1. MCN 202
NURSING CARE OF CHILDREN
DEVELOPMENTAL MILESTONES OF THE
PRESCHOOLER AND SCHOOL AGE
University of Northern Philippines
Graduate School
Master of Arts in Nursing

2. DEVELOPMENTAL
MILESTONES
OF THE
PRESCHOOLER

3. DEVELOPMENTAL MILESTONES OF
THE PRESCHOOLER
 The preschool period traditionally
includes ages 3, 4, and 5 years.
 Although physical growth slows
considerably during this period,
personality and cognitive growth
are substantial.

4. A.PHYSICAL DEVELOPMENT
 The preschoolers are able to independently
dress including buttoning and zippering.
 Brushing teeth still requires some assistance.
 Around the age of 5 the child will be able to
walk steadily both forward and backward.
He/she walk up and down stairs one foot at a
time, as well skip, jump and climb.
 At this time he also learns to throw and catch
a ball and to ride a tricycle independently.

5. B. SOCIAL, PLAY AND LANGUAGE DEVELOPMENT
Social
 Between the ages of 3 and 5, preschooler is becoming a more social
creature.
 He is now learning to share and cooperate.
Play
 Preschoolers do not need many toys.
 Play is more focused on make-believe than on toys or games.
 Many preschoolers have imaginary friends as a normal part of having an
active imagination.
 Four and five year olds divide their time between rough-housing and
imitative play.
 Five-year-olds are also interested in group games or songs they have
learned in kindergarten or preschool.

6. Language
 Three-year-olds have acquired about 900 to 1,000
words. They easily can produce three-word
sentences.
 At four years of age, vocabulary consists of about
4,000 to 6,000 words, and they are typically
speaking in five- to six-word sentences.
 Five-year-olds’ language continues to grow, and
their vocabularies are expanding to 5,000 to 8,000
words. The number of words in sentences is
increasing, and sentence structure is becoming
more complex.

7. C. EMOTIONAL DEVELOPMENT
 At three, their emotions are usually extreme and short-lived.
They need to be encouraged to express their feelings with
words. They begin to learn to share.
 At four, they tend to brag and be bossy. They need to feel
important and worthwhile. They need opportunities to feel
more freedom and independence. They are learning to take
turns and to share.
 The phase of 5-year-old development is fraught with
emotional extremes and contradictions. A 5-year-old may be
able to exhibit much more self-control, such as sitting for
periods of time in a classroom and listening to a teacher's
instructions.

8. D. COGNITIVE DEVELOPMENT
 The preschool years are important and
vibrant time for learning.
 Preschoolers learn best by doing.
 Along with learning new words, preschoolers
will learn colors, shapes, and some basic
abstract concepts (which helps them begin to
understand consequences).

9. AT 3 YEARS OLD, PRESCHOOLERS:
 Have a word for almost everything.
 Are understood by others about 75 percent of the time.
 Know the colors red, blue, and yellow.
 May talk more often and for longer periods of time.
 Like to use nonsense (and sometimes "naughty")
words, rhymes and songs with actions.
 Ask questions to get information - "Why?", "Where's the
puppy?", or "What is that?"

10. AT 4 YEARS OLD, PRESCHOOLERS:
 Describes pictures in detail.
 Identify and names primary colors.
 Understands concepts of grouping and matching.
 Recognizes own name in print.
 Increased concentration.
 Draw a person adding much detail to the body.
 Count to at least to 10.
 Tell you their physical address and often their home
telephone number.
 Make their own rhyming words, mimic sounds or even
create their own sounds or words.
 Understand that events have a cause and effect reaction
(e.g. if you drop a glass then it will break).
 Begins to learn rules of behavior and reasons behind them.

11. AT 5 YEARS OLD, PRESCHOOLERS:
 Identify and name secondary colors.
 Can count 10 or more objects.
 Actively seeks information through “why” and “how”
questions.
 Learns through observations and social
interactions.
 Understands order and process.
 Recognizes most letters of the alphabet.
 Understands basic concept of time.
 Knows what common objects are used for.

12. E. MORAL AND SPIRITUAL DEVELOPMENT
 Children of preschool age determine right from wrong based
on their parents’ rules.
 Preschoolers begin to have an elemental concept of God if
they have been provided some form of religious training.
 Preschoolers tend to do good out of self-interest rather than
because of strong spiritual motivation.
 Preschoolers enjoy the security of religious holidays, and
religious rituals such as prayer and grace before meals
because these rituals offer them the same reassurance and
security as a familiar nursery rhyme read over and over.

13. F. PROMOTING DEVELOPMENT OF THE
PRESCHOOLER IN DAILY ACTIVITIES
DRESSING
 Many preschoolers can dress themselves except
for difficult buttons.
 Preschoolers prefer bright colors or prints and may
select items that do not match.

14. SLEEP
 Preschoolers are aware of their needs; when they
are tired, they often curl up on a couch and fall
asleep.
 Children in this age group may also refuse to go to
sleep because of fear of the dark.
 Preschoolers may need a night light.
 A helpful suggestion for parents is to screen out
frightening stories or TV watching just prior to
bedtime.

15. EXERCISE
 The preschool period is an active phase, so
children receive a great deal of exercise.
 Preschoolers love time-honored games such as
ring-around-the-rosy, or other more structured
games which can help them develop motor skills as
well as prevent childhood obesity.

16. BATHING
 Preschoolers can wash and dry their hands perfectly
adequately.
 Preschoolers should not be left unsupervised at bath
time to prevent accidents such as scalding, drowning in
the bathtub and slipping on wet floors.
 Preschoolers do not clean their fingernails or ears well,
so these areas often need “touching up” by a parent or
older sibling.
 Hair washing can be a problem. They cannot close their
eyes well enough or long enough to keep soap out.
Parents can hang a mobile over the tub so they have a
reason to look up for rinsing and they can use a
nonirritating shampoo.

17. CARE OF TEETH
 If independent toothbrushing was not started as a
daily practice during the infant or toddler years, it
should be started during the preschool years.
 Encourage them to eat fruits and vegetables for
snacks rather than candy or sweets to prevent
tooth decay.
 Children should have made a first visit to a dentist
by 2.5 years of age for evaluation of tooth
formation.

18. G. PARENTAL CONCERNS ASSOCIATED
WITH THE PRESCHOOL PERIOD
1. COMMON HEALTH PROBLEMS OF THE
PRESCHOOLER
 The mortality of children during preschool years is low
and becoming lower every year as more infectious
diseases are preventable.
 The major cause of death is automobile accidents,
followed by poisoning and falls.
 In contrast, the number of minor illnesses, such as
colds, ear infections, and flu symptoms are
exceptionally high.

19. 2. COMMON FEARS OF THE PRESCHOOLER
a. Fear of the Dark
 Parents should monitor the stimuli their children are
exposed to which trigger their fear, especially
around bedtime. This includes televisions, adult
discussion and frightening stories.
 Burning a dim night light can solve the problem and
costs only pennies.
 Children who awake terrified and screaming need
reassurance they are safe. They may require an
understanding adult to sit on their bed until they can
fall back to sleep again.

20. b. Fear of Mutilation
 Fear of mutilation is revealed by the intense
reaction of a preschooler to even a simple injury
such as falling and scraping a knee.
 They dislike invasive procedures, such as
needlesticks, rectal temperature assessment,
otoscopic examination.
 They need good explanations of the limits of
health care procedures (e.g., a tympanic
thermometer does not hurt, a finger prick heals
quickly) in order to feel safe.
c. Fear of Separation or Abandonment
 Fear of separation intensifies because their keen
imagination allows them to believe they are being
deserted when they are not.

21. 3. BEHAVIOR VARIATIONS
a. Telling Tall Tales
 Stretching stories to make them seem more
interesting is a phenomenon frequently
encountered in this age group.
 Parents should not encourage this kind of
storytelling, but instead help a child separate fact
from fiction by saying, “That’s a good story, but now
tell me what really happened.” This conveys the
idea a child has not told the truth, yet does not
squash imagination or initiative.

22. b. Imaginary Friends
 Imaginary friends are a normal, creative part of the preschool
years and can be invented by children who are surrounded by
real playmates.
 Parents can help their preschooler separate fact from fantasy
about their imaginary friend by saying, “I know Eric isn’t real, but if
you want to pretend, I’ll set a place for him.” This helps a child
understand what is real and what is fantasy without restricting a
child’s imagination or creativity.
c. Difficulty Sharing
 Sharing is a concept that first comes to be understood around the
age of 3 years.
 Preschoolers begin to understand that some things are theirs,
some belong to others, and some can belong to both.
 As with most skills, preschoolers need practice to understand and
learn it.

23. d. Regression
 Some preschoolers, generally in relation to stress, revert to
behavior they previously outgrew, such as thumb sucking,
loss of bladder control, and inability to separate from their
parents.
 Stress is usually the result of such things as a new baby in
the family, a new school experience, seeing frightening
television news, marital and financial difficulties, or
separation caused by hospitalization.
 Regression in these circumstances is normal.
 Manifestations of stress are best ignored; calling them to a
child’s attention merely causes more stress, because it
makes a child aware that he or she is not pleasing parents.

24. e. Sibling Rivalry
 Jealousy of a brother or sister may first become evident
during the preschool period, partly because this is the first
time that children have enough vocabulary to express how
they feel and partly because they are more aware of family
roles and how responsibilities at home are divided.
 For many children, this is also the time when a new brother
or sister is born.
 Because preschooler can sense that a younger sibling is
being allowed behavior that was not tolerated in them, this
can lead to sibling rivalry.

25. 4. PREPARING FOR A NEW SIBLING
 Introduction of a new sibling is such a major happening that
parents need to take special steps to be certain their preschooler
will be prepared
 .
 If the preschooler has been sleeping in a crib that is to be used
for the baby, it is usually best if he or she is moved to a bed about
3 months in advance of the birth. Explaining that it is time to sleep
in a new bed because he is growing up.
 If children are to start preschool or childcare, they should do so
either before the baby is born or 2 or 3 months afterward, if
possible. That way, children can perceive starting school as a
result of maturity and not of being pushed out of the house by the
new child.
 If the mother will be hospitalized for the birth, she should be
certain her child is prepared for this separation in advance.
 Mother should maintain contact with their preschooler during the
short time they are hospitalized for the birth.

26. 5. SEX EDUCATION
 Preschoolers’ questions about genital organs are simple
and fact-finding. It is important for parents not to convey that
these body parts are never to be talked about to leave an
open line of communication for sexual questions.
 It is common for preschoolers to engage in masturbation.
Calling unnecessary attention to the act can increase
anxiety and cause increased, not decreased activity.
 An important part of sex education is teaching them to avoid
sexual abuse, such as not allowing anyone to touch their
body unless they agree it is all right. Because children have
been taught this, remember to ask permission before giving
nursing care that involves touching.

27. 6. CHOOSING A PRESCHOOL OR CHILDCARE
CENTER
 Be sure to investigate preschools or
childcare centers carefully before enrolling to
be certain that the child will be safe and have
an enjoyable experience.

28. 7. BROKEN FLUENCY
 Broken fluency is the repetition and prolongation of
sounds, syllables and words.
 It is often referred to as secondary stuttering
because a child begins to speak without this
problem and then, during the preschool years,
develops it.
 It is a part of normal development and, if accepted
as such, will pass.

29. H. NURSING CARE OF THE HOSPITALIZED
PRESCHOOLER

32. DEVELOPMENTAL
MILESTONES
OF THE
SCHOOL AGE

33. DEVELOPMENTAL MILESTONES OF
THE SCHOOL AGE
 School-age child development
describes the expected physical,
emotional, and mental abilities of
children ages 6-12.
 The school-age years are a time of
steady growth and development.

34. A.PHYSICAL DEVELOPMENT
 School-age children usually have smooth and strong motor
skills. However, their coordination (especially eye-hand),
endurance, balance, and physical abilities vary.
 Fine motor skills may also vary widely. These skills can
affect a child's ability to write neatly, dress appropriately, and
perform certain chores, such as making beds or doing
dishes.
 There will be big differences in height, weight, and build
among children of this age range.
 A sense of body image begins developing around age 6.
Sedentary habits in school-aged children are linked to a risk
of obesity and heart disease in adults. Children in this age
group should get 1 hour of physical activity per day.

35. There can also be a big difference in the age at which children
begin to develop secondary sexual characteristics.
For girls, secondary sex characteristics include:
 Breast development
 Underarm and pubic hair growth
For boys, they include:
 Growth of underarm, chest, and pubic hair
 Growth of testicles and penis

36. B. PSYCHOMOTOR DEVELOPMENT
Gross Motor Development
 At the age of 6, children endlessly jump, tumble, skip and
hop. They have enough coordination to walk a straight line.
Many can ride a bicycle. They can skip rope with practice.

 A 7-year-old appears quiet compared with a rough-and-
tumble 6-year-old. Gender difference usually begin to
manifest in play: there are “girl games,” such as dressing
dolls, and “boy games,” such as pretending to be pirates.
 The movements of 8-year-olds are more graceful. They ride
a bicycle well and enjoy sports.

37.  Nine-year-olds are on the go constantly. They have enough
eye-hand coordination to enjoy baseball, basketball and
volleyball.
 By 10, they are more interested in perfecting their athletic
skills than they were previously.
 At age 11, they feel awkward because of their growth spurt
and drop out of sports activities. They may channel their
energy into constant motion such as drumming fingers and
tapping pencils and feet.
 Twelve-year-olds plunge into activities with intensity and
concentration. They often enjoy participating in sports
events for charities (walk-a-thons). They are cooperative
around the house.

38. Fine Motor Development
 Six-year-olds can easily tie their shoelaces. They can cut
and paste well and draw a person with good detail.
 For seven-year-olds this has been called the “eraser year”
because they are never quite content with what they have
done.
 By 8 years of age, children’s eyes are developed enough so
they can read regular-size type. They learn to write script
rather than print.

 By 9, their writing begins to look mature and less awkward.

 Older school children begin to evaluate their teacher’s ability
and may perform at varying levels, depending on each
teacher’s expectations.

39. C. PLAY AND LANGUAGE DEVELOPMENT
Play
 Play continues to be rough at age 6 years; however, when
they discover reading as an enjoyable activity, they can
begin to spend quiet time with books.
 Many children spend hours playing video games, an activity
that can either foster a healthy sense of competition or
create isolation from others.

 By 7 years of age, children require more props for play. This
is the start of a decline in imaginative play.

 Girls begin to prefer teenage dolls.


40.  Around 7, children also develop an interest in collecting
items such as cards, dolls, rocks, or marbles.
 Eight-year-olds like table games but hate to lose, so they
tend to avoid competitive games.

 Many children of 8 or 9 enter a phase of reading comic
books.
 Many 10-year-olds spend most of their time playing video
games. Boys and girls plays separately at age 10, although
interest in the opposite sex is apparent.
 Eleven and 12-year-old enjoy dancing to popular music and
playing table games and are accommodating enough to be
able to play with younger siblings.

41. Language Development
 Early school-age children should be able to use simple, but
complete sentences that average five to seven words.
 Language delays may be due to hearing or intelligence
problems.
 A 6-year-old child normally can follow a series of three
commands in a row.
 By age 10, most children can follow five commands in a row.

42. D. EMOTIONAL DEVELOPMENT
 Children who enter the school-age period have the ability to
trust others and a sense of respect for their own worth.
 They can accomplish small tasks independently because
they have gained a sense of autonomy.
 They have learned to share, and discovered that doing
things is more important and rewarding than watching things
being done (a sense of initiative).

43. E. COGNITIVE DEVELOPMENT
The period from 5 to 7 years of age is a transitional stage where
children undergo a shift from the preoperational thought to concrete
operational thought or the ability to reason through any problem they
can actually visualize.
Children can use concrete operational thought because they learn
several new concepts, such as:
 Decentering, the ability to project one’s self into other people’s
situation and see the world from their viewpoint rather than focusing
only on their own view.
 Accommodation, the ability to adapt through processes to fit what is
perceived (i.e. understanding that there can be more than one
reason for other peoples’ action).
 Conservation, the ability to appreciate that a change in shape does
not necessarily mean a change in size.
 Class inclusion, the ability to understand that objects can belong to
more than one classification

44. F. PROMOTING DEVELOPMENT OF A SCHOOL
AGE CHILD IN DAILY ACTIVITIES
DRESSING
 School-age children have definite opinions about clothing
styles, based on the likes of their friends or a popular icon
rather than the preference of their parents.
 Parents must be aware that a child who wears different
clothing than others may become the object of exclusion
from a school club or group.
 Many schools require school uniforms to avoid this problem

45. SLEEP
 Younger school-age children typically require 10-12
hours of sleep, older ones require about 8-10
hours.
 During early school years, many children enjoy a
quiet talk or a reading time at bedtime.
 At about age 9, when friends become more
important, children generally give up these
activities.

46. EXERCISE
 School-age children need daily exercise because
school is basically a sit-down activity.
 Exercise need not involve organized sports. It can
come from neighborhood games, walking with
parents, or bicycle riding.
 School-age children must participate in some daily
exercises, or else obesity, or osteoporosis later in
life can result.

47. HYGIENE
 Six or 7 years of age still need help in regulating
the bath water temperature and in cleaning their
ears and fingernails.
 By age 8, they are generally capable of bathing
themselves.
 Both boys and girls become interested in showering
as they approach their teens.

48. CARE OF TEETH
 School-age children should visit a dentist at least
twice yearly for a checkup, cleaning, and possibly a
fluoride treatment.
 School-age children have to be reminded to brush
their teeth daily.
 Snacks are best limited to high-protein foods rather
than candy.

49. G. COMMON HEALTH PROBLEMS OF THE
SCHOOL-AGE PERIOD
 Children in their early school years have one of the
lowest rates of death and serious illness of any age
group.
 The two leading causes of death are accidents and
cancer.
 Minor illnesses are largely due to dental
caries, gastrointestinal disturbances, and upper
respiratory infections.

50. DENTAL CARIES
 Caries (cavities) are progressive, destructive
lesions or decalcification of the tooth enamel and
dentin.
 Neglected caries result in poor chewing and
therefore poor digestion, abscess and pain, and
sometimes osteomyelitis (bone infection).
 Dental caries are largely preventable with proper
brushing and fluoride application.

51. MALOCCLUSION
 Children with malocclusion of the teeth (a deviation
from normal) should be evaluated by an
orthodontist to see if orthodontic braces or other
therapy is necessary.
 Braces and retainers, once thought of as
implements to be made fun of, have become such
a common feature of life for school children today.
 Some even view them as a mark of pride or badge
of courage.

52. H. CONCERNS AND PROBLEMS OF THE SCHOOL-
AGE PERIOD
 One of the most important disorders of the school-
age period is attention deficit hyperactivity disorder
(ADHD) because it interferes so dramatically with
school progress. Other problems concern
language, fears, and responsibility.

53. 1.Problems Associated With Language
Development
 The most common speech problem of a school-age
child is articulation. The child has difficulty
pronouncing s, z, th, l, r, and w or substitutes w for r
(“westroom” instead of “restroom”).
 This is most noticeable during the first and second
grades; it usually disappears by the third grade.

54. 2. Common Fears and Anxieties of a School-Age
Child
Anxiety Related to Beginning School
 Preschool learning was carried out through fun activities;
whereas part of every day in grade school involves obvious
work.
School Phobia
 School phobia is fear of attending school.
 Children may develop signs of illness such as vomiting,
diarrhea, headache, or abdominal pain on school days.
 A particular child may be reacting to a situation such as
harsh teacher or facing a class bully every day. Counseling
may help the child manage the situation better.

55. 3. Home Schooling
 Because of religious or personal preference or
because of disillusionment with the school system,
a growing number of children are home schooled
today.
 It is important to identify these children at a health
care visit because with their less extensive
experience with peers, they may not be comfortable
with peer interaction.

56. 4. Latchkey Children
 Latchkey children are schoolchildren who are
without adult supervision for part of each weekday
because both parents work outside the home.
 A major concern of latchkey children is that they will
develop an increased tendency to accidents,
delinquent behavior, alcohol, or beginning drug
abuse, or decreased school performance for lack of
adult supervision.
 Many communities offer special after-school
programs so children do not have to be home
alone.

57. 5. Sex Education
Sex education should be incorporated into health education
throughout the school years in a manner that is appropriate to
age and development. Topics include:
 Reproductive organ function
 Secondary sexual characteristics, so children will know what
is going on with their bodies
 Physiology of reproduction, so they understand what
menstruation is and why it occurs
 Male sexual functioning, including why the production of
increased amounts of seminal fluid leads to nocturnal
emissions
 Explanation of the physiology of pregnancy and the
possibility that comes with sexual maturity for unplanned or
unwanted pregnancies
 Birth control measures and the principles of safe sex
 Social and moral implications of sexual maturity

58. 6. Stealing
 Stealing usually happens at around 7 years of age,
when children discover the importance of money.
 A parent should tell the importance of property
rights. Youngsters who continue to steal past 9
years of age may require counseling.

59. 7. Violence or Terrorism
 Children basically view their world as safe, so it is a
shock when violence such as school shooting or
reports of international terrorists enter their lives.
 A number of organizations have proposed
guidelines on how to help children deal with
violence and terrorism.

60. 8. Bullying
To avoid bullying school personnel should:
 Supervise recreation periods closely
 Intervene immediately to stop bullying
 Insist that if such behavior does not stop, both
school and parents will become involved
 Therapy may be needed to correct bullying
behavior
 Advise parents to discuss bullying with their school-
age child and tell them how it should be reported,
so that adults can intervene

61. 9. Recreational Drug Use
 Once considered a college or high school problem, illegal
drugs are now available to children as early as elementary
school.
 Alcohol is available in so many homes and can be
purchased in small stores without proof of age.
 Inhalants that are easily available such as airplane glue
(toluene) and aerosolized cooking oil may be abused by
school age children.
 Parents should suspect glue sniffing if their child regularly
appears irritable, inattentive or drowsy.
 School health personnel should be aware of this and look
for warning signs.
 Cigarette smoking also begins in school-age children. To
discourage use of tobacco, health care professionals and
parents need to be role models of excellent health

62. 10. Children of Alcoholic Parents
 Children of alcoholic parents are at greater risk from having
emotional problems because of the frequent disruption in
their lives.
 Alcoholism may have a genetic cause, so children of
alcoholics are more likely to become alcoholics.
 Manifestations of these children are: failing marks in school,
withdrawal from friends or social activities, and delinquent
behavior such as stealing.
 School nurses are in excellent position to identify such
children, monitor their school progress and refer them to
organizations such as Al-Anon for support.

63. 11. Obesity
 Many families rely on fast food meals, and such
foods tend to be high in calories and fat and can
lead to obesity
 Children of obese parents are also inclined to
obesity. Obese children begin to develop many of
the same health problems as obese adults such as
hypertension, type 2 diabetes, and an elevated
cholesterol.
 They also may be ridiculed for their size and be
unable to participate on sports teams.

64. Such programs should contain three aspects:
 Intake of about 1,200 calories
 An active exercise program
 A counseling program to discuss self-image and
motivation to reduce weight

65. H. NURSING CARE OF THE HOSPITALIZED
SCHOOL AGE

67. Thank you!!!
BARROGA, Marilyn Richelle
DIGUEL, Brenda Lee
GRAGERA, Jennifer C.
MASIGMAN, Mary Ann
PAESTE, Gloria
SERRANO, Cecille
VALENTON, Kathleen Anne Marie