Chapter 27

Chapter 27: Growth and Development of the Preschooler

Physical Growth

• Average growth is 2-3 inches per year, and they gain 4-5 pounds per year.

• A 3-year-old is approximately 37 inches tall.

• A 4-year-old is approximately 40-41 inches tall.

• A 5-year-old is approximately 43 inches tall, weighing around 41 pounds.

• They lose baby fat, gain muscle, the skull elongates, and the lower jaw becomes more pronounced. The upper jaw widens to prepare for permanent teeth.

Physiologic Changes

Growth in Other Systems

• Most body systems have matured:

  • Neurologic:

    • Myelination of the spinal cord allows for bowel and bladder control by age 3.

  • Respiratory:

    • Continues to grow in size and number of alveoli until age 7.

    • Eustachian tubes remain short and straight.

  • Cardiovascular:

    • Heart rate decreases, blood pressure slightly increases.

    • An innocent heart murmur and splitting of the second heart sound (S2) may occur, a normal finding when the aortic and pulmonary valves close at different times.

  • Musculoskeletal:

    • Should have 20 deciduous teeth present.

    • Bones continue to increase in length.

    • Muscles continue to strengthen and mature.

    • Stool is not fully mature, making them susceptible to injury.

  • Gastrointestinal & Genitourinary:

    • Small intestine continues to grow in length.

    • Stool passage occurs 1-2 times daily.

    • A 4-year-old generally has good bowel control.

    • Urethra remains short in both males and females, increasing the chances of UTI.

    • Bladder control is typically achieved by ages 4-5, though accidents may still occur.

Motor Skills

Gross Motor Skills:

• Agile while running, jumping, standing, and walking.

• Can go up and down stairs, walk forward and backward.

• Stand on tiptoes or one foot, and are in constant motion at age 3.

Fine Motor Skills:

• Can move each finger independently.

• Grasp utensils and crayons like an adult.

• By age 5, can scribble, trace shapes, feed themselves, write letters, cut with scissors, and tie shoes.

Cognitive Development

• Erickson: Initiative vs. Guilt (Age 3-6).

• Piaget:

  • Preoperational/Preconceptual (Age 2-4).

  • Preoperational/Intuitive (Age 4-7).

• Kohlberg: Punishment-Obedience Orientation (Age 2-7).

• Freud: Phallic Stage (Age 3-7).

Definitions:

• Preoperational Thought (Piaget): Dominates toddler stage and preschool stage. Based on a self-centered understanding of the world. The child remains egocentric, approaches problems from a single point of view, may understand the concept of counting, and engages in fantasy play.

• Magical Thought: The preschooler believes their thoughts are "all-powerful," allowing them to create room in their world for the actual or the real. This thinking helps satisfy curiosity about differences in the world around them.

• Imaginary Friend: A not real but existing character in the child’s mind. This “friend” is a creative way for the preschooler to sample different activities and behaviors and practice conversation.

Cognitive Development Continued

• Transduction: Converting something into inanimate objects. Preschoolers relate one situation to another even though the situations may not be similar.

• Animism: Preschoolers attribute life-like qualities to inanimate objects.

• Vocabulary explosion occurs during this age, but they do not understand that death is permanent.

Emotional and Social Development

• By age 5, social skills such as cooperation, sharing, kindness, generosity, affection display, conversation, expression of feelings, helping others, and making friends are present.

• They experience strong emotions—happy one moment, devastated/angry the next—and can name feelings.

• They have vivid imaginations and a growing sense of identity, along with the ability to use self-control. They need roles and boundaries.

• Friendships: They desire interactions with friends and may want to follow rules to please them. Disagreements may occur, but they can resolve them.

Temperament

• By age 3, they recognize that their actions matter; it is vital for parents to understand the child's temperament to better handle them.

Fears

• Due to vivid imaginations, they have many fears, including loud noises, sirens, barking dogs, and strangers such as Santa or clowns. They are often afraid of the dark and doctors.

Communication Skills

• A 3-year-old demonstrates telegraphic speech—using short sentences that contain essential words.

• Two-word explosion during preschool years: 2-year-olds have 50-100 words, while by age 5, 2000 words are used.

• By the end of preschool, children are using more appropriate sentences but may still struggle with some sounds, typically mastering them by age 6. Communication is concrete; they do not have abstract thinking.

Promoting Healthy Growth and Development

• Help build self-esteem; Erickson’s psychosocial task emphasizes establishing a sense of initiative vs. guilt. Building self-esteem during this stage is essential to avoid guilt and low self-esteem, which most kids gain from a loving nurturing environment.

• Preschoolers need routine rituals for a sense of time and to develop a conscience. Routine also makes children feel safe and secure.

• Making expectations known through everyday routines helps avoid confrontations.

Promoting Growth and Development through Play

• Providing sincere encouragement helps develop a sense of initiative.

• Giving small choice options also aids development.

• Preschoolers enjoy creating, drawing, coloring, and keeping collections.

• They love to use toys for their intended purpose as well as for imaginative purposes.

• Cooperative play with friends begins during this stage, and make-believe play is significant.

• Television use should be limited to encourage imaginative play.

Safety in the Home

• Maintain the same safety measures as with toddlers.

Promoting Healthy Eating and Nutrition

• Preschoolers have a full set of primary teeth and can use utensils effectively to feed themselves. They need to continue learning healthy eating habits that will continue through childhood into adolescence.

Daily Nutritional Requirements

• Preschoolers need:

  • 1000 mg of calcium per day.

  • 10 mg of iron.

  • 19g of fiber.

  • Total fat: 25% to 35% of daily calories, with saturated fats less than 10%.

  • Diets high in nutrient-rich foods.

  • Regulated meals with healthy snacks between meals.

Building Healthy Eating Habits

• Use smaller-sized plates and bowls with appropriately sized utensils.

• Encourage the child to serve themselves and to decide when to stop eating; do not force food.

• Snacks should be high in quality, including lean proteins, whole grains, fruits, vegetables, and dairy. Family mealtimes allow parents to model appropriate behaviors at meals and facilitate communication.

Promoting Healthy Sleep and Rest

• Preschoolers need 10-13 hours of sleep.

• Most will require assistance going to bed. Bedtime rituals continue to be important, so have a time for relaxation and decrease stimulation before bed.

• Many children are scared at night and need a security item or night light. Nightmares can occur in preschoolers, often being interactive following them. Validate fears and provide comfort.

• Night terrors usually happen shortly after falling asleep, where the child appears awake but screams, usually not responding to parents. They will eventually stop screaming and go back to sleep.

Lying

• Lying is common in preschoolers; this may occur because the child fears punishment. Less punishment should be used if the child admits to the lie.