4. Nursing interventions/parental guidance:
1. Play: preschool years - associative and cooperative.
1. Likes to play house, “work,” school, firehouse.
2. “Arts and crafts”: color, draw, paint dot-to-dot, color by number, cut and paste, simple sewing kits.
3. Ball, rollerskate, jump rope, jacks.
4. Swimming.
5. Puzzles, blocks (e.g., Lego blocks).
6. Tricycle, then bicycle (with/without training wheels).
7. Simple card games and board games.
8. Costumes and dress-up: “make-believe.”
2. Safety: Emphasis shifts from protective supervision to teaching simple safety rules. Preschoolers are “the great imitators” of parents, who now serve as role models.
1. Teach child car/street safety rules.
2. Change to “child booster seat” in car at 6 yr or 60 lb.
3. Teach child not to go with strangers or accept gifts or candy from strangers.
4. Teach child danger of fire, matches, flame: “drop and roll.”
5. Teach child rules of water safety; provide swimming lessons.
6. Provide adult supervision, frequent checks on activity/location. Despite safety teaching, preschooler is still a child and may be unreliable.


4. School age (6-12 years)
1. Erikson’s theory of personality development
1. Central task: industry vs. inferiority; central person: school, neighborhood friends.
2. Behavioral indicators
1. Moving toward complete independence in ADL.
2. May be very competitive - wants to achieve in school, at play.
3. Likes to be alone occasionally, may seem shy.
4. Prefers friends and peers to siblings.
3. Parental guidance/teaching
1. Be accepting of the child as he or she is.
2. Offer consistent support and guidance.
3. Avoid authoritative or excessive demands on child.
4. Respect need for privacy.
5. Assign household tasks, errands, chores.


2. Physical growth (by 12 years)
1. Height and weight
1. Almost double in weight from 6-12 yr.
2. Period of slow, steady growth.
3. 1-2 in/yr.
4. 3-6 Ib/yr.
5. Girls and boys differ in size at end of school-age years.
2. Vital signs
3. Cardiac system
1. Increased size of left ventricle (to meet demands for increased blood to growing structures).
2. Decreased heart rate, increased blood pressure from preschool values.
4. Pulmonary system
1. Front sinuses develop (by 7 yr).
2. Lymphatic tissue completes growth (by 9 yr).
3. Remains well oxygenated on exertion.
4. Continued decrease in respiratory rate from preschool values; using intercostal muscles more effectively for breathing.
5. Gastrointestinal system
1. Higher metabolic rate requires adequate food and fluids to ensure nutrition and hydration.
2. Food retained in stomach for longer periods of time.
6. Genitourinary system
1. Bladder capacity increase continues.
2. Kidneys mature.
3. Less likely to have fluid and electrolyte (F/E) imbalance as increased conservation of water occurs.
7. Immune system
1. Growth of lymphoid tissue increases, then plateaus, then decreases.
2. Continued improvement noted with body’s increased ability to localize infections.
8. Neurological system
1. Central nervous system matures.
2. Myelinization continues increase in both fine motor-adaptive and gross motor skills.
9. Sensory
1. Vision: 20/20 vision well established between 9 and 11 yr.
2. Should be screened for vision/hearing annually, usually in school.
10. Teeth
1. Begins to lose primary teeth around sixth birthday.
2. Eruption of permanent teeth, including molars; 28 permanent teeth (by 12 yr).
3. Dental screening annually, daily brushing.
11. Pubescence (preliminary physical changes of adolescence)
1. Average age of onset: girls at 10, boys at 12.
2. Beginning of growth spurt.
3. Some sexual changes may start to occur.