Peds, part 11: G&D - Preschoolers - Development and Parental Guidance

December 22, 2021 Updated: January 17, 2022 6 min read

Full Transcript

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,, 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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