MATERNAL AND CHILD NURSING

COLEGIO DE DAGUPAN
Arellano St. Dagupan City
COLLEGE OF NURSING

PEDIATRIC NURSING

THE PRESCHOOLER

Growth and Development

Developmental Timetable:

A. 3 years
1. Physical
 Usual weight gain 1.8 to 2.7 kg (4 – 6 lbs)
 Average weight of 14. 6 kg (32 lbs)
 Usual height gain 7.5 cm (3 inches)
 Average height of 95 cm (37.5 in)
 May have achieved night-time control of bowel and bladder
2. Gross Motor
 Rides tricycle
 Jumps off bottom step
 Stands on one foot for a few seconds
 Goes up stairs using alternate feet; may still come down using both
feet on step
 Broad jumps
 May try to dance, but balance may not be adequate
2. Fine Motor
 Builds tower of 9 to 10 blocks
 Builds bridge with 3 cubes
 Adeptly places small pellets in narrow-necked bottle
 In drawing, copies a circle imitate, imitates a cross, names what has
been drawn, cannot draw stick figure but may make circle with
facial features
3. Sensory: visual acuity of 20/30
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4. Vocalization and socialization:

 Vocabulary of about 900 words; uses three-four word sentences
 Uses primarily “telegraphic” speech
 Uses complete sentences of three or four words
 Talks incessantly regardless of whether anyone is paying attention
 Repeats sentence of six syllables
 Asks many questions
 May have normal hesitation in speech pattern
 Uses plurals
 Begins to understand ideas of sharing and taking turns
 Dresses self almost completely if helped with back buttons and told
which shoe is right or left
 Pulls on shoes
 Has increased attention span
 Feeds self completely
 Can prepare simple meals, such as cold cereal and milk
 Can help to set table; can dry dishes without breaking any
 May have fears, especially of dark and going to bed
 Knows own gender and gender of others
 Play is parallel and associative; begins to learn simple games, but
often follows own rules; begins to share
5. Mental abilities
 Beginning understanding of the past, present, future, or any aspect of
time
 Stage of magical thinking
 Is in the preconceptual phase
 Is egocentric in thought or behavior
 Has improved concept of space, as demonstrated by understanding
of prepositions and ability to follow directional command
6. Family Relationships
 Attempts to please parents and conform to their expectations
 Is less jealous of younger siblings; may be opportune time for birth
of additional sibling
 Is aware of family relationships and sex-role functions

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 Boys tend to identify more with father or male figure

 Has increased ability to separate self easily and comfortably from
parents for short periods
B. 4 years
1. Physical
 Height and weight increases are similar to previous year
 Pulse and respiration rates decrease slightly
2. Gross Motor
 Skips and hops on one foot
 Walks up and down stairs like an adult
 Throws ball overhand
3. Fine Motor
 Uses scissors successfully to cut out picture following outline
 Can lace shoes but may not be able to tie bow
 In drawing copies a square, traces a cross and diamond, adds three
parts to stick figure
4. Vocalization and socialization
 Vocabulary of 1500 words or more
 Uses sentences of four or five words
 Questioning is at peak
 Knows simple songs
 May have an imaginary companion
 Tends to be selfish and impatient, but takes pride in
accomplishments
 Exaggerates, boasts, and tattles on others
 May be mildly profane if associates with older children
 Obeys four prepositional phrases, such as “under”, “on top of”,
“beside”, “in back of”, “in front of”.
 Names one or more colors
 Comprehends analogies, such as “if ice is cold, fire is ________”.
 Very independent
 Tends to be selfish and impatient
 Aggressive physically as well as verbally
 Takes pride in accomplishment

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 Has mood swings

 Shows off dramatically, enjoys entertaining others
 Tells family tales to others with no restraint
 Still has many fears
 Play is associative
 Uses dramatic, imaginative, and imitative devices
 Sexual exploration and curiosity demonstrated through play, such as
being “doctor” and “nurse”
5. Mental abilities
 In phase of intuitive thought
 Understands time better, especially in terms of sequence of daily
events
 Unable to conserve matter
 Can repeat four numbers and is learning number concept
 Knows which is the longer between two lines
 Has poor space perception
 Judging everything according to one dimension, such as height,
width, or order
 Is beginning to develop less egocentrism and more social awareness
 May count correctly but has poor mathematical concept of numbers
 Obeys because parents have set limits, not because of understanding
of right or wrong
6. Family Relationships
 Rebels if parents expect too much, such as impeccable table manners
 Takes aggression and frustration out on parents or siblings
 Do’s and don’ts become important
 May have rivalry with older or younger siblings; may resent older
siblings privileges and younger sibling’s invasion of privacy and
possessions
 Identifies strongly with parent of opposite sex
 Is able to run simple errands outside the home
C. 5 years
1. Physical
 Height and weight increases are similar to previous year

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 Pulse and respiratory rates decrease slightly

 Eruption of permanent dentition may begin
 Handedness is established (about 90% are right handed)
2. Gross Motor
 Gross motor abilities are well developed
 Can balance on one foot for about 10 seconds
 Skips and hops on alternate feet
 Throws and catches ball well
 Can jump rope and roller skate
 Walks backward with heel to toe
 Jumps from height of 12 inches and lands on toes
 Balances on alternate feet with eyes closed

3. Fine Motor
 Can draw a picture of a person
 Prints first name and other words as learned
 May be able to tie shoelaces
 Uses scissors, simple tools, or pencil very well
 In drawing, copies a diamond or triangle; adds seven to nine parts to
stick figure; prints a few letters, numbers, or words such as the first
name
4. Sensory
 Minimal potential for amblyopia to develop
 Color recognition is well established
5. Vocalization and socialization
 Vocabulary of about 2100 words
 Uses sentences of six to eight words, with all parts of speech
 Names coins
 Names four or more colors
 Describes drawing or pictures with much comment or enumeration
 Knows names of days of week, months, and other time associated
words

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 Knows composition of articles, such as “A shoe is made of

_______”
 Can follow three commands in succession
 Talks constantly
 Asks meaning of new words
 Generally cooperative and sympathetic toward others
 Basic personality structure is well established
 Less rebellious and quarrelsome than age 4 years
 More settled and eager to get down to business
 Not as open and accessible in thoughts and behavior as in earlier
years
 Independent but trustworthy, not foolhardy; more responsible
 Has fewer fears; relies on outer authority to control world
 Eager to do things right and to please; tries to live “by the rules”
 Has better manners
 Cares for self totally, occasionally needing supervision in dress and
hygiene
 Not ready for concentrated close work or small print because of
slight farsightedness and still unrefined eye-hand coordination
 Play is associative; tries to follow rules but may cheat to avoid
losing
6. Mental abilities
 Beginning understanding of time in terms of days as part of a week
 Beginning understanding of conversation of numbers
 Has not mastered the concept that parts equal a whole regardless of
their appearance
 Begins to question what parents think by comparing them with age-
mates and other adults
 May notice prejudice and bias in outside world
 Is more able to view other’s perspective, but tolerates differences
rather than understanding them
 Use time oriented words with increased understanding
 Very cautious about factual information regarding world
7. Family relationships
 Gets along well with parents
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 May seek out parent more often than at age 4 years for reassurance
and security, especially when entering school
 Begins to question parents’ thinking and principles
 Strongly identifies with parent of same sex, especially with their
fathers
 Enjoys activities such as sports, cooking and shopping with parent of
same sex

Play during Preschool Years (Cooperative play)

A. Loosely organized group play where membership changes readily, as do rules.

B. Through play, the child deals with reality, learns control of feelings, and expresses
emotions more through words than through actions.
C. Play is still physically oriented but is also imitative and imaginary.
D. Increasing sharing and cooperation among preschool children, especially 5-year-
old children.
E. Suggested toys:
1. Puppets
2. Additional dress-up clothes, dolls, house, furniture, small trucks, animals,
etc.
3. Painting sets, coloring books, paste, and cut-out sets.
4. Illustrated books
5. Puzzles with large pieces and more shapes.
6. Tricycle, swing, slide, and other playground equipment.

Common Safety Measures to Prevent Accidents in the Preschool Years

Possible Accident Prevention Measures
Motor Vehicular Teach safety with tricycle (look before crossing drive ways; do
not cross the street)
Teach child to always hold hands with grownup, before crossing
the street
Teach parking lot safety (hold hands with a grownup, do not run
behind cars that are backing up)
Children should wear helmets when riding bicycles
Falls Supervise preschooler at playgrounds
Remove drawstrings from hooded clothing
Help child to judge safe distances for jumping or safe heights for
climbing
Drowning Teach beginning swimming

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Animal bites Do not allow child to approach strange dogs

Supervise child’s play with family pets
Poisoning Never present medication as candy
Never take medication in front of child
Never store food or substances in containers other than their own
Post telephone number of local poison control center by the
telephone
Teach child that medication is a serious substance and not for play
Burns Store matches in closed containers
Do not allow preschooler to help light birthday candles,
fireplaces, etc (fire is not fun or “treat”)
Community safety Teach preschooler that not all people are friends (“Do not talk to
strangers or take candy from strangers”)
Define stranger as someone a child does not know, not someone
odd-looking
Teach a child to say “no” to people whose touching she does not
enjoy, including family members (when the child is sexually
abused, the offender is usually the family member or close family
friend)
General Know whereabouts of preschooler at all times
Be aware that frequency of accidents is increased 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 accidents than others.

HEALTH PROBLEMS MOST COMMON IN PRESCHOOLERS

Hospitalization

A. Reaction of the child

1. Fears about body image are now greater than fear of separation
2. The fears include:
a. Intrusive experiences: needles, thermometer, otoscope
b. Punishment and rejection
c. Pain
d. Castration and mutilation
B. If possible, parents can be helped to prepare the child beforehand, since increased
cognitive and verbal ability makes explanations possible.

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SCHOOL-AGED CHILDREN

GROWTH AND DEVELOPMENT

Developmental Timetable:

1. 6 Years
a. Physical and motor
 Height and weight gain continues slowly
 Weight: 16-23.6 kg (35.5-58 lbs); height: 106.6-123.5 cm (42 to 48
cm)
 Central mandibular incisors erupt
 Loses first tooth
 Gradual increase in dexterity
 Active age; constant activity
 Often returns to finger feeding
 More aware of hand as a tool
 Likes to draw, print, or color
 Vision reaches maturity
b. Mental
 Develops concept of numbers
 Can count 13 coins
 Knows whether it is morning or afternoon
 Defines common objects such as fork and chair in terms of their use
 Obeys triple commands in succession
 Knows right and left hands
 Says which is pretty and which is ugly of a series of drawings or
faces
 Describes the objects in a picture rather than simply enumerating
them
 Attends first grade
c. Adaptive
 At table, uses knife to spread butter or jam on bread
 At play, cuts, folds, pastes paper toys; sews crudely if needle is
threaded
 Takes bath without supervision; performs bedtime activities alone

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 Reads from memory; enjoy oral spelling game

 Likes table games, checkers, or simple card games
 Giggles a lot
 Sometimes steals money or attractive items
 Has difficulty owning up to misdeeds
 Tries out own abilities
d. Personal-social
 Can share and cooperate better
 Has great need for children of own age
 Will cheat to win
 Often engages in rough play
 Often jealous of younger brother or sister
 Does what adults are seen doing
 May have occasional temper tantrums
 Is a boaster
 Is more independent, probably influence of school
 Has own way of doing things
 Increases socialization
2. 7 Years Old
a. Physical and motor
 Begins to grow at least 5 cm (2 in) in height per year
 Weight: 17.7-30 kg (39-66.5 lbs); height: 111.8-129.7 cm (44-51
lbs)
 Maxillary central incisors and lateral mandibular incisors erupt
 More cautious in approaches to new performances
 Repeats performances to master them
 Jaw begins to expand to accommodate permanent teeth
b. Mental
 Notices that certain items are missing from pictures
 Can copy a diamond
 Repeats three numbers backwards
 Develops concept of time; reads ordinary clock or watch correctly to
nearest quarter hour; uses clock for practical purposes
 Attends second grade

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 More mechanical in reading; often does not stop at the end of a

sentence, skips word such as “it”, “the”, and “he”
c. Adaptive
 Uses table knife for cutting meat; may need help with tough or
difficult pieces
 Brushes and combs hair acceptably without help
 May steal
 Likes to help and have a choice
 Is less resistant and stubborn
d. Personal-social
 Is becoming a real member of a family group
 Takes part in group play
 Boys prefer playing with boys; girls prefer playing with girls
 Spends a lot of time alone, does not require a lot of companionship
3. 8-9 Years Old
a. Physical and Motor
 Continues to gain 5 cm (2 inches) in height per year
 Weight: 19.6-39.6 kg (43-87 lbs); height: 117-141.8 cm (46-56 in)
 Lateral incisors (maxillary) and mandibular cuspids erupt
 Movement fluid; often graceful and poised
 Always on the go: jumps, chases, and skips
 Increased smoothness and speed in fine motor control; uses cursive
writing
 Dresses self completely
 Likely to overdo; hard to quiet down after recess
 More limber; bones grow faster than ligaments
b. Mental
 Gives similarities and differences between two things from memory
 Counts backward from 20 to1; understands concept of reversilbility
 Repeats days of the week and months in order; knows the date
 Describes common objects in detail, not merely their use
 Makes change out of a quarter
 Attends third and fourth grades
 Reads more; may plan to wake up early just to read

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 Reads classic books, but also enjoys comics

 More aware of time; can be relied on to get to school on time
 Can grasp concepts of parts and whole (fractions)
 Understands concepts of space, cause and effect, nesting (puzzles),
conservation (permanence of mass and volume)
 Classifies objects by more than one quality; has collections
 Produces simple paintings or drawings
c. Adaptive
 Makes use of common tools such as hammer, saw, screwdriver
 Uses household and sewing utensils
 Helps with routine household tasks such as dusting, sweeping
 Assumes responsibility for share of household chores
 Looks after all of own needs at table
 Buys useful articles; exercises some choice in making purchases
 Runs useful errands
 Likes pictorial magazines
 Likes school; wants to answer all the questions
 Is afraid of failing a grade; is ashamed of bad grades
 Is more critical of self
 Takes music and sport lessons
d. Personal-social
 Is easy to get along with at home
 Likes the reward system
 Dramatizes
 Is more sociable
 Is better behaved
 Is interested in boy-girl relationship but will not admit it
 Goes about home and community freely, alone or with friends
 Likes to compete and play games
 Shows preference in friends and groups
 Plays mostly with groups of own sex but is beginning to mix
 Develops modesty
 Compares self with others
 Enjoys organizations, clubs, and group sports

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4. 10-12 Years Old

a. Physical and Motor
 Boys: slow growth in height and rapid weight gain; may become
obese in this period
 Weight: 24.3-58 kg (54-128 lbs); height: 127.5-162.3 cm (50-64 in)
 Posture is more similar to an adult’s’ will overcome lordosis
 Girls: pubescent changes may begin to appear; body lines soften and
round out
 Remainder of teeth will erupt and tend toward full development
(except wisdom teeth)
b. Mental
 Writes brief stories
 Attends to fifth to seventh grade
 Writes occasional short letters to friends or relatives on own
initiative
 Uses telephone for telephone purposes
 Responds to magazine, radio, or other advertising
 Reads for practical information or own enjoyment-stories or library
books of adventure or romance, animal stories
c. Adaptive
 Makes useful articles or does easy repair work
 Cooks or sews in small way
 Raises pets
 Washes and dries own hair
 Is responsible for a thorough job of cleaning hair, but may need
reminding to do so
 Is sometimes left alone at home for an hour or so
 Is successful in looking after own needs or those of other children
left in his or her care
d. Personal-social
 Loves friends, talks about them constantly
 Chooses friends selectively, may have a “best friend”
 Enjoys conversation
 Develops beginning interest in the opposite sex
 Is more diplomatic

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 Likes family; family really has meaning

 Likes mother and wants to please her in many ways
 Demonstrates affection
 Likes father, who is admired and may be idolized
 Respects parents

Play during School-Aged Years

A. Play activities vary with age

B. Number of play activities decreases while the amount of time spent in one
particular activity increases
C. Likes game with rules because of increased mental abilities
D. Likes games of athletic competition because of increased motor abilities
E. Should learn how to work as well as play, with a beginning appreciation for
economics and finances
F. In beginning of school years, boys and girls play together but gradually separate
into sex-oriented type of activities
G. Suggested play for 6 – 9 years old:
1. More housekeeping toys that work, doll accessories, paper-doll sets, simple
sewing machines, and needlework
2. Simple work and number games
3. Physically active games such as hopscotch, jump rope, climbing trees
4. Collections and hobbies such as stamp collection and building simple
models
5. Bicycle riding

H. Suggested play for 9 -12 years olds

1. Handicrafts of all kind
2. Model kits, collections, hobbies
3. Archery, dart games, chess, jigsaw puzzles
4. Sculpturing materials such as pottery clay
5. Science toys, magic sets

Common Safety Measures to Prevent Accidents During the School Years

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Possible Accident Prevention Measures

Motor Vehicular Encourage children to use seat belts in a car; role model their use
Accidents Teach street-crossing safety; stress that streets are no place for
rough-housing, pushing, or shoving.
Teach bicycle safety, including advice not take “passengers” on a
bicycle and to use a helmet
Teach parking lot and school bus safety (do not walk in back of
parked cars, wait for crossing guard, etc)
Community Avoid unsafe areas, such as train yards, grain silos, back alleys.
Do not go with strangers (parents can establish a code word with
child, child does not leave school with anyone who does not know
the word)
Children should say “no” to anyone who touches them if they do
not wish it, including family member (most sexual abuse is by a
family member, not a stranger)
Burns Teach safety with candles, matches, campfires-fire is not fun.
Teach safety with beginning cooking skills (remember to include
microwave oven safety, such as closing firmly before turning an
oven; not using metal containers). Teach safety with sun
exposure-use sun block
Do not climb electric poles

Falls Teach that rough-housing on fences, climbing on roofs etc. are

hazardous
Teach skateboard, scooter, and skating safety.
Sports Injuries Teach that wearing appropriate equipment for sports (face masks
for hockey; mouthpiece and cup for football; helmet for bicycle
riding, skateboarding, or in-line skating; batting helmets for
baseball) is not babyish but smart
Stress not to play to a point of exhaustion or in a sport beyond
physical capability (no pitching baseball or toe-ballet for an early
grade-school child)
Use trampolines only with adult supervision to avoid serious neck
injury
Drowning Teach how to swim; dares and rough-housing when diving or
swimming are not appropriate. Do not swim beyond limits of
capabilities
Drugs Help your child avoid all recreational drugs and take prescription
medicine only as directed. Avoid tobacco and alcohol
Firearms Teach safe firearm use. Keep firearms in locked cabinets with
bullets separate from gun.

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General School-age children should keep adults informed as to where they

are and what they are doing.
Be aware that the frequency of accidents increases when parents
are under stress and therefore less attentive. Special precautions
must be taken at these times.
Some children are more active, curious, and impulsive and there
are more vulnerable to accidents than others.

HEALTH PROBLEMS MOST COMMON IN SCHOOL-AGED CHILDREN

Hospitalization

A. Reactions of the school-aged child

1. Usually handles separation well but prefers parents to be near
2. Fears the unknown, especially when dependency or loss of control is
expected; fears bodily harm, especially disfigurement
3. Possesses realistic concept of death by age 9 to 10 years of age
4. Self-image about reaction to pain is important; may use avoidance to deal
with physical discomfort
5. Wants to know scientific rationale for treatments and procedures
B. If possible parents can be helped to prepare the child beforehand, since increased
cognitive and verbal ability makes explanations possible.

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