1. Mrs. McIntyre RN, BSN Leifer/Hartston Chapter 7
Early Childhood
Mrs. McIntyre RN, BSN
Leifer/Hartston Chapter 7

2. What is Early Childhood?
Children between the ages 1 to 6 years old
Separated into two phases Toddler (1-2years) and Preschool (2-6 years)

3. Early Childhood
Preschooler gains about 5 to 7 lbs and grows about 2 ½ to 3 inches per year
Important to have developmental screenings at well visits

4. Developmental Tasks Developing social interaction skills
Mastery of self-control (toilet training)
Developing self-image and sense of autonomy
Increasing motor ability
Working on aquiring receptive and expressive language

5. Developmental Tasks Toddler Preschool
Autonomy vs. Shame or Doubt (1-4 yrs)
Initiative vs. Guilt (4-6 yrs)
According to Erikson

6. Physiological Changes
Walk steadily by months
By 2 years old lumbar curve of spine causes abdomen to protrude
By 3 years old posture is more erect
Hop by 4 years
Skip by 5 years

7. Physiological Changes
Can touch thumb to each finger sequentially by 5 yrs
Draw a person with 3 body parts at 4 yrs
Most 5 yr olds can print name
Hand preference emerges between 18 months and 5 years old
Anterior fontanel closes at 18 months

8. 1) Bow-legged appearance 12-18 months, feet flat when walking
Knock-knee appearance between 18 months-2 years and by 2 yrs knees and toes are in alignment and gait is steadier
2) Climb stairs by 2½ years old
3) Copy a straight line by 2 years
4) Alternate feet when climbing stairs and ride a tricycle by 3 years old
5) Copy a circle and use scissors by age 3
6) Hearing fully developed in toddler phase – eustachian tube (connects middle ear to oropharynx)is still short and straight which is a reason why ear infections are common in childhood

9. Can run by 2 years old
Toddlers should be able to eat with a fork and spoon by usually prefer finger foods. Appetite decreases at 2 yrs
Development of sphincter control (toilet training)
Development of fine motor skills such as self-feeding, undressing, and dressing
20/20 vision typically achieved by 4 years old
Reading readiness occurs during preschool years (looking up and down and side to side to locate item on a page)
Twenty primary teeth erupt by 2 yrs

10. Toilet Training
Communication techniques are also forming to enable child to express need to go to bathroom
Modeling behavior , special dolls, rewards, potty books, etc are helpful to achieve success with potty training
Should not be rushed and may not be complete before ______
Nighttime potty training may take longer
Sphincter control is related to development of self-concept therefore accidents should not be scolded or punished
Toilet training may not be complete before 3 ½ years old
Bowel control occurs before bladder control

11. Brain Function
Myelinization of neurons within brain increases brain function but complete myelinization does not occur before 6 to 7 years
Neocortex of brain is responsible for thought, emotion, and higher-level brain function
Example: Riding a bike involves vision, hearing, sensation, balance

12. The Brain
1) Frontal lobes are responsible for memory, attention, behavior, and emotions
2) Left Hemisphere is implicated in language disorders

13. Nutrition Starts before conception
During early childhood nutrition is dependent on adults whose feeding habits could be based on ethnicity, culture, folklore, or fads
Some families need guidance on how to purchase and prepare nutritious well-balanced meals for their children
Eating habits are formed during early childhood years whether good or bad
USDA Food Pyramid for 2 to 6 yrs old and includes portion servings (Leifer/Hartston p. 109 Figure 7-2) **

14. Language Development and Communication
Communication is seen during infancy by a cry, coo, smile
Initial purpose is to make needs known and then regulate another’s behavior, attract attention, and socially interact
Speech development follows a predictable sequence and is influenced by others talking to them and encouragement
Speech development is a reflection of mental and emotional development
Speech delays can usually be detected by age 2 yrs
Language acquired during preschool years sets stage for success in school-age child

15. Language Development and Communication
Toddler
Preschooler
By 1 yr, first clear word and responds to simple/single demands
By 15 mos, speaks 4-6 words and points to body parts
By 18 mos, speaks 15 words
By 19 mos, 2 word sentences
By 2 yrs, vocab > 100 words and follows 2 step commands
Occurs rapidly
By 2 yrs, repeats commands of others
By 2 ½ yrs, expresses possession
By age 4 yrs, uses past tense
By age 5 yrs, present tense and vocab > 2000 words
Number of words in a sentence for a preschooler should be equal to the age of the child.
Example: A 5 year old should be using 5 words in a sentence.

16. Cognitive Development
Sensorimotor stage ends when Toddler begins to use words to express ideas and solve problems (beginning of symbolic thought which is when one object represents another)
Preschool thinking involves Piaget’s preoperational phase (magical thinking and egocentrism)
Pretend play is common at 2 yrs
Role play scenarios by age 5 yrs

17. Cognitive Development
Major task of preschoolers is to develop _____ and is usually achieved by 4 yrs
Negativism or tantrums can be seen as expressions of frustration when something is not understood or not able to be expressed by the preschooler
1) impulse control of behaviors (biting, kicking, throwing toys)

18. Moral Development
According to Kohlberg, early childhood moral tasks involve learning self-control and learning to share with others (pre-conventional stage)
Often model parents
Constantly test limits to confirm behavior is unacceptable or to gain attention
Parents often complain that preschoolers lie but they do not have the abstract reasoning to actually deceive
Preschoolers truth is as they interpret it or would like it to be

19. Moral Development
A 2 yr old can’t differentiate between intentional acts and accidents and readily assigns blame
A 3 yr old becomes ritualistic and aware that rules must be obeyed. Can differentiate between intentional acts and accidents but may still blame others
A 5 yr old extends the blame and can easily excuse the accident
Preschoolers see taking an object as ownership and not stealing

20. Discipline Purpose is to guide, teach, correct a behavior
Should not be a punishment
Use consistently
Remember Skinner’s Operant conditioning
Goal for toddlers should be to help them develop self-control while maintaining positive self-esteem
Nurses should be nonjudgmental nor give advice. Should assist parents in the development of an acceptable and safe discipline plan
Skinner - (repeating a behavior that results in a positive outcome)

21. Discipline Techniques
Limit setting, praise for good behavior (positive reinforcement such as hug, smile, praise, material reward) is most effective method for achieving desired behavior
Time-out used between 1 to 6 yrs. One minute per year of age. Remove child from situation with brief explanation and remind of cause for time-out when over. Use consistently!
***Preschoolers learn socially acceptable behavior by positive reinforcement***

22. Discipline – Corporal Punishment
Focuses on the pain of punishment, role models aggression
Rarely accomplishes goal of discipline
Child abuse becomes a risk

23. Sexuality
Children in early childhood do have the capacity for sexual pleasure and response (penile erection, thrusting, masturbation)
Children between 4 – 7 yrs have play activities that involve looking and/or touching the genitals (normal curiosity)
Parent’s response to child’s elimination is an early influence related to sexuality as well as the reaction of hugging and kissing as emotions
Modesty gradually appears between 5-6 yrs

24. Types of Play
Parallel – plays next to a friend but does not interact (seen in 2 year olds)
Cooperative – cooperate to act out a scene or build blocks together (see in 3-4 yr olds)

25. Play
Allows imitation of adult roles, assume superpowers, solve problems
Drawings sometime reflect inner emotional conflicts
Group songs/music/dancing are enjoyed by toddlers and preschoolers
Age-appropriate toys are safe toys that promote the cognitive and motor development of a specific age group
By age 5, organized group play and assigned roles

26. Teaching Techniques
Appropriate response to children’s words help stimulate communication
Use of picture books and reading sessions help with language development
Help with expression of feelings by using words instead of acting act helps with social development