Physical Growth and Vital Signs Preschoolers generally gain 4.5 to 6.5 lb (2 to 3 kg) and grow 2.5 to 3.5 inches (6.5 to 9 cm) per year. As they lose baby fat and gain muscle, they assume a more mature, sturdy posture. Neurologic myelination is typically complete by age 3, facilitating bowel and bladder control.

For children ages 3 to 5, normal vital signs are:

• Pulse: 70 to 120 beats per minute.

• Respirations: 20 to 25 breaths per minute.

• Temperature: Averages 37.2°C (99.0°F) at age 3, decreasing to 37.0°C (98.6°F) by age 5.

• Blood Pressure: Systolic ranges from 89–98 mm Hg and diastolic from 46–53 mm Hg, depending on sex.

• Pain Assessment: The FLACC scale is appropriate for ages 2 months to 7 years; however, children aged 3 and older can use self-report tools like the FACES scale or the Oucher photographic scale.

Developmental Stages

• Psychosocial (Erikson): This period is defined by "Initiative vs. Guilt," where children learn to plan activities, please parents, and develop a conscience. They may feel remorse when behaving badly.

• Cognitive (Piaget): Preschoolers are in the preoperational stage, characterized by magical thinking (thoughts cause events), animism (lifelike qualities to inanimate objects), and egocentrism.

• Motor Skills:

◦ Age 3: Rides a tricycle, goes up stairs with alternating feet, builds towers of 9-10 blocks, and undresses self.

◦ Age 4: Throws ball overhand, hops on one foot, uses scissors, and copies capital letters.

◦ Age 5: Skips, somersaults, prints some letters, ties shoelaces, and dresses independently.

• Language: Vocabulary expands from 1,500 words at age 4 to 2,100 words by age 5. Children ask "why" and "when" questions and speak in sentences of 4 to 5 words by age 5.

Health Promotion and Safety Preschoolers require 10 to 13 hours of sleep daily. Nightmares (remembered, child wakes up) differ from night terrors (child remains asleep, no memory of event). Nutritional needs include 700 to 1,000 mg of calcium and 7 to 10 mg of iron daily. Milk intake should be limited to 16 to 24 oz per day to prevent iron deficiency and obesity. Safety measures include using forward-facing car seats with a harness until outgrown, then a belt-positioning booster seat until a height of 145 cm is reached.

Vaccination Schedule (Ages 4–6 Years) Routine immunizations for this age group focus on booster doses before entering school. The schedule includes:

• DTaP (Diphtheria, tetanus, acellular pertussis): 5th dose recommended at ages 4–6 years.

• IPV (Inactivated Poliovirus): 4th dose recommended at ages 4–6 years.

• MMR (Measles, mumps, rubella): 2nd dose recommended at ages 4–6 years.

• Varicella (Chickenpox): 2nd dose recommended at ages 4–6 years.

• Influenza: 1 or 2 doses annually, depending on vaccination history.

• COVID-19: Recommended based on current formulations and guidelines.

For children who are behind schedule, catch-up guidance indicates that the 5th DTaP dose is not necessary if the 4th dose was administered at age 4 or older. Similarly, a 4th IPV dose is indicated if all previous doses were given before age 4