Chapter 31: Nursing Care of Families With Preschool Children

Key physical changes include a shift from the toddler's body contour to a slimmer, more childlike appearance, and the potential emergence of future body builds like ectomorphic or endomorphic. Physiologically, the pulse rate decreases to about 85 beats per minute, and lymphatic tissue, such as the tonsils, begins to increase in size. Cognitively, children enter the phase of intuitional thought, according to Piaget, where they learn by constantly asking questions, potentially up to 400 per day by age three. However, their thinking is limited by egocentrism, meaning they perceive their own viewpoint as the only valid one, and centration, where they focus on only one characteristic of an object. Furthermore, preschoolers are unable to understand conservation—the idea that an object’s amount remains the same even if its form changes. The major emotional task, as defined by Erikson, is achieving a sense of initiative versus guilt, fostered through providing varied experiences and encouraging creative activities like finger painting. Socially, children begin to transition from parallel play to cooperative group activities and may develop common psychological traits such as having imaginary friends and demonstrating strong emotional attachments to the parent of the opposite gender, often referred to using the Freudian concepts of the Oedipus or Electra complexes. Nursing care must integrate QSEN competencies, focusing heavily on safety promotion, as unintentional injury remains the leading cause of death in this age group. Safety education includes emphasizing bicycle helmet use, proper automobile restraint (booster seats), gun safety, and teaching children appropriate boundaries related to community safety. Common parental concerns addressed include managing broken fluency (secondary stuttering), dealing with fears (such as fear of the dark or fear of mutilation), and minimizing sibling rivalry, particularly when preparing the child for the arrival of a new baby.