The Preschool Child: GROWTH AND DEVELOPMENT
Ages 3–6 years
Gains ~4–5 lbs and 2–3 inches/year. Body becomes more slender — 'toddler belly'
disappears.
By age 3
900-word vocabulary, full sentences, asks 'why' constantly. By age 4: tells stories, uses past tense.
Signs of respiratory distress
nasal flaring, retractions (skin pulls in at neck/between ribs/under sternum),
grunting (auto-PEEP), stridor (high-pitched on inhale = upper airway obstruction), wheezing (expiratory = lower
airway), cyanosis (late, ominous sign).
Ages 6–12 years
Gains ~5–7 lbs and 2 inches/year. Girls often surpass boys in height by end of this stage due
to earlier puberty onset.
Dental health
all 20 primary teeth lost and replaced. Good brushing/flossing habits established now prevent
lifelong problems.
Erikson: Initiative vs Guilt
preschoolers love to plan, imagine, and try new things. Support initiative; constant
criticism creates guilt and suppresses creativity.
By age 5
2,000+ words, follows 3-step instructions.
Croup (LTB)
Age 6 months–3 yrs, Gradual onset, viral, Barky seal-like cough, Low-grade fever, Subglottic swelling, Tx: cool mist, racemic epi, steroids
Erikson: Industry vs Inferiority
driven to feel capable and competent. School-age children measure
themselves against peers constantly. Success builds industry; repeated failure without support builds
inferiority.
School avoidance and anxiety
recurrent stomachaches or headaches on school days (resolved on weekends).
Address underlying anxiety, not just the physical complaint.
Piaget: Preoperational stage (2–7 yrs).
Key traits: egocentrism (cannot see another's viewpoint — not
selfishness), animism (objects have feelings), magical thinking (wishing can cause things), centration (focuses
on one feature at a time).
Associative play
preschoolers play together, share materials, talk to each other — but without organized rules
or roles. Bridge between parallel play (toddler) and cooperative play (school-age).
Epiglottitis
Age 2–6 yrs (any age), Muffled voice, drooling, Sudden onset, bacterial (H. flu), High fever, toxic appearance, Supraglottic swelling, Tx: AIRWAY FIRST, NO throat exam
NEVER examine throat with tongue blade or lay child flat. This can cause complete airway obstruction. Keep calm, tripod position, humidified O2, intubation equipment ready at bedside.
Piaget: Concrete Operational (7–11 yrs)
uses logic, but only with real tangible objects. Understands
conservation (same water in different cup = same amount), classification, and seriation. Cannot yet reason
abstractly.
Obesity increasingly common.
Screen time, fast food, decreased activity are contributors. Approach: focus on
healthy habits, not weight — never restrict diet without medical supervision.
Biggest fears
bodily harm and mutilation. They believe procedures are punishment. They fear blood ('all my
blood will come out'), masks (who is hiding?), and anesthesia ('like dying').
ASTHMA
Most common chronic disease in children. Chronic inflammation causing reversible bronchospasm, mucus production, and airway edema. Triggers: allergens, smoke, exercise, cold air, viral infections, stress.
Rescue medication: Albuterol (short-acting beta-2 agonist) — relaxes bronchial smooth muscle within minutes.
Controller medication: Inhaled corticosteroids (fluticasone, budesonide) — used daily for prevention. NEVER use controller as rescue.
Cooperative play with rules
team sports, board games, clubs with organized structure. Following rules and
understanding fairness are major cognitive achievements.
COMMUNICATING WITH SCHOOL-AGE KIDS
Give honest, complete, concrete explanations. They think literally — vague answers create fear. Ask what THEY
think is happening — correct misconceptions. Biggest hospital fear: missing school and peer separation.
CYSTIC FIBROSIS
Autosomal recessive — abnormally thick, sticky mucus in lungs, pancreas, GI tract, and sweat glands. Classic sign: salty-tasting skin. Diagnosis: elevated sweat chloride test.
Pulmonary care: chest physiotherapy (CPT) before meals, nebulized dornase alfa to thin secretions,
bronchodilators. GI: pancreatic enzyme replacement with ALL meals and snacks. High-calorie, high-fat diet needed.
Moral reasoning develops
understand rules, fairness, consequences. Dislike cheating; may tattle when
peers break rules.