Study Notes on Developmental Stages: Preschoolers, School-Aged Children, and Adolescents
Preschoolers (ages 3 to 6 years old)
Development
- Physical Development
- Gaining approximately 4.5 pounds and growing about 3 inches per year.
- Gross Motor Skills
- Skills such as running, jumping, and throwing become more refined during preschool years.
- Fine Motor Skills
- Preschoolers learn to use safety scissors, draw shapes, and dress themselves.
- Psychosocial Development
- Development of a sense of individuality while considering others' thoughts and feelings outside immediate family.
- Frequent questioning, primarily the question “why,” helps with understanding and exploring their world.
- Use of words and symbols to represent objects and people facilitates connections and enhances thinking ability.
- Cognitive Theories
- Piaget
- Preoperational stage characterized by egocentrism and magical thinking.
- Nurses should utilize play to assist children in coping with illness or hospitalization.
- Erikson
- Stage of initiative vs. guilt; nurses can support initiative by allowing children to make choices and participate in their own care.
- Social Development
- Language Development
- Preschoolers can articulate sentences containing more than four words.
- Language comprehension is very literal.Play
- Used to reduce child anxiety related to medical procedures and equipment.
- Types of Play:
- Parallel Play: Playing next to another child without interaction.
- Associative Play: Playing with another child, sharing or interacting in their play.Possible Concerns for the Preschool-Aged Child
- Speech Delays
- Early intervention is crucial.
- Aggression
- Work on emotional regulation with the child.
- Discipline
- Timeouts can be effective, followed by discussions about the incident and improvements.
- Body Image
- Positive communication is important; opportunities for discussion should be created.
- Sexuality
- Curiosity about bodies and differences is normal.
- Preschool/Kindergarten Readiness
- Children develop many cognitive, language, and social skills preparing them for kindergarten.Health Promotion and Prevention of Disease/Injury
- Car Seat Safety
- Transition to a forward-facing car seat or booster seat as appropriate.
- Poisoning
- Main cause is improper storage of household chemicals or medications.
- Nurses should educate on safe storage—keeping medicines out of reach and using child-proof containers.
- Ensuring parents know how to contact the Poison Control Center is essential.
- Water Safety
- Supervision and barriers like pool fences are essential to preventing drowning.
- Caregivers should learn CPR and ensure safety equipment like life jackets are available.
- Trampoline Safety
- Ensure trampolines have netting and padding to reduce injury risks.
- Bicycle Safety
- Wearing helmets significantly reduces the risk of head and face injuries.
- Parents must model helmet use and teach safe riding practices.
- Health Promotion/Disease Prevention
- Vaccinations
- Recommended immunizations for ages 4-6 include:
- DTAP (Diphtheria, Tetanus, Pertussis)
- IPV (Inactivated Polio Vaccine)
- MMRV (Measles, Mumps, Rubella, Varicella)
- Annual Influenza
- Nursing approaches for immunization coping:
- Use distraction, offer rewards, or apply buzzy or cold spray.
- Dental Care
- Visits to the dentist should occur every six months.
- Teeth brushing twice per day and flossing once a day with parental help.
- Nutrition
- Encourage a variety of food groups for healthy eating habits.
- Sleep
- Preschoolers should receive approximately 12 hours of sleep daily with established sleep routines aiding emotional regulation, school performance, independence, and adaptability.
- Physical Activity
- Minimum recommendation of 180 minutes of physical activity daily, with enjoyment found in family activities.
School-Aged Children (ages 6 to 12 years old)
Development
- Physical Development
- School-aged children grow about 2 to 2.5 inches and gain 4 to 7 pounds annually.
- They begin losing baby teeth and acquiring permanent teeth; awareness of bodies and onset of puberty occurs.
- Motor Skill Development
- Gross Motor:
- Capable of running and jumping rope, enjoying physical activity and team sports.
- Fine Motor:
- Learning to tie shoes, dress, and groom, refining skills such as writing, drawing, and painting.
- Psychosocial Development
- Value peer opinions significantly, desiring acceptance and to fit in.
- Enjoyment of school attendance.
- Erikson’s Stage: Industry vs. Inferiority; school-aged children find satisfaction in tasks and excel academically.
- Nursing consideration: Involve children in their care and tasks suited to their abilities.
- Development of body image awareness and self-esteem; nurses should educate on promoting positive self-esteem.
- Sexual identity: Development occurs between ages 10 to 17; encourage open, honest communication.
- Stress Levels:
- Increased pressure to fit in, peer pressure, and academic success create stress.
- May not recognize stress; it may express itself physically.
- Signs of Stress:
- Physical: rapid breathing, increased heart rate, muscle tension, gastrointestinal issues, headaches.
- Behavioral: anxiety, new fears, clinginess, anger, emotional instability, regression, avoidance of activities.
- Behavioral changes also include alterations in eating habits, sleep disturbances, nightmares, and somatic complaints.
- Language Development
- Most children start reading by age 5 and read independently by ages 10 to 12; enjoy conversing with others.
- Play
- Participate in group activities or games with structured rules; their active nature encourages participation.Safety Promotion and Injury Prevention
- Bicycle Safety
- Bright-colored clothing during the day and reflective clothing at night recommended.
- Bus/Car Safety
- Waiting for the bus driver’s signal before boarding or crossing, never walking behind a bus/car, and remaining seated until instructed by the driver are crucial rules.
- Wearing seat belts must be emphasized; do not unbuckle until the vehicle is turned off.
- Social Media and Internet Use
- Education on online safety, limiting information sharing, and the importance of reducing screen time.
- Firearms
- Discuss with parents safe storage practices for firearms; ensure they are unloaded and stored separately from ammunition, locked.
- Parents should verify safety regarding firearms at friends' homes.
- Discuss differences between firearms in digital media and real-life dangers.
- Physical Activity
- Daily requirement of 60 minutes of physical activity for school-aged children.
- Sleep Needs
- 9 to 12 hours of sleep recommended per night; consistent routines and conducive environments aid rest.
- Nutrition
- Caloric needs range from 1,200 to 2,600 calories daily, contingent on age, sex, and activity level; promote a varied diet with fruits, vegetables, and lean proteins while limiting sugar and fats.
Adolescents (ages 12 to 20 years old)
Development
- Physical Development
- Experience growth spurts with the emergence of secondary sex characteristics; nurses support adolescents during these changes through open, honest communication.
- Continued refinement of both gross and fine motor skills occurs.
- Psychosocial Development
- Adolescents navigate Erikson’s stage of identity vs. role confusion, focusing on developing their identity.
- Nursing actions: Foster positive identity formation by guiding in finding healthy peer groups.
- Promotion of problem-solving, reading, and writing skills enhances cognitive and language development.
- Encourage participation in sports or clubs to mitigate social isolation.
- Developmental Considerations
- Self-esteem
- Influenced by peer and family relationships, physical appearance, and social norms; nurses should employ therapeutic communication and engage adolescents actively in their care.
- Sexuality
- Provide sex education and a safe atmosphere for discussion.
- High-Risk Behaviors
- Substance use, unprotected sex, and reckless driving may occur; education on consequences and promotion of safe alternatives is essential.
- Acne Management
- Treatment may include topical agents, oral antibiotics, hormonal treatments, or oral contraceptives depending on severity; nurses should emphasize adherence to treatment plans and recognize barriers to compliance.
- Acne can adversely affect self-esteem and lead to social isolation due to visibility.Health Promotion and Disease Prevention
- Safety Promotion and Injury Prevention
- Educate on safe driving practices and the significance of protective gear in sports.
- Health Promotion and Disease Prevention
- Vaccinations:
- HPV vaccine (recommended at ages 11-12, can start from age 9, administered in 2 or 3 doses depending on timing).
- Meningococcal vaccine (recommended at ages 11-12 and again at 16).
- Screenings for STIs and mental health issues are recommended.
- Nutrition
- Adolescents require balanced diets rich in protein, calcium, and essential nutrients due to growth.
- Sleep
- Discuss the importance of healthy sleep habits, such as limiting technology usage before bedtime.
- Recognize challenges to achieving adequate sleep created by academic, extracurricular, and social schedules.
- Activity
- Continuous engagement in physical exercise is critical; usable technology should not hinder physical activity participation.