Which levels of physical capability would the nurse expect in a 3 year old child?

Play

Various types of play are typical of this period, but preschoolers especially enjoy associative play (i.e., group play in similar or identical activities but without rigid organization or rules). Play should provide for physical, social, and mental development.

Play activities for physical growth and refinement of motor skills include jumping, running, and climbing. Tricycles, wagons, gym and sports equipment, sandboxes, wading pools, and activities at water parks can help develop muscles and coordination (Fig. 33-4). Activities such as swimming and skating teach safety and muscle development and coordination. Children involved in the work of play do not require expensive toys and gadgets to keep them entertained but often enjoy playing with common household items such as a broom handle or even items that adults consider junk (boxes, sticks, rocks, and dirt). The imaginative mind of the preschooler enjoys playing for play’s sake.

Manipulative, constructive, creative, and educational toys provide for quiet activities, fine motor development, and self-expression. Easy construction sets, large blocks of various sizes and shapes, a counting frame, alphabet or number flash cards, paints, crayons, simple carpentry tools, musical toys, illustrated books, simple sewing or handicraft sets, large puzzles, and clay are suitable toys. Electronic games and computer programs are especially valuable in helping children learn basic skills such as letters and simple words.

Probably the most characteristic and pervasive preschool activity is imitative, imaginative, and dramatic play. Dress-up clothes, dolls, housekeeping toys, dollhouses, play store toys, telephones, farm animals and equipment, village sets, trains, trucks, cars, planes, hand puppets, and medical kits provide hours of self-expression (Fig. 33-5). Probably at no other time is the reproduction of adult behavior so faithful and absorbing as in 4- and 5-year-old children. Toward the end of the preschool period children are less satisfied with make-believe or pretend objects and enjoy doing the actual activity such as cooking and carpentry.

Television and other media also have their place in children’s play, although each should be only one part of children’s total repertoire of social and recreational activities. Parents and other caregivers should supervise the selection of programs, watch and discuss programs with their children, schedule limited time for television viewing, and set a good example of television viewing (American Academy of Pediatrics [AAP], 2007). Children enjoy and learn from educational programs; however, television viewing may limit time spent in other meaningful activities such as reading, physical activity, and socialization (AAP, 2007). Prolonged television viewing by young children has been linked to an increase in psychologic distress and decreased time spent in active playing, which increases the risk for obesity among certain children (Hamer, Stamatakis, and Mishra, 2009). Fast-paced television cartoons have been linked to a temporary decrease in executive functioning in 4-year-olds (self-regulation and working memory) (Lilard and Peterson, 2011).

Although the potential negative effects of television viewing have been well documented in literature, research has also shown that prosocial behavior and later academic achievement can result from viewing educational media during the preschool years; however, positive effects depend on the media content, the age of the viewer, the length of viewing time, and the presence of a co-viewing parent (Kirkorian, Wartella, and Anderson, 2008). When parents view media with their children, the activity can become interactive, with parents and children discussing program content. Considering the significant increase in media accessibility through various portable electronic devices and cell phones, parents need to be aware of the potential positive and negative effects of media exposure.

Play is so much a part of young children’s lives that reality and fantasy become blurred. Make-believe is reality during play and only becomes fantasy when the toys are put away or the dress-up clothes are removed. It is no wonder that imaginary playmates are so much a part of this age period. The appearance of imaginary companions usually occurs between 2½ and 3 years of age, and for the most part such playmates are relinquished when the child enters school. Differences in birth order and gender have been noted in studies of imaginary companion play. Firstborn children have a higher incidence of imaginary companions as do young girls; young boys more often tend to impersonate characters (Trionfi and Reese, 2009).

Imaginary companions serve many purposes: they become friends in times of loneliness, accomplish what the child is still attempting, and experience what the child wants to forget or remember. It is not unusual for the “friend” to have myriad vices and be blamed for wrongdoing. Sometimes the child hopes to escape punishment by saying, “My friend George broke the glass.” At other times the child may fantasize that the companion misbehaved and play the role of the parent. This becomes a way of assuming control and authority in a safe situation.

Parents often worry about the imaginary playmates, not realizing how normal and useful they are. They need to be reassured that the child’s fantasy is a sign of health that helps differentiate make-believe and reality. Parents can acknowledge the presence of the imaginary companion by calling him or her by name and even agreeing to simple requests such as setting an extra place at the table, but they should not allow the child to use the playmate to avoid punishment or responsibility. For example, if the child blames the companion for messing up a room, parents need to state clearly that the child is the only one they see; therefore the child is responsible for cleaning up.

Children also benefit from play that occurs between them and a parent. Mutual play fosters development from birth through the school years and provides enriched opportunities for learning. Through mutual play parents can provide tactile and kinesthetic experiences, maximize verbal and language abilities, and offer praise and encouragement for exploration of the world. In addition, mutual play encourages positive interactions between the parent and child, strengthening their relationship.

Table 33-1 summarizes the major developmental achievements for children 3, 4, and 5 years of age.

TABLE 33-1

GROWTH AND DEVELOPMENT DURING PRESCHOOL YEARS

Which cognitive developmental stage would the nurse expect for a 3

Which gross motor skills would the nurse expect children 3 to 5 years of age to develop?

Which of the following is a fine motor skill that a 3

Which activity would the nurse recognize as age appropriate for a 3