THE PRESCHOOL CHILD
The child at this stage displays developing initiative. The preschooler take on tasks independently and plans the task and see s it through. A child of this age is often cooperative, helpful, and easy to involve. However, children of this age have fantasies and may see illness as punishment for being “bad.” The concept of body image is limited. The child fears of any body injury or mutilation, so he or she will recoil fro invasive procedures, e.g. tongue blade, rectal temperature, injection, and venipuncture.
Position
- With a 3-year-old, the parent should be present and may hold the child on his or her lap.
- A 4- or 5-year-old child usually feels comfortable on the examining table, with the parent present.
Preparation
- A preschooler can talk. Verbal communication becomes helpful now, but remember that the child’s understanding is still limited. Use short, simple explanations.
- The preschooler is usually willing to undress. Leave underpants on until the genital examination.
- Talk to the child and explain the steps in the examination exactly.
- Do not allow a choice when there is none.
- As with the toddler, enhance the autonomy of the preschooler by offering choice when possible.
- Allow the child to play with equipment to reduce fears.
- A preschooler likes to help; have the child hold the stethoscope for you.
- Use games. Have the child “blow out” the light on the penlight as you listen to the breath sounds. Or, pretend to listen to the heart sounds of the child’s teddy bear first. One technique that is absorbing to a preschooler is to trace their shape on the examining table paper (Wong, 1999). You can comment on how big the child is, then fill in the outline with a heart or stomach and listen to the paper doll first. After the examination, the child can take the paper doll home as a souvenir.
- Use a slow, patient, deliberate approach. Do not rush.
- During the examination give the preschooler needed feedback and reassurance: “Your tummy feels just fine.”
- Compliment the child on his or her cooperation.
Sequence
Examine the thorax, abdomen, extremities, and genitalia first. Though the preschooler is usually cooperative, continue to assess head, eye, ear, nose and throat last.