1. Preschooler and School-Aged Child Part 1 Health Promotion

2. Objectives Identify changes in development in preschool and school- aged child from infant and toddler Provide examples of development Explain the need for parental education in caring for their pre-school and school-aged child Describe some key activities of health promotion for the preschooler and school-aged child

3. Parenting Styles Types Authoritarian Permissive Neglectful Intimidated Secure Must be adapted to child’s temperament

4. Preschooler and School-aged child Preschooler ages 3-5 Schooled-aged from 6 -12 years of age

5. Relationships Parents Step-parents New Baby Older Siblings Grandparents Other adults

6. Family Developmental Tasks Increasing emphasis on accountability and measureable outcomes Prepare the child for separation Encourage and accept child’s skills Maintain some personal privacy and outlet for tension Share household and child-care responsibility

7. Family Developmental Tasks cont. Strengthen partnership with mate Learn to accept failures, mistakes, and blunders; rework codes and values Nourish common interests and friendships Create and maintain effective communication Cultivate relationships with extended family Tap resources and serve others

8. Assessment/Development System/Test and MeasureCharacteristics Growth PatternsLimbs › trunk; height more proportional to weight; head circumference slower VitalsTemp, HR, RR, BP (norms) Postural ChangesKnees/legs – see bowing shift to knock knees should self correct early school-aged; flexible flat feet are typical SensoryVision is farsighted ; all other senses intact Fine MotorIncrease eye hand coordination; increased adaptive skills with more precise movements; dressing/undressing, toileting alone Gross MotorIncreased energy for running, jumping, climbing, improved balance etc. Internal OrgansIncrease in size to fit space and allows for change in vial signs. B & B control improves

9. Assessment Should consider more than chronological age Whole and unique child must be considered Many standardized tools that are focus on certain domains or cover each of the domains Denver Developmental Screening Test (DDST) Ages and Stages

10. Cognitive Development Brain undergoes rapid spurts developmentally Most rapid growth is in frontal lobe Child learns by Interacting with more knowledgeable people Being confronted with others’ opinions Being actively involved with objects and processes

11. Preoperational Stage Literal thinking with absence of reference system Intermingling of fantasy, intuition, and reality Absolute thought and centering Difficulty remembering conversation topic Inability to state cause-effect relationships, categories, or abstraction

12. Preoperational Stage cont Preoperational Stage is divided into 2 parts Preconceptual Stage (2-4 years) Intuitive Stage (4-7 years) Another approach used is Vygotsky’s Sociocultural Theory Cognitive growth occurs in sociocultural context and evolves out of child’s social interactions

13. Preschooler Communication Use somatic or physical symptoms, action, and verbal expression Learn new words quickly, flexibly, and efficiently Connected to familiar words, experiences, or themselves Participate in private speech, social speech, and later inner speech

14. Emotional Development Child appears more self-confident and relaxed Child ready for prosocial behavior Encourage parents to be role models for standards of behavior Encourage parents to choose stories, songs, games and videos that promote prosocial behavior

15. Initiative versus Guilt Initiative is enjoyed energy displayed in action, assertiveness, learning, increasing dependability, and ability to plan Guilt is sense of defeatism, anger, and feeling shameful or deserving of punishment Guilt can come from excessive expectations, sibling rivalry, lack of opportunity, and lack of guidance

16. Adaptive Mechanisms Fear is common Frustration arises in response to self- and other’s expectations Emotional regulation is a task Mechanisms include introjection, secondary identification, fantasy, repression, and suppression

17. Self-Concept Learning about the body is important at this stage Child should learn some control over feelings and behavior Child feels great self-esteem when a problem is faced and handled Teach parents ways to increase the child’s self-esteem and self-concept and develop concept of body image

18. Sexuality Preschooler Identifies self as girl or boy Adopts gender-appropriate behavior through identification Interested in function and appearance of body Teach parents that they foster gender roles Encourage importance of variety of play activities and experiences

19. Moral and Spiritual Development Child learns by example Child needs simple explanation matched with daily practices to learn religion Child develops superego at this stage Child needs to learn about consequences of behavior on others Teach parents importance of superego development and beginning moral development

20. Preschooler Play Intrusive in play Pregang stage-parallel play Purposes include learning cooperation, expressing imagination, and building self-esteem Play materials should be stimulating and encourage different types of play Inform parents of their role in play

21. Areas for Health Promotion Nutrition Exercise Sleep Immunizations Dental Care Safety

22. Nutritional Needs Review recommended daily nutritional intake Guide for caloric intake is 1000 calorie baseline + 100 calories for each year of life Protein, fat, and vitamins needed daily Eating assumes social significance Eating habits may include overeating or not wanting to eat

23. Exercise Needs at least 60 minutes of active exercise daily Needs time and space for physical exercise Needs comfortable shoes and clothing Needs adult-initiated rest periods

24. Sleep Bedtime routines important Sleep time decreases from 10-12 hours for younger preschooler to 9-11 hours for older preschooler Dreams and nightmares occur Emphasize that parents should teach sleep strategies and set limits Help parents understand how to deal with night terrors and sleepwalking

25. Immunizations Counsel about the benefit of state law Ensure the following before giving immunization Parent’s consent Need for vaccination Knowledge of contraindication or past history Education to parents about administration, benefits, and risks Proper storage and date of expiration

26. Dental Care Dental carries begin at this age Deciduous teeth guide in the permanent ones Fluoride is important to dental health Teeth should be brushed after eating Refined sugar intake should be limited Child required to have physical and dental examination before school

27. Safety Teach parents Developmental characteristics that may cause hazardous risk Measures for teaching safety to the child Measures parents can institute for child’s safety Measures to avoid falls and related injury Measures for parents to teach child related to abduction, running away, or getting lost Why child may continually fail to listen or obey

28. Common Health Risks Respiratory asthma Inform about dangers of smoking Bites from animals or children Ensure dog does not have rabies Lead Watch for signs of lead poisoning

29. Child Maltreatment Abuse can be physical, psychological, or sexual Abuse can be intrafamilial or extrafamilial Sexual abuse can be contact or noncontact Abuse can be ritualistic Abuse can be neglect Abuse can cause autonomic or hyperarousal response

30. Developing Initiative in Preschooler Encourage use of child’s imagination, planning, and creativity Limit punishment to acts that are truly dangerous or wrong Reinforce appropriate behavior Affirm emotional experiences and set aside time each day to review them Help preschooler learn about different feelings and how to express and cope

31. Development Tasks Settle into healthy daily routine of eating, exercising, resting, and following health promotion Master large- and small-muscle coordination and movement Participate in life and activities of family Identify with parents of the same gender Conform somewhat to other’s expectations Express emotions healthfully

32. Teaching a Child Most critical factor is loving caretaker Learning occurs from Motor activity, play, and language games Talking with adults and peers Paying attention to both trivial and important aspects of environment Avoid too much television or aggressive, fast-paced shows, videotapes, and videogames

33. Guidance and Discipline Teach parents Set consistent, fair, and kind limits that preserve parent’s and child’s respect Stop immediately behavior that hurts others Explain reasons for limits Avoid spanking Use time-out and reward to help guide behavior Encourage parents to use age and developmentally appropriate discipline