Care of the

PRESCHOOL CHILD

LEARNING OBJECTIVES:

On completion of this unit, you are

expected to demonstrate understanding
of the concepts related to the care of a
family with a preschooler.

Specifically, you are able to:

1. Describe the normal growth and

development of a preschool child
and associated parental concerns.

2. Distinguish each milestone achieved

by the preschooler and its
implication.

3. Use critical thinking to analyze

methods of a family-centered care of
a preschooler.
 GROWTH & DEVELOPMENT OF A
PRESCHOOL CHILD

LESSON 11

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to the care of a family with a preschool child. Specifically, students are
able to:

1. Identify key terms that are significant in the care of a preschool child and the family.
2. Discuss the preschool child’s biologic-proportional changes and their implications.
3. Evaluate the relationship among the motor, language, psychosocial, cognitive and
temperament milestones of a preschool child..

INTRODUCTION

Preschoolers are fascinating creatures. As their social circles enlarge to include peers
and adults outside the family, preschoolers’ language, play patterns, and appearance
change markedly. Their curiosity about the world around them grows, as does their ability
to explore that world in greater detail and see new meanings in what they find.
At 3 years of age, the child still has the chubby, baby-face look of a toddler; by age 5, a
leaner, taller, better-coordinated social being has emerged. The child works and plays
tirelessly, “making things” and telling everyone about them. In children this age, exploring
and learning go on continuously. According to Erikson, the developmental task of the
preschool age is initiative versus guilt. Preschoolers often try to find ways to do things to
help, but they may feel guilty if scolded when they fail because of inexperience or lack of
skill.
Our main role as nurses is understanding the process of their growth and development
so that we can aid the family as they raise their child. Moreover, being adept with the
concept of their growth and development allows us to device health teachings and do
assessments and interventions that are child and family centered which is unique to their
characteristic.
 ACTIVITY 11.1

INSTRUCTION: Match the presented preschool concepts (column 1) based on the different child
development theories (column 2). Place your answer on the left side of each number.

ANSWER COLUMN 1 COLUMN 2

1. Phallic Stage A. Erik Erikson’s Theory
2. Preconceptual Intuitive B. Moral and Spiritual Development
3. Play C. Mutilation and castration
4. Level 1 preconventional D. Simple jigsaw puzzle, dolls, color-
ing books, pencils, pens
5. Preconceptual preoperational E. Cognitive Development

6. Initiative VS Guilt F. (5-7 years old) Child learns

through asking questions
7. Fear G. Sigmund Freud’s Theory

8. Centration H. Perceiving that one’s thoughts

and needs are better or more im-
portant than those of others

9. Toys I. Focused on the characteristic of an

object or person and based their de-
cision on that one characteristic.

10. Egocentrism J. Associative play and imitation play

 CONCEPT DISCUSSION

PRESCHOOL STAGE
Age: 3 to 6 years
Erikson: Initiative vs Guilt
Freud: Phallic
Cognitive Development:
• Preconceptual Preoperational (3-4 years old)
• Preconceptual Intuitive (5-7 years old)
 learn by asking questions
 Centration: focused on the characteristic of an object or person and based their decision
on that one characteristic
 not aware of the Law of Conservation
Moral and Spiritual Development
• Level 1 Preconventional: Individualism & Exchange
• determines right and wrong based on their parents’ rules
Fear: Mutilation and castration
Play: Associative Play, Imitation Play
Toys: simple jigsaw puzzle, dolls, coloring book, pencils, pens & crayons

EXPECTED GROWTH AND DEVELOPMENT

Physical Growth
• slimmer, taller, and much more childlike proportions.
• Contour changes are so definite that future body type—ectomorphic (slim) or endomorphic
(large)—becomes apparent.
• Handedness begins to be obvious.
• Lymphatic tissue begins to increase in size, particularly the tonsils, and levels of IgG and IgA
antibodies increase
• PR= 85 bpm, BP= 100/60 mmHg
• bladder – easily palpable at symphysis pubis (9-10 times voiding daily)
• well formed arch in the foot

Weight, Height, BMI & Head Circumference

• Slight weight gain (4.5 lg or 2 kg/ year)
• Appetite is the same with toddler years
• Height gain- minimal (2-3.5 inches or 6-8 cm)
Teeth
• 20 deciduous teeth by 3 years old
• Teeth needs to be preserved because:
1. permanent teeth erupts by school-age period
2. deciduous teeth hold the position for permanent teeth as the jaw grows larger

Gross and Fine Motor Development

AGE FINE MOTOR GROSS MOTOR

MILESTONE MILESTONE

3 years old • undress self; stack tower • runs; alternates feet on stairs;
of blocks; draws a cross rides tricycle; stands on one foot

4 years old • can do simple buttons • constantly in motion; jumps; skips

5 years old • can draw a six part figure; • throws overhead

laces shoe

Language
• 3 y.o – vocabulary of 900 words
• 4 y.o – vocabulary of 1500 words
• 5 y.o – vocabulary of 2100 words

Play
• 3 y.o – able to take turns; very imaginative
• 4 y.o – pretending is a major activity; roughhousing and imitative play
• 5 y.o – likes games with number or letters; interested in group games and reciting songs
they have learned

Language Development
• uses vocabulary to ask questions
• Egocentrism is strong
*** Egocentrism: perceiving that ones thoughts and needs are better or more important than
those of others
• defines objects mainly in relation to themselves
• 4-5 years old: children enjoy participating in mealtime conversation & can describe an
incident from their day in great detail
Emotional Development

• Initiative: like to explore because they have discovered that learning new things is fun
• Guilt: develops when children are punished/ criticized for attempts at initiative
*** Implication: children may have difficulty later in life making decisions about
everything; they can’t envision their capability to solve problems that may come with
change
How to promote initiative?
 Expose children to a wide variety of experiences and play materials so they can
learn how things work
 Explore outside homes
 Provide materials that encourage creative play (Free form play)

Imitation: role modeling; imitate activities best they see their parents performing;
introduce child to parents’ work environment to let child learn words such as photocopi-
er, assembly line, fax machine, etc.

Fantasy: differentiation starts; magical thinking; deal with fantasy by supporting the
imitation but present reality at the same time
• Oedipus Complex: strong emotional attachment a preschool boy demonstrates toward his
mother
• Electra Complex: attachment of a preschool girl to her father
*** Assure parents that these are normal phenomena

Gender Roles
• awareness of the difference between sexes
• Preschoolers need exposure to an adult of the opposite gender so they can become
familiar with opposite gender roles
• Children’s gender-typical actions are strengthened by parents, strangers, preschool
teachers, other family members, and other children.

Socialization
• exposure to other playmates makes preschoolers relate to other people easily than those
raised in an environment where they rarely see other children of the same age (Paulus &
Moore, 2012)
• 4-year-old children may be involved in arguments because of their awareness of their role
in the group
• 5-year-old children begin to develop best friendship on the basis of who they walk to
school or who lives closest to them
 ASSIGNMENT 11.1

INSTRUCTION: Answer the questions below pertaining to the preschool development stage.
Write your answers on the space provided in a concise yet substantial manner. This is a graded
exercise. Each question will be graded according to the short answer rubric.

1. Differentiate the gross motor milestone and fine motor milestone of the preschool
developmental stage.

2. Explain the language development and emotional development of preschool stage.

3. Define the emotional attachments which normally occurs during the preschool stage:
Oedipus complex and Electra complex. Also relate the concept of preschool gender roles in
the normal emotional attachments.
 FEEDBACK
Let us look into how well you fared. If you answered all
questions correctly, congratulations! It shows that you are
already familiar with the topics discussed in lesson 11. If your
answers are quite not close to the discussion, you have some
ideas about the topics covered but need to learn more.
Now, you have a glimpse of the Growth and Development of
a Preschool child. Read on and continue exploring this topic.
Read further on your textbook pages _______ to _________
and on other Maternal and child health nursing references.

Quiz 11.1

Congratulations! You are done with Lesson 11. In order to see how much you have learned,
an online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your NDMU Academic Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 12 entitled Growth & Development of a
Preschooler.
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf
 WELLNESS PROMOTION & INJURY PREVENTION
FOR THE PRESCHOOL CHILD

LESSON 12

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to coping with preschool concerns, wellness promotion and injury
prevention. Specifically, students are able to:

1. Discuss various parental concerns related to a preschooler’s growth and development .

2. Manage parental concerns related to preschooler’s growth and development through
formulation of health teachings suited for each concern.
3. Recognize important safety issues for the preschooler.
4. Formulate interventions and health teachings for the prevention of injury.

INTRODUCTION

Preschoolers can be said to soak up information “like a sponge.” “Why?” and “how?” are
favorite words. This curiosity also means that accidents are still a serious concern. They
sometimes have problems separating fantasy from reality.
Routine checkups, family teaching, as well as accident and infection prevention are all
important aspects of health promotion and maintenance for the preschool child. These are
significant in assuring the optimum health of these children as they discover their
environment and continue to achieve milestones. These are also important areas wherein
family health teachings must be given according to the unique characteristics of the
preschooler and family.
In this lesson, you will get familiar with the wellness promotion and injury prevention
measures to ensure that you are competent enough to promote the safety and overall
functioning of the preschool through formulation of well though of health teachings for the
family.
 ACTIVITY 12.1

An activity has been prepared in the Learning Management System to kickstart this lesson.
Follow the steps stated herewith.
1. Log in to your Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the activity prepared under Week 13 entitled Wellness Promotion & Injury
Prevention for Preschoolers.
4. The activity is published only on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the activity within the time set in the system and in order to
proceed to the succeeding activities.

CONCEPT DISCUSSION

HEALTH PROMOTION OF A PRESCHOOLER AND FAMILY

• Daily Activities
• Dressing: they prefer bright colors or prints; needs the experience of choosing their clothes
• Sleep: resistance in taking naps; refuses to sleep at night due to fear of the dark
• Exercise: Roughhousing
• Hygiene: must not be left unsupervised at bath time; discourage bubble bath especially to
girls to avoid vulvar irritation and bladder infection
• Care of teeth: start independent brushing; floss; fluoride water or supplement for children;
encourage fruits and protein for snacks instead of sweets; 1st visit to dentist is not later than
2 years old; dental services at 3 years old, teeth grinding (bruxism) may begin
• Promoting Safety
Motor vehicle & Bicycle Safety
 buckle children into car seats or booster seat in the back seat
 stress the importance of seatbelts
 let children wear safety helmets approved for their age and size

• Common Fears
1. Fear of the Dark
- leave a dim night light
- reassure children that they are safe when they woke up terrified & screaming
2. Fear of mutilation
3. Fear of separation or Abandonment
- due to their distorted sense of time

• Behavior Variations
- due to their keen imagination and immature reasoning
1. Telling Tall Tales
- stretching stories to make them seem more interesting
*** may lead to chronic lying if not manage accordingly
*** help child separate fact from fiction
 2. Imaginary Friends
- assure parents that this normal and that they just have to ensure that the child has
exposure to real playmates and imaginary friends should not prevent the child from so-
cializing
- pretend friends can encourage language development and provide means for the
child to express their feelings
- accommodate imagination at the same time present reality

3. Difficulty Sharing
- already have a concept that some things are theirs, some belong to others and some
can belong to both
- can stand in line to wait for their turn
- assure parents that sharing is a difficult concept to grasp and needs practice to
understand and learn it (Sutherland & Friedman, 2012)
- parents must teach property rights as part of learning to share

4. Regression
- in relation to stress, revert to behavior they previously outgrew
- help parents understand that regression is normal
- remove stress to discontinue this behavior

5. Sibling Rivalry
- jealousy may become evident because preschoolers have enough vocabulary to
express themselves and because they are more aware of family roles

Preparing for a New Sibling

- Introduction should be before the child begins to feel the difference the new baby will
make (mother first begins to look pregnant)
- Children can be sent to school before the baby is born to let them perceive it as part
of maturity
- Include them in the preparation for the upcoming baby

• Sex Education
- Give factual but simple answers to questions related to genitals
- Do not convey that these body parts are never to be talked about but rather leave an
open line of communication
- masturbation: explain that certain thins are done in some places but not in others
- Teach how to avoid sexual maltreatment: not allowing anyone to touch their body
unless they and their parents agree that it is alright (Perez-Fuentes, Olfson, Villegas, et
al, 2012)

• Broken Fluency: repeating words or syllables; repetition and prolongation of sounds, sylla-
bles and words (secondary stuttering)
- Do not discuss in the child’s presence that he/she is experiencing difficulty of speech
- Listen with patience rather than interrupting or asking the child to speak slowly or start
over
- Always talk to the child in a calm, simple way to role model slow speech
- Do not force a child to speak if she/ he does not want to
- Do not reward or punish a child for fluent or non fluent speech respectively
 PRESCHOOL

Play is associative
Regular dental care is essential
Elektra complex
Sibling rivalry
Castration and mutilation fears
Has Imaginary friends
Oedipus complex
Often asks questions
Listen with patience
(broken fluency)
 EXERCISE 11.1
NOT

PRESCHOOL
Play is associative
Regular dental care is essential
Elektra complex
Sibling rivalry
Castration and mutilation fears
Has Imaginary friends
Oedipus complex
Often asks questions
Listen with patience (broken fluency)

INSTRUCTION: Create your own learning abbreviation related to the concepts discussed about
the preschool stage, similar on the above presentation. You can make use of the same terminolo-
gy PRESCHOOL or other related terminologies. Just provide one learning abbreviation only.
 FEEDBACK
Let us look into how well you fared. If you answered all
questions correctly, congratulations! It shows that you are
already familiar with the topics discussed in lesson 12. If your
answers are quite not close to the discussion, you have some
ideas about the topics covered but need to learn more.
Now, you have a glimpse of the Wellness promotion and
injury prevention of a Preschool child. Read on and continue
exploring this topic.
Read further on your textbook pages _______ to _________
and on other Maternal and child health nursing references.

Quiz 12.1

Congratulations! You are done with Lesson 12. In order to see how much you have learned,
an online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your NDMU Academic Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 13 entitled Wellness promotion and Injury
prevention of a Preschooler.
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf