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Chapter 5: Health Promotion of Preschoolers (3 to 6 Years)

Unit 1: Foundations of Pediatric Nursing

Page 1

SECTION 1 | Perspectives of Pediatric Nursing

Chapter 5: Health Promotion of Preschoolers (3 to 6 Years)

Expected Growth and Development

Physical Development

Weight: Preschoolers should gain about 2 to 3 kg (4.5 to 6.5 lb) per year.
Height: Preschoolers should grow about 6.4 to 9 cm (2.5 to 3.5 in) per year.

Average height and weight by age

	3-YEAR-OLD	4-YEAR-OLD	5-YEAR-OLD
WEIGHT	14.5 kg (32 lb)	16.5 kg (36.5 lb)	18.5 kg (41 lb)
HEIGHT	95 cm (37.5 in)	103 cm (40.5 in)	110 cm (43.5 in)

Preschoolers’ bodies evolve away from the characteristically unsteady wide stances and protruding abdomen of the toddler, into a more graceful, erect posture, and physical stance.

Developmental Skills

Preschoolers should show improvement in fine motor skills, which will be displayed by activities like copying figures on paper and dressing independently.

	Motor (fine and gross)	Cognitive	Language	Social	Client Education
3 years	Strings beads or other items together Puts on some clothes independently Uses a fork Rides a tricycle Stands on one foot for a few seconds Jumps off a bottom step	Returns demonstration of the drawing of a circle Avoids touching hot objects after receiving a warning Builds a tower with 9-10 blocks	Combines 3-4 words to create simple sentence Talks in conversation with others using back-and-forth exchanges Says first name after being asked	Calms down within 10 minutes after being left in the care of others Notices other children and joins them in play	Encourage child to play with others Give child healthy and simple food choices Teach child opposites, counting numbers Play matching games with child Encourage child to say their name and age Limit screen time to less than 1 hour per day under supervision, if desired
4 years	Catches a large ball Serves themselves food or pours their drinking liquids, with supervision Unbuttons some buttons Holds crayon or pencil between fingers and thumb	Names a few colors Tells what comes next in a well-known story Draws a person with three or more body parts	Says simple sentences with four or more words Says some words from a song, story, or nursery rhyme Talks about at least one thing that happened during their day, like “I played soccer.” Answers simple questions like “What is a coat for?” or “What is a crayon for?”	Pretends to be something else during play Inquiries about playing with other children Comforts others who are hurt or sad Likes to assist others Changes behavior based on their location (library, grocery store)	Reinforce positive behaviors in a positive manner Allow child to play with others Provide calm, quiet environment during bedtime Provide response when child ask questions Allow child to help with simple chores Encourage the counting items
5 years	Buttons some buttons Hops/skips on one foot Throws a ball overhead Laces shoes	Counts to 10 Identifies some numbers between 1 and 5 and letters when pointed to Uses words about time Pays attention for 5 to 10 minutes during activities. Writes some letters of their name	Tells a story with at least two events Uses or identifies simple rhymes Answers simple questions about a book or story Keeps a conversation going with more than three back-and-forth exchanges	Follows rules or takes turns when playing with other children Sings, dances, or acts in front of others Performs simple chores at home	Teach child about safe touching Allow child to perform tasks independently Use words to assist child with understanding of time Allow time for active play daily Allow for creative play time
Information adopted from the Centers for Disease Control and Prevention, CDC’s Developmental Milestones 2022 Update

A nurse is performing a developmental screening on a preschooler. Sort the following findings by the nurse into the correct motor skills category?

A nurse is performing a developmental screening on a 3-year-old child. Which of the following gross motor skills should the nurse expect the child to perform?

Cognitive Development QEBP

Piaget: preoperational phase
The preconceptual thought transitions to the phase of intuitive thought around the age of 4 years. The phase of intuitive thought lasts until the age of 7 years.

The preschooler moves from totally egocentric thoughts to social awareness and the ability to consider the viewpoints of others.
Preschoolers make judgments based on visual appearances. Variations in thinking during this age include:
- Magical thinking: Thoughts are all powerful and can cause events to occur.
- Animism: Ascribing lifelike qualities to inanimate objects.
- Centration: Focus on one aspect instead of considering all possible alternatives.
- Time: Preschoolers begin to understand the sequence of daily events. Time is best explained to them in relation to an event. By the end of the preschool years, children have a better comprehension of time-oriented words.

Language development

The vocabulary of preschoolers increases to more than 2,100 words by the end of the fifth year.
Preschoolers speak in sentences of three to four words at the ages of 3 and 4 years, and four to five words at the age of 4 to 5 years.
This age group enjoys talking, and language becomes their primary method of communication.
Names familiar objects, body parts, animals and family members. Imitates new words proficiently.

Psychosocial Development QEBP

Erikson: initiative vs. guilt

Preschoolers become energetic learners, despite not having all the physical abilities necessary to be successful at everything.
Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task.
Guiding preschoolers to attempt activities within their capabilities while setting limits is important.

Kohlberg: moral development

Preschoolers at 2 to 4 years old have a basic understanding of moral judgment, and actions are taken based on whether it will result in a reward or punishment.
Preschoolers at 4 to 6 years old primarily take actions based on satisfying personal needs yet understand the concepts of justice and fairness.

Body-image changes

Preschoolers begin to recognize differences in appearances and identify what is considered acceptable and unacceptable.
By the age of 5 years, preschoolers begin comparing themselves with peers.
Poor understanding of anatomy makes intrusive experiences (injections or cuts) frightening to preschoolers. Therefore, preschoolers believe it is important to use bandages after an injury.

Social development

Preschoolers generally do not exhibit stranger anxiety and have less separation anxiety.
Changes in daily routine are tolerated, but they can develop more imaginary fears.
Prolonged separation (during hospitalization) can provoke anxiety. Favorite toys and appropriate play should be used to help ease preschoolers’ fears.
Pretend play is healthy and allows preschoolers to determine the difference between reality and fantasy.

Age-Appropriate Activities QEBP

Parallel play shifts to associative play during the preschool years. Play is not highly organized, but cooperation does exist between children. Appropriate activities include:

Playing ball
Putting puzzles together
Riding tricycles
Playing pretend and dress-up activities
Role playing
Hand puppets
Painting
Simple sewing
Reading books
Wading pools
Sand boxes
Skating
Computer programs
Musical toys
Electronic games

Health Promotion

Immunizations

The Centers for Disease Control and Prevention (CDC) immunization recommendations for healthy preschoolers 3 to 6 years of age include: QEBP
4 to 6 Years: Diphtheria and tetanus toxoids and pertussis (DTaP); measles, mumps, and rubella (MMR); varicella; and inactivated poliovirus (IPV)
3 to 6 Years: Yearly seasonal influenza vaccine; inactivated influenza vaccine; or live, attenuated influenza vaccine by nasal spray
Follow the current CDC recommendations for administration of the COVID-19 vaccine to children 3 to 6 years of age.

A nurse is conducting a well-child visit with a 5-year-old child. Which of the following immunizations should the nurse plan to administer?

(Select all that apply.)

Nutrition

Preschoolers who are mildly active require an estimated caloric intake range from 1200 to 1400 kcal/day.
Finicky eating can remain a behavior in preschoolers, but often by 5 years of age they become more willing to sample different foods.
Preschoolers need 13 to 19 g/day of protein (2- to 4-oz equivalents), in addition to 700 to 1000 mg/day of calcium and19 to 25 g/fay of fiber.
Total fat should be 30% of total caloric intake over several days.
With obesity rates in young children increasing, the American Academy of Pediatrics recommends a 5-2-1-0 framework, which includes that preschoolers have 5 servings of fruits and vegetables per day, 2 hr or less of screen time, 0 servings of sugar-sweetened beverages, and 1 hr of physical activity per day. SDOH
Parents should follow the American Academy of Pediatrics’ healthy diet recommendations.

A nurse is preparing an education program for a group of caregivers of preschool-age children about promoting optimum nutrition. Which of the following information should the nurse include in the teaching?

Sleep and Rest

On average, preschoolers need about 12 hr of sleep per day, and infrequently take daytime naps.
Sleep disturbances frequently occur during early childhood, and problems range from difficulty going to bed to night terrors. Recommended interventions vary but can include the following.
- Keep a consistent bedtime routine.
- Use a night light in the room.
- Provide the child with a favorite toy.
- Leave a drink of water by the bed.
- Reassure preschoolers who are frightened but discourage sleeping with parents.
- Ignore attention-seeking behaviors.

A nurse is providing teaching to the caregiver of a preschool-age child about methods to promote sleep. Which of the following statements by the caregiver should the nurse identify as indicating an understanding of the teaching?

Dental health

Eruption of deciduous (primary) teeth is finalized by the beginning of the preschool years.
To prevent dental caries, parents should assist and supervise brushing and flossing to ensure it is performed correctly.
Trauma to teeth is common in preschoolers and should be immediately evaluated by a dentist.

Injury Prevention QS

Bodily harm

Firearms should be kept in locked cabinets or containers.
Preschoolers should be taught stranger safety.
Preschoolers should be taught to wear protective equipment (helmet, pads).
Preschoolers are less prone to falls due to improved fine and gross motor skills, coordination, and balance.

Burns

Hot water thermostats should be set at or below 49° C (120° F).
Working smoke detectors should be kept in the home.
Preschoolers should have sunscreen applied when outside.

Drowning

Preschoolers should not be left unattended in bathtubs.
Preschoolers should be closely supervised when near the pool or any other body of water.
Preschoolers should be taught to swim.

Motor-vehicle injuries

Preschoolers should use a federally approved car restraint according to the manufacturer recommendations.
When the forward-facing car seat is outgrown, the preschooler transitions to a booster seat.
It is recommended that children use an approved car restraint system until they achieve a height of 145 cm (4 feet, 9 in) or 8 to 12 years old.
Safest area for children is the backseat of the car.
Supervise preschool-age children when playing outside, and do not allow them to play near a curb or parked cars.
Teach pedestrian safety rules to preschool-age children.
- Stand back from curb while waiting to cross the street.
- Before crossing the street, look left, then right, then left again.
- Travel on the left, facing traffic, when there are no sidewalks.
- At night, wear light-colored clothing with fluorescent materials attached.

Active Learning Scenario

A nurse is providing anticipatory guidance to the parents of a preschool-age child. Use the ATI Active Learning Template: Growth and Development to complete this item.

Physical Development: Identify general expectations for height and weight during the preschool years.

Cognitive Development: List two concepts related to language development in preschool-age children.

Age-Appropriate Activities: List five activities appropriate for preschool-age children.

Injury Prevention: Identify two pedestrian safety rules parents should teach children.

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