The preschool child: developmental themes and clinical issues.
The preschool years are a remarkable period of dramatic growth in the areas of physical, affective, and cognitive development. Physical development is characterized by a slow but steady rate of somatic growth and the mastery of motor skills that facilitate the child's achievement of autonomy and independence. Major themes in affective development include the achievement of autonomy and independence from family, a lessening of attachment to parents and the alleviation of separation anxiety, and the acquisition of impulse control and socialization skills. Cognitive development during the so-called preoperational period is best characterized by the mastery of language. The remarkable developmental gains achieved during this dynamic period culminate in a child who can function independently and competently and begin the major occupation of childhood--attending school. Health maintenance issues during the preschool years directly reflect the child's developmental stage. For example, nutritional issues reflect not only physical growth and motor skills, but also negativism and the child's struggle to achieve autonomy. Similarly, safety and injury prevention related to the "motor-minded" behavior so characteristic of children at this age, as well as the illogical, egocentric thought that predominates during this period of cognitive development. Examples of other stage-related issues addressed during health maintenance visits include discipline and behavior problems, sleep problems and night awakening, and toilet training. The unique aspects of development during the preschool years also have implications for other components of child health maintenance, including developmental screening, procedures and immunizations, and physical assessment. A number of clinical issues are of special significance during the preschool years. For example, the most common causes of children's short stature, constitutional delay in growth and familial short stature, may result in major parental concerns at this time. Recurrent otitis media is an important problem during this period of language acquisition. Among preschool children with urinary tract infections, the risk of an underlying structural anomaly of the urinary tract and the danger of irreversible renal damage is greater than for older children.(ABSTRACT TRUNCATED AT 400 WORDS)
Dworkin
P H
PH
Division of General Pediatrics, University of Connecticut Health Center, Farmington.
D000367:Age Factors; D001293:Attitude to Death; D002657:Child Development; D002675:Child, Preschool; D002908:Chronic Disease; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D003967:Diarrhea / Q000453:epidemiology; D004688:Encopresis / Q000453:epidemiology / Q000628:therapy; D004775:Enuresis / Q000453:epidemiology / Q000628:therapy; D006130:Growth Disorders / Q000453:epidemiology; D006801:Humans; D006948:Hyperkinesis / Q000453:epidemiology / Q000628:therapy; D007806:Language Disorders / Q000453:epidemiology / Q000628:therapy; D010033:Otitis Media / Q000453:epidemiology / Q000628:therapy; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000628:therapy