Mental health & crisis management 7 APRIL qui z

Jack Fowler

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Chapter 38

The Preschooler and Family

Promoting Optimal
Growth and Development

The preschool period: ages 3 to 5 years
Preparation for most significant lifestyle change—going to school
Experience of brief and prolonged separation
Use of language for mental symbolization
Increased attention span and memory

Biological Development

Physical growth slows and stabilizes.
Body systems mature and stabilize; child can adjust to moderate stress and change.
Muscle development and bone growth are still not mature.

Gross and Fine Motor Behaviour

Gross motor: walking, running, climbing, and jumping well established by 36 months
Refinement in eye–hand and muscle coordination
Drawing, artwork, dressing

Fig. 38-1. A 3-4-year-old child has sufficient balance to stand or hop on one foot.

Psychosocial Development

Erikson; developing sense of initiative
Initiative vs. Guilt
Chief psychosocial task of preschool period
Feelings of guilt, anxiety, and fear may result from thoughts that differ from expected behaviour
Development of superego (conscience)
Learning right from wrong; moral development

Initiative Vs. Guilt

Bethany Geltner YouTube video

https://www.youtube.com/watch?v=kDWhl1h9vfA

Initiative

Sense of initiative is strengthened when they are allowed to try out new skills with little risk of disapproval and disappointment, and by being given the independence and reinforcement to play. Play creates a social group of children where they learn to engage and cooperate with others to achieve shared goals.

Guilt

Being threatened, criticized and punished excessively by adults can lead to development of a sense of guilt among children.. This may affect their social interactions negatively and may also hinder their creativity. However, some guilt is deemed necessary for them to learn self-control and feel the significance of conscience. A balance between initiative and guilt must therefore be achieved.

Cognitive Development

Readiness for school
Readiness for scholastic learning
Typically ages 5 to 6 years

Cognitive Development—cont.

Piaget; preoperational phase
Spans 2 to 7 years
Divided into two stages
Preconceptual phase: ages 2 to 4
Intuitive thought phase: ages 4 to 7
Shifts from egocentric thought to social awareness
Able to consider other viewpoints

Jean Piaget Pre-operational Stage Experiment (By: C & E)

YouTube video

https://www.youtube.com/watch?v=QQtzPKHxHp0

Cognitive Development—cont.

Language continues to develop.

(Incessant talking at age 3)

(Stammering, stuttering can be normal)

Concept of causality begins to develop.
Concept of time is incompletely understood.
Use of “magical thinking” is frequent.

(usually age 5)

Theory of Moral Development

Kohlberg;
Premoral/conventional/post conventional ladder
Can only progress to next step once you are finished the stage you are in
“Heinz”

Heinz Dilemma

Heinz’s wife was dying from a peculiar type of cancer, and the doctors said a new drug might be able to save her. The drug had been discovered by a local chemist and Heinz tried desperately to buy some, but the chemist was charging ten times the money it cost to make the drug and it was much more than the Heinz could afford.

Even after help from family and friends, Heinz could only raise a fraction of the cost for the drug. He explained to the chemist that his wife was dying and asked if he could have the drug for a cheaper price or pay the rest of the money later. The chemist refused, saying that he had discovered the drug and was going to make money from it. The husband was desperate to save his wife, and he was wondering what he should do.

Points to Ponder…

Should he steal the drug?

Should he steal the drug and face the consequences?
Should he obey the law and not steal the drug, only to let his wife die?

Premoral

Obedience vs. Punishment

Reasoning based on physical consequence of action

Rules fixed and absolute

Conventional

Good Boy & Good Girl

The child is ‘good’ based on what is perceived as others as good…So now the child is aware of others perceptions and is influenced by others

Post Conventional

Social Contract

Self-chosen principles direct thinking based on individual rights and justice for he greater good

Heinz…was protection of life more important than maintaining Law and Order?

School-Aged view of Heinz Dilemma

https://www.youtube.com/watch?v=CjPfI4Xu2CU

Spiritual Development

Knowledge of faith and religion learned from significant others and religious practices
Development of conscience strongly linked to spiritual development
May misinterpret illness as punishment from God

Development of Body Image

Increasing comprehension of “desirable” appearances
Awareness of racial identity, differences in appearances, and biases
Poorly defined body boundaries
Fear that if skin is “broken” all blood and “insides” can leak out
Intrusive experiences frightening (Dr/ Dentist)

Development of Sexuality

Child forms strong attachment to opposite-sex parent while identifying with same-sex parent.
Modesty becomes a concern.
Sex-typing occurs.
Sex role limitation occurs, with child “dressing up like Mommy or Daddy.”
Sexual exploration is more pronounced.
Questions arise about sexual reproduction.

Social Development

Separation–individuation process completed
Overcoming stranger anxiety and fear of separation from parents
Still need parental security and guidance
Security from familiar objects
Play therapy beneficial for working through fears, anxieties, and fantasies

Language

Major mode of communication and social interaction
By age 6, can use all parts of speech correctly
Define simple things…i.e. ball is round and an toy…not just ‘red’ or ‘ball’

Fig. 38-2. Preschool children enjoy friends and often use nonverbal messages to communicate.

Personal–Social Behaviour

Self-dressing
Willing to please
Have internalized values and standards
of family and culture
May begin to challenge family's code of conduct

Fig. 38-3. Most preschoolers are able to dress themselves but need help with more difficult items of clothing.

Play

Associative play (watching and conversing without interacting)
Imitative play (role play)
Imaginative play—imaginative playmates
Dramatic play (play out a part or ‘role’)

Fig. 38-4. Preschoolers enjoy play activities that promote motor skills such as jumping and running. Water play is an exciting activity for preschooler.

Imitation

Coping With Concerns Related to
Normal Growth and Development

Preschool and kindergarten
Developmental screening tool to assess readiness for school
Importance of infection control in
school setting
Introduction of child to school

Fig. 38-6. Thorough hand washing is the single most effective method of preventing infection.

Sex Education

Find out what children know and think.
Be honest.
Discuss masturbation.
Sexual exploration and sexual curiosity are common.

Formal edu. usually starts at Age 10

Fears

Dark
Being left alone
Animals (e.g., snakes, large dogs)
Ghosts
Sexual matters
Objects or people associated with pain
Animism – spiritual essence to natural phenomena

Stress

Realization that minimal amounts of stress can be beneficial
Parental awareness of signs of stress
in child's life
Prevention of stress
Scheduling adequate rest
Preparing child for upcoming changes to maximize coping strategies

Stress Symptoms in Children

Start at 1:05.
YouTube Video

Aggression

Behaviour that attempts to hurt person or destroy property
May be influenced by biological, sociocultural, and familiar variables
Factors that increase aggressive behaviour: gender, frustration, modelling, and reinforcement

Speech Problems

Dysfluency (inability to say word)

Dyslalia (problems with articulation)

Promoting Optimal Health
During the Preschool Years

Nutrition
Caloric requirements dependent on age and gender
Fluid requirements approximately
100 mL/kg/day, depending on activity and climate
Food fads, strong tastes common

Fig. 38-7. Preschool-age children enjoy helping adults and are more likely to try new foods if they can assist in the preparation.

Sleep and Activity

12 hours of sleep per night, infrequent naps
Free play encouraged
Emphasis on fun and safety

- current debate re: increasing # of organized activities

Sleep Problems

Thorough assessment of sleep problems
Nightmares
Sleep terrors
Encourage consistent bedtime routine

Dental Health

Eruption of deciduous teeth complete
Professional care and prophylaxis
Fluoride supplements

Injury Prevention

Safety education
Increase in pedestrian motor vehicle accidents
Development of long-term safety behaviours
Wearing protective equipment
*bike safety

Anticipatory Guidance—
Care of Families

Child care focus shifts from protection
to education.
Children begin questioning previous teachings of parents.
Children begin to prefer companionship
of peers.

Child Maltreatment

Intentional physical abuse (20%) or neglect (34%)
Emotional abuse (9%) or neglect
Sexual abuse of children (3%)

Types of Neglect

Physical neglect
Deprivation of food, clothing, shelter, supervision, medical care, and education
Emotional neglect
Lack of affection, attention, and emotional nurturance
Emotional abuse—destroy or impair child's self-esteem

Physical Abuse

Deliberate infliction of physical injury on child
Shaken baby syndrome
Violent shaking of infant or young child
Munchausen syndrome by proxy
Factitious disorder by proxy or medical child abuse

Factors Predisposing
to Physical Abuse

Parental characteristics
Social isolation, young parents, single parents
Characteristics of the child
Disabled, preterm, and under 3
Environmental characteristics
Divorce, poverty, unemployment

Sexual Abuse

No universal definition exists.
Sexual abuse and exploitation in Canada involves using a child for sexual purposes.

Sexual Abuse—cont.

Incest
Molestation
Exhibitionism
Child pornography
Child prostitution
Pedophilia

Characteristics of Abusers
and Victims

Typical abuser is male whom victim knows, but may be anyone.
All socioeconomic backgrounds can be involved.

Nursing Care of the
Maltreated Child

Identify abusive situations as early as possible.
Obtain history pertaining to incident.
Evidence of maltreatment includes:
Pattern or combination of indicators that arouse suspicion and further investigation
Protect child from further abuse
Prevent abuse.

END HERE

School Age

Group Work

Puberty

Body Image

Erkison/Piaget

Moral Development

Adolescent

Erikson/Piaget
Peer Relationships
Obesity
Sleep and Rest

Injury Prevention