The preschool period is generally considered to be three to five years of age (4). I observed a five year old female playing at a playground. The tasks witnessed were running, playing on a slide, ascending stairs, and climbing on a jungle gym (a circular interlocked metal object with a ladder). Play was performed in the presence of her mother and older brother. The preschooler is a very social individual who is making friends and exploring the world (4).

This child had a tendency to mimic the actions of her older, seven year old brother. He made a point of showing his sister when he walked up the slide rather than sliding down it. Repition is a coping behavior and helps children learn (2). She was so amused by her brother that she started to copy the action and, when mastered, called to her mother to watch her perform this amazing feat. The child was proud once she was able to accomplish the task and looked for parental praise. In the psychosocial aspect in the six to eleven year old age, industry, or being permitted to make and do things and being praised for accomplishments is something that is exhibited when she looks for approval of her brother and her mother on her activities (5). The conforming behavior of following the lead of her brother is consistent with a five year old (5). There was constant communication with her brother.

The two children interacted not only on the slide, but also through different areas of the playground. Motor skills are important in social interactions (4). The brother and sister team would go down the slide like a train, connected to one another, and kept each other within view at all times. The girl would follow her brother around for a little while, but then would perform self exploration. While running, this five year old exhibited trunk rotation, a forward lean, head bob and reciprocal symmetric arm swing. This is consistent with her age group increasing arm swing in gait (1). Performing gait tasks on even ground, there was independence with unsupported running and walking. However, when adjusting to changing terrain, the child used holding with one or two hands to right herself. She seemed to have good proprioception. The girl ran with her legs close together with a counter rotation of the trunk during running, but not with stairs as predicted for her age (1). This is indicative of normal development given the ability to rotate forward or back twelve degrees and five degrees of hip abduction and adduction (7). To be able to move on to further develop, this child should being doing more hopping and jumping tasks to aid in increasing the lower extremity strength and more proximal stability prior to refining her movements and increasing her velocity.

During climbing, the little girl was able to find a good grip with straightforward tasks and reciprocally used her arms in a supportive placement to climb effectively. She also had good eye-hand coordination with a tendency to grab with the right arm first. This is the age when handedness is established (9). The child also seemed right arm dominant when reaching for the next bar during ladder climbing or tapping her brother to get his attention. Although this child had good dexterity, alternating extremities for climbing a straight ladder, her base of support was wide. It might be a possibility that there was a hip flexor and extensor weakness since the preference was to climb with abducted and externally rotated hips in a “spider-man” position. This stance seemed inefficient and awkward.

Ascending stairs this girl alternated legs however she exhibited a valgus position that looked unstable. At five, most children walk upstairs and down stairs using each foot every other step (10). The valgus might just be attributed to her normal postural alignment which when in standing seemed to be present, but there could be a weakness that exists. Anatomically, this child had genu valgum and her feet were in the neutral position. She did not appear to have weak abdominals or back extensors, although I question how strong her neck extensors are secondary to the bobbing while running. At this age there is an increase in abdominal control (1). Her body looked in proportion as you would expect of a five year old (1). In the fifth year of life, one would expect a little more varus than valgus and a little more antetorsion than what was present. Normally, antetorsion is 23 to 26 degrees and valgum is 12 to -5 degrees (3).

While performing exploration independently, this child tried to trouble-shoot how to approach an odd-shaped climbing object. After several attempts in a short period of time, she was quickly discouraged and moved back to the known task of going up and down the slide. At this age, it is important to encourage attempting new tasks. I would have liked to have had someone assist her in the climb rather than seeing her become frustrated and give up on the task. To move into the next stage of development, there is a need to work on perceptual motor planning to trouble-shoot a resolution to new problems.

As a five year old, this child was aware of her environment and able to interact within it. She adapted to changing terrains using her upper extremity to stabilize. She was cognitively aware of people around her and responded to them appropriately. She would respond to questions and ask questions of her own. There was a tendency to look for attention of the parent within the environment. There was also a younger girl approximately two and a half years old who entered the playground that the five year old wanted to help and play with. At this age, positive social encounters and cooperative activity are important aspects which are foundations of friendship (2). The interactions with other children add to competition and the challenge to try new things. At this stage, highly cooperative play is prevalent and a preference during activities (8; 9). Playing with others, such as her brother, assisted her in experimentation away from what is already known and mastered.

Language plays a key roll in gross motor function (6). At one point, the mother called her daughter, which set the child into a run. Accomplishing a task and running over to tell her mother created a relationship between the gross motor abilities and the language interaction. She would shout commands to her brother and respond to his wishes in return. There was fluidity to her speech, speaking several sentences in a row. The child’s body language was very important. The child was very direct in seeking out and making eye contact to whomever she wished to speak with, smiling and leaning in while chatting. She was aware that she needed to yell to be heard from a distance. The child was able to get someone’s attention and make her desires known.

Special considerations for physical therapy are based in psychosocial interactions, stages of development, cognition and communication. Although uncorroborated, this child may have muscular weakness in the lower extremities. At this age, children talk clearly and use adult speech sounds (8). One should talk to the child and make them aware that something is being planned. It would be beneficial to have her mother and brother present because it would add to her comfort level. She has a tendency to mimic her brother, which might be beneficial if you could get him involved to assist in an activity you would like his sister to perform. She wants her mother’s attention and encouraging successful situations and having the mother praise her will add to the effectiveness of a physical therapy session. There is a strong desire to experiment on her own, yet becomes discouraged when the task cannot be accomplished and moves back to more comfortable known tasks. If we could set an environment that allows for exploration with assistance when needed to decrease frustration, this would allow for learning and growth to continue. It is important to acknowledge that this child has good cognition, is expressive and conveys her desires through body language, if not verbally. One must keep a keen eye on the child, as her actions and words change every minute. (NUPT Issues in Pediatrics Class Lectures 10/21/2005 &10/25/2005)

References

1. Department of physical therapy and human movement sciences Feinberg school of Medicine, Northwestern University. Issues in Pediatrics 3-5 years.10/2005.
2. Department of physical therapy and human movement sciences Feinberg school of Medicine, Northwestern University. Developmental Guidelines 10/2005.
3. Department of physical therapy and human movement sciences Feinberg school of Medicine, Northwestern University. Developmental Features of the foot and leg.
4. Effgen, Susan K. Meeting the Physical Therapy Needs of Children. FA Davis Co, Philadelphia, 2005.
5. Ripple RE, Viehler RF, Jaquish GA. Personality development as proposed by Erikson: Human Development, Houghton Mifflin Co, Boston, 1982.
6. Vance Maggie; Stackhouse Joy; Wells Bills. Speech-production skills in children aged 3- 7 year. International Journal of Language & Communication Disorders, Volume 40, Number 1, January-March 2005, pp. 29- 48(20).
7. Weck, Mary, PT. Development of gait 10/2005.
8. www.childdevelopmentinfo.com/development/normaldevelopment.shtml.
9. www.childdevelopmentinfo.com/development/dersequence.shtml.
10. www.healthtouch.com/bin/econtent-HT/cnoteshowlfts.asp