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Pediatric Essay Essay

According to Hockenberry & Wilson (2013), during the preschool years between the ages of 3 and 5, a combination of milestone developments in physical growth, motor skills, cognitive, social and psychosocial best prepare children to enter school (p. 408). Prior to beginning school, preschoolers need to be able to demonstrate that they can tolerate small separation periods from their parents and maintain control of their bodily functions (Hockenberry & Wilson, 2013, p. 408).

Additionally, they want to interact with adults and other children in a cooperative manner, and have the mental acuity and discipline to be able to learn in a classroom setting (Hockenberry & Wilson, 2013, p. 408). The focus of this paper will be on evaluating the significant milestones reached by a healthy, three-year-old girl named Giada. She is a tall, slender girl with full lips, curly red hair and striking, clear blue eyes. Currently, Giada is attending preschool two afternoons per week. Additionally, she is an only child who was full-term at birth.

Her American-born parents are a married, heterosexual couple, and in their mid to late forties. Her father is 100% Italian, and her mother is Portuguese-German blend. Giada’s parents were both raised Catholic. Occasionally, they attend Sunday Spanish speaking services at the local church. Milestones Evaluation Between the ages of three and five, the physical rate of growth slows to about 2. 5-3. 5 inches per year and weight gain averages about 4. 5-6. 5 pounds per year (Hockenberry & Wilson, 2013, p. 408). The average height and weight for a three year old is 37.

5 inches and 32 pounds, respectively (Hockenberry & Wilson, 2013, p. 408). Giada’s height is about 41 inches, and she weighs 41 pounds. According to CDC growth charts for girls 2-20 years old, Giada is 90 percentile in the weight-to-age measurement and 80 percentile in the stature-for-age measurement. Giada’s father is a slightly portly man who is 6’2”. Her mother is a slim, muscular woman with a height of 5. 7”. Based on the CDC growth charts and the physical stature of her parents, Giada is appropriate in weight and height for her age.

The daily calorie requirement for a preschooler is 90 kcal/kg with protein between 13 and 19 g/day and fat consumption limited to 20-30% (Hockenberry & Wilson, 2013, p. 417). Giada’s mother does not count calories, but focuses, instead, on using natural, organic ingredients. For example, Giada’s favorite breakfast dish is “Egg in a Nest”. Her mother uses only organic eggs purchased at her local farmers’ market. She makes the bread at home, from flour ground in an industrial blender. Giada and her family have a communal garden in the city and use the vegetables and fruits grown from seeds they planted.

Giada’s nutritional needs appear to be adequate for her age and size. According to Hockenberry & Wilson (2013), three-year-old preschoolers “can ride a tricycle, walk on tiptoe, balance on one foot for a few seconds, and do broad jumps” (p. 408) and increase their fine motor development by drawing copies of circles, crosses and names (p. 414). Giada loves to walk on her tiptoes and demonstrate the ballerina skills she learned in dance class. At her preschool, she likes to play hopscotch on the indoor rug.

Giada also likes to ride her bicycle with training wheels along side her mother when they go out. This is a significant safety concern for Giada’s parents. According to a study by Abu-Kishk, Vaiman, Rosenfeld-Yehoshua, Kozer, Lotan, & Eshel (2010), in “the last decade, we observed increasing incidence of hospitalizations due to bicycle-related injuries in our PICU” and “most of the cases presented (were) abdominal injuries (54. 4%), followed by head (32. 6%)” (p. 644). Her mother ensures that Giada wears a proper fitting helmet and holds onto her handlebars firmly.

As far as fine motor skills, Giada likes to copy the letters of her name repeatedly with a crayon after her father demonstrates how to write out her name. Additionally, she can use scissors to cut out oval shapes. Overall, Giada is appropriate to exceptional for gross and fine motor skills for three-year olds. Based on Piaget, three-year olds are in the preconceptual phase and tend to be egocentric in their behavior and thoughts, but begin to view ideas from another person’s viewpoint (Hockenberry & Wilson, 2013, p. 414). Giada is well aware of the homeless people that live in her immediate area.

Her mother recalls that Giada noticed a homeless man sitting by himself and thought he looked sad and wanted to know why. Her mother answered by saying she did not know, but maybe he was hungry. Giada then insisted they walk over to the man and give him her almond butter and jelly sandwich. Giada also greets her father with “feel better hugs” when he returns home from a difficult day at work. Additionally, Giada understands the sequence of daily events, which is a trait prevalent in four-year-olds (Hockenberry & Wilson, 2013, p. 414). Giada knows that she has to brush her teeth after breakfast.

She also knows that preschool naptime is between lunch and snack. According to her mother, Giada can count up to twenty in English and up to five in Spanish. Cognitively, Giada is appropriate to exceptional for her age. In Erikson’s psychosocial stage of development, the three-year-olds’ main task is to acquire initiative by learning through energetic work and play (Hockenberry & Wilson, 2013, p. 408). However, if preschoolers push beyond their ability and behave inappropriately, feelings of guilt, fear and anxiety may also develop (Hockenberry & Wilson, 2013, p. 411).

According to Hockenberry & Wilson (2013), imitative and imaginative play is normal for preschoolers (p. 414). Giada likes to gather the other girls at preschool and assign them to be different Disney princesses. She makes her self the head princess who tells the other “princesses” what to do. Sometimes she likes to play the “damsel in distress”, especially if boys are part of the playgroup. At home, Giada likes to pretend that she is the mother and her parents have to do her bidding. Occasionally, this creates conflict when her parents want to end the pretend game and reinstate the normal rules.

When Giada realizes that others do not always want to play, she pouts and cries. Sometimes she is sent to her room where she calms down by talking to her dolls about how she feels. Based on the observed behavior, Giada reflects the socialization skills of the four-year-old. Psychosocially, she is appropriate to exceptional for her age. Conclusion Giada appears to meet or exceed the milestones in height, weight, gross and fine motor skills. She is on target with Piaget’s cognitive and Erikson’s psychosocial stages for a three-year old preschooler.

As Giada continues to grow into the four-year old phase, her parents will need to be prepared for an increase in aggressive behavior, which may include offensive language and increased opposition to parental authority (Hockenberry & Wilson, 2013, p. 420). Because of increasing motor activities, safety education and awareness of potential hazards will need to be emphasized and continuously reinforced (Hockenberry & Wilson, 2013, p. 419 & 420). Considering the milestones that Giada is achieving, she is well on her way to be ready for the next level of school-age growth and development.

References: Abu-Kishk, I. , Vaiman, M. , Rosenfeld-Yehoshua, N. , Kozer, E. , Lotan, G. , & Eshel, G. (2010). Riding a bicycle: Do we need more than a helmet? Pediatrics International, 52(4), 644-647. doi: http://dx. doi. org/10. 1111/j. 1442-200X. 2010. 03159. x Growth Charts – Homepage. (n. d. ). Centers for Disease Control and Prevention. Retrieved March 13, 2013, from http://www. cdc. gov/growthcharts/ Hockenberry, M. J. , & Wilson, D. (2013). Wong’s essentials of pediatric nursing (9th ed. ). St. Louis, Mo. : Mosby.

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