1. Preschooler (3-5 years)
    1. Erikson’s theory of personality development
      1. Central task: initiative vs. guilt; central persons: basic family unit.
      2. Behavioral indicators
        1. Attempts to perform activities of daily living (ADL) independently.
        2. Attempts to make things for self/others.
        3. Tries to “help.”
        4. Talks constantly: verbal exploration of the world (“Why?”).
        5. Extremely active, highly creative imagination: fantasy and magical thinking.
        6. May demonstrate fears: “monsters,” dark rooms, etc.
        7. Able to tolerate short periods of separation.
      3. Parental guidance/teaching
        1. Encourage child to dress self by providing simple clothing.
        2. Remind to go to bathroom (tends to "forget").
        3. Assign small, simple tasks or errands.
        4. Answer questions patiently, simply; do not offer child more information than he or she is asking for.
        5. Normal to have “imaginary playmates.”
        6. Offer realistic support and reassurance with regard to fears.
        7. Expose to a variety of experiences: zoo, train ride, shopping, sleigh riding, etc.
        8. Enroll in preschool/nursery school program; kindergarten at 5 yr.
    2. Physical growth (by 5 years)
      1. Height and weight
        1. Continued slow, steady growth.
        2. Generally grows more in height than weight.
        3. Posture: appears taller and thinner; “lordosis” of toddler gradually disappears.
      2. Vital signs
      3. Cardiac system
        1. Increased heart size (4 times larger than at birth); heart function is comparable to a healthy adult (by 5 years).
        2. Heart assumes vertical position in thoracic cavity.
        3. May hear “splitting” of heart sounds, as well as innocent murmurs on auscultation
        4. Decreased heart rate, steady blood pressure from toddler values.
      4. Pulmonary system
        1. Increase in amount of lung tissue.
        2. Adult-like lung sounds heard on auscultation.
        3. Decreased respiratory rate from toddler
      5. Gastrointestinal system
        1. Continued increase in size.
        2. Position is straighter and more upright than adult stomach —> more rapid emptying (defecation, vomiting).
        3. Lining still sensitive to roughage and spices.
        4. Elimination controlled.
      6. Genitourinary systems
        1. Bladder remains palpable above symphysis pubis.
        2. Needs to void frequently, or "accidents" may occur despite sphincter control.
        3. Low-grade urinary tract infections common.

      7. Immune system
        1. Growth of lymphoid tissue (especially tonsils).
        2. Illnesses (especially respiratory) tend to be more localized.
        3. Continued increase in IgA and IgG.
      8. Neurological system
        1. “Handedness” (right or left) is established.
      9. Sensory
        1. Vision-far-sightedness is improving; visual acuity: 20/30.
        2. Vision and hearing screening should be conducted before kindergarten, and annually thereafter.
      10. Teeth
        1. All 20 primary or deciduous teeth (“baby teeth”) should be present.
        2. Annual dental checkups; continue daily brushing.

    3. DDST/developmental norms:
      1. 3 yr
        1. Personal-social
          1. Dresses without help.
          2. Plays board/card games.
        2. Fine motor-adaptive
          1. Picks longer of two Unes.
          2. Copies circle, intersecting lines.
          3. Draws person, three parts.
        3. Language
          1. Comprehends “cold,” “tired,” “hungry.”
          2. Comprehends prepositions: “over,” “under.”
          3. Names four colors.
        4. Gross motor
          1. Pedals tricycle; hops, skips on alternating feet.
          2. Broad jumps, jumps in place.
          3. Balances on one foot.
      2. 4 yr
        1. Personal-social
          1. Brushes own teeth, combs own hair.
          2. Dresses without supervision.
          3. Knows own age and birthday.
          4. Ties own shoes.
        2. Fine motor-adaptive
          1. Draws person with six body parts.
          2. Copies square.
        3. Language
          1. Knows opposite analogies (two of three).
          2. Defines seven words.
        4. Gross motor
          1. Balances on each foot for 5 sec.
          2. Can walk heel-to-toe.
      3. 5 yr
        1. Personal-social
          1. Interested in money.
          2. Knows days of week, seasons.
        2. Fine motor-adaptive
          1. Prints name.
        3. Language
          1. Counts to 10.
          2. Verbalizes number sequences (e.g., telephone number).
        4. Gross motor
          1. Attempts to ride bike.
          2. Rollerskates, jumps rope, bounces ball.
          3. Backward heel-toe walk.