The preschool years are often referred to as “the magic years” because of the growth children experience during this time.  Their personalities emerge as they master the use of their bodies and gain awareness of themselves and the people around them.

Developmental Milestones

The biggest development that occurs during the preschool years is in the area of social and language development.  Up until now, children have been growing rapidly and mastering the use of their body.  Between the ages of 3 and 5, verbal skills change dramatically.  By age 5, most people should be able to understand everything your child says.  They should have thousands of words to express themselves with in complete sentences.  Emotions can be recognized and labeled.  Books become increasingly more interesting, and your child may “read” to themselves by narrating a book based on the illustrations.  Some children with spina bifida excel in language, and may be able to carry on a conversation at an early age.  It is not unusual for this to be a strong area in their development.  Preschoolers start to become social beings.  They forge friendships outside their family.  Family and societal roles are explored and identified with.  It is important that the child with spina bifida be in the least restrictive, most inclusive program possible.

In the area of gross motor skills, a child that was previously unable to stand or walk, they may start building enough strength and balance to start ambulating.  You may begin introducing a walker, crutches, or a wheelchair.

Fine motor skills are also being honed.  While obviously affecting gross motor skills, spina bifida can also delay fine motor skills as well.  If the area of the lesion is higher, it can actually cause weakness in the arms and hands.  Even with a lower lesion, skills may be delayed because of the reliance on the hands for mobility as opposed to exploration.  Preschool aged children should be learning to hold a pencil correctly, and by age 4 or 5, they should be able to copy pictures such as a cross, vertical and horizontal lines, circles, and even simple letters.
Activities of Daily Living

Preschool children should advance from being dressed by their parents, to being dressed with assistance, and finally to being able to dress without assistance.  Depending on their abilities, the child with spina bifida may or may not reach this level of independence during their preschool years.  However, they should be encouraged to assist with their own dressing as much as possible.  Putting on pants usually tends to be the hardest step to complete.  Working with an occupational therapist should help parents and children develop strategies for dressing.  Leaning against a wall or chair, for instance, may help a child with balance as they use their arms for pulling on clothing.  Children should also be learning to assist in activities such as taking braces on and off, transferring in and out of their wheelchair, and learning to bathe themselves.
Bowel and Bladder

Infants with spina bifida can often go for a period without any particular bowel routine and possibly no catheterizations.  Once a child reaches preschool age, and their peers start to wear underwear instead of diapers, the bowel and bladder routine becomes more of a concern.  Of course, the health care aspect is very important.  A good bowel routine avoids constipation and all its ensuing problems.  Catheterization ensures the bladder is emptied, avoiding kidney reflux and urinary tract infections.  However, there is an important social aspect to a good bowel and bladder routine.  Some children are able to transition into underwear- an important step toward feeling more like their peers.  Those who remain in diapers are at least able to avoid constant voiding, and the smell that comes with dirty diapers.
Physical and Emotional Issues

Since preschoolers are often starting the journey of learning to stand or walk, the orthopedic surgeon may start to play a larger part in their healthcare.  It is the surgeon’s job to ensure that the hips, knees, legs, and feet are aligned in a manner that allows standing without injury.  Surgery is often necessary to reshape or realign the feet or hips.  This leads into a new area of concern.  The preschooler with spina bifida is much more aware of their environment, and unlike the infant, will experience more fear in the event of surgery.  It is important to explain, in age appropriate language, the details about the surgery and subsequent hospitalization and recovery.  Parents should prepare their children before being admitted to the hospital- but not too far in advance.  Children this age do not have a good grasp of time, so discussing the surgery too soon will just give them a longer period to possibly worry about the situation.  Once in the hospital, request a nurse or child life specialist to come and talk to your child about their procedure and what to expect.

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