CH 8: Physical Growth in Preschool Children

Question 1

Body Growth

Answer 1

• Preschool children grow steadily, adding about 5-8 cm and 1.8 kg each year
- Growth during the preschool years is not as rapid as during the infant and toddler years.
- Because growth is stable at this age, we can more accurately predict a child’s height as an adult
• Loss of “baby” fat and changing proportions.
- look more mature, more adult
• Cartilage turns to bone: ossification

Question 2

Brain Development

Answer 2

• Preschool years are a time of rapid growth for the brain.
- much more quick than body growth
• Between 2-5 years, unnecessary synaptic connections are pruned
• Myelinization continues, particularly of the corpus callosum and sensory and motor regions of the brain.
- corpus callosum in babies is slow and disorganized
> due to myelinization
> functioning well at age 5 - brain has decided what occurs where (specialize/lateralize)
• Synaptic pruning and myelinization make the brain more efficient
• Brain becomes more specialized as the child matures but at a price of plasticity

Question 3

Sleep

Answer 3

• Typically about 12 hours each night
• Most growth hormone is secreted during sleep
• Amount of sleep decreases, including giving up naps around 4 years.
• Bedtime struggles occur nightly in 20-30% of children.
- falling asleep
- can be helped by following a consistent bedtime routine (facilitates pleasant bedtime)

Question 4

Gross Motor Skills

Answer 4

• Improve steadily
- i.e. running, hopping
• Improved ability to catch and throw a ball.
- most 2 or 3 year olds throw a ball using only their forearms , but 6 year olds use their arm, upper body and legs
• Advanced motor skills lead to unstructured play.
• Motor skills show amazing improvements during these years as a result of brain development.

Question 5

Fine Motor Skills

Answer 5

• Improved dexterity leads to more precise and delicate movements.
• Improved hand-eye coordination
• Greater fine motor skill means that children can feed and dress themselves
• Better grip of writing implements means improved drawings.
- first around age 2, consists of scribbles; rapidly progress to drawing shapes and combining shapes
- ~ 4 or 5, begin to draw recognizable objects, such as people or animals

Question 6

Stages of Drawing

Answer 6

• The origins of writing start with the stages of drawing.

• Basic Scribble
• Shape Stage
• Design Stage
• Pictorial Stage

Question 7

Handedness

Answer 7

• By 2 years, most children show a clear hand preference
- 90% are right-handed.
• Left-handed people are more likely to have migraines, allergies, and language-based problems (disorders).
• Lefties are more likely to be artistically, spatiously, and mathematically talented.
• For most children, language functioning is typically localized in the left hemisphere
- for some left handed children, language is localized in the right hemisphere, and for others (left-handed) it is localized in both
- brain organization usually the same regardless of handedness

Question 8

Gender Differences in Motor Skills

Answer 8

• Gender differences in motor skills might be due more to socialization than biological male-female differences.
• Boys tend to be more muscular and more active.
- becomes more prevalent during puberty
• Boys better at running and throwing.
• Girls tend to be better at balancing, hopping, skipping, and fine motor activities.
• Recent studies of hand strength show no difference
- activities such as throwing and catching are related to hand length, such that children with larger hands tend also to have greater ability to grip and pinch

Question 9

Nutrition in Preschool Years

Answer 9

• Preschoolers need to eat less per kilogram than infants and toddlers.
- ~1500-1700 calories (low in sugar and fat)
• Some preschoolers become picky eaters.
- partly due to autonomy, control, and mobility - worried about poisons
• Parents should encourage a well-balanced diet.
• Canada’s Food Guide Table 8-1
• Health Canada’s guidelines for children nutrition should be followed to ensure children get adequate nutrients they require.
• No more than ~30% of the daily calorie intake should come from fat, which works out to be roughly 500 calories

Question 10

Childhood Obesity in Canada

Answer 10

• Melanin concentrating hormone causes increase in appetite
• Significant risk for familial obesity in Canada
• Feldman & Beagan
- ~ 5% of children have an underlying disease process that produces the obesity, but researchers concluded that most obese children simply take in more calories than they expend, making control of exercise and diet very important during the childhood years
• Middle childhood: gender difference grows more
- 19% of boys and 6% of girls

Question 11

Threats to Children’s Development

Answer 11

• Farms (machinery, animals, etc.)
• Minor illnesses are common in preschoolers.
• Chronic illness, except asthma, is not common in childhood.
• Stress and poverty are more likely to lead to injury and illness.
• Hospital stays can be made less traumatic with parents and health-care professionals working together.
- addressing children’s concerns
- offering some choices while in hospital
- Canada has adopted a “child-first” approach to service delivery for children (Jordan’s Principle).

Question 12

Ways to reduce risk of vehicle accidents

Answer 12

Children should always ride in a properly installed, approved car seat and should stay clear of large or dangerous farm equipment

Question 13

Ways to reduce risk of drowning

Answer 13

Children should never be left unattended near sources of water, particularly swimming areas, but also bathtubs or buckets filled with water

Question 14

Ways to reduce risk of poisoning

Answer 14

Keep all medications in child-resistant containers; keep them and all other harmful substances (e.g. animal poisons, cleansers) out of children’s way (out of reach, locked up or both)

Question 15

Ways to reduce risk of cycling accidents

Answer 15

When a child rides in a seat on a bicycle, be sure that the seat is installed properly, that the child is strapped securely, and that the child wears a helmet.
When riding a tricycle or bicycle, the child should stay off streets, be supervised by a parent, and wear a helmet.

Question 16

Ways to reduce risk of firearms accidents

Answer 16

All firearms should be locked in a safe place, with ammunition store in a separate, locked location. Children should not have access to the keys.

Question 17

Ways to reduce risk of fires

Answer 17

Install smoke detectors, and check them regularly. Keep fire extinguishers handy. Tell children how to leave the house in case of a fire, practice leaving the house, and have a safety plan.

Question 18

Threats to Children’s Development: Minor Illness

Answer 18

• Preschool children frequently have minor illnesses (i.e. colds)
• Having a minor illness benefits children by helping them develop immunities and by teaching them about the nature of illness and recovery

Question 19

Threats to Children’s Development: Chronic Illness

Answer 19

• Most chronic illnesses are rare, but an increasing number of children are asthmatic and have difficulty breathing because air passages in their lungs are inflamed
• Children with asthma can lead normal lives, as long as they follow their physician’s guidelines, such as taking proper medications
• 8.25% of children under 4 in Canada
• Disruptions within the normal human microbiome are associate with both behavioural and neurological changes in the person
- understanding it could lead to a better understanding of human health and psychology

Question 20

Threats to Children’s Development: Accidents

Answer 20

• More preschool children die from accidents than from any other cause
• Parents can either avoid most accidents entirely (i.e. ensuring child cannot get to poisons) or reduce the chance for injury from an accident (i.e. car seat)

Question 21

Threats to Children’s Development: Stress and Poverty

Answer 21

• Children are more prone to illness and injury when they are living in stress and when they live in poverty

Question 22

Government and Aboriginal Children

Answer 22

Governmental disputes and inaction, often arising out of jurisdictional turf wars, have a serious impact on service delivery to children, especially those of Aboriginal heritage in Canada

• underfunded child welfare
• 1 in 10 are in foster care (compared to 1 in 200 of non-Aboriginal children)

Question 23

Canadian Pediatric Society

Answer 23

publishes guidelines for the stunting/shortness and underweight/wasting categories
• children scoring below the 3rd percentile for height and weight on the growth charts, considered to be below recommended height and weight guidelines compared with age peers
• weight guidelines for overweight and obese children tend to use the body mass index as a measure
- children being at or over the 85th percentile considered overweight
- children at or over the 97th percentile considered obese relative to peers

Question 24

Teeth

Answer 24

• First tooth - usually one of the lower front teeth - doesn’t appear until 6-10 months
• Proper dental care should begin as soon as the first tooth appears
- within six months after, or by first birthday, then every six months after, unless recommended otherwise
• By 1 year, many infants have 4 teeth
• Usually have all 20 primary teeth by the age of 3 years.

Question 25

Location of Skills in the Brain

Answer 25

• speaking and comprehending speech, become more localized in the brain’s left hemisphere
• skills associated with understanding emotions and compreheding spatial relations become more localized in the right hemisphere

Question 26

Nightmares

Answer 26

dreaming that occurs toward morning that is vivid, frightening, and usually wakes the child
• occasionally normal and need nothing more than on-the-spot parental comfort and reassurance
• sometimes can pinpoint cause (i.e. movie) and fix
• Persistent, repeated, or troubling nightmares might require professional intervention

Question 27

Night Terrors

Answer 27

waking in a panicked state, breathing rapidly and perspiring heavily

• not fully awake, typically don’t respond to parent and go back to sleep quickly
• usually occur earlier in the night
• usually don’t remember
• seem to be a by-product of waking too rapidly from a deep sleep

Question 28

Good Bedtime Routine

Answer 28

• Usually takes from 15-45 mins
• Can ask what’s next (and enthusiastically praise them when they give the right answer)
- helps child to remember
• As child relaxes, they usually like to talk about their day
- if conversation will likely take longer than time permits, encourage the child that you will talk about it tomorrow, unless it’s an emergency
• If child requests something and it seems legitimate, parents should respond promptly
- if it is to delay, it is better to say “No more games; now go to sleep” and not return for unnecessary requests

Question 29

Fears

Answer 29

• Genuine - attend to promptly
• Specific fears of unrealistic events
• Children need to know that their parents will be their for them and protect them
• Consider consulting with a clinical child psychologist to help them deal with intense or persistent fear

Question 30

Types of Sleep Disturbances

Answer 30

(1) nightmares (occasional, most common type)
(2) night terrors and sleep walking (less common)
- if child sleepwalks a lot, parents should make sure there are no special hazards
(3) bed-wetting (many children; not a major problem unless it persists past preschool years)
- ~25% at age 4 wet the bed occasionally

Question 31

Shape Stage

Answer 31

the period during which children draw six basic shapes:

(1) circles
(2) rectangles
(3) triangles
(4) crosses
(5) X’s
(6) odd-shaped forms

Question 32

Design Stage

Answer 32

the period during which children combine the six basic shapes into more complex patterns

Question 33

Pictorial Stage

Answer 33

the period during which children depict recognizable objects in drawings

Question 34

Lateralization

Answer 34

the functional specialization of each half of the brain, which makes each half different form the other

Question 35

Obesity rates tend to be linked to the following factors:

Answer 35

• Environmental factors
• Genetic factors contribute to obesity in Canadian families.
• Geography (regional differences): Children in Atlantic Canada are twice as likely as becoming obese relative to children that live on the Prairies.

Question 36

Relationship between asthma and obesity

Answer 36

• Hilary Sandig and colleagues
• In asthmatic people, Th2 immune cells in the lungs overreact to environmental stimuli and cause inflammation
• Th2 cells also have been observed to cause the release of “melanin concentrating hormone” (MCH) which causes an increase in appetite and could result in overeating
• Obesity is hypothesized to produce low levels of inflammation in the body, placing a person at higher risk for allergic reactions and asthma, and additional release of MCH

Question 37

Health Canada’s examples of normal preschool eating habits

Answer 37

• being curious about new foods and ways of eating them
• examining food before they eat it
• requiring food to be in a specific shape
• trying only a bite today, maybe more tomorrow
• needing specific type of dish or cutlery
• loving something today, hating it tomorrow
• needing food as a whole, not in pieces
• wanting the same type of food everyday for a week
• lack of patience
• preferring simple foods they recognize
• attempting to mimic their parents (i.e. drinking out of a mug)

Question 38

To encourage children to be more open-minded about food, experts have recommended several guidelines for parents:

Answer 38

• when possible, allow them to select from among different healthy foods
• allow children to eat foods in any order they want
• offer them new foods one at a time and in small amounts; encourage but don’t force children to eat new foods
• don’t force children to clean their plates
• don’t spend mealtimes talking about what the child is/isn’t eating; instead, talk about other topics that interest the child
• never use food as reward or punishment

Question 39

Human Microbiome Project

Answer 39

Researchers are attempting to sequence and understand the genetic structure and functioning of the human microbiome across a variety of sites on the human body to see whether all people share a core set of microbes, and how those microbes affect human health and well-being
• Through the Canadian Institute of Health Research and the Institute of Infections and Immunity, Canada has launched the Microbiome Initiative and is participating in the HMP, as are other nations

Question 40

Environmental Contributions to Illness and Injury

Answer 40

• some children are more likely to be ill or injury-prone

• stress (reduces resistance)
• poverty (lack of adequate nutrition, stress, etc.)

Question 41

Impact of Hospitalization

Answer 41

• Hospitalization often upsets children because of the separation from parents, the fear of the unknown, and the loss of control

• when parents and health-professionals work together, stay can be more predictable and less traumatic
• parents encouraged to spend as much time in the hospital with their children
• clinical psych. and social workers sometimes are involved in preparing children for stay (i.e playing with non-hazardous hospital materials)

Question 42

McKechnie and Fetal Alcohol Spectrum Disorder

Answer 42

In order for people with FASD to have their needs met, co-operation is required of several levels or departments of government in Canada, including provincial, federal, territorial, and tribal.
Government policies, as well as communication mishaps and barriers, often prevent children from qualifying for necessary services or obtaining services form any source at all

Question 43

First Nations Children and Foster Care

Answer 43

• According to the First Nations Child and Family Caring Society of Canada, the neglect which causes these children to end up in foster care is an umbrella term which covers:
- poverty
- poor housing
- substance abuse
• Despite the numbers of First Nations children in foster care, these children often are denied or delayed services as a result of jurisdictional disputes, typically between federal or provincial governments

Question 44

The case of “Jordan”

Answer 44

• a Manitoba First Nations child
• jurisdictional disputes dragged on for two years after physicians wanted to discharge Jordan from the hospital to live in a family-home setting
• Jordan’s serious health problems required that he receive special in-home services
- resulted in a protracted dispute between Health Canada, Indian Affairs, and the provincial government
• Jordan spent the remaining two years of his life in the hospital, and died before these governments were able to resolve their jurisdictional turf war

Question 45

“Jordan’s Principle”

Answer 45

• the First Nations Child and Family Caring Society of Canada has recommended that a “child-first” principle, called “Jordan’s Principle” be adopted by all levels of government involved in providing services to children
• it recommends that:
a child first principle be adopted whereby the government who first receives a request for payment of services for a First Nations child will pay without disruption or delay when these services are otherwise available to non Aboriginal children in similar circumstances. The government then has the option of referring the matter to a jurisdictional dispute resolution process.

Question 46

Why do jurisdictional disputes of First Nations children occur?

Answer 46

• Social-service delivery for First Nations children in Canada is an extremely complex matter
• Because of the way Canadian federal and provincial laws are written, children living off-reserve have to access services through federal and provincial agencies only and may not access services from their home First Nations
• On-reserve, First Nations Child and Family Services agencies often have authority to deliver services to First Nations youth belonging to a particular band or tribal agency
• These case transfers result in serious gaps in services and are not dealt with in the same manner from province to province, increasing the possibility of unequal treatment
• Federal and provincial governments don’t always communicate effectively with each other