Peds, part 11: G&D - Preschoolers - Development and Parental Guidance
by Meris Shuwarger BSN, RN, CEN, TCRN December 22, 2021 Updated: August 09, 2023 6 min read
This article discusses normal growth and development and expected milestones for preschoolers (children between four and six years of age).
The Pediatric Nursing series follows along with our Pediatric Nursing Flashcards, which are intended to help nurses and nursing students learn and retain information about caring for pediatric patients. The flashcards are a clear, complete study tool and a helpful reference for practicing RNs, PNs, and other medical professionals.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
Physical growth and development milestones for preschoolers
At this point in their development, preschoolers start to level out their rate of growth from the more intense growth rates that they had when they were infants and toddlers.
As with toddlers, weight, height, gross motor skills, and fine motor skills are among the most common physical growth and development milestones for preschoolers.
Weight expectations for preschoolers
Preschoolers are expected to gain about four to six pounds per year.
Height expectations for preschoolers
Preschoolers grow about three inches per year.
Gross motor skills in preschoolers
Gross motor skills refers to big movements using big muscles.
By age three, preschoolers should be able to ride a tricycle — the pedaling motion is a noteworthy gross motor skill. Preschoolers should be able to balance on one foot and jump off of a bottom step, that is, jumping from one height to a lower height.
At four years, preschoolers should be able to hop on one foot, catch a ball, and skip.
At five years, preschoolers should be able to jump rope and use roller skates.
Fine motor skills in preschoolers
Fine motor skills refers to small movements, using small muscles. Over the next few years, we see the same concepts and ideas becoming more and more complex in how a preschooler achieves them.
At three years, preschoolers should be able to draw a circle, and they can draw a face. They can’t yet draw a complete stick figure, but they are able to draw a circle with some facial features.
At age four, preschoolers should be able to use safety scissors. This is a complex motion. They will also start to add three parts to their stick figure drawings, and they should be able to draw a square. Remember from the toddler video previously, children first learn to draw circles, then squares, then triangles — from the simple to the more complex. You can remember this order is alphabetical: C, S, T.
Age five, preschoolers should be able to tie their shoelaces, draw a diamond and a triangle, and add seven to nine parts to a stick figure.
Cognitive development in preschoolers: the preoperational stage
In terms of cognitive development, preschoolers are now in the preoperational stage. This is the second stage in Piaget’s Theory of Cognitive Development, a theory that describes perception and cognition across a person’s lifespan.
Language development in preschoolers
In terms of language development, preschoolers should now have telegraphic speech, which means using two-to-four-word sentences. For instance, sentences that include a noun and verb.
Preschoolers also ask lots of questions, especially “Why?” They are trying to learn more about the world around them. Although this can become repetitive and exhausting for the parent, caregivers need to know that this persistent questioning is normal.
Normal behaviors for preschoolers
The following are other normal behaviors in preschoolers.
Animism is when we attribute human characteristics to inanimate objects. A preschooler will exhibit this normal behavior with a stuffed animal or a doll. They might attribute a thought or a feeling to the stuffed animal or doll; they may talk to it, too.
Magical thinking is defined as thinking that magic is real, and that things can happen in the child’s environment because of magic. This is the stage where children start to believe in the Tooth Fairy, for example, and in the idea that “I can kiss it and make it better,” where the child believes that kissing a wound will magically heal it.
A preschooler may think that they can make events happen — for good or ill — based on their thoughts. This is reflected in a young child’s perception of death. For example, if a parent is terminally ill, the preschooler might think, “I caused mommy to get sick because I had bad behavior,” or, if it is the child who has a serious illness, they might think they are being punished for their behavior: “I behaved badly and it will cause my death.”
Egocentrism is the inability to see someone else’s perspective. This is normal in preschoolers. Note their focus on themselves when they are little — it's always “I, I, I.”
Incomplete concept of time
Preschoolers have an incomplete concept of time. That is, if the parent tells their child they are going to have dinner at 6:30 p.m., the child will have no idea what that means. But they do understand the concept of dinner, and that dinner happens in the later part of the evening and before bed. So adults often use cues to help a child understand something temporal. For instance, if the parent wants to communicate to their child when they are going to go to the park, they say, “We're going to go to the park after the baby’s nap” and not “at two o’clock.” This use of cues helps the preschooler to better understand the relationship of space and time.
Psychosocial Development in preschoolers: initiative vs. guilt
Initiative vs. guilt is one of Erikson’s Stages of Psychosocial Development — a theory that describes key stages in human development and the “psychosocial crisis” encountered during each stage. From 3 to 6 years of age, children take initiative in the world and assert themselves through their social and physical interactions. Basically, they want to do things on their own.
Age-appropriate play for preschoolers
Associative play is when children play together, but without too much organization.
Dramatic play is where children play-pretend. They might act out scenes from movies or cartoons. They might want to dress up or play “house,” including the use of props to act out normal life activities.
In addition to dressing up, preschoolers like simple games, puzzles, dolls, and puppets.
Nutrition for preschoolers — what parents should know
In terms of nutrition for preschoolers, we start to move on from the very specific and structured guidance for nutrition that was so important for infants and toddlers.
Quality of food vs. quantity of food
At this point in the child’s development, the quality of food is more important than the quantity consumed. This means rather than having a certain amount of food served at each meal, it is more important to give preschoolers a variety of good-quality food — meats, vegetables, grains, fruits, etc. Note that preschoolers will tend to eat what they want to eat (rather than what the parent wants them to eat).
Food portions for preschoolers
In terms of food portions for preschoolers, this is approximately half that of an adult serving.
The 5-2-1-0 framework is a way to remember: the servings of fruits and vegetables preschoolers should get per day (5), how much screen time they should have per day (no more than 2 hours), how many hours of physical activity they should get per day (at least 1 hour), and the amount of sugar-sweetened beverages they should consume daily (zero). These are guidelines; they won’t always be followed strictly.
Sleep requirements for preschoolers
A preschooler should get about 12 hours of sleep at night, and it is (still) important to maintain a consistent bedtime routine.
Preschooler vaccination schedule
My preschooler is afraid of the dark, so I keep the lights Very DIM.
From four to six years, children are vaccinated with more live virus vaccines. These include varicella, DTaP, IPV, MMR. They should also continue to receive an annual influenza vaccine.
Varicella is a herpes virus that causes chickenpox and shingles (a viral infection that causes a painful rash).
DTaP is a combined vaccine for diphtheria (a highly contagious bacterial disease), tetanus (a serious disease of the nervous system caused by a toxin-producing bacterium), and pertussis (whooping cough).
IPV is the polio vaccine.
MMR is the abbreviation for the combined vaccine for measles (an infectious viral disease causing fever and a red rash on the skin), mumps (a contagious disease caused by a virus whose symptoms include swollen salivary glands and a fever), and rubella (German measles).
Note: The charts on our Pediatric Nursing Flashcards are a handy way to get to know the pediatric vaccination schedule for young and older children.
Hi, I'm Meris with Level Up RN, and today, I'm going to be talking to you about the normal growth and development for preschoolers, which is children ages three to six. I'm going to be following along using our pediatric flashcards. These are available on our website, leveluprn.com, if you want to get a set for yourself. If you already have your own flashcard deck, I'd invite you to follow along with me. All right. Let's get started. So, first up, we are talking about the physical growth and development of these children. So you'll see here on the card we've got so much information, and we have some bold, red text, so we think it's pretty important for you to know. But when it comes to weight, they're going to gain about four to six pounds a year, and they're going to grow upwards by about three inches per year. So we're starting to level out that crazy, intense amount of growth that they do when they are infants, right? So we grow a whole lot, and then we slow down. So we've kind of slowed down, leveled out some.
Gross motor skills. At age three, they should be able to ride a tricycle. We should be able to do that pedaling motion. That's a very important one to develop. They should be able to balance on one foot and jump off of a bottom step, meaning jumping from a height to a lower height. At four years, they should be able to hop on one foot, catch a ball, and skip, although personally, I couldn't skip until I was like seven. I did not understand the mechanism of it. And at five years, they should be able to jump rope and skate.
Now, let's talk about fine motor skills. Remember, fine motor is small movements, small muscles. So at three years, they should be able to draw a circle, and they can draw a face. So they can't do a stick figure, but they'll draw just a circle with some facial features. At age four, they should be able to use scissors. Again, this is a complex motion. Of course, these are safety scissors, but they should be able to start to use scissors. They should be able to add three parts to a stick figure, and they should be able to draw a square. Remember, I said circle, square, triangle. We're going in alphabetical order. So CST, and that's how we learn to draw shapes. So now, at age four, we can draw a square. Age five, we should be able to tie our shoelaces, draw a diamond and a triangle, and add seven to nine parts to a stick figure. So everything's sort of the same idea. It's just getting more complex.
All right. Moving on, we are going to talk about the cognitive and psychosocial development. So, cognitive, they are in the pre-operational phase. In terms of our language, they should now have telegraphic speech, which means two-to-four-word sentences: for instance, a noun and verb. I would say that, by the time they get to like six years old, they probably have pretty large sentence structure. But at that early age, they're just going to have a few words being strung together, and they're going to ask so many questions. They will ask why for everything? And they're not trying to get on your nerves. They're trying to learn more about the world around them. I remember, one time, my daughter pointed to a sock. She said, "What is that?" And I said, "That's your sock." And she said, "Why?" And I said, "Why what?" She said, "Why is that a sock?" And I was like, "I don't know how to answer that." So they can ask a lot of questions, and this can become repetitive and exhausting for the parent, but remind them that this is normal behavior.
Now, some more normal behavior for them. Animism, you'll see it's in bold, red text on this card. Animism means that we are attributing human characteristics to inanimate objects. So this is very common when it comes to a stuffed animal or a doll, for instance, and maybe the child will talk like it's-- talk for the doll, or they will attribute a thought or a feeling to that stuffed animal or doll. Magical thinking. Magical thinking means that I can make events happen good or bad based on my thoughts. So this can also have to do with perception of death, that I caused mommy to get sick and die because I had bad behavior, or that if I have a terminal illness as a child of this age, that it's because I'm being punished for my bad behavior, that I behaved badly and it caused my death. So magical thinking is a big deal, and this is where we have things like the tooth fairy, right, or the idea that I can kiss it better, that I will kiss that wound and magically make it better.
Egocentrism, again, we're very I, I, I, right? It's all about me when I'm little, and then an incomplete concept of time. So if I tell my daughter that we're going to have dinner at 6:30 PM, she has no idea what that means, but she understands the concept of dinner, right? She knows that dinner happens in the later part of the evening but before bed. So we often will use these sorts of cues to help a child understand something. So, for instance, if I say that we're going to go to the park, I'm not going to say, "We're going to go to the park at 2:00 PM." I'm going to say, "We're going to go to the park after Finley's nap." And that helps her to kind of put it in space and time, right? She understands what I'm talking about then.
Psychosocial development. We are in the initiative versus guilt stage here, so there's a lot of wanting to do this on my own, right? Age-appropriate play. We're starting to have associate of play, meaning that we're playing together, but without too much organization, we're sort of just loosely playing together. We will also have dramatic play. This is where they play-pretend. They'll act out scenes from movies or cartoons. They maybe want to dress up or play house. All of those things are dramatic play. And then toys that they like: big one here is going to be dress-up toys for that dramatic play, but they also like simple games, puzzles, dolls, puppets. And then, lastly, let's talk about some parental guidance. So, for nutrition, we kind of get away from the very specific and structured guidance for nutrition prior to this. Now, we sort of just say they should have good-quality food over the quantity. We're not saying you have to have a certain amount of food with each meal; more that give them good-quality food - meats, vegetables, grains, fruits, all of those things - and they'll eat what they want to. And that is going to be the most important thing. Their food portion is going to be approximately half that of an adult's.
Now, here's the five-two-one-zero framework. I could never remember this or stick to it, but you should have greater than or equal to five servings of fruit and vegetables per day, less than or equal to two hours of screen time per day, greater than or equal to one hour of physical activity per day, and zero or limited sugar-sweetened beverages. I would say that that one hour of playtime is so important. If you think about how fast kids' metabolisms are, they're just running around all the time, and it's important for them to build those strong bones and muscles. So, remember, weight-bearing exercise gives us strong bones, so that is what they are doing right then, and improving their cardiovascular health as well.
Now, for sleep, they sleep about 12 hours a night, so, again, consistent bedtime routine. And then, for vaccinations, okay, from three to six years old, they're really just kind of getting that annual influenza vaccine. But from four to six years old, this is where we are getting some more live virus vaccines. We do have a cool chicken here on the card to help you remember. So it's my preschooler is afraid of the dark, so I keep the lights very dim. So VDIM. So V is for varicella, D is for DTaP, I is for IPV, the polio vaccine, and M is for MMR, measles, mumps, and rubella. Varicella and MMR are live virus vaccines, but it's okay because they are over the age of one, so very dim. All right. I'm going to ask you some questions to test your knowledge of key facts I provided in this video.
First up, I want you to tell me what shape should a four-year-old be able to draw? At what age should a child be able to ride a tricycle? A child in the hospital holds up their teddy bear and says, "He says his tummy hurts." What is the name of this behavior, and is it normal? Do preschoolers engage in cooperative or associative play? And lastly, I want you to tell me what are all of the vaccines that a four-year-old should receive? Let me know how you did in the comments. I can't wait to hear. Be sure to check out the other videos in this playlist if you need to brush up on some more pedes information. Thanks so much, and happy studying.
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