• Dental services can be performed at 3
years of age e for an evaluation of
tooth formation because deciduous
(baby) teeth must be preserved to
protect the dental arch.
• 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 to grow enough to accommodate
them
• Teeth grinding (Bruxism) may begin at
this age as a way of “letting go”,
similar to body rocking.
• Children who grind their teeth
extensively may have greater than
average anxiety
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MATERNAL AND CHILD HEALTH NURSING
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HEALTHY FAMILY FUNCTIONING
DISCIPLINE
• An important role of preschooler
parents is to respect creativity
• A “time-out” is a useful technique for
parents to correct behavior
throughout the preschool years
• It allows parents to discipline without
using physical punishment and allows
a child to learn a new way of behavior
without extreme stress.
• 3 to 5 minutes is appropriate for
preschoolers
PARENTAL CONCERNS
COMMON HEALTH PROBLEMS OF THE
PRESCHOOLER
• The mortality of children during the
preschool years is low and becoming
lower as more infectious diseases are
preventable, with the major cause of
death being automobile accidents,
followed by poisoning and falls.
• Minor illnesses such as common colds
and ear infections are high, and
children who live in homes with smoke
have a higher incidence of the ear
(otitis media) and respiratory
infections.
• Parents should assess to be certain
that constant minor illnesses are not
causing them to perceive a child as
sickly or not able to cope with
everyday life
• As parents become more experienced
in handling these conditions, their
perception of whether an illness is
serious or not and their ability to cope
with them will change.
COMMON FEARS OF THE PRESCHOOLER
A. FEAR OF THE DARK
• It is an example of a fear heightened
by a child’s vivid imagination: a stuffed
toy by daylight becomes a threatening
monster at night.
• 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
• If a child continues to have this kind of
disturbance every night, it may be a
reaction to undue stress, which needs
to be investigated and eliminated.
• Giving sleep medication does not solve
sleep disturbance, so it is rarely
recommended.
B. FEAR OF MUTILATION
• This is also significant during the
preschool age, as revealed by the
intense reaction of a preschooler to
even a simple injury such as falling and
scraping a knee or having a needle
inserted for an immunization
• According to Freud, boys develop a
fear of castration because,
developmentally, they are more in
tune with their body parts and are
starting to identify with the same-sex
parent as they go through the Oedipal
phase
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C. FEAR OF SEPARATION OR
ABANDONMENT
• Their sense of time is still so distorted
that they cannot be comforted by
assurances such as “Mommy will pick
you up from preschool 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, such as meals,
television shows, or a friend’s house, is
more effective.
BEHAVIOR VARIATIONS
A. TELLING TALL TALES
• Stretching stories to make them seem
more interesting is a phenomenon
frequently encountered in
preschoolers.
• The child perceives something exciting
that has happened.
• Parents may be concerned that tall
tales of this nature can lead to chronic
lying if supported.
• Conveys the idea that the child has not
told the truth, yet does not squash
imagination or initiative.
B. IMAGINARY FRIENDS
• 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
• 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
C. DIFFICULTY SHARING
• Sharing does not come easily,
however; children who are ill or under
stress have greater difficulty with it
than usual.
• Assure parents that sharing is a
difficult concept to grasp, and, as with
most skills, preschoolers need the
practice to understand and learn it
• Defining limits and exposing children
to these three categories: Mine Yours
Ours
o Helps them determine which
objects belong to which category
D. REGRESSION
• Some preschoolers, generally about
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 may take
many forms but it is usually the result
of things such as:
o New baby in the family
o New school experience
o Seeing frightening and graphic
television news or programming
o Stress in the home from financial
marital difficulties Separation
caused by hospitalization
E. SIBLING RIVALRY
• The parents are untried, unsure of
how far they should let a first child
venture or what level of responsibility
a child could accept, allowing the
firstborn to serve as the “trial run” for
all children who come after.
• To help preschoolers feel secure and
to promote self-esteem during this
time, reminding them that there are
things they can do that a younger
sibling is not allowed to do
F. PREPARING FOR A NEW SIBLING
• There is no rule as to when this
preparation should begin, but it
should be before the time the child
begins to feel the difference the new
baby will make.
• The unknown is always more fearful
than a definite event because those
can be faced and conquered.
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• Help parents not to underestimate the
significance of a bed to a preschool
child because it is security,
consistency, and “home.
• If the mother will be hospitalized for
the birth, parents should be certain
their child is prepared for this
separation some preschoolers may
react very coldly to their mothers,
turning their heads away and refusing
to come to them after even a few days
of separation when they return home
• Allow the child to visit the hospital to
help relieve this type of separation
anxiety
G. SEX EDUCATION
• Preschool children have the
beginnings of sexual awareness and
are interested in learning where
babies grow.
• A parent could introduce the subject
by visiting a new baby in the
neighborhood with the child or
pointing out a neighbor who is
pregnant
• Encourage parents to prepare children
thoroughly for this experience, or else
the sight of their mother in pain and
the wonder of birth can become an
overwhelming and negative
experience rather than a positive one
for them.
• Correct terminology should be used
when providing an explanation to a
child.
• Teach the preschoolers to avoid
sexual maltreatment, such as allowing
anyone to touch their body unless
they and their parents agree that it is
all right.
H. CHOOSING A PRESCHOOL OR CHILD CARE
CENTER
• Traditionally, the main purpose of a
child care center 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.
• 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, by
being certain their immunizations are
up-to-date, but also emotionally.
• If school is discussed as something to
look forward to, as an adventure that
will be satisfying and rewarding, a
child comes to look forward to it as a
positive experience. If school is
presented as a punishment there can
be a little delight in anticipating it.
I. PREPARING A CHILD FOR SCHOOL
• Identifying colors should be
established by this age, but some
children are not coordinated enough
at 4 to 5 years of age to tie their shoes
or print
• If a child is to ride a bus to school, a
parent might take a child on a
municipal bus as an introduction to
this form of transportation.
• If a child is to walk to school, a trial
walk is in order If a child will be
required to take a lunch to school, a
parent can introduce this new
experience by preparing a bagged
lunch at home.
• If a child was not attending preschool,
some parents may have to change
their child’s daily routine a few months
in advance of beginning school to
accustom the child to waking earlier or
going to bed earlier.
J. BROKEN FLUENCY
• Repetition and prolongation of
sounds, syllables, and words
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• It is often referred to as secondary A. NUTRITION AND THE PRESCHOOLER

stuttering because the child began to WITH SPECIAL NEEDS
speak without this problem and then, • Experiences with eating help to
during the preschool years, develops reinforce a sense of initiative in
it. preschoolers.
• For example A child may begin to • Chronically ill preschoolers who are
repeat words or syllables, saying, “I-I-I limited in the foods they can eat or in
want a n-n-new spoon-spoon spoon their ability to help with food
Rules preparation may miss this
• Do not discuss in the child’s presence reinforcement.
that he or she is having difficulty with • If their appetite is diminished because
speech. of illness to the point where they take
• Listen with patience rather than little or nothing orally, it is still
interrupt or ask the child to speak important that they continue to join
more slowly or to start over. the family at meals if at all possible.
• Always talk to the child in a calm, • In most households, this is a time for
simple way to role model slow speech. socialization, and preschoolers are
• Protect space for the child to talk if ripe for the learning that goes with
there are other children in the family this type of daily interaction.
• Do not force a child to speak if he or
she does not want to.
• Do not reward a child for fluent
speech or punish for nonfluent speech
K. BATHROOM LANGUAGE
• 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.
• If parents become emotional, a child
realizes the value of such a word and
may continue using it for the attention
it creates
CONCERNS OF THE FAMILY WITH A
PRESCHOOLER WITH UNIQUE NEEDS
• A preschooler with a disability has a
greater need for problem-solving skills
than the average child because even
simple procedures such as eating or
getting dressed can be difficult if their
physical challenge limits the options.
• Physically challenged or chronically ill
preschoolers should attend a preschool
program if at all possible because of the
socialization benefits

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