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Preschoolers are still developing their sense of reality. Expecting them to fully distinguish between reality and fantasy is unrealistic at this age. The behavior is not problematic, but expected.

While hospitalization can increase stress and lead to regressive behaviors, this type of fantasy play is not abnormal only because the child is out of routine, it’s developmentally typical regardless of setting.

This behavior does not interfere with care, in fact, it can facilitate cooperation if the nurse respects the child’s developmental needs and plays along with the imaginary friend briefly to gain trust and reduce anxiety.

Making a project may be appropriate for older school-age children, but a 4-year-old may lack the attention span or fine motor skills for a meaningful project tied to surgery. It’s also too abstract for effective preparation.

Asking about feelings is developmentally too advanced for a 4-year-old. While it’s important to be emotionally supportive, preschoolers may not be able to articulate their feelings clearly or respond meaningfully to open-ended emotional questions.

Listening to music without further instructions does not engage the child in a developmentally appropriate way for preoperative preparation. While music can calm anxiety, it does not address the child’s need for active, visual, and play-based learning.

Limiting genital touching only to urination may imply that natural curiosity is wrong, leading to confusion or shame. This does not help the child learn about privacy or autonomy.

Telling the child that only boys "old enough to have sex" can touch themselves is developmentally inappropriate, confusing, and introduces adult concepts prematurely.

Warning the child that “bad men” may try to hurt him for touching his penis is frightening, misleading, and potentially traumatizing. It uses fear rather than education and does not teach healthy or appropriate boundaries.

Egocentrism refers to a child's inability to see things from another person’s perspective. While also common in the preoperational stage, it does not explain assigning emotions to objects.

Centration is when a child focuses on one aspect of a situation and ignores others such as focusing only on the height of liquid in a glass, not the width. It doesn’t relate to attributing feelings to objects.

Irreversibility is the child’s difficulty in understanding that actions can be reversed such as not realizing that if you pour the water back into the original cup, it’s the same amount. It’s unrelated to believing an object has feelings.

Skipping with alternate feet typically emerges around age 5. It requires advanced coordination and rhythm beyond the motor abilities of a typical 3-year-old.

Jumping rope is a more advanced gross motor skill that involves timing, coordination, and strength, and is generally expected around age 5 to 6.

Tying shoelaces is a fine motor skill, not a gross motor one, and typically develops closer to age 5 to 6 due to the need for dexterity and sequencing.