Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2014  |  Volume : 32  |  Issue : 4  |  Page : 292--296

Relevance of Piaget's cognitive principles among 4-7 years old children: A descriptive cross-sectional study

Sharath Asokan1, Sharmila Surendran2, Sureetha Asokan3, Sivakumar Nuvvula4,  
1 Department of Pediatric Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, India
2 Department of Pediatric Dentistry, Penang International Dental College, Penang, Malaysia, Malaysia
3 Department of Bioinformatics, Institute of Bioinformatics, Bengaluru, Karnataka, India
4 Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Correspondence Address:
Sharath Asokan
Department of Pediatric Dentistry, KSR Institute of Dental Science and Research, Tiruchengode - 637 215, Tamil Nadu


Background: According to Jean Piaget, children between 4 and 7 years of age are under the intuitive sub-stage of preoperational stage. Children possess specific characteristics based on their age. These characteristic cognitive principles have not been assessed in a dental setting. Research on the cognitive development of the child and its application to dental health care can enable pediatric dentists to better understand, approach and deliver improved quality of care to children. Purpose: The purpose of this study is to assess the prevalence of Piaget«SQ»s cognitive principles among preoperational children. Materials and Methods: This cross-sectional study was conducted among 200 children, aged 4-7 years. Various characteristics, specific for this age group, such as egocentrism, concept of cardinal numbers based on centration, lack of conservation, and reversibility were assessed, using three tangible experiments and two interview questions. A comparison of the prevalence of each character was carried out among the children based on their age. Results: The prevalence of egocentrism based on the three mountain experiment was 65% and the personal interview showed a prevalence of 58%. Centration was appreciated in 83% of the study sample. The beaker experiment and the interview question revealed a lack of conservation in 89% and 59% of the children, respectively. There was a gradual and uniform reduction in the prevalence of the characters with an increase in age. Conclusion: All the three features assessed were observed in most of the children between 4 and 7 years of age as described by Piaget and most of his principles still appear valid today.

How to cite this article:
Asokan S, Surendran S, Asokan S, Nuvvula S. Relevance of Piaget's cognitive principles among 4-7 years old children: A descriptive cross-sectional study .J Indian Soc Pedod Prev Dent 2014;32:292-296

How to cite this URL:
Asokan S, Surendran S, Asokan S, Nuvvula S. Relevance of Piaget's cognitive principles among 4-7 years old children: A descriptive cross-sectional study . J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2020 Aug 13 ];32:292-296
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The "cognitive revolution" in the field of psychology took place during the 1960s. It represented a break from behaviorism and focused once again on the important role of mental process in how people process information, develop language, think and solve problems. [1] Swiss psychologist Jean Piaget (1896-1980) put forward the most influential theory of cognitive development. He preferred to call himself as a "genetic epistemologist," a person who studies the origin of how we come to know and understand things. [2] While working in Binet's IQ test lab in Paris, Piaget noticed that young children's answers were qualitatively different from that of older children. It revealed to him that the younger ones answered the questions differently because they thought differently. [3] The answers were not based on the child's level of intelligence, but rather on the child's stage of development. For each stage of development the child forms a view of reality for that age period. At the next stage, the child must keep up with earlier level of mental abilities to reconstruct concepts. Piaget concluded intellectual development as an upward expanding spiral in which children must constantly reconstruct the ideas formed at earlier levels with the new, higher order concepts acquired at the next level. He believed that childhood development precedes from an egocentric position, through a predictable step such as, consistent expansion and incorporation of learned experiences - "invariant developmental sequence." [4],[5],[6]

Most of his theory was based on his careful observation of individual children, especially his own children. We wished to know whether the characteristic features explained by Piaget, still valid in the present, can these development based principles be extended to study development based learning in a dental setting or the prevalence of these characteristics be assessed in children of preoperational period today and then applied/extended to study dental health awareness, based on stages of development? No data are available on this topic. Hence, in an attempt to answer some of these questions, the present study was conducted to assess the prevalence of Piaget's cognitive principles among 4-7 years old children along with a dental health awareness program and to observe dental implications, if any, that could help in providing better pediatric dental health care.

 Materials and Methods

This cross-sectional study was conducted from the Department of Pedodontics and Preventive Dentistry, the study proposal was approved by the Institutional Review Board and Ethical Committee clearance was obtained. Prior to the study, a letter of permission was obtained from the schools. Letters explaining the nature of the study, request for parental consent for the child's participation were done through the principal of the schools. 200 healthy children aged 4-7 years were included in the study and they were divided into four groups:

(4-year-old);(5-year-old);(6-year-old); and(7-year-old).

All the children were of Asian Indian origin. Care was taken to include children of the same socio-economic status. The age, socio-economic status and the ethnicity of the child were obtained from the school records.

Five experiments were conducted to assess the three classical characteristics of these children,

Egocentrism,Concept of cardinal numbers based on centration, andLack of conservation and reversibility.

Three tangible experiments were carried out and all the children were asked two interview questions in person. The experiments used in the study were based on Piaget's cognitive theory. To ensure the reliability and validity of the personal interview questions and the applicability of the experiments in Indian children a pilot study was carried out with 40 children (10 participants in each age group). All the children were given a tour of the pediatric dental clinic and a dental health education program was conducted before the study was carried out.


Egocentrism is the inability to take another person's perspective or point of view. [1] It is the assumption that others view the world as one does oneself. [5] It does not mean that the child is selfish but rather the child lacks the ability to consider another person's point of view. It was assessed by the classical three mountain experiment as explained by Piaget [Figure 1]. The child was seated on one side of the table and a doll was placed at one of the other ends of the table on which the three mountains of different heights were placed. The child was shown a series of photographs from which s/he was asked, to select the one that reflects the doll's view. An egocentric child often picks their own view rather than the doll's view as s/he is unable to understand another person's perspective. Then an interview question was asked to assess egocentrism in the dental setting. The child was asked to choose from a series of pictures, the gift s/he would like to get after a dental treatment. S/he was then asked to choose a gift from the same group for his/her friend. If the child chose the same gift, s/he was considered to be egocentric.{Figure 1}

Concept of cardinal numbers based on centration principle

Centration is the tendency to focus, or center, on only one aspect of a situation and ignore other aspects of the situation. [1] The focus is on the most striking or compelling aspect of the situation. To assess the concept of cardinal numbers, the coin experiment was used [Figure 2]. The child, on seeing two rows of equal number of coins answered whether both the rows had the same number of coins. Then the second row of coins was spread out a little and the child was asked the same question as above. The child with the concept of centration pointed out that the spread out row had more number of coins whereas the child with the concept of cardinal numbers would answer, both rows had the same number of coins.{Figure 2}

Lack of conservation and reversibility

The principle of conservation holds that two equal physical quantities remain equal even if the appearance of one is changed, as long as nothing is added or subtracted. [1] To assess the conservation task, the classical beaker experiment was used [Figure 3]. The child was presented with two identical beakers having the same amount of colored liquid. Then the liquid from one beaker was poured into a third taller and thinner beaker. The child was asked to identify the beaker that contained more liquid. If the child pointed out the taller beaker as the one containing more liquid, s/he was marked to lack the concept of conservation. The child is not able to cognitively reverse the series of events, mentally returning the poured liquid to its original container because of the concept of irreversibility. [1] Thus, the child fails to understand that the two amounts of liquids are still the same. To test this concept in a dental setting, the child was then shown a picture of a healthy, happy tooth, who on eating chocolates and toffees turned into a decayed, unhappy tooth. The child was asked to explain what could have helped the tooth remain healthy and happy. Children who could explain that the toffees were the reason for the unhappy tooth were marked as ones who had mastered the concept of conservation and reversibility. These children might have already known that eating chocolates/toffees was not good for teeth from a previous dental experience, or they might have learnt it from the offered health education program.{Figure 3}

The presence or absence of the three characteristics among these 4-7 years old children was assessed in percentage values. A comparison of the prevalence was done among the children based on their age.


The prevalence of egocentrism based on the three mountain experiment was 65% and based on the face to face interview question was 58%. Centration was seen in the 83% of the study sample. Lack of conservation was noted in 89% and 59% of the children based on the beaker experiment and interview question, respectively. The comparison of the prevalence of the 3 characteristics among the different age groups is shown in [Figure 4], [Figure 5], [Figure 6].{Figure 4}{Figure 5}{Figure 6}


Piaget believed that the same sequence of development occurs in every child and he divided them into different stages. The preoperational period is the second stage of cognitive development during which children think symbolically about objects, but reason is based on appearance rather than logic. [5] This period includes preconceptual (2-4 years) and intuitive stage (4-7 years). Prelogical reasoning appears in the intuitive stage. The child begins to construct more complex images and more elaborate concepts. [1],[4] These intuitive stage children who could be difficult to behavior manage and pose a challenge to the dentists were included in the study. Children below 4 years of age who lacked the cognitive ability to understand the study were excluded. The characteristic features common in this age group, include egocentrism, centration and lack of conservation. The child's understanding is largely based on what he sees. His reaction or comprehension of an object or situation is based on the most compelling and striking feature of the stimulus. This paper has attempted to assess the prevalence of these three features in the study sample, along with a dental health awareness program.

The results of this study show that all the three features are observed in most of the children between 4 and 7 years of age as suggested by Piaget. There was a gradual and uniform reduction in the prevalence of the three characters studied (based on the classical experiments) with increase in age as shown in the [Figure 4], [Figure 5], [Figure 6]. [Figure 4] also shows a gradual reduction of the prevalence of egocentrism based on the question about the gift after dental treatment. Based on age, children understood the relationship between tooth, chocolates and dental decay differently. Furthermore, some children who had previous dental visits and experiences mentioned that the tooth wouldn't revert back to normal unless the tooth was "filled or painted with cements" to make it happy again. The reduction in the prevalence of conservation based on age was not uniform as shown in [Figure 6]. This was in accordance with the fact that children answer qualitatively different based on their understanding of the question.

Piaget's first work, "The language and thought of the child" deals with the nature of egocentrism; the idea that the child views the world subjectively, in a special, self-centered way. [2],[3] The child is incapable of assuming another person's point of view and they believe that everyone else perceives the environment in the same way they do. The children believe that the world was created for them, everyone thinks like them and everyone shares their wishes and feelings. Piaget feels that the growth of intelligence frees the child from egocentrism. [7] The child of about seven or eight is considered to understand and deal with situations much better than the younger children. [8] In the present study, the prevalence of egocentrism dropped from 90% to 42% and 82% to 34% in the experiment and interview question respectively between 4 and 7 years.

In a dental setting, it would not be useful to point out to a child that, his parents would feel proud, if he stopped the digit sucking habit because the child thinks that his parent's attitude about sucking would be exactly the same as his own. Children's understanding of pain and the concept of local anesthesia varies with age and their cognitive development. Even though, the child receives a good elaborate and age appropriate explanation, s/he does not really seem to understand these concepts well. It is always better to administer a local anesthesia for egocentric children to ensure a near pain free dental treatment. Taking advantage of egocentrism, the child could be allowed to make believe s/he is in-charge and could be permitted to take some decision about the treatment, e.g., when to temporarily stop using hand signals or allow them to be 'in-charge' of the saliva ejector. [3] Piaget viewed the child as a little scientist actively exploring his/her world and the driving force for this behavior was curiosity. Piaget termed real curiosity as "intelligent experimentation." [9] In the dental office, the child constructs his/her knowledge about dentistry by observing, touching, handling and working with dental instruments and equipments. [10],[11],[12] This also allows the child to be treated like an important person in his own right.

Concept of conservation, reversibility and cardinal numbers are based upon the concept of centration. In the present study, lack of conservation based on the beaker experiment was more prevalent in 4 year olds (96%) compared with the 7 year olds (77%). A similar result was obtained from the coin experiment too; 92% in 4 year olds and 72% in 7 year olds. In both the cases, younger children were misled by the most striking feature, the height of the beaker and the length of the row, respectively. The child could not simultaneously consider the height and the width of the liquid in the container due to centration. The child between 2 and 7 cannot decenter; s/he cannot think about more than the one compelling feature. [3] S/he has a difficulty solving problems because he does not consider all the aspects involved in the problem. During treatment, the child will tend to be terrified looking at multiple instruments. S/he should be directed to focus on the hand mirror given to him and concentrate in watching the procedure. [2],[10],[11],[12],[13]

Distraction is the key to practicing painless dentistry. Audio and visual distractions like the presence of an aquarium next to the dental chair, the use of audio-visual aids, and 3D video glasses also work on the principle of centration. [2],[3] Head phones with pleasant music could reduce dental anxiety and ease/relax the child and divert the child from the noise of the drill. The child at this stage of development focuses on the most striking and exciting features in the dental office. Hence, providing the children a strikingly colorful, friendly, relaxing environment to focus on can distract them from the possibly "terrifying" instruments present in a dental setting. Distractions help the children relax, behave well and also indirectly reduces the time they need to be distracted to complete treatment. Decentration is the ability to concentrate on more than one aspect of a problem at the same time. [4] When various distraction techniques are used in the dental operatory, the child learns to focus on the other interesting and curious aspects in the environment and forget about the dental treatment and the anxiety caused because of it.

Scientific research on the applications of cognitive science in pediatric dental practice is warranted. Behavior prediction, oral health education and motivation are some of the most common challenges faced by a pediatric dentist. Research on the cognitive development of the child and its application to dental health care can enable pediatric dentists to better understand, approach and deliver improved quality of care to pediatric patients. This could not only benefit the patient immensely and but also be productive for the pediatric dentist and his team in terms of time, energy and patient revisits.


This cross-sectional study provides an insight of the distribution and prevalence of classical characteristics described by Piaget among 4-7 years age children. The results of the study show that egocentrism, lack of conservation and concept of cardinal numbers based on centration were appreciated in most of the children between 4 and 7 years of age and most of Piaget's principles are still valid today. There was a gradual and uniform reduction in the prevalence of the three characters studied with increase in age from 4 to 7 years.


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