WEBVTT 00:00:06.059 --> 00:00:09.800 Welcome to the bed. We'll go ahead and give you 00:00:09.800 --> 00:00:12.580 the story. This is all going to happen super 00:00:12.580 --> 00:00:46.350 fast. Welcome to the emergency room. Welcome 00:00:46.350 --> 00:00:49.329 back to the Deep Dive. The show that takes that 00:00:49.329 --> 00:00:51.829 overwhelming stack of pediatric source material, 00:00:52.390 --> 00:00:54.770 filters out all the noise, and really just delivers 00:00:54.770 --> 00:00:57.109 the critical, high -yield knowledge you need 00:00:57.109 --> 00:01:00.950 to ace your exams and walk confidently into clinical 00:01:00.950 --> 00:01:03.829 practice. Today, we are focusing our energy on, 00:01:03.990 --> 00:01:07.730 well, arguably the most fascinating group developmentally, 00:01:08.670 --> 00:01:11.109 the preschooler. Pages three to six, right? Exactly. 00:01:11.189 --> 00:01:14.069 It's this pivotal time when the highly dependent 00:01:14.069 --> 00:01:17.760 toddler morphs into an independent imaginative 00:01:17.760 --> 00:01:20.700 little person. If you're preparing for BEDS exams, 00:01:21.099 --> 00:01:23.459 the preschooler is mandatory knowledge. Why is 00:01:23.459 --> 00:01:25.400 that? What makes them so critical? Because they 00:01:25.400 --> 00:01:27.640 are the nexus where physical readiness meets 00:01:27.640 --> 00:01:30.480 the chaos of preoperational thought. That's a 00:01:30.480 --> 00:01:32.200 great way to put it. This is definitely the age 00:01:32.200 --> 00:01:34.459 group where I see nursing students trip up because 00:01:34.459 --> 00:01:36.680 they are a bridge. They are. They're leaving 00:01:36.680 --> 00:01:39.379 that intense physical growth rate of infancy 00:01:39.379 --> 00:01:42.579 and entering this world defined by imagination 00:01:42.579 --> 00:01:46.079 and rules and questions. So, so many questions. 00:01:46.239 --> 00:01:49.079 The lie stage. Oh, absolutely. So our mission 00:01:49.079 --> 00:01:52.900 today is crystal clear. Distill the essential 00:01:52.900 --> 00:01:55.849 developmental theories. link them directly to 00:01:55.849 --> 00:01:58.829 required nursing care and safety, and absolutely 00:01:58.829 --> 00:02:01.530 master the school readiness components, especially 00:02:01.530 --> 00:02:05.290 that daunting immunization schedule. Yeah, and 00:02:05.290 --> 00:02:07.569 we've synthesized a lot of sources for this one, 00:02:07.829 --> 00:02:09.830 from the rigid clinical guidelines on growth 00:02:09.830 --> 00:02:13.409 curves and CDC vaccination schedules, to the 00:02:13.409 --> 00:02:16.409 more nuanced psychological frameworks of Ericsson 00:02:16.409 --> 00:02:18.789 and PHA. So we're connecting the dots. We have 00:02:18.789 --> 00:02:20.800 to. We need to connect the development of their 00:02:20.800 --> 00:02:23.060 conscience, the explosion of their motor skills, 00:02:23.280 --> 00:02:25.680 and their peculiar cognitive processes directly 00:02:25.680 --> 00:02:28.580 to the interventions you, as a nurse, must perform. 00:02:28.740 --> 00:02:30.560 OK, let's unpack this. I think we should start 00:02:30.560 --> 00:02:33.039 with the physical transformation. Compared to 00:02:33.039 --> 00:02:35.520 an infant or a toddler, the preschooler's physical 00:02:35.520 --> 00:02:38.319 growth seems to slow way down. But that's actually 00:02:38.319 --> 00:02:40.900 a key sign of maturation, right? It is. So what 00:02:40.900 --> 00:02:42.560 are the foundation points we need to know about 00:02:42.560 --> 00:02:44.539 their physical body? OK, so the key word here 00:02:44.539 --> 00:02:47.219 is consistency. The growth is slow, and it's 00:02:47.219 --> 00:02:49.389 steady, which marks a move. toward what will 00:02:49.389 --> 00:02:52.030 become future adult norms. Weight gain averages 00:02:52.030 --> 00:02:56.550 about four to five pounds per year and their 00:02:56.550 --> 00:02:59.289 height increases by about 2 .5 to 3 inches per 00:02:59.289 --> 00:03:01.629 year. This number seems so small compared to 00:03:01.629 --> 00:03:04.530 the first year of life. They are and that's why 00:03:04.530 --> 00:03:06.469 clinically we're not so focused on the number 00:03:06.469 --> 00:03:10.240 itself. We're watching for one thing. consistent 00:03:10.240 --> 00:03:13.439 movement along their established growth curve. 00:03:13.840 --> 00:03:17.020 So if a child drops from say the 75th percentile 00:03:17.020 --> 00:03:19.360 down to the 25th for height or weight within 00:03:19.360 --> 00:03:21.979 a year, even if the numbers are still technically 00:03:21.979 --> 00:03:24.979 in the normal range, that's a massive clinical 00:03:24.979 --> 00:03:28.539 flag. Precisely. It is the deviation from their 00:03:28.539 --> 00:03:31.360 personal trajectory that alerts us. Got it. And, 00:03:31.360 --> 00:03:34.180 you know, visually this is the phase where they 00:03:34.180 --> 00:03:36.599 shed that toddler chubbiness. They start to thin 00:03:36.599 --> 00:03:39.819 out. They do. They actively lose baby fat, that 00:03:39.819 --> 00:03:42.439 padding of infancy, and start gaining lean muscle 00:03:42.439 --> 00:03:45.250 mass. This gives them that stronger, slimmer, 00:03:45.289 --> 00:03:47.530 more athletic look. It's really preparing them 00:03:47.530 --> 00:03:49.069 for the gross motor explosion we're going to 00:03:49.069 --> 00:03:51.229 talk about later. And that change in body composition 00:03:51.229 --> 00:03:53.729 must affect their balance too. It fundamentally 00:03:53.729 --> 00:03:55.909 shifts their center of gravity. It's why they 00:03:55.909 --> 00:03:58.530 become far less clumsy than their toddler counterparts. 00:03:58.949 --> 00:04:01.610 That makes perfect sense. Increased muscle, better 00:04:01.610 --> 00:04:04.800 balance. fewer of those classic toddler tumbles. 00:04:05.419 --> 00:04:07.819 Exactly. Okay, so let's talk about the maturation 00:04:07.819 --> 00:04:10.139 happening kind of beneath the surface, specifically 00:04:10.139 --> 00:04:13.199 in their physiology and their vitals. How are 00:04:13.199 --> 00:04:16.399 their vital signs changing to reflect this move 00:04:16.399 --> 00:04:19.649 toward adult function? Their cardiovascular system 00:04:19.649 --> 00:04:22.389 is maturing significantly. We see the heart rate 00:04:22.389 --> 00:04:24.629 continue its normal descent. It was slowing down. 00:04:24.689 --> 00:04:27.250 It is, which reflects the increased efficiency 00:04:27.250 --> 00:04:29.709 of the heart muscle and stroke volume. And at 00:04:29.709 --> 00:04:32.069 the same time, their blood pressure gradually 00:04:32.069 --> 00:04:34.790 increases slightly, which is a completely normal 00:04:34.790 --> 00:04:37.029 developmental trend as they head towards school 00:04:37.029 --> 00:04:39.310 age ranges. I remember a clinical note about 00:04:39.310 --> 00:04:42.329 this age group and heart sounds, something specific 00:04:42.329 --> 00:04:44.670 nurses need to be aware of. Yes, absolutely. 00:04:44.910 --> 00:04:47.680 It's crucial for documentation. An innocent heart 00:04:47.680 --> 00:04:51.060 murmur, a functional benign murmur, may be occasionally 00:04:51.060 --> 00:04:53.079 heard in this age group. Why is that? It's due 00:04:53.079 --> 00:04:55.860 to the rapid structural and flow changes occurring 00:04:55.860 --> 00:04:57.959 in the chest cavity as they grow and mature. 00:04:58.720 --> 00:05:01.379 A nurse has to recognize it, document it, but 00:05:01.379 --> 00:05:04.180 generally understand that in an otherwise asymptomatic 00:05:04.180 --> 00:05:07.800 child, it's often a benign finding. But it always 00:05:07.800 --> 00:05:10.149 warrants a follow -up. Just to be sure. Oh, always. 00:05:10.290 --> 00:05:12.069 Yeah. You always want to confirm its innocent 00:05:12.069 --> 00:05:14.470 nature, but it's a great example of that clinical 00:05:14.470 --> 00:05:17.970 nuance that exams just love to test. OK, moving 00:05:17.970 --> 00:05:21.170 on to the neurological system. There is a massive 00:05:21.170 --> 00:05:23.930 shift here that dictates one of the most visible 00:05:23.930 --> 00:05:26.589 milestones of the whole preschool period. This 00:05:26.589 --> 00:05:29.110 is. This is the neurological key to the entire 00:05:29.110 --> 00:05:32.019 age group. Complete myelination of the spinal 00:05:32.019 --> 00:05:34.519 cord is achieved by approximately age three. 00:05:34.660 --> 00:05:36.899 And myelination is, it's like the insulation 00:05:36.899 --> 00:05:39.899 on a wire, right? Perfect analogy. It's the insulation 00:05:39.899 --> 00:05:42.579 that allows nerve impulses to travel rapidly 00:05:42.579 --> 00:05:45.660 and efficiently. Before this is complete, control 00:05:45.660 --> 00:05:48.399 is highly reflexive. But once that myelination 00:05:48.399 --> 00:05:50.639 is done, the nerves controlling the bladder and 00:05:50.639 --> 00:05:52.680 bowel sphincter muscles are fully mature. Which 00:05:52.680 --> 00:05:55.600 allows for? Voluntary control. Voluntary inhibition 00:05:55.600 --> 00:05:57.879 and release. So this is why a two -year -old 00:05:57.879 --> 00:06:00.139 might struggle with potty training. It's not 00:06:00.139 --> 00:06:02.519 behavioral, it's anatomical. They just haven't 00:06:02.519 --> 00:06:04.600 achieved full physical readiness yet. Exactly. 00:06:04.720 --> 00:06:06.220 So if a healthy three -year -old is struggling, 00:06:06.660 --> 00:06:08.879 we've ruled out that physiological barrier of 00:06:08.879 --> 00:06:11.439 myelination, and we can confidently address the 00:06:11.439 --> 00:06:14.199 issue as developmental or emotional or behavioral. 00:06:14.379 --> 00:06:17.100 But if a child enters the preschool years and 00:06:17.100 --> 00:06:19.939 still shows no progress in sphincter control... 00:06:19.980 --> 00:06:22.819 That's a red flag. That demands a more comprehensive 00:06:22.819 --> 00:06:25.579 neurological assessment. This myelination fact 00:06:25.579 --> 00:06:29.399 is its prime test material. Okay, let's pivot 00:06:29.399 --> 00:06:32.600 to infection risk. Why, despite their systems 00:06:32.600 --> 00:06:35.319 growing, do they remain so susceptible to common 00:06:35.319 --> 00:06:37.579 childhood illnesses, especially things like ear 00:06:37.579 --> 00:06:40.470 infections and UTIs? It really comes down to 00:06:40.470 --> 00:06:42.449 immature structural anatomy in a couple of key 00:06:42.449 --> 00:06:44.610 areas. First, the respiratory system is improving. 00:06:44.990 --> 00:06:47.670 The alveoli increase in number. Airways get bigger, 00:06:47.670 --> 00:06:49.949 so they're less prone to those lower respiratory 00:06:49.949 --> 00:06:53.490 illnesses of infancy. But in the head, eyes, 00:06:53.569 --> 00:06:56.110 ears, nose, and throat system, the HETA system, 00:06:56.629 --> 00:06:59.970 their Eustachian tubes remain short and, critically, 00:07:00.329 --> 00:07:03.550 very straight, more horizontal. And that horizontal 00:07:03.550 --> 00:07:07.089 orientation is like a straight pipeline for germs. 00:07:07.230 --> 00:07:10.350 It's a direct conduit. Bacteria and secretions 00:07:10.350 --> 00:07:12.550 from the back of the nose and throat can travel 00:07:12.550 --> 00:07:14.769 horizontally with almost no difficulty right 00:07:14.769 --> 00:07:16.949 up into the middle ear. Which predisposes them 00:07:16.949 --> 00:07:19.870 to recurrent otitis media. Exactly. So as a nurse, 00:07:19.870 --> 00:07:21.750 you're always watching for those subtle signs 00:07:21.750 --> 00:07:24.389 like pulling at the ears or a fever, knowing 00:07:24.389 --> 00:07:26.769 this structural vulnerability is there. And the 00:07:26.769 --> 00:07:29.829 genitourinary system, the GU system, has a similar 00:07:29.829 --> 00:07:32.790 vulnerability, doesn't it? Yes. The urethra remains 00:07:32.790 --> 00:07:35.470 short in all young children, which predisposes 00:07:35.470 --> 00:07:38.269 them to UTIs, especially in girls. Because it's 00:07:38.269 --> 00:07:40.449 a shorter path for bacteria to travel. Right. 00:07:40.610 --> 00:07:43.050 It allows bacteria, often E. coli, to ascend 00:07:43.050 --> 00:07:46.149 very quickly into the bladder. Nursing care here 00:07:46.149 --> 00:07:48.509 involves vigilance for symptoms like pain with 00:07:48.509 --> 00:07:51.810 urination, frequency or urgency, and of course 00:07:51.810 --> 00:07:54.290 providing excellent hygiene education to parents 00:07:54.290 --> 00:07:56.629 and to the child. And we can't forget about teeth. 00:07:56.870 --> 00:07:59.810 Dentition is a big focus in the exam room. It 00:07:59.810 --> 00:08:02.649 is. By the time they enter this preschool period, 00:08:03.129 --> 00:08:06.470 all 20 of their deciduous or primary teeth should 00:08:06.470 --> 00:08:08.750 be fully erupted. So the nursing focus shifts. 00:08:09.089 --> 00:08:11.470 It shifts heavily to preventive dental care. 00:08:11.610 --> 00:08:14.810 Parents need guidance on fluoride, ensuring regular 00:08:14.810 --> 00:08:17.550 dental visits, and active supervision of brushing 00:08:17.550 --> 00:08:20.750 to prevent those early childhood cavities, which 00:08:20.750 --> 00:08:22.769 can actually affect the placement of the permanent 00:08:22.769 --> 00:08:24.610 teeth that are developing right underneath. OK, 00:08:24.649 --> 00:08:27.009 so this section really defines the physical landscape. 00:08:27.410 --> 00:08:29.850 We have steady growth, mature neurology that 00:08:29.850 --> 00:08:33.669 leads to potty training, and two key structural 00:08:33.669 --> 00:08:37.090 weak spots, the ears and the GU system to keep 00:08:37.090 --> 00:08:39.370 an eye on. That's a perfect summary. So for what 00:08:39.370 --> 00:08:42.190 nurses watch for, you're checking for a consistent 00:08:42.190 --> 00:08:44.929 progression along their established growth curves, 00:08:45.049 --> 00:08:46.610 not just looking at the absolute number. And 00:08:46.610 --> 00:08:48.750 you're observing for symptoms that point to those 00:08:48.750 --> 00:08:51.210 vulnerabilities. Right. Signs of an ear infection 00:08:51.210 --> 00:08:54.409 or a UTI because of those short eustachian tubes 00:08:54.409 --> 00:08:56.929 and urethra. Now, what exam writers love to test? 00:08:57.149 --> 00:08:59.470 The specific physiological reason for achieving 00:08:59.470 --> 00:09:02.659 voluntary potty training. complete spinal cord 00:09:02.659 --> 00:09:05.799 myelination by age three. That connection is 00:09:05.799 --> 00:09:09.080 clinically crucial and it is highly, highly testable. 00:09:09.360 --> 00:09:11.139 And one easy way to remember this age group. 00:09:11.480 --> 00:09:14.139 They're losing their toddler chubbiness and starting 00:09:14.139 --> 00:09:16.519 to look like little people gaining muscle, losing 00:09:16.519 --> 00:09:18.379 fat and getting ready for that explosion into 00:09:18.379 --> 00:09:21.139 coordinated activity. This increased physical 00:09:21.139 --> 00:09:23.679 ability wouldn't be possible without a massive 00:09:23.679 --> 00:09:26.360 leap in how their brain controls their body, 00:09:26.799 --> 00:09:28.539 and I think more importantly, how their brain 00:09:28.539 --> 00:09:30.879 perceives the world. So let's talk about the 00:09:30.879 --> 00:09:33.559 psychological key. Erickson's stage for ages 00:09:33.559 --> 00:09:36.500 three to six. Okay, so we enter the stage of 00:09:36.500 --> 00:09:39.000 initiative versus guilt. And this is perhaps 00:09:39.000 --> 00:09:41.659 the most defining psychosocial stage for the 00:09:41.659 --> 00:09:44.450 preschooler. What does initiative really mean 00:09:44.450 --> 00:09:46.629 here? It means the child is now an energetic 00:09:46.629 --> 00:09:49.570 learner, actively planning and attempting activities. 00:09:49.850 --> 00:09:52.549 They love starting new projects, making up games, 00:09:52.669 --> 00:09:55.710 and they have this intense desire to please their 00:09:55.710 --> 00:09:57.649 parents. They're practicing their independence 00:09:57.649 --> 00:10:00.159 through action. This is where we see that explosion 00:10:00.159 --> 00:10:02.600 of make -believe play, right? Where they take 00:10:02.600 --> 00:10:04.639 the initiative in creating entire worlds and 00:10:04.639 --> 00:10:07.159 stories. They're testing out their boundaries 00:10:07.159 --> 00:10:09.899 and their competence. Exactly. And they are developing 00:10:09.899 --> 00:10:12.320 a conscience. They realize they can start things, 00:10:12.580 --> 00:10:14.580 but because their abilities still often exceed 00:10:14.580 --> 00:10:17.039 their judgment, they sometimes fail or break 00:10:17.039 --> 00:10:19.159 rules or misbehave. And that's where the guilt 00:10:19.159 --> 00:10:21.379 part comes in. That's the opposite of initiative. 00:10:21.919 --> 00:10:24.559 Guilt occurs when their attempts at initiative 00:10:24.559 --> 00:10:28.110 are constantly thwarted. or criticize or overly 00:10:28.110 --> 00:10:31.149 punished. They begin to develop feelings of remorse 00:10:31.149 --> 00:10:33.529 and start to believe they are inherently bad 00:10:33.529 --> 00:10:36.269 for their actions or even for their desires. 00:10:36.570 --> 00:10:39.629 This emerging conscience ties directly into Kohlberg's 00:10:39.629 --> 00:10:42.149 theory of moral development. They're operating 00:10:42.149 --> 00:10:44.509 primarily in that pre -conventional level, right? 00:10:44.789 --> 00:10:47.429 The punishment obedience orientation. That is 00:10:47.429 --> 00:10:50.529 the critical link. For the preschooler, an action 00:10:50.529 --> 00:10:53.259 is good or bad. based purely on the immediate 00:10:53.259 --> 00:10:55.720 consequence. So if I hit my brother, I get sent 00:10:55.720 --> 00:10:58.600 to time out, so hitting is bad. Precisely. If 00:10:58.600 --> 00:11:00.980 I share my toy, I get praised, so sharing is 00:11:00.980 --> 00:11:04.679 good. They don't yet grasp complex intent or 00:11:04.679 --> 00:11:07.200 abstract moral principles. Which means discipline 00:11:07.200 --> 00:11:10.279 has to be immediate, clear, and consistent. Yes, 00:11:10.279 --> 00:11:13.039 to link the action directly to the consequence. 00:11:13.419 --> 00:11:16.720 That's how you foster initiative while minimizing 00:11:16.720 --> 00:11:19.759 that sort of paralyzing guilt. That explains 00:11:19.759 --> 00:11:22.000 so much about their sensitivity. Okay, let's 00:11:22.000 --> 00:11:25.440 move to their cognitive framework. Piaget's preoperational 00:11:25.440 --> 00:11:28.960 stage, which spans ages two to seven and explains 00:11:28.960 --> 00:11:32.320 why they view the world and illness so strangely. 00:11:32.500 --> 00:11:34.399 The preoperational stage is a world governed 00:11:34.399 --> 00:11:38.399 by appearances, not by logic. It's split into 00:11:38.399 --> 00:11:40.639 the preconceptual, which is ages two to four, 00:11:40.919 --> 00:11:43.610 and the intuitive. from four to seven. And they 00:11:43.610 --> 00:11:46.309 lack the concept of conservation. Right. They 00:11:46.309 --> 00:11:48.629 believe a tall skinny glass holds more water 00:11:48.629 --> 00:11:51.690 than a short wide one, even if they just watched 00:11:51.690 --> 00:11:53.970 you pour the water from one to the other. Their 00:11:53.970 --> 00:11:55.909 thoughts are influenced so heavily by what they 00:11:55.909 --> 00:11:59.299 see. And this. This flawed logic leads directly 00:11:59.299 --> 00:12:02.080 to that trifecta of cognitive concepts that nursing 00:12:02.080 --> 00:12:05.419 exams test so heavily. Magical thinking, transduction, 00:12:05.620 --> 00:12:07.940 and animism. Let's start with magical thinking 00:12:07.940 --> 00:12:10.919 and its huge clinical implications. Magical thinking 00:12:10.919 --> 00:12:13.340 is the belief that their thoughts are all powerful. 00:12:13.860 --> 00:12:15.799 It often leads to this sense of omniscience. 00:12:16.179 --> 00:12:18.419 In a clinical setting, this manifests as self 00:12:18.419 --> 00:12:20.899 blame. What's a classic example of that? The 00:12:20.899 --> 00:12:23.259 child was angry at their mother and secretly 00:12:23.259 --> 00:12:26.059 wish she would go away. Then the mother gets 00:12:26.059 --> 00:12:28.879 sick and is hospitalized. The preschooler becomes 00:12:28.879 --> 00:12:31.720 convinced that their wish caused the illness. 00:12:32.019 --> 00:12:35.179 Wow. So if a nurse admits a preschooler whose 00:12:35.179 --> 00:12:37.279 sibling has just been diagnosed with a serious 00:12:37.279 --> 00:12:40.679 illness, the nurse's primary proactive communication 00:12:40.679 --> 00:12:44.080 has to be nothing you did or thought or said 00:12:44.080 --> 00:12:46.440 made your brother sick. You have to explicitly 00:12:46.440 --> 00:12:48.620 counter that internal guilt. You have to say 00:12:48.620 --> 00:12:51.279 it out loud. Absolutely. The guilt can be overwhelming 00:12:51.279 --> 00:12:54.080 and it can impede their healing or their cooperation. 00:12:54.279 --> 00:12:56.879 OK. Next up is transduction. Transduction is 00:12:56.879 --> 00:12:59.720 taking one specific instance and extrapolating 00:12:59.720 --> 00:13:02.320 it in a accurately to a general rule. They don't 00:13:02.320 --> 00:13:05.259 grasp cause and effect logically. They just generalize 00:13:05.259 --> 00:13:07.519 based on chronological appearance. Give us a 00:13:07.519 --> 00:13:10.039 clear, high yield example of transduction in 00:13:10.039 --> 00:13:12.779 the hospital. Okay. If a nurse, let's call her 00:13:12.779 --> 00:13:15.460 nurse A, comes in, takes the child's vitals, 00:13:15.639 --> 00:13:17.279 and immediately after that, the child gets a 00:13:17.279 --> 00:13:19.679 painful shot from the doctor. The child uses 00:13:19.679 --> 00:13:21.919 transduction to conclude that nurse A caused 00:13:21.919 --> 00:13:25.299 the pain. Or even worse, every time a nurse touches 00:13:25.299 --> 00:13:27.679 me, something bad is going to happen. Exactly. 00:13:27.899 --> 00:13:30.759 They generalize the negative experience of the 00:13:30.759 --> 00:13:33.000 shot to the non -painful experience of getting 00:13:33.000 --> 00:13:35.580 your blood pressure taken or even to the entire 00:13:35.580 --> 00:13:38.419 profession. It is a major barrier to building 00:13:38.419 --> 00:13:41.179 rapport. That's fascinating. It really emphasizes 00:13:41.179 --> 00:13:43.519 why procedural preparation needs to be separated 00:13:43.519 --> 00:13:45.460 from the actual performance of the procedure. 00:13:45.519 --> 00:13:49.919 It does. And finally, animism. Animism is attributing 00:13:49.919 --> 00:13:54.360 human or life -like qualities to inanimate objects. 00:13:55.220 --> 00:13:57.679 This is why their teddy bear is their best friend. 00:13:57.850 --> 00:14:00.090 or why they might get mad at the table they bumped 00:14:00.090 --> 00:14:02.830 into. So clinically, this means they might believe 00:14:02.830 --> 00:14:05.529 the IV pole is breathing. Or that the blood pressure 00:14:05.529 --> 00:14:07.490 cuff is trying to squeeze them to death. We see 00:14:07.490 --> 00:14:09.950 this all the time with equipment fears. So you 00:14:09.950 --> 00:14:12.049 should never say something like, the machine 00:14:12.049 --> 00:14:14.850 is broken. Never. Because the child may believe 00:14:14.850 --> 00:14:18.210 the machine is just sad or angry. This all confirms 00:14:18.210 --> 00:14:20.730 why simple concrete language is so essential. 00:14:21.610 --> 00:14:23.950 We use play like puppet play, but we have to 00:14:23.950 --> 00:14:26.659 be so careful about the materials we use. Well, 00:14:26.740 --> 00:14:29.580 if you use a doll to demonstrate a shot, the 00:14:29.580 --> 00:14:32.100 child might believe the doll is now permanently 00:14:32.100 --> 00:14:35.960 hurt, so it demands total clarity. We use the 00:14:35.960 --> 00:14:38.360 concept of doing a procedure on the doll, not 00:14:38.360 --> 00:14:41.179 hurting the doll. The use of play is vital for 00:14:41.179 --> 00:14:43.740 mastery giving the child control by letting them 00:14:43.740 --> 00:14:46.200 place a bandage on the doll or listen to a teddy 00:14:46.200 --> 00:14:49.240 bear's heart. This counters their intense fear 00:14:49.240 --> 00:14:51.620 of bodily harm and loss of control, which is 00:14:51.620 --> 00:14:53.759 just compounded by their pre -operational thought. 00:14:53.980 --> 00:14:57.460 Okay. So what nurses watch for? You're watching 00:14:57.460 --> 00:15:00.299 for signs of self blame or overwhelming guilt 00:15:00.299 --> 00:15:02.740 related to a family illness or hospitalization. 00:15:03.019 --> 00:15:05.799 Nurses must use simple, direct, concrete language 00:15:05.799 --> 00:15:08.220 and actively dispel magical thinking. You have 00:15:08.220 --> 00:15:10.419 to say, this sickness is not a punishment for 00:15:10.419 --> 00:15:12.779 being bad. And what do exam writers love to test? 00:15:12.919 --> 00:15:15.259 They love matching Erickson's stage, initiative 00:15:15.259 --> 00:15:18.460 versus guilt with its core outcome, the development 00:15:18.460 --> 00:15:20.480 of conscience and moral understanding, which 00:15:20.480 --> 00:15:23.480 is Kohlberg's punishment obedience. Also, scenarios 00:15:23.480 --> 00:15:25.799 where you have to identify and apply the correct 00:15:25.799 --> 00:15:28.639 technique to counteract animism or transduction 00:15:28.639 --> 00:15:31.279 in a clinical setting. Perfect. And one easy 00:15:31.279 --> 00:15:33.269 way to remember this age group. They are the 00:15:33.269 --> 00:15:35.769 pre -group, pre -operational, preconceptual, 00:15:35.769 --> 00:15:39.649 and preschool. Their entire world is defined 00:15:39.649 --> 00:15:43.029 by what they see. Not by what they logically 00:15:43.029 --> 00:15:45.149 know. So because of that physical maturation 00:15:45.149 --> 00:15:47.649 we talked about, the myelination, the muscle 00:15:47.649 --> 00:15:50.789 game, losing that top heaviness, the preschooler 00:15:50.789 --> 00:15:53.950 undergoes a, well, a truly spectacular explosion 00:15:53.950 --> 00:15:56.529 of coordinated motor skills. It really is an 00:15:56.529 --> 00:15:58.970 explosion. If a nursing student can just track 00:15:58.970 --> 00:16:01.690 the progression from age three to five, they'll 00:16:01.690 --> 00:16:03.750 grasp the entire physical development of this 00:16:03.750 --> 00:16:05.909 period. Okay, let's nail the hallmarks then. 00:16:06.110 --> 00:16:08.509 Age three is the age of independence, and it's 00:16:08.509 --> 00:16:10.370 powered by the tricycle. The three -year -old 00:16:10.370 --> 00:16:12.789 is highly independent. For gross motor skills, 00:16:12.830 --> 00:16:15.730 they can climb well, run easily, and critically, 00:16:16.210 --> 00:16:18.450 they can pedal a tricycle. Which requires a lot 00:16:18.450 --> 00:16:20.830 of coordinated movement and balance. It does. 00:16:21.269 --> 00:16:23.370 And the biggest fine motor achievement is that 00:16:23.370 --> 00:16:25.649 they master walking up and down stairs using 00:16:25.649 --> 00:16:27.789 alternate feet, so they're transitioning away 00:16:27.789 --> 00:16:29.789 from that toddler two -feet -per -step shuffle. 00:16:29.909 --> 00:16:32.289 And they're fine motor skills. Also crucial. 00:16:32.379 --> 00:16:34.820 They can undress themselves, hold a pencil in 00:16:34.820 --> 00:16:37.039 the correct writing position, build a tower of 00:16:37.039 --> 00:16:39.240 nine or 10 cubes, and the one that always shows 00:16:39.240 --> 00:16:42.200 up on tests, they can copy a circle. The circle, 00:16:42.340 --> 00:16:45.139 that is the classic three -year fine motor check. 00:16:45.960 --> 00:16:49.580 OK, what massive leap happens at age four? The 00:16:49.580 --> 00:16:51.580 four -year -old refines their gross movements 00:16:51.580 --> 00:16:54.539 and gains more control. They transition from 00:16:54.539 --> 00:16:57.799 just climbing to true agility. So for gross motor, 00:16:57.879 --> 00:17:00.179 they can throw a ball overhand, which is a complex 00:17:00.179 --> 00:17:02.519 skill involving trunk rotation. They can kick 00:17:02.519 --> 00:17:05.339 a ball forward and hop on one foot. They can 00:17:05.339 --> 00:17:07.319 also stand on one foot for up to five seconds. 00:17:07.420 --> 00:17:09.539 And fine motor gets more precise. A lot more 00:17:09.539 --> 00:17:12.180 precise. They can now use scissors successfully, 00:17:12.700 --> 00:17:15.380 copy capital letters, and draw circles and squares. 00:17:16.079 --> 00:17:18.180 And they can draw a person, but typically only 00:17:18.180 --> 00:17:20.539 with two to four body parts, like a head, maybe 00:17:20.539 --> 00:17:22.299 two limbs sticking out. And the five -year -old 00:17:22.299 --> 00:17:24.799 is essentially school ready. They have skills 00:17:24.799 --> 00:17:27.180 almost comparable to an adult in terms of basic 00:17:27.180 --> 00:17:29.819 mobility. That's the goal. The five -year -old 00:17:29.819 --> 00:17:32.059 demonstrates complete mastery and coordination. 00:17:32.720 --> 00:17:34.859 For gross motor, the hallmarks include standing 00:17:34.859 --> 00:17:37.539 on one foot for 10 seconds or longer, swinging 00:17:37.539 --> 00:17:40.339 and climbing well, and the ultimate coordination 00:17:40.339 --> 00:17:43.859 marker, skipping. Skipping is a big one. It is. 00:17:44.000 --> 00:17:46.200 They can also somersault. And they often start 00:17:46.200 --> 00:17:48.740 structured activities like basic skating or swimming. 00:17:49.039 --> 00:17:52.039 For fine motor skills, they're impressive. They 00:17:52.039 --> 00:17:54.859 can print some letters, dress and undress completely 00:17:54.859 --> 00:17:57.480 without any help, and they can use cutlery, including 00:17:57.480 --> 00:18:00.420 a supervised knife. And the definitive fine motor 00:18:00.420 --> 00:18:03.759 milestone. They can copy a triangle and draw 00:18:03.759 --> 00:18:06.549 a person with a body and at least six distinct 00:18:06.549 --> 00:18:09.410 parts. That progression tricycle at three, scissors 00:18:09.410 --> 00:18:11.549 at four, and then skipping in the triangle at 00:18:11.549 --> 00:18:14.009 five, that's a perfect memory hook for an exam. 00:18:14.130 --> 00:18:17.369 It is. But physical skills aren't the only explosion. 00:18:17.750 --> 00:18:20.009 Their language becomes functionally adult -like. 00:18:20.150 --> 00:18:22.930 Yes. The sheer volume of language increases, 00:18:22.930 --> 00:18:26.329 and the quality improves dramatically. By age 00:18:26.329 --> 00:18:29.490 four, their vocabulary hits around 1 ,500 words. 00:18:29.869 --> 00:18:32.390 They speak in complete sentences with adult -like 00:18:32.390 --> 00:18:34.390 grammar. And there's a key nursing check for 00:18:34.390 --> 00:18:37.250 them. Yes, their ability to follow a three -part 00:18:37.250 --> 00:18:39.869 command. If you can tell a four -year -old, pick 00:18:39.869 --> 00:18:41.769 up the block, put it on the table, and give me 00:18:41.769 --> 00:18:44.210 the ball, and they do it, their auditory processing 00:18:44.210 --> 00:18:46.990 is on track. And by five, they're basically fluent 00:18:46.990 --> 00:18:49.329 in asking all those critical thinking questions. 00:18:49.490 --> 00:18:52.910 Their vocabulary grows to 2 ,100 words. They 00:18:52.910 --> 00:18:55.769 can explain how to use something. They can talk 00:18:55.769 --> 00:18:58.849 about past and future events, which is a huge 00:18:58.849 --> 00:19:01.349 cognitive leap. And they're constantly using 00:19:01.349 --> 00:19:04.140 why. and when. Their language reflects their 00:19:04.140 --> 00:19:06.660 cognitive effort to understand cause and effect 00:19:06.660 --> 00:19:09.160 even if their pre -operational mind still struggles 00:19:09.160 --> 00:19:10.960 with the logic. That's a great way to put it. 00:19:11.099 --> 00:19:13.420 So for a nurse, tracking these milestones is 00:19:13.420 --> 00:19:16.240 just the first step. The really crucial part 00:19:16.240 --> 00:19:19.119 is recognizing the red flags and initiating that 00:19:19.119 --> 00:19:22.539 referral process. What are the key signs of developmental 00:19:22.539 --> 00:19:25.339 delay we have to watch for? Early recognition 00:19:25.339 --> 00:19:28.160 changes outcomes. We have to be particularly 00:19:28.160 --> 00:19:30.900 vigilant for a four -year -old who has difficulties 00:19:30.900 --> 00:19:33.460 with gross motor skills, like they can't jump 00:19:33.460 --> 00:19:36.440 in place or ride a tricycle. Or fine motor signs, 00:19:36.599 --> 00:19:38.700 like not grasping a crayon with their thumb and 00:19:38.700 --> 00:19:41.299 fingers. And for communication. We'd be concerned 00:19:41.549 --> 00:19:44.730 if they can't use me and you appropriately or, 00:19:44.930 --> 00:19:47.430 and this is critical, if they do not engage in 00:19:47.430 --> 00:19:50.609 fantasy play. Why is that lack of fantasy play 00:19:50.609 --> 00:19:53.009 such a major red flag for a four -year -old? 00:19:53.630 --> 00:19:56.130 Because fantasy play role -playing is how they 00:19:56.130 --> 00:19:58.630 process their world, is how they practice social 00:19:58.630 --> 00:20:01.130 skills and develop that sense of initiative we 00:20:01.130 --> 00:20:04.190 talked about. If that's absent, it signals a 00:20:04.190 --> 00:20:06.490 potential broader delay in their cognitive or 00:20:06.490 --> 00:20:08.369 social development. And for the five -year -old? 00:20:08.569 --> 00:20:10.710 Red flags would include little interest in playing 00:20:10.710 --> 00:20:12.650 with other children. That's a social marker. 00:20:12.849 --> 00:20:15.089 Or continued language deficits, like they can't 00:20:15.089 --> 00:20:17.589 use plurals or passpens. And what about their 00:20:17.589 --> 00:20:19.769 attention span? That's directly related to classroom 00:20:19.769 --> 00:20:22.250 readiness. Absolutely essential. If a five -year 00:20:22.250 --> 00:20:24.869 -old is easily distracted and cannot concentrate 00:20:24.869 --> 00:20:27.349 on a single activity for five minutes, that is 00:20:27.349 --> 00:20:30.210 a massive concern. Five minutes is the bare minimum 00:20:30.210 --> 00:20:32.410 attention span required for structured learning 00:20:32.410 --> 00:20:35.670 tasks. If they can't maintain that focus, it's 00:20:35.670 --> 00:20:38.329 a likely obstacle to classroom success and warrants 00:20:38.329 --> 00:20:40.170 immediate follow -up. Okay, so let's summarize 00:20:40.170 --> 00:20:42.789 this section. What do nurses watch for? You're 00:20:42.789 --> 00:20:44.890 watching if a four -year -old struggles to follow 00:20:44.890 --> 00:20:47.470 a simple three -part command, or if a five -year 00:20:47.470 --> 00:20:49.650 -old cannot sustain concentration on a single 00:20:49.650 --> 00:20:52.430 activity for at least five minutes. These are 00:20:52.430 --> 00:20:55.450 highly specific, quantifiable markers that tell 00:20:55.450 --> 00:20:58.269 you a referral is limited. And what do exam writers 00:20:58.269 --> 00:21:00.789 love to test? Identifying the definitive physical 00:21:00.789 --> 00:21:04.230 milestones. the three -year skill, which is pedaling 00:21:04.230 --> 00:21:06.990 a tricycle and copying a circle, and the five 00:21:06.990 --> 00:21:09.130 -year skill, which is skipping and drawing a 00:21:09.130 --> 00:21:12.009 person with six parts. And an easy way to remember 00:21:12.009 --> 00:21:14.809 this age group. They are the age of gross skills 00:21:14.809 --> 00:21:17.950 getting finer. They conquer the coordinated tricycle 00:21:17.950 --> 00:21:20.470 at age three and the complex triangle at age 00:21:20.470 --> 00:21:23.369 five. The physical and cognitive growth really 00:21:23.369 --> 00:21:25.609 fuels their work, and their work at this age 00:21:25.609 --> 00:21:28.299 is, well, it's play. How does their play evolve 00:21:28.299 --> 00:21:30.400 socially from the toddler who was content with 00:21:30.400 --> 00:21:32.960 just parallel play? The defining shift is moving 00:21:32.960 --> 00:21:35.400 from parallel play, which is playing merely next 00:21:35.400 --> 00:21:37.980 to another child, to associative play. And that 00:21:37.980 --> 00:21:39.940 happens around age three or four. Typically, 00:21:40.119 --> 00:21:43.359 yes. In associative play, children engage in 00:21:43.359 --> 00:21:45.819 similar or identical activities. They exchange 00:21:45.819 --> 00:21:47.819 materials, they talk to each other, and they 00:21:47.819 --> 00:21:49.900 might even participate in a group. But there's 00:21:49.900 --> 00:21:53.029 a key distinction here. There is. There is usually 00:21:53.029 --> 00:21:56.910 no formal organization, no mutual goal, and no 00:21:56.910 --> 00:21:59.490 specific role assignment. They're playing with 00:21:59.490 --> 00:22:01.849 each other, but not necessarily for a shared 00:22:01.849 --> 00:22:05.569 outcome. True cooperative, competitive, or highly 00:22:05.569 --> 00:22:08.170 organized play, that awaits the school age period. 00:22:08.529 --> 00:22:10.490 OK, so if they're building separate towers in 00:22:10.490 --> 00:22:12.630 the same sandbox and borrowing each other's shovel, 00:22:12.809 --> 00:22:15.069 that's associative play. But if they're planning 00:22:15.069 --> 00:22:17.990 a detailed script for a puppet show, that's moving 00:22:17.990 --> 00:22:21.420 towards cooperative play. Precisely. And the 00:22:21.420 --> 00:22:23.640 activities we suggest must support this development. 00:22:24.200 --> 00:22:25.859 We encourage things that promote all domains. 00:22:26.400 --> 00:22:29.119 Playing ball, doing puzzles, sandboxes, dress 00:22:29.119 --> 00:22:31.599 up, and especially role playing or fantasy playing. 00:22:31.740 --> 00:22:34.059 Role playing seems incredibly vital. It is. It's 00:22:34.059 --> 00:22:35.960 their safe laboratory to practice conservation 00:22:35.960 --> 00:22:38.619 skills, to sample behaviors, and to work out 00:22:38.619 --> 00:22:40.960 those initiative versus guilt conflicts. They 00:22:40.960 --> 00:22:43.160 can be the doctor, or the parent, or the teacher. 00:22:43.359 --> 00:22:45.279 Speaking of role -playing, we should probably 00:22:45.279 --> 00:22:47.500 address the imaginary friend, which I know often 00:22:47.500 --> 00:22:50.500 causes a lot of anxiety for parents. The imaginary 00:22:50.500 --> 00:22:53.200 friend is a completely normal and often a very 00:22:53.200 --> 00:22:56.829 healthy developmental tool. It's a creative way 00:22:56.829 --> 00:22:59.230 for the preschooler to practice conversation 00:22:59.230 --> 00:23:02.490 skills, to test out social rules, and to work 00:23:02.490 --> 00:23:04.849 through complex emotions. It's a low -stakes 00:23:04.849 --> 00:23:06.789 relationship where they're always in control. 00:23:07.130 --> 00:23:10.250 Exactly. They never feel judged. A nurse should 00:23:10.250 --> 00:23:12.809 respect this friend as a valid part of the child's 00:23:12.809 --> 00:23:15.369 world. You wouldn't dismiss the child if they 00:23:15.369 --> 00:23:17.609 talk about their friend's preferences or worries. 00:23:17.900 --> 00:23:20.440 Socially and emotionally, their ability to navigate 00:23:20.440 --> 00:23:22.920 real relationships takes a huge step forward, 00:23:23.200 --> 00:23:25.859 too. What are they mastering here? They are learning 00:23:25.859 --> 00:23:28.240 the foundational skills of making and keeping 00:23:28.240 --> 00:23:31.019 a friend, which involves cooperation, sharing 00:23:31.019 --> 00:23:34.039 objects and feelings, displaying affection, and 00:23:34.039 --> 00:23:36.839 learning basic generosity. They're becoming more 00:23:36.839 --> 00:23:39.619 empathetic, but their empathy is still largely 00:23:39.619 --> 00:23:42.380 based on observed consequences. Like, if I cry 00:23:42.380 --> 00:23:44.480 when I fall, my friend cries when they fall. 00:23:44.700 --> 00:23:46.740 We talked about their sensitivity earlier because 00:23:46.740 --> 00:23:49.579 of magical thinking. Let's double down on the 00:23:49.579 --> 00:23:51.559 fears they exhibit, especially in the hospital 00:23:51.559 --> 00:23:53.880 environment. The major clinical fear for the 00:23:53.880 --> 00:23:56.940 hospitalized preschooler is fear of bodily harm 00:23:56.940 --> 00:24:01.019 or mutilation. Their pre -operational mind struggles 00:24:01.019 --> 00:24:03.440 intensely with the concept of body integrity. 00:24:03.700 --> 00:24:07.220 So they believe that even a small cut or a puncture 00:24:07.220 --> 00:24:10.059 is permanent. Yes, and that their internal stuff 00:24:10.059 --> 00:24:13.420 might leak out. This fear is why procedures like 00:24:13.420 --> 00:24:16.119 getting a shot or drawing blood or placing an 00:24:16.119 --> 00:24:19.579 IV are so absolutely terrifying for them. The 00:24:19.579 --> 00:24:21.759 needle represents a permanent break in their 00:24:21.759 --> 00:24:24.940 physical integrity. It does. And this fear dictates 00:24:24.940 --> 00:24:28.019 key nursing interventions. Always provide a bandage, 00:24:28.240 --> 00:24:30.059 no matter how small the puncture, because the 00:24:30.059 --> 00:24:32.559 bandage visually keeps the insides in. And you 00:24:32.559 --> 00:24:34.920 have to use non -threatening language. You must. 00:24:35.400 --> 00:24:38.819 Avoid words like cut, stab, fix, or put to sleep. 00:24:38.960 --> 00:24:41.519 Instead, use make a small opening, clean, or 00:24:41.519 --> 00:24:43.460 help the sore get better. We have to minimize 00:24:43.460 --> 00:24:45.400 their imagination, filling in those terrifying 00:24:45.400 --> 00:24:47.779 gaps. Let's transition to managing behavior. 00:24:48.420 --> 00:24:50.779 What are the principles of discipline that support 00:24:50.779 --> 00:24:53.180 their development of initiative without causing 00:24:53.180 --> 00:24:55.519 that crippling guilt? Discipline has to exist 00:24:55.519 --> 00:24:58.059 within a loving, nurturing relationship, and 00:24:58.059 --> 00:25:00.400 it needs to be defined by clear, consistent, 00:25:00.559 --> 00:25:03.640 and immediate limits. The goals are to teach 00:25:03.640 --> 00:25:06.380 the difference between right and wrong. encourage 00:25:06.380 --> 00:25:09.660 self -control, and foster empathy. And physical 00:25:09.660 --> 00:25:12.359 punishment is out. Strongly discouraged by the 00:25:12.359 --> 00:25:15.599 American Academy of Pediatrics. Striking or spanking 00:25:15.599 --> 00:25:17.960 just models aggression and it fails to teach 00:25:17.960 --> 00:25:20.640 self -regulation. So the highest yield discipline 00:25:20.640 --> 00:25:23.940 technique for this age is timeout. What's the 00:25:23.940 --> 00:25:26.240 standard nursing guidance on how long a timeout 00:25:26.240 --> 00:25:29.079 should be? The timeout rule is simple and it's 00:25:29.079 --> 00:25:31.640 highly effective. One minute per year of age 00:25:31.869 --> 00:25:33.849 A four -year -old gets four minutes, a five -year 00:25:33.849 --> 00:25:36.309 -old gets five. And the space matters, too. The 00:25:36.309 --> 00:25:38.670 timeout area has to be boring, non -stimulating, 00:25:38.710 --> 00:25:41.890 and safe. Not the room full of toys, but a designated 00:25:41.890 --> 00:25:44.769 chair or a quiet corner. And the timeout must 00:25:44.769 --> 00:25:47.509 begin after the child has quieted down, not while 00:25:47.509 --> 00:25:49.569 they're still thrashing, to ensure they learn 00:25:49.569 --> 00:25:51.990 self -regulation. And what about the common issue 00:25:51.990 --> 00:25:54.589 of lying? Why is it such a staple of this age? 00:25:55.069 --> 00:25:57.569 Lying is extremely common, and it's a symptom 00:25:57.569 --> 00:26:01.009 of two underlying issues. Fear of punishment. 00:26:01.279 --> 00:26:04.339 and those blurred lines between fantasy and reality, 00:26:04.640 --> 00:26:07.220 which is their magical thinking. They desperately 00:26:07.220 --> 00:26:09.680 want a please. And if they think admitting they 00:26:09.680 --> 00:26:11.779 broke the vase will lead to severe punishment, 00:26:12.160 --> 00:26:14.200 they'll choose the path that avoids that consequence. 00:26:14.640 --> 00:26:17.059 So the nursing guidance to parents has to address 00:26:17.059 --> 00:26:19.799 both the action and the root cause. Exactly. 00:26:20.519 --> 00:26:22.599 Parents should gently acknowledge the child's 00:26:22.599 --> 00:26:25.519 fear, then guide them back to reality. Avoid 00:26:25.519 --> 00:26:28.180 labeling the child as a liar. Instead, you address 00:26:28.180 --> 00:26:31.500 the behavior. The vase is broken. and I know 00:26:31.500 --> 00:26:33.420 you are scared of being in trouble, but the truth 00:26:33.420 --> 00:26:36.759 is important. This reinforces truthfulness without 00:26:36.759 --> 00:26:38.900 damaging their emerging self -worth and initiative. 00:26:39.119 --> 00:26:41.660 Okay, let's wrap this section. What should nurses 00:26:41.660 --> 00:26:44.339 watch for? If a five -year -old exhibits a lack 00:26:44.339 --> 00:26:46.599 of interest in playing with other children, or 00:26:46.599 --> 00:26:49.119 if a child of any preschool age fails to engage 00:26:49.119 --> 00:26:52.420 in fantasy play, these signal potential deficits 00:26:52.420 --> 00:26:54.839 in their social and cognitive development. And 00:26:54.839 --> 00:26:57.519 what do exam writers love to test? Identifying 00:26:57.519 --> 00:27:00.220 associative play as the primary type of play. 00:27:00.490 --> 00:27:03.509 It's not cooperative yet. And the critical understanding 00:27:03.509 --> 00:27:06.349 that the preschooler's greatest fear is bodily 00:27:06.349 --> 00:27:09.630 harm or mutilation. And the easy way to remember 00:27:09.630 --> 00:27:12.309 the sage group. They're shifting from playing 00:27:12.309 --> 00:27:14.970 next to others, which is parallel play, to playing 00:27:14.970 --> 00:27:17.859 with others, which is associative. and they use 00:27:17.859 --> 00:27:20.900 make believe as their primary tool for working 00:27:20.900 --> 00:27:23.240 through their conscience. So if we synthesize 00:27:23.240 --> 00:27:25.099 what we've talked about, their high mobility 00:27:25.099 --> 00:27:27.559 and strong physical capability combined with 00:27:27.559 --> 00:27:30.339 that pre -operational illogical judgment, we 00:27:30.339 --> 00:27:33.660 get an age group at extremely high risk for accidental 00:27:33.660 --> 00:27:36.400 injury. Absolutely. Injuries remain the leading 00:27:36.400 --> 00:27:38.500 cause of death in this age group, so our teaching 00:27:38.500 --> 00:27:41.220 has to be laser focused on prevention. We have 00:27:41.220 --> 00:27:44.160 to remember they just lack the ability to truly 00:27:44.160 --> 00:27:46.700 assess danger. They're risk -takers because they 00:27:46.700 --> 00:27:49.079 have initiative, but they don't have the abstract 00:27:49.079 --> 00:27:51.779 thought to predict the consequences. So the top 00:27:51.779 --> 00:27:54.460 risk, statistically, is still motor vehicle injuries. 00:27:54.900 --> 00:27:57.079 Let's cover the car seat rules, which are mandatory 00:27:57.079 --> 00:28:00.680 for nurses to teach consistently. Okay. Preschoolers 00:28:00.680 --> 00:28:03.359 must be secured in a federally approved car restraint. 00:28:04.059 --> 00:28:06.119 Generally, they're moving from a forward -facing 00:28:06.119 --> 00:28:09.319 car seat with a five -point harness toward a 00:28:09.319 --> 00:28:11.279 booster seat. And the rule for the booster seat 00:28:11.279 --> 00:28:14.160 is? Nurses have to reinforce the safety guidance 00:28:14.160 --> 00:28:16.380 that a booster seat is required until the child 00:28:16.380 --> 00:28:19.299 reaches one of two criteria. Four feet, nine 00:28:19.299 --> 00:28:22.460 inches in height, that's 145 centimeters, or 00:28:22.460 --> 00:28:24.539 R, they're eight to 12 years old. This is the 00:28:24.539 --> 00:28:26.640 gold standard. It's non -negotiable. Why is that 00:28:26.640 --> 00:28:29.099 specific height four foot nine the key? It ensures 00:28:29.099 --> 00:28:31.920 that the adult lap belt lies low across the hips 00:28:31.920 --> 00:28:34.259 and upper thighs, and the shoulder belt crosses 00:28:34.259 --> 00:28:36.480 the middle of the chest and collarbone. And if 00:28:36.480 --> 00:28:39.079 the child is too short? The lap belt rides up 00:28:39.079 --> 00:28:41.640 over the abdomen, risking serious internal injuries, 00:28:41.859 --> 00:28:44.240 it's called seat belt syndrome, in a crash. And 00:28:44.240 --> 00:28:46.299 the shoulder belt rests dangerously across their 00:28:46.299 --> 00:28:49.019 neck or face. We teach parents to ignore the 00:28:49.019 --> 00:28:51.279 pressure to transition them out early. What about 00:28:51.279 --> 00:28:53.779 outdoor and pedestrian safety, given their increased 00:28:53.779 --> 00:28:56.279 gross motor freedom? Since they're on tricycles 00:28:56.279 --> 00:28:58.680 and moving toward bicycles, protective equipment 00:28:58.680 --> 00:29:01.559 is non -negotiable. Helmets, knee pads, elbow 00:29:01.559 --> 00:29:05.440 pads. For pedestrian safety, we need structured 00:29:05.630 --> 00:29:08.289 repetitive teaching of the stop look method. 00:29:08.829 --> 00:29:11.490 Stop the curb. Look left, look right, and then 00:29:11.490 --> 00:29:13.950 look left again before crossing. Because they 00:29:13.950 --> 00:29:16.309 are still so egocentric, they need to practice 00:29:16.309 --> 00:29:19.170 recognizing that cars are fast and cannot stop 00:29:19.170 --> 00:29:21.990 instantly for them. OK, moving inside the home. 00:29:22.710 --> 00:29:25.269 The major preventable risks are drowning, poisoning, 00:29:25.509 --> 00:29:28.349 and burns. Let's start with drowning, which sees 00:29:28.349 --> 00:29:30.750 a spike in this age group as they become fearless 00:29:30.750 --> 00:29:34.180 near water. Drowning risk is paramount. Preschoolers 00:29:34.180 --> 00:29:36.519 must never be left unsupervised in bathtubs, 00:29:36.720 --> 00:29:39.539 near wading pools, or any body of water. Not 00:29:39.539 --> 00:29:41.240 even a small bucket of water. And what about 00:29:41.240 --> 00:29:43.539 swimming lessons? Well, swimming lessons are 00:29:43.539 --> 00:29:45.140 recommended for children four years and older 00:29:45.140 --> 00:29:47.759 as a skill -building exercise. Nurses have to 00:29:47.759 --> 00:29:49.859 teach parents that lessons are not a substitute 00:29:49.859 --> 00:29:52.980 for active, constant adult supervision. That 00:29:52.980 --> 00:29:54.960 is a classic test question because lessons can 00:29:54.960 --> 00:29:57.460 give parents a false sense of security. So what 00:29:57.460 --> 00:30:00.059 does active supervision really mean for this 00:30:00.059 --> 00:30:02.529 age? It means the adult should be within arm's 00:30:02.529 --> 00:30:05.650 length, or touch supervision. Not just sitting 00:30:05.650 --> 00:30:08.349 nearby reading a book. The child should always 00:30:08.349 --> 00:30:11.069 be the focus of the adult's attention. Even a 00:30:11.069 --> 00:30:13.769 brief distraction, answering a phone, walking 00:30:13.769 --> 00:30:17.130 inside for a moment, can be fatal for a preschooler. 00:30:17.630 --> 00:30:20.029 OK, now for poisoning, which ties directly back 00:30:20.029 --> 00:30:22.670 to their cognitive process of transduction. Right. 00:30:23.069 --> 00:30:25.130 Because of transduction and their preoperational 00:30:25.130 --> 00:30:27.950 thought, they mistake look -alike substances. 00:30:28.359 --> 00:30:30.680 They might see a colorful cleaning product that 00:30:30.680 --> 00:30:33.259 resembles juice or a vitamin that looks like 00:30:33.259 --> 00:30:35.819 candy. They just lack the logic to understand 00:30:35.819 --> 00:30:38.859 chemical danger. So the teaching point is? Nurses 00:30:38.859 --> 00:30:41.279 have to teach that all cleaning, garden, and 00:30:41.279 --> 00:30:44.059 automotive chemicals and all medicines, including 00:30:44.059 --> 00:30:46.940 vitamins, Tylenol, iron tablets, must be kept 00:30:46.940 --> 00:30:48.859 in locked cabinets up high and out of sight. 00:30:49.559 --> 00:30:52.220 Childproof caps offer a barrier, but not total 00:30:52.220 --> 00:30:54.559 security against a curious persistent five -year 00:30:54.559 --> 00:30:56.599 -old. And what about burns? What is the single 00:30:56.599 --> 00:30:58.740 most effective intervention against scald burns? 00:30:59.059 --> 00:31:01.339 The key intervention is managing the water temperature. 00:31:01.599 --> 00:31:04.279 You have to ensure the household water heater 00:31:04.279 --> 00:31:07.940 thermostat is set at or below 49 degrees Celsius, 00:31:08.440 --> 00:31:11.140 which is 120 degrees Fahrenheit. Why that number 00:31:11.140 --> 00:31:13.940 specifically? Water at 140 degrees F can cause 00:31:13.940 --> 00:31:16.500 a full thickness burn in less than five seconds. 00:31:17.259 --> 00:31:20.240 At 120 degrees F, it takes minutes, which allows 00:31:20.240 --> 00:31:23.319 the child time to react and pull away. That number, 00:31:23.660 --> 00:31:26.559 120 degrees F, is high yield safety data. And 00:31:26.559 --> 00:31:29.079 finally, firearms and falls, especially in the 00:31:29.079 --> 00:31:31.819 hospital environment. Firearms pose a risk because 00:31:31.819 --> 00:31:34.599 a preschooler has the physical strength and coordination 00:31:34.599 --> 00:31:37.890 to handle and fire a weapon. They should be stored 00:31:37.890 --> 00:31:40.369 unloaded in a locked cabinet with ammunition 00:31:40.369 --> 00:31:42.769 stored separately and locked away. And falls. 00:31:43.150 --> 00:31:45.089 Their improved mobility encourages risk -taking 00:31:45.089 --> 00:31:47.190 behaviors like climbing on railings or jumping 00:31:47.190 --> 00:31:49.990 off furniture. In the hospital, this means increased 00:31:49.990 --> 00:31:52.769 vigilance, clear rules, and ensuring side rails 00:31:52.769 --> 00:31:54.990 are up as their initiative can quickly override 00:31:54.990 --> 00:31:57.029 their sense of caution. Okay, time for the summary. 00:31:57.250 --> 00:31:59.450 What do nurses watch for? You're watching for 00:31:59.450 --> 00:32:01.609 parents planning to graduate a child out of a 00:32:01.609 --> 00:32:04.349 booster seat prematurely. You have to reinforce 00:32:04.349 --> 00:32:06.430 that critical four foot nine height requirement, 00:32:06.809 --> 00:32:08.869 and you're monitoring the home environment for 00:32:08.869 --> 00:32:10.950 accessible poisons or high water temperatures. 00:32:11.269 --> 00:32:14.250 And what exam writers love to test? The specific 00:32:14.250 --> 00:32:17.450 maximum water temperature, 120 degrees Fahrenheit, 00:32:17.630 --> 00:32:20.589 to prevent skull burns, and the mandatory teaching 00:32:20.589 --> 00:32:23.529 point that swimming lessons do not replace constant 00:32:23.529 --> 00:32:25.990 active adult supervision. And the easy way to 00:32:25.990 --> 00:32:28.390 remember this age group? They're highly mobile, 00:32:28.589 --> 00:32:32.009 highly curious, but crucially, they lack the 00:32:32.009 --> 00:32:34.430 cognitive judgment that preoperational thinking 00:32:34.430 --> 00:32:37.890 to assess danger, which leads to high risk exploration. 00:32:38.210 --> 00:32:41.190 This section is pure clinical high yield material. 00:32:41.549 --> 00:32:43.970 The four - to six -year visit is the final push 00:32:43.970 --> 00:32:46.369 before kindergarten, and it's characterized by 00:32:46.369 --> 00:32:49.089 a cluster of mandatory booster shots. We lovingly 00:32:49.089 --> 00:32:51.250 call this the four -shot fours. I like that. 00:32:51.369 --> 00:32:53.190 This is the checkup that ensures completion of 00:32:53.190 --> 00:32:56.109 the primary series for four major diseases. The 00:32:56.109 --> 00:32:58.009 four key doses administered between age four 00:32:58.009 --> 00:33:01.210 and six are DTaP, which is diphtheria, tetanus, 00:33:01.369 --> 00:33:04.500 and a cellular pertussis. IPV. inactivated polio 00:33:04.500 --> 00:33:08.240 virus. MMR for measles, mumps, and rubella, and 00:33:08.240 --> 00:33:11.700 VAR for varicella. Mastering the nuances of DTAP 00:33:11.700 --> 00:33:14.359 and IPV is absolutely essential. Okay, let's 00:33:14.359 --> 00:33:16.460 start with DTAP. It's a five -dose series. What 00:33:16.460 --> 00:33:18.779 are the rules surrounding that four to six -year 00:33:18.779 --> 00:33:21.539 dose? The dose given at four to six years is 00:33:21.539 --> 00:33:23.680 typically the fifth and final dose of the childhood 00:33:23.680 --> 00:33:26.640 series. However, here is the rule that exam writers 00:33:26.640 --> 00:33:30.099 love to use as a catch -up scenario. Dose five 00:33:30.099 --> 00:33:32.619 is unnecessary if dose four was administered 00:33:32.619 --> 00:33:35.640 at age four years or older, and the other was 00:33:35.640 --> 00:33:37.839 at least a six -month interval after dose three. 00:33:38.059 --> 00:33:40.220 Okay, so picture this. A child is four years 00:33:40.220 --> 00:33:42.160 and three months old. They got their third dose 00:33:42.160 --> 00:33:44.660 at 18 months and their fourth dose at 48 months, 00:33:44.819 --> 00:33:47.059 which is age four. Since dose four was given 00:33:47.059 --> 00:33:49.059 after age four, and it's been way more than six 00:33:49.059 --> 00:33:51.079 months since dose three, they're good. They don't 00:33:51.079 --> 00:33:53.460 need dose five. Precisely. If, however, they 00:33:53.460 --> 00:33:55.920 received dose four three years old, They absolutely 00:33:55.920 --> 00:33:57.859 still need dose five at their four to six year 00:33:57.859 --> 00:34:00.140 visit, as long as it's been six months since 00:34:00.140 --> 00:34:02.720 dose four. The rule protects against unnecessary 00:34:02.720 --> 00:34:04.940 dosing while still ensuring immunity. Right. 00:34:05.299 --> 00:34:07.619 OK. IPV inactivated polio virus is the other 00:34:07.619 --> 00:34:10.820 vaccine with complex final dose timing. IPV is 00:34:10.820 --> 00:34:13.599 a four dose series. The dose administered at 00:34:13.599 --> 00:34:15.760 four to six years is the fourth and final dose. 00:34:16.000 --> 00:34:18.840 The absolute requirement is that the final dose 00:34:18.840 --> 00:34:22.380 must be administered on or after age four years, 00:34:22.460 --> 00:34:25.559 A and D, at least six months after the previous 00:34:25.559 --> 00:34:28.260 or third dose. So if a child gets that fourth 00:34:28.260 --> 00:34:30.739 dose at three years and 11 months, that dose 00:34:30.739 --> 00:34:32.980 is invalid. It is. It's considered invalid because 00:34:32.980 --> 00:34:35.420 it was given before the minimum age of four years. 00:34:35.840 --> 00:34:38.880 Okay, MMR and VAR are simpler. They're both just 00:34:38.880 --> 00:34:41.000 getting their second dose. Correct. Both MMR 00:34:41.000 --> 00:34:43.300 and Varicella start their series around 12 to 00:34:43.300 --> 00:34:46.300 15 months. The four to six years visit is for 00:34:46.300 --> 00:34:49.519 that second or booster dose. These are crucial 00:34:49.519 --> 00:34:51.619 for long -term immunity against these highly 00:34:51.619 --> 00:34:54.260 contagious diseases, especially as the child 00:34:54.260 --> 00:34:56.500 enters the dense environment of elementary school. 00:34:56.800 --> 00:34:59.360 Let's talk about combination vaccines. They reduce 00:34:59.360 --> 00:35:01.420 the number of painful injections, which is a 00:35:01.420 --> 00:35:03.699 major win for a preschooler with a fear of bodily 00:35:03.699 --> 00:35:06.139 harm. Combination vaccines are efficient, but 00:35:06.139 --> 00:35:09.380 you have to know the specific ACIP contraindications. 00:35:09.760 --> 00:35:12.519 Person's MMRV combines measles, mumps, rubella, 00:35:12.599 --> 00:35:14.440 and varicella. And there's a critical test alert 00:35:14.440 --> 00:35:18.469 here. Yes, MMRV is not recommended for ages 12 00:35:18.469 --> 00:35:21.389 to 47 months due to a slightly increased risk 00:35:21.389 --> 00:35:24.070 of fever and febrile seizures compared to giving 00:35:24.070 --> 00:35:27.210 MMR and VAR separately. And it's also not recommended 00:35:27.210 --> 00:35:30.210 for ages 13 to 18 years. So if you have a child 00:35:30.210 --> 00:35:32.590 in either of those age windows, you have to give 00:35:32.590 --> 00:35:35.449 the two vaccines separately. You must. That is 00:35:35.449 --> 00:35:38.269 a classic trap question. Know those two age groups 00:35:38.269 --> 00:35:41.199 where MMRV is contraindicated. Okay, let's talk 00:35:41.199 --> 00:35:43.679 about the annual influenza vaccine, which is 00:35:43.679 --> 00:35:46.519 required starting at six months. Annual flu vaccination 00:35:46.519 --> 00:35:48.679 is mandatory for everyone six months and older. 00:35:49.380 --> 00:35:52.139 The dosing rule hinges on prior vaccination history 00:35:52.139 --> 00:35:54.829 for children under nine. How so? Children aged 00:35:54.829 --> 00:35:57.090 six months to eight years require two doses, 00:35:57.289 --> 00:35:59.909 separated by at least four weeks, only if they 00:35:59.909 --> 00:36:02.010 have received fewer than two doses of any flu 00:36:02.010 --> 00:36:04.349 vaccine before July 1st of the current season. 00:36:04.449 --> 00:36:06.389 And if they're nine or older or they've had those 00:36:06.389 --> 00:36:08.190 two doses before, then they normally require 00:36:08.190 --> 00:36:11.869 one annual dose. And the absolute mandatory testable 00:36:11.869 --> 00:36:14.469 contraindication regarding the live attenuated 00:36:14.469 --> 00:36:19.469 influenza vaccine, LAIV3 or FluMist. Since LAIV3 00:36:19.469 --> 00:36:22.329 is a live vaccine given intranasally, it has 00:36:22.329 --> 00:36:25.130 several important contraindications, the high 00:36:25.130 --> 00:36:28.170 yield one for this age group. It is contraindicated 00:36:28.170 --> 00:36:30.869 for children aged two to four years with a history 00:36:30.869 --> 00:36:33.429 of asthma or recurrent wheezing. Why is that? 00:36:33.909 --> 00:36:36.650 The concern is that the live virus could potentially 00:36:36.650 --> 00:36:39.630 exacerbate their reactive airway disease. So 00:36:39.630 --> 00:36:41.730 if a parent requests flimist for their wheezy 00:36:41.730 --> 00:36:44.449 four -year -old, you have to refuse and administer 00:36:44.449 --> 00:36:47.809 the inactivated injectable vaccine, the IIV. 00:36:47.920 --> 00:36:50.840 Other contraindications include being immunocompromised 00:36:50.840 --> 00:36:53.760 or having close contact with severely immunosuppressed 00:36:53.760 --> 00:36:56.340 individuals. Before we leave immunizations, let's 00:36:56.340 --> 00:36:58.659 quickly review the critical rules about administration 00:36:58.659 --> 00:37:01.539 timing, the four -day grace period versus the 00:37:01.539 --> 00:37:05.019 repeat dose rule. These rules ensure valid immunity 00:37:05.019 --> 00:37:07.590 documentation. Doses administered up to four 00:37:07.590 --> 00:37:09.849 days before the minimum age or minimum interval 00:37:09.849 --> 00:37:12.070 are considered valid. It's a minor grace period. 00:37:12.690 --> 00:37:14.989 But doses administered five days or more earlier 00:37:14.989 --> 00:37:17.250 than the minimum age or interval should be considered 00:37:17.250 --> 00:37:20.369 invalid, not counted, and must be repeated. So 00:37:20.369 --> 00:37:22.409 if the minimum age is 48 months and they got 00:37:22.409 --> 00:37:25.389 the shot at 47 months and 25 days, it's invalid. 00:37:25.530 --> 00:37:27.610 It has to be repeated. And what about the major 00:37:27.610 --> 00:37:30.150 contraindications for live vaccines in general? 00:37:30.610 --> 00:37:34.679 Live vaccines, so MMR, VAR, LAIV. rotavirus, 00:37:35.119 --> 00:37:36.980 are generally contraindicated in the presence 00:37:36.980 --> 00:37:40.260 of severe immunodeficiency. This includes chemotherapy, 00:37:40.820 --> 00:37:43.519 congenital immunodeficiency, or high -dose long 00:37:43.519 --> 00:37:46.340 -term immunosuppressive therapy. They are also 00:37:46.340 --> 00:37:48.860 contraindicated during pregnancy. The nurse must 00:37:48.860 --> 00:37:51.159 always screen for these conditions before administration. 00:37:51.360 --> 00:37:53.280 Let's do the wrap -up. What should nurses be 00:37:53.280 --> 00:37:55.199 watching for? Ensuring the four to six -year 00:37:55.199 --> 00:37:58.760 boosters, DTAP, IPV, MMR, and VAR are correctly 00:37:58.760 --> 00:38:01.320 documented and timed, and rigorously screening 00:38:01.320 --> 00:38:03.739 patients aged two to four for a history of wheezing 00:38:03.739 --> 00:38:05.980 before you even think about administering LAIV 00:38:05.980 --> 00:38:08.460 -3. And what do exam writers love to test? The 00:38:08.460 --> 00:38:10.840 complex catch -up rule for DTAP, so dose five 00:38:10.840 --> 00:38:13.920 and the IPV final dose timing, all so that LAIV 00:38:13.920 --> 00:38:16.360 -3 contraindication regarding asthma or a wheezing 00:38:16.360 --> 00:38:18.320 history. And one easy way to remember this age 00:38:18.320 --> 00:38:21.500 group? The four -shot fours, DTAP, IPV, MMR, 00:38:21.840 --> 00:38:24.659 VAR, they mark school readiness. Now that we've 00:38:24.659 --> 00:38:26.219 covered their structure, their mind, and their 00:38:26.219 --> 00:38:29.099 mandatory shots, let's look at the daily clinical 00:38:29.099 --> 00:38:32.739 concerns nurses address. Sleep, nutrition, and 00:38:32.739 --> 00:38:35.239 common behavioral issues. Let's start with sleep, 00:38:35.599 --> 00:38:37.639 where nighttime arousal issues frequently come 00:38:37.639 --> 00:38:40.400 up. They do. Preschoolers generally need about 00:38:40.400 --> 00:38:43.079 10 to 13 hours of sleep daily, and most begin 00:38:43.079 --> 00:38:45.280 dropping their afternoon nap around age four 00:38:45.280 --> 00:38:48.550 or five. The critical skill for the nurse here 00:38:48.550 --> 00:38:51.190 is distinguishing between the two major causes 00:38:51.190 --> 00:38:55.050 of sleep disruption. Nightmares and night terrors. 00:38:55.230 --> 00:38:57.269 They're managed completely differently. Okay, 00:38:57.530 --> 00:38:59.630 lay out the fundamental difference for us because 00:38:59.630 --> 00:39:01.809 this is confusing for parents and it is highly 00:39:01.809 --> 00:39:05.090 testable. A nightmare is a bad dream. It occurs 00:39:05.090 --> 00:39:07.530 during REM sleep, usually in the second half 00:39:07.530 --> 00:39:10.349 of the night. The child will fully awaken, cry, 00:39:10.489 --> 00:39:13.130 be scared, and crucially, they will remember 00:39:13.130 --> 00:39:15.630 the dream. They respond to their parents' comfort 00:39:15.630 --> 00:39:17.829 and reassurance, though they often return to 00:39:17.829 --> 00:39:19.429 sleep with difficulty because they're conscious 00:39:19.429 --> 00:39:22.369 and scared. They're aware of their parents' presence. 00:39:22.710 --> 00:39:25.010 So it's a true scary dream. What about a night 00:39:25.010 --> 00:39:28.289 terror? A night terror is a sudden partial arousal 00:39:28.289 --> 00:39:31.489 from deep, non -REM sleep. And it usually happens 00:39:31.489 --> 00:39:33.989 about an hour after the child falls asleep. The 00:39:33.989 --> 00:39:36.929 child may thrash, scream, sit up, stare, appear 00:39:36.929 --> 00:39:39.389 terrified, have a racing heart. But they are 00:39:39.389 --> 00:39:41.190 in an altered state of consciousness. So they're 00:39:41.190 --> 00:39:43.820 not really awake. They're not. They are generally 00:39:43.820 --> 00:39:46.119 unaware of the parent's presence, they do not 00:39:46.119 --> 00:39:48.159 remember the episode the next morning, and they 00:39:48.159 --> 00:39:50.500 often fall back asleep rapidly without fully 00:39:50.500 --> 00:39:53.559 awakening. That distinction, the memory, the 00:39:53.559 --> 00:39:56.340 awareness, and the time of night, that is everything. 00:39:56.780 --> 00:39:58.840 So the intervention for a night terror is essentially 00:39:58.840 --> 00:40:01.940 minimal interference, right? Exactly. For a night 00:40:01.940 --> 00:40:04.139 terror, the parent should gently ensure the child 00:40:04.139 --> 00:40:06.659 is safe from injury, but avoid trying to fully 00:40:06.659 --> 00:40:09.059 awaken or comfort them, as the child isn't truly 00:40:09.059 --> 00:40:11.989 conscious and may resist. The intervention focuses 00:40:11.989 --> 00:40:15.010 on prevention, establishing a consistent bedtime 00:40:15.010 --> 00:40:17.210 routine, making sure the child isn't overtired, 00:40:17.590 --> 00:40:20.030 and avoiding stimulating activities or media 00:40:20.030 --> 00:40:22.710 before sleep. Okay, let's pivot to nutrition. 00:40:23.210 --> 00:40:25.489 Growth has slowed dramatically from toddlerhood, 00:40:25.690 --> 00:40:27.969 which means their appetite often becomes erratic 00:40:27.969 --> 00:40:30.550 and that causes parental anxiety. Their appetite 00:40:30.550 --> 00:40:32.590 decreases because their growth rate has decreased. 00:40:33.150 --> 00:40:35.710 Their caloric needs range from about 1 ,000 to 00:40:35.710 --> 00:40:38.989 1 ,600 kilocalves a day based on their size and 00:40:38.989 --> 00:40:41.980 activity. We need to focus on the key nutritional 00:40:41.980 --> 00:40:45.260 requirements. 700 to 1 ,000 milligrams of calcium 00:40:45.260 --> 00:40:48.239 for bone growth, 7 to 10 milligrams of iron to 00:40:48.239 --> 00:40:50.760 prevent anemia, and 8 to 10 grams of dietary 00:40:50.760 --> 00:40:53.380 fiber for GI health. And what is the high -yield 00:40:53.380 --> 00:40:56.079 nursing guidance for managing that picky eater 00:40:56.079 --> 00:40:59.679 phase? We guide parents to offer small, appropriately 00:40:59.679 --> 00:41:02.500 sized portions, encourage the child to self -feed, 00:41:02.639 --> 00:41:04.780 and crucially, allow the child to decide when 00:41:04.780 --> 00:41:07.039 they're full. Never force food or turn meal time 00:41:07.039 --> 00:41:08.900 into a battle. Because that can lead to negative 00:41:08.900 --> 00:41:11.400 associations or eating disorders later on. Again. 00:41:11.760 --> 00:41:14.159 We also emphasize family meal times as a chance 00:41:14.159 --> 00:41:16.440 for parental modeling of healthy choices. And 00:41:16.440 --> 00:41:18.900 what about the two major numerical health promotion 00:41:18.900 --> 00:41:21.320 facts that appear everywhere? Juice intake and 00:41:21.320 --> 00:41:23.900 screen time limits. Absolute must -know facts. 00:41:24.300 --> 00:41:26.239 For nutritional health and the prevention of 00:41:26.239 --> 00:41:28.739 dental cavities, fruit juice intake must be limited 00:41:28.739 --> 00:41:31.699 to a maximum of four to six ounces per day. Any 00:41:31.699 --> 00:41:33.780 more than that displaces nutrient -rich foods 00:41:33.780 --> 00:41:36.380 and contributes excess sugar. And for screen 00:41:36.380 --> 00:41:38.340 time, given their engagement with electronic 00:41:38.340 --> 00:41:41.000 games and TV. To promote social interaction, 00:41:41.480 --> 00:41:44.119 physical activity, and adequate sleep, screen 00:41:44.119 --> 00:41:46.880 time, which includes television, tablets, phones, 00:41:47.440 --> 00:41:49.940 must be limited to a maximum of one hour per 00:41:49.940 --> 00:41:52.900 day for this age group. Nurses have to be firm 00:41:52.900 --> 00:41:55.139 on this guidance, especially when counseling 00:41:55.139 --> 00:41:57.679 parents about childhood overweight and obesity. 00:41:58.039 --> 00:42:00.320 Which leads right to our final high -yield clinical 00:42:00.320 --> 00:42:03.480 concern, the management of weight status. Overweight 00:42:03.480 --> 00:42:07.380 is defined as a BMI at or above the 85th percentile 00:42:07.380 --> 00:42:10.980 and obesity is at or above the 95th. These children 00:42:10.980 --> 00:42:13.260 are at risk for developing adult health complications 00:42:13.260 --> 00:42:16.219 like hypertension, hyperlipidemia, and type 2 00:42:16.219 --> 00:42:18.719 diabetes. So nursing interventions are key. Yes. 00:42:18.960 --> 00:42:21.840 We encourage 60 minutes of daily physical activity 00:42:21.840 --> 00:42:24.260 and we enforce that screen time limit of one 00:42:24.260 --> 00:42:26.699 hour per day. Our role is focused on prevention 00:42:26.699 --> 00:42:28.860 and early intervention to manage these risks. 00:42:29.179 --> 00:42:30.780 Let's do the final summary for this section. 00:42:30.920 --> 00:42:33.360 What do nurses watch for? You're watching for 00:42:33.360 --> 00:42:36.059 parents confusing night terrors, which are partial 00:42:36.059 --> 00:42:39.039 arousal with no memory, with nightmares, which 00:42:39.039 --> 00:42:41.960 are full awakening with memory. We have to ensure 00:42:41.960 --> 00:42:43.900 parents know how to differentiate and manage 00:42:43.900 --> 00:42:46.639 each event correctly. And what exam raters love 00:42:46.639 --> 00:42:49.420 to test? The direct numerical health promotion 00:42:49.420 --> 00:42:52.860 limits. Maximum juice intake is four to six ounces 00:42:52.860 --> 00:42:55.780 per day, and maximum screen time is one hour 00:42:55.780 --> 00:42:58.440 per day. And one easy way to remember this age 00:42:58.440 --> 00:43:01.170 group. They are the sleep -scared group, frequently 00:43:01.170 --> 00:43:03.809 dealing with nighttime -arisal issues that demand 00:43:03.809 --> 00:43:06.670 clear differentiation and consistency in their 00:43:06.670 --> 00:43:10.329 bedtime routine. We have navigated the incredibly 00:43:10.329 --> 00:43:12.610 complex world of the preschooler, ages three 00:43:12.610 --> 00:43:15.090 to six. This deep dive has really highlighted 00:43:15.090 --> 00:43:17.489 why this age is so critical. They're the bridge 00:43:17.489 --> 00:43:19.750 from dependent toddlers to independent school 00:43:19.750 --> 00:43:22.369 -age children, a period defined by the explosive 00:43:22.369 --> 00:43:24.409 growth of their conscience and their imagination. 00:43:24.730 --> 00:43:26.829 The essential concepts to lock down for your 00:43:26.829 --> 00:43:29.929 exams and clinicals remain the four key vaccines 00:43:29.929 --> 00:43:32.650 due at that four to six -year checkup DTaP dose 00:43:32.650 --> 00:43:36.110 five, IPV dose four, and the second doses of 00:43:36.110 --> 00:43:40.019 MMR and VAR. And remember Erickson's stage, initiative 00:43:40.019 --> 00:43:42.400 versus guilt, which centers on the development 00:43:42.400 --> 00:43:44.559 of conscience through action and consequence. 00:43:44.960 --> 00:43:47.579 And you can never forget Piguet's cognitive limitations, 00:43:48.119 --> 00:43:50.619 magical thinking, transduction, and animism. 00:43:51.139 --> 00:43:53.119 These illogical processes dictate their fear 00:43:53.119 --> 00:43:55.239 of bodily harm or mutilation in the hospital 00:43:55.239 --> 00:43:57.920 and explain why safety education, from the four 00:43:57.920 --> 00:44:00.739 foot nine booster seat rule to the 120 degree 00:44:00.739 --> 00:44:03.480 water temperature, has to be so specific and 00:44:03.480 --> 00:44:06.139 so consistent. The preschooler has a truly imaginative 00:44:06.139 --> 00:44:08.980 mind. But this imagination struggles profoundly 00:44:08.980 --> 00:44:11.639 with abstract concepts, and most notably, the 00:44:11.639 --> 00:44:14.000 concept of time. They live in an event -based 00:44:14.000 --> 00:44:16.219 world, not a time -based one. So let's revisit 00:44:16.219 --> 00:44:18.320 that challenge for you, the future nurse. Knowing 00:44:18.320 --> 00:44:20.000 that a four -year -old struggles to grasp the 00:44:20.000 --> 00:44:22.699 concept of time, how would you explain a complex 00:44:22.699 --> 00:44:24.619 treatment plan like the need for antibiotics 00:44:24.619 --> 00:44:27.340 for 10 full days in a way that genuinely respects 00:44:27.340 --> 00:44:29.380 their preoperational mind and promotes compliance? 00:44:29.760 --> 00:44:32.539 You can't use Thursday or in 10 days. You have 00:44:32.539 --> 00:44:35.639 to anchor the time to a concrete, predictable 00:44:35.639 --> 00:44:38.840 daily event. So instead of saying, you will take 00:44:38.840 --> 00:44:41.510 this pink medicine for 10 days, you would say 00:44:41.510 --> 00:44:43.570 something like, you will take this pink medicine 00:44:43.570 --> 00:44:45.809 every morning right before you eat your favorite 00:44:45.809 --> 00:44:48.230 cereal, and every night after we read the bedtime 00:44:48.230 --> 00:44:50.809 story. When the medicine bottle is completely 00:44:50.809 --> 00:44:53.719 empty, that means you are all better. That's 00:44:53.719 --> 00:44:56.300 the core application. We swap the abstract calendar 00:44:56.300 --> 00:44:59.579 for the concrete, predictable daily ritual. And 00:44:59.579 --> 00:45:01.639 that's how you move from just knowing the facts 00:45:01.639 --> 00:45:04.059 to truly understanding and applying pediatric 00:45:04.059 --> 00:45:06.659 care. That level of application is what ensures 00:45:06.659 --> 00:45:09.059 success, both on the high -stakes test and at 00:45:09.059 --> 00:45:11.179 the patient's bedside. That's it for this deep 00:45:11.179 --> 00:45:13.300 dive. Go integrate that knowledge, and we'll 00:45:13.300 --> 00:45:15.360 catch you next time for another essential breakdown 00:45:15.360 --> 00:45:16.559 of clinical information.