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 --> 00:00:46.889 fast. Welcome to the emergency room. Welcome 00:00:46.889 --> 00:00:50.109 back to the deep dive. So you're getting ready 00:00:50.109 --> 00:00:52.670 for your pes rotation, you're staring down those 00:00:52.670 --> 00:00:56.789 big foundational exams and you know the school 00:00:56.789 --> 00:00:59.530 -aged child is a huge piece of that puzzle. It 00:00:59.530 --> 00:01:01.909 really is. So today, we're taking all that source 00:01:01.909 --> 00:01:04.549 material, your textbooks, those CDC schedules, 00:01:04.769 --> 00:01:07.109 the developmental checklists, and we are boiling 00:01:07.109 --> 00:01:08.629 it all down. We're going to pull out the most 00:01:08.629 --> 00:01:11.390 critical, high -yield info you absolutely need 00:01:11.390 --> 00:01:14.480 to know. And this age group, the six to 12 year 00:01:14.480 --> 00:01:17.400 old, is, well, it's arguably one of the most 00:01:17.400 --> 00:01:20.939 important transitions to understand. We sometimes 00:01:20.939 --> 00:01:23.420 call it the era of industry. Or the calm before 00:01:23.420 --> 00:01:25.079 the storm. I've heard that one, too. Right. The 00:01:25.079 --> 00:01:27.659 calm before the teenage storm. You get the slow, 00:01:28.040 --> 00:01:30.420 steady physical growth, which is a nice break 00:01:30.420 --> 00:01:32.840 after the toddler years. But at the same time, 00:01:33.340 --> 00:01:37.000 their social and cognitive growth is just exploding. 00:01:37.280 --> 00:01:39.700 It's accelerated. And that's the core of it for 00:01:39.700 --> 00:01:41.950 nursing, isn't it? That transition. whole world 00:01:41.950 --> 00:01:43.890 shifts completely they go from being totally 00:01:43.890 --> 00:01:46.290 focused on the family to a world that's you know 00:01:46.290 --> 00:01:48.489 dominated by their friends by school by teachers 00:01:48.489 --> 00:01:51.629 by coaches so if you are listener are looking 00:01:51.629 --> 00:01:54.329 for that one single thread that one idea that 00:01:54.519 --> 00:01:56.579 connects everything we're about to talk about 00:01:56.579 --> 00:01:59.579 today. What is it? It's Erickson's core stage 00:01:59.579 --> 00:02:02.980 for this age. Industry versus inferiority. OK. 00:02:03.260 --> 00:02:05.579 That is your clinical lens, everything. Play, 00:02:05.980 --> 00:02:08.560 safety, how they handle being sick. It all revolves 00:02:08.560 --> 00:02:11.740 around this fundamental drive they have for competence, 00:02:12.120 --> 00:02:13.560 for mastery. They don't want to be good at things. 00:02:13.800 --> 00:02:15.960 They need to be good at things. If you get that, 00:02:16.060 --> 00:02:18.870 you get the school -age child. Perfect. So that's 00:02:18.870 --> 00:02:21.210 our mission today. We're gonna use that industry 00:02:21.210 --> 00:02:23.750 lens to connect all the dots for you. We'll cover 00:02:23.750 --> 00:02:27.389 vitals, development, immunizations, play, and 00:02:27.389 --> 00:02:30.750 of course, the huge topic of safety. Let's jump 00:02:30.750 --> 00:02:33.409 right in with the body itself, the physiology. 00:02:33.650 --> 00:02:36.650 Okay, so physiologically, the big theme here 00:02:36.650 --> 00:02:39.930 seems to be things slowing down, but also maturing. 00:02:40.250 --> 00:02:42.189 That's a great way to put it. Think deceleration 00:02:42.189 --> 00:02:44.669 in terms of rates, but maturation in terms of 00:02:44.669 --> 00:02:46.789 function. The body is just getting more efficient, 00:02:47.069 --> 00:02:48.990 it's refining itself, moving closer and closer 00:02:48.990 --> 00:02:53.020 to adult norms. I see that phrase slow, progressive, 00:02:53.259 --> 00:02:55.860 physical growth in all the textbooks. So let's 00:02:55.860 --> 00:02:58.360 break that down. Which systems are really making 00:02:58.360 --> 00:03:00.639 a big leap during this time? Well, the neurologic 00:03:00.639 --> 00:03:02.919 system is a fantastic place to start. The brain 00:03:02.919 --> 00:03:06.139 itself, it's already about 90 % of its adult 00:03:06.139 --> 00:03:08.719 size by age five. So the actual growth of the 00:03:08.719 --> 00:03:11.620 brain and the skull slows way down. Right. But 00:03:11.620 --> 00:03:14.879 that physical slowdown allows for this incredible 00:03:14.879 --> 00:03:16.879 functional development. The wiring is getting 00:03:16.879 --> 00:03:19.680 optimized. Myelination of the nerve fiber is 00:03:19.680 --> 00:03:21.680 continuing and that's what allows for faster 00:03:21.680 --> 00:03:23.699 processing for the complex thinking we'll talk 00:03:23.699 --> 00:03:26.139 about with Piaget. So the hardware is basically 00:03:26.139 --> 00:03:28.300 in place and now it's all about upgrading the 00:03:28.300 --> 00:03:31.340 software and the connection speed. Exactly. Which 00:03:31.340 --> 00:03:34.340 leads us to the immune system. This is a huge 00:03:34.340 --> 00:03:36.659 high yield point for any nursing student. The 00:03:36.659 --> 00:03:38.909 number of sick visits just plummets, doesn't 00:03:38.909 --> 00:03:40.909 it? It really does. And here's the clinical fact 00:03:40.909 --> 00:03:43.710 you need to remember. The immune system matures 00:03:43.710 --> 00:03:46.069 to an adult level right around 10 years old. 00:03:46.150 --> 00:03:48.990 10 years old. OK. So think about it. The preschooler 00:03:48.990 --> 00:03:51.449 you saw last week was in for their, what, fifth 00:03:51.449 --> 00:03:53.620 year infection? Right, it's just a constant cycle. 00:03:53.900 --> 00:03:57.120 But by 10, their immune system is fully competent. 00:03:57.319 --> 00:03:59.219 They've been exposed to a lot. They've built 00:03:59.219 --> 00:04:02.539 up antibodies. So they get far fewer colds, fewer 00:04:02.539 --> 00:04:05.659 stomach bugs, fewer infections in general. Which 00:04:05.659 --> 00:04:08.039 means if a 10 -year -old is coming in with constant 00:04:08.039 --> 00:04:11.680 nagging infections, that's a bit of a red flag 00:04:11.680 --> 00:04:14.530 for you. It's not just a kid thing anymore. Precisely. 00:04:14.610 --> 00:04:17.470 It warrants a deeper look. And this shift also 00:04:17.470 --> 00:04:20.589 means that the leading cause of, well, morbidity 00:04:20.589 --> 00:04:23.629 and mortality, it moves away from infectious 00:04:23.629 --> 00:04:25.889 disease and moves squarely into the category 00:04:25.889 --> 00:04:28.490 of unintentional injuries. Which we will definitely 00:04:28.490 --> 00:04:30.610 get to in the safety section. Yep. What about 00:04:30.610 --> 00:04:32.949 the musculoskeletal system? They look so much 00:04:32.949 --> 00:04:34.870 more coordinated. They're playing sports. But 00:04:34.870 --> 00:04:36.470 you're saying there's a hidden vulnerability. 00:04:36.649 --> 00:04:38.949 There is. Their coordination and strength are 00:04:38.949 --> 00:04:41.810 increasing like crazy. They can run, jump, swim, 00:04:41.949 --> 00:04:45.269 all of that. but the internal structure is still 00:04:45.269 --> 00:04:48.569 immature. What does that mean specifically? Specifically, 00:04:48.829 --> 00:04:51.430 we're talking about the growth plates, the epiphyseal 00:04:51.430 --> 00:04:53.350 plates at the ends of their long bones. They're 00:04:53.350 --> 00:04:55.970 still open, they're still soft, they're... relatively 00:04:55.970 --> 00:04:58.910 weak until they finish puberty. So their muscles 00:04:58.910 --> 00:05:00.870 might actually be stronger than their bones at 00:05:00.870 --> 00:05:03.430 certain points. That's the risk. The muscle strength 00:05:03.430 --> 00:05:06.750 can outpace the bones structural integrity. This 00:05:06.750 --> 00:05:09.370 makes them super prone to injuries during sports, 00:05:09.769 --> 00:05:11.689 especially fractures right at that growth plate, 00:05:11.750 --> 00:05:14.370 which can be a serious problem. So you can't 00:05:14.370 --> 00:05:17.790 treat a 10 year old athlete like a mini adult 00:05:17.790 --> 00:05:19.930 athlete. You absolutely cannot. The whole safety 00:05:19.930 --> 00:05:22.759 approach has to be different. OK, let's translate 00:05:22.759 --> 00:05:25.600 this maturation into the hard numbers, the vital 00:05:25.600 --> 00:05:28.779 signs. This is so testable. What's the overall 00:05:28.779 --> 00:05:32.319 trend? The trend is simple. Heart rate and respiratory 00:05:32.319 --> 00:05:34.899 rate go down and blood pressure goes up. The 00:05:34.899 --> 00:05:37.300 body is bigger. It's more efficient. It doesn't 00:05:37.300 --> 00:05:39.980 have to work as hard at rest. So let's compare 00:05:39.980 --> 00:05:42.939 a preschooler versus our school age kid. Let's 00:05:42.939 --> 00:05:45.240 start with pulse rate. OK, for a preschooler, 00:05:45.240 --> 00:05:48.220 you're looking at a range of, say, 70 to 120 00:05:48.220 --> 00:05:50.860 beats per minute. For the school -aged child, 00:05:51.079 --> 00:05:54.300 that slows down to about 60 to 110. So a heart 00:05:54.300 --> 00:05:56.839 rate of 115, which is totally fine in a four 00:05:56.839 --> 00:05:58.899 -year -old, might make you raise an eyebrow in 00:05:58.899 --> 00:06:01.339 a nine -year -old. It should, yeah. It's on the 00:06:01.339 --> 00:06:03.019 high end of normal. You'd want to watch that. 00:06:03.199 --> 00:06:05.839 And respirations, do they drop as much? They 00:06:05.839 --> 00:06:08.439 also slow down a bit, usually hovering in the 00:06:08.439 --> 00:06:12.110 20 or 25. breast -per -minute range, but the 00:06:12.110 --> 00:06:14.509 really critical change here, and exam writers 00:06:14.509 --> 00:06:18.189 love this detail, is the way they breathe. It 00:06:18.189 --> 00:06:21.529 becomes diaphragmatic. abdominal breathing. They're 00:06:21.529 --> 00:06:24.370 moving away from that chest wall, accessory muscle 00:06:24.370 --> 00:06:26.870 breathing you see in younger kids. It's just 00:06:26.870 --> 00:06:29.310 another sign of a more mature, more efficient 00:06:29.310 --> 00:06:32.329 respiratory system. So if you see a calm 10 -year 00:06:32.329 --> 00:06:35.050 -old with retractions or using their neck muscles 00:06:35.050 --> 00:06:37.829 to breathe, that's a significant sign of distress. 00:06:38.029 --> 00:06:39.850 A very significant sign. They shouldn't need 00:06:39.850 --> 00:06:41.910 to work that hard. Now, the one that goes the 00:06:41.910 --> 00:06:43.930 other way is blood pressure. Right. It starts 00:06:43.930 --> 00:06:46.310 to climb. It does. It moves toward adult norms, 00:06:46.350 --> 00:06:48.930 which reflects their bigger body mass and increased 00:06:49.620 --> 00:06:52.480 can you give us a general range to keep in mind? 00:06:52.670 --> 00:06:55.569 Well, it is very age and sex dependent, but generally 00:06:55.569 --> 00:06:58.949 systolic for boys is around 96 to 106, and for 00:06:58.949 --> 00:07:02.949 girls maybe 94 to 105. Diastolic for both is 00:07:02.949 --> 00:07:06.050 in that 55 to 62 range. The key takeaway for 00:07:06.050 --> 00:07:08.589 a student isn't to memorize every single number, 00:07:09.129 --> 00:07:12.370 but to know the trend. Know the trend. On a pediatric 00:07:12.370 --> 00:07:15.410 BP chart, this is the age where that line starts 00:07:15.410 --> 00:07:19.490 a clear, steady climb upwards. And thank goodness 00:07:19.490 --> 00:07:22.560 temperature taking gets easier. Finally. we can 00:07:22.560 --> 00:07:24.740 reliably switch to the oral route usually around 00:07:24.740 --> 00:07:27.139 age seven, once they can cooperate and hold it 00:07:27.139 --> 00:07:30.079 under their tongue safely. The temp itself is 00:07:30.079 --> 00:07:33.959 very stable, right around 37 Celsius or 98 .6 00:07:33.959 --> 00:07:35.899 Fahrenheit. Okay, before we wrap this section, 00:07:36.899 --> 00:07:39.399 that clinical calculation tip for bladder kinacity, 00:07:39.879 --> 00:07:42.079 it's so practical. It is, and you'll use it all 00:07:42.079 --> 00:07:45.790 the time. The formula is simple. Age in years 00:07:45.790 --> 00:07:49.009 plus two equals the capacity in ounces. So a 00:07:49.009 --> 00:07:51.350 10 -year -old has about a 12 -ounce bladder capacity. 00:07:51.670 --> 00:07:53.850 Exactly. And that's critical for you when you're 00:07:53.850 --> 00:07:56.610 assessing urine output, calculating IV fluids, 00:07:56.790 --> 00:07:59.069 or figuring out if a child is in urinary retention. 00:07:59.290 --> 00:08:01.470 It gives you a baseline for what to expect. That's 00:08:01.470 --> 00:08:03.629 incredibly useful. OK. Let's synthesize this 00:08:03.629 --> 00:08:06.170 section for everyone studying. All right. So 00:08:06.170 --> 00:08:09.279 what nurses watch for? You're watching for any 00:08:09.279 --> 00:08:11.800 sudden jump in heart rate or respiratory rate, 00:08:11.980 --> 00:08:14.620 remembering their baseline is way slower than 00:08:14.620 --> 00:08:17.480 a toddler's. You're also starting to watch for 00:08:17.480 --> 00:08:19.560 signs of prepubescence toward the end of this 00:08:19.560 --> 00:08:22.300 stage, around 10 or 12. And why is that important 00:08:22.300 --> 00:08:24.699 from a nursing perspective? Because their bodies 00:08:24.699 --> 00:08:26.740 might start to look more mature, but their brain 00:08:26.740 --> 00:08:29.240 is still that of a 10 -year -old. You have to 00:08:29.240 --> 00:08:31.180 base your communication and your expectations 00:08:31.180 --> 00:08:33.679 on their cognitive age, not their physical appearance. 00:08:33.960 --> 00:08:36.399 That's a great point. And what exam writers love 00:08:36.399 --> 00:08:39.080 to test? They love the maturation points, the 00:08:39.080 --> 00:08:41.000 immune system hitting adult levels around age 00:08:41.000 --> 00:08:43.779 10, and they love the vital sign trends heart 00:08:43.779 --> 00:08:46.879 rate and respirations down, BP up. They'll give 00:08:46.879 --> 00:08:49.320 you a scenario and ask if the vitals are normal 00:08:49.320 --> 00:08:52.019 for the age. Okay, and finally, one easy way 00:08:52.019 --> 00:08:54.559 to remember this age group. Their body is running 00:08:54.559 --> 00:08:57.779 like a more efficient car lower RPMs at idle, 00:08:58.179 --> 00:09:00.440 but the frame is still under construction. The 00:09:00.440 --> 00:09:02.940 driver, the brain, needs to be extra cautious. 00:09:03.120 --> 00:09:05.460 That's a perfect transition. The body's on a 00:09:05.460 --> 00:09:07.799 slower, steadier track, which means all that 00:09:07.799 --> 00:09:10.259 energy can be focused outward, focused on the 00:09:10.259 --> 00:09:12.879 world. And focused on success in that world. 00:09:13.000 --> 00:09:16.139 This is where we get to Erickson's industry versus 00:09:16.139 --> 00:09:19.799 inferiority. OK, so if the preschooler's job 00:09:19.799 --> 00:09:23.279 was initiative, just starting things, the school 00:09:23.279 --> 00:09:27.039 -aged child's job is What? It's production. Their 00:09:27.039 --> 00:09:29.379 entire developmental drive is to achieve a sense 00:09:29.379 --> 00:09:32.039 of personal competence. That's what industry 00:09:32.039 --> 00:09:34.799 means. So if they're in the hospital, their self 00:09:34.799 --> 00:09:36.980 -esteem, their whole sense of self, is tied to 00:09:36.980 --> 00:09:39.860 their ability to... Do stuff. To contribute, 00:09:40.440 --> 00:09:43.860 to master things, to achieve. Success for them 00:09:43.860 --> 00:09:46.419 is getting a good grade, scoring a goal, even 00:09:46.419 --> 00:09:49.240 just completing a chore correctly. So as nurses, 00:09:49.240 --> 00:09:51.340 we have to tap into that. We have to give them 00:09:51.340 --> 00:09:53.539 opportunities for industry. Give me a concrete 00:09:53.539 --> 00:09:55.500 example of that on the pediatric floor. OK, so 00:09:55.500 --> 00:09:57.679 instead of just silently measuring their fluid 00:09:57.679 --> 00:10:00.100 intake, you give them the chart and a pen. You 00:10:00.100 --> 00:10:02.700 say, your job is to be my official hydrator. 00:10:02.960 --> 00:10:05.139 I need you to mark this sheet every time you 00:10:05.139 --> 00:10:07.039 finish a cup of water. You're giving them a roll. 00:10:07.200 --> 00:10:09.340 A job. Exactly. You're making them a partner. 00:10:09.440 --> 00:10:11.899 They crave that responsibility. They need to 00:10:11.899 --> 00:10:14.360 feel helpful and competent, especially when so 00:10:14.360 --> 00:10:17.139 much else feels out of their control. And the 00:10:17.139 --> 00:10:21.019 flip side of that coin is inferiority. How does 00:10:21.019 --> 00:10:24.139 that manifest? It's a profound danger. Inferiority 00:10:24.139 --> 00:10:26.799 is what happens when the tasks are too hard, 00:10:26.980 --> 00:10:29.320 when the goals are too high, and the child just 00:10:29.320 --> 00:10:32.360 feels like a failure. They feel inadequate, worthless 00:10:32.360 --> 00:10:35.080 even. And school is a huge breeding ground for 00:10:35.080 --> 00:10:37.889 that. A huge one. If a child is struggling with 00:10:37.889 --> 00:10:40.289 reading or they're not good at sports and they're 00:10:40.289 --> 00:10:43.110 constantly reminded of that, that feeling of 00:10:43.110 --> 00:10:45.870 being less than can just take over their whole 00:10:45.870 --> 00:10:48.490 self -concept. So our job is to help set them 00:10:48.490 --> 00:10:52.230 up for success, for small wins. Always. Set achievable 00:10:52.230 --> 00:10:54.289 goals. This connects directly to how they think, 00:10:54.350 --> 00:10:57.090 right? To PJ's stage. Absolutely. We're now in 00:10:57.090 --> 00:10:59.230 the concrete operational stage, usually from 00:10:59.230 --> 00:11:01.909 about age 7 to 11. Concrete, that's the key word. 00:11:02.169 --> 00:11:05.250 It is. This is the beginning of logical, organized 00:11:05.250 --> 00:11:07.450 thought. They can understand processes, they 00:11:07.450 --> 00:11:09.950 can follow steps, they can classify things. It 00:11:09.950 --> 00:11:12.529 unlocks so much for our health teaching. But 00:11:12.529 --> 00:11:14.330 there's a huge limitation that you mentioned 00:11:14.330 --> 00:11:16.549 earlier. The huge limitation is that they still 00:11:16.549 --> 00:11:18.870 cannot think abstractly. Everything has to be 00:11:18.870 --> 00:11:22.070 concrete, tangible, and related to the here and 00:11:22.070 --> 00:11:24.269 now. So what's the clinical implication there? 00:11:24.450 --> 00:11:27.009 How does that change how you teach? It means 00:11:27.009 --> 00:11:30.110 you can't talk about long -term abstract consequences. 00:11:30.389 --> 00:11:32.649 Telling an eight -year -old smoking might give 00:11:32.649 --> 00:11:35.610 you cancer in 40 years is, you know, meaningless. 00:11:35.889 --> 00:11:38.250 It's too far away, too abstract. Right. But if 00:11:38.250 --> 00:11:40.190 you tell that same child, if you don't use your 00:11:40.190 --> 00:11:41.990 asthma inhaler correctly, you won't be able to 00:11:41.990 --> 00:11:44.509 play in the soccer game tomorrow. That's concrete. 00:11:44.789 --> 00:11:47.529 That's immediate. And it directly impacts their 00:11:47.529 --> 00:11:50.330 drive for industry. Let's hit that classic skill 00:11:50.330 --> 00:11:53.529 they master in this stage, conservation. Yes. 00:11:53.789 --> 00:11:57.029 Conservation is a huge cognitive leap. It's the 00:11:57.029 --> 00:11:59.350 understanding that the amount or volume of something 00:11:59.350 --> 00:12:02.009 stays the same even if you change its shape or 00:12:02.009 --> 00:12:04.950 appearance. The classic water glass test. A classic 00:12:04.950 --> 00:12:08.289 test. You pour water from a short, fat glass 00:12:08.289 --> 00:12:11.730 into a tall, skinny glass. A preschooler will 00:12:11.730 --> 00:12:14.529 say the tall glass has more water, but the school 00:12:14.529 --> 00:12:17.190 -aged child who has mastered conservation knows 00:12:17.190 --> 00:12:19.570 it's the same amount. They can mentally reverse 00:12:19.570 --> 00:12:22.370 the action. That ability to mentally manipulate 00:12:22.370 --> 00:12:24.759 things is the core of it all. It is. And they're 00:12:24.759 --> 00:12:27.879 also learning to tell time, they understand reversibility, 00:12:28.279 --> 00:12:31.240 and crucially, they become much less egocentric. 00:12:31.419 --> 00:12:33.500 They can finally see things from someone else's 00:12:33.500 --> 00:12:35.940 perspective. Genuinely see it, yes. Which is 00:12:35.940 --> 00:12:39.000 the foundation for empathy, for teamwork, for 00:12:39.000 --> 00:12:41.659 following rules in a game. And all of this plays 00:12:41.659 --> 00:12:43.639 out in their physical milestones too. It's not 00:12:43.639 --> 00:12:46.000 just running and jumping anymore. No, the gross 00:12:46.000 --> 00:12:48.620 motor skills get very refined, which is why organized 00:12:48.620 --> 00:12:51.460 sports become so popular. But the real expression 00:12:51.460 --> 00:12:54.279 of industry is often in their fine motor skills. 00:12:54.379 --> 00:12:57.200 How so? Their dexterity improves so much that 00:12:57.200 --> 00:12:59.860 they take incredible pride in activities that 00:12:59.860 --> 00:13:03.360 require precision. Like what? Like neat handwriting, 00:13:03.820 --> 00:13:06.480 building complex Lego models, learning a musical 00:13:06.480 --> 00:13:09.100 instrument, drawing detailed pictures. They love 00:13:09.100 --> 00:13:10.879 to show you what they've made. So if you notice 00:13:10.879 --> 00:13:13.539 a child is really avoiding those kinds of tasks, 00:13:13.779 --> 00:13:16.299 that could be a clue. A big one. Which brings 00:13:16.299 --> 00:13:18.759 us to a major developmental warning sign we have 00:13:18.759 --> 00:13:21.679 to screen for, vision problems. Because if you 00:13:21.679 --> 00:13:24.539 can't see well, you can't succeed in school. 00:13:25.039 --> 00:13:28.799 You can't achieve industry. Exactly. So you, 00:13:28.919 --> 00:13:32.169 as the nurse, need to watch for the signs. eye 00:13:32.169 --> 00:13:35.169 rubbing, squinting, headaches after school, holding 00:13:35.169 --> 00:13:37.929 a book super close to their face. Any of those 00:13:37.929 --> 00:13:40.230 are red flags. Let's do a quick deep dive on 00:13:40.230 --> 00:13:42.690 amblyopia, the lazy eye. Yeah. Because that's 00:13:42.690 --> 00:13:44.730 such a classic issue for this age. Right. And 00:13:44.730 --> 00:13:47.509 it's not just a weak eye. Amblyopia is when the 00:13:47.509 --> 00:13:51.149 brain starts to ignore or suppress the visual 00:13:51.149 --> 00:13:53.919 input from one eye. Why would it do that? It's 00:13:53.919 --> 00:13:56.580 usually because the image from that eye is blurry, 00:13:56.700 --> 00:13:58.899 maybe from a refractive error or misaligned, 00:13:58.940 --> 00:14:01.779 which is called strabismus. To avoid double vision, 00:14:01.879 --> 00:14:04.080 the brain just says, nope, I'm only listening 00:14:04.080 --> 00:14:06.100 to the good eye. And if that goes on for too 00:14:06.100 --> 00:14:08.120 long? The vision loss in that suppressed eye 00:14:08.120 --> 00:14:10.460 can become permanent. The critical window for 00:14:10.460 --> 00:14:12.899 visual development is still open. So the intervention 00:14:12.899 --> 00:14:15.740 is patching. Patching the strong eye, yes. You 00:14:15.740 --> 00:14:18.019 have to force the brain to use the weaker eye 00:14:18.019 --> 00:14:20.500 to build up those neural pathways. Which I imagine 00:14:20.500 --> 00:14:22.620 a nine -year -old is not a huge fan of. They 00:14:22.620 --> 00:14:24.940 hate it. Compliance is the number one challenge. 00:14:25.340 --> 00:14:27.259 So again, you leverage industry. You don't just 00:14:27.259 --> 00:14:29.919 say, wear this. You say, your job for the next 00:14:29.919 --> 00:14:32.019 four hours is to be an eye trainer. By wearing 00:14:32.019 --> 00:14:33.799 this patch, you're doing the hard work to make 00:14:33.799 --> 00:14:35.539 your eyes stronger so you can see better for 00:14:35.539 --> 00:14:38.379 video games. Frame it as a task to be mastered. 00:14:38.759 --> 00:14:41.379 Always. OK, let's wrap up development. What's 00:14:41.379 --> 00:14:44.360 the bottom line here? All right. What nurses 00:14:44.360 --> 00:14:47.320 watch for? You're looking for signs of inferiority. 00:14:47.980 --> 00:14:50.179 Is the child withdrawn? Are they always saying, 00:14:50.360 --> 00:14:53.509 I can't do it? Are they avoiding school or group 00:14:53.509 --> 00:14:56.509 activities? Those are major psychosocial red 00:14:56.509 --> 00:14:59.850 flags. And, of course, screen for vision problems 00:14:59.850 --> 00:15:02.470 aggressively. And for our students studying for 00:15:02.470 --> 00:15:06.070 exams, what exam writers love to test? They love 00:15:06.070 --> 00:15:08.389 to test the difference between concrete operations 00:15:08.389 --> 00:15:11.309 and industry versus inferiority. They'll give 00:15:11.309 --> 00:15:13.529 you a scenario about teaching a child and ask 00:15:13.529 --> 00:15:15.309 you to pick the best approach based on their 00:15:15.309 --> 00:15:17.950 concrete, non -abstract thinking. And your memory 00:15:17.950 --> 00:15:20.730 trick. One easy way to remember this age group. 00:15:20.919 --> 00:15:23.639 Their whole world revolves around CIP, they've 00:15:23.639 --> 00:15:25.840 mastered conservation, they're driven by industry, 00:15:26.000 --> 00:15:28.159 and they're learning perspective taking. Okay, 00:15:28.179 --> 00:15:30.639 let's move into clinical prevention. This is 00:15:30.639 --> 00:15:32.559 where the rubber meets the road, and we have 00:15:32.559 --> 00:15:35.440 to start with the immunization schedule. It feels 00:15:35.440 --> 00:15:38.279 like this age group is caught between two big 00:15:38.279 --> 00:15:40.700 vaccine pushes. That's a good way to describe 00:15:40.700 --> 00:15:42.960 it. They're finishing up the early childhood 00:15:42.960 --> 00:15:45.059 series and just about to start the adolescent 00:15:45.059 --> 00:15:47.559 series. So there are two key moments to know 00:15:47.559 --> 00:15:49.820 for your exams. The first one is right before 00:15:49.820 --> 00:15:51.679 they start school, right? Yes, the post preschool 00:15:51.679 --> 00:15:54.600 boosters. This is that four to six year old checkup. 00:15:54.659 --> 00:15:57.960 It's usually the fifth dose of DTaP, fourth IPV, 00:15:58.179 --> 00:16:00.970 and the second doses of MMR and varicella. And 00:16:00.970 --> 00:16:03.830 there's a key clinical detail about DTAP if a 00:16:03.830 --> 00:16:06.370 child is a little behind schedule. A very important 00:16:06.370 --> 00:16:08.950 one. If a child is seven years or older and needs 00:16:08.950 --> 00:16:11.950 a tetanus diphtheria pertussis vaccine, you do 00:16:11.950 --> 00:16:15.350 not give them DTAP. You switch to Tdap. Why is 00:16:15.350 --> 00:16:18.009 that? DTAP has a higher dose of the diphtheria 00:16:18.009 --> 00:16:20.230 and pertussis antigens, which can cause more 00:16:20.230 --> 00:16:22.710 significant reactions in older kids and adults. 00:16:23.370 --> 00:16:26.289 By age seven, Tdap is enough to boost their immunity 00:16:26.289 --> 00:16:28.929 without the increased side effect risk. Got it. 00:16:29.009 --> 00:16:31.179 Okay, now for the second big moment. The big 00:16:31.179 --> 00:16:34.620 11 to 12 year set. The middle school shots. Right. 00:16:35.000 --> 00:16:37.259 There are three critical vaccines here. First 00:16:37.259 --> 00:16:40.320 is Tdap. This is their one dose adolescent booster. 00:16:41.139 --> 00:16:44.019 And the big rationale here is that immunity from 00:16:44.019 --> 00:16:47.200 their childhood shots starts to wane. This protects 00:16:47.200 --> 00:16:49.720 them and others from things like whooping cough. 00:16:49.960 --> 00:16:52.759 And there is a super high yield clinical fact 00:16:52.759 --> 00:16:55.519 about Tdap and pregnancy. You see this on exams. 00:16:55.870 --> 00:16:58.730 All the time. All the time. The rule is, Tdap 00:16:58.730 --> 00:17:00.950 is recommended during every single pregnancy. 00:17:01.129 --> 00:17:03.730 Every single one. Yes, usually between 27 and 00:17:03.730 --> 00:17:06.509 36 weeks. And it doesn't matter when her last 00:17:06.509 --> 00:17:09.369 Tdap was. The reason is to protect the baby. 00:17:10.029 --> 00:17:12.329 The mother creates antibodies that cross the 00:17:12.329 --> 00:17:14.829 placenta and give the newborn passive immunity 00:17:14.829 --> 00:17:17.730 to Pertussis, which can be deadly for them. The 00:17:17.730 --> 00:17:19.809 mother is cocooning the baby with her own immunity. 00:17:19.930 --> 00:17:21.750 That's a perfect way to think about it. OK, second 00:17:21.750 --> 00:17:25.049 vaccine in that set. HPV, the human papillomavirus 00:17:25.049 --> 00:17:28.250 vaccine. The goal is to give it before any potential 00:17:28.250 --> 00:17:30.190 exposure because it prevents the majority of 00:17:30.190 --> 00:17:33.210 cancers caused by HPV. The dosing can be a little 00:17:33.210 --> 00:17:36.170 tricky. It can. But the rule is pretty simple. 00:17:36.309 --> 00:17:38.829 If you start the series between ages 9 and 14, 00:17:39.089 --> 00:17:41.890 it's a two -dose series. If you wait until they're 00:17:41.890 --> 00:17:44.529 15 or older, or if they're immunocompromised, 00:17:44.630 --> 00:17:46.910 it becomes a three -dose series. Simple enough. 00:17:47.410 --> 00:17:53.240 And the third one. Meningococcal vaccine. This 00:17:53.240 --> 00:17:55.539 is to protect against bacterial meningitis, which 00:17:55.539 --> 00:17:58.019 can be devastatingly fast and fatal. And this 00:17:58.019 --> 00:18:00.119 is a two dose series as well, but spread out. 00:18:00.819 --> 00:18:03.839 Yes. Dose one is at 11 to 12 years, and the crucial 00:18:03.839 --> 00:18:06.779 booster dose is given at age 16. just in time 00:18:06.779 --> 00:18:09.019 for them to be heading into more crowded environments 00:18:09.019 --> 00:18:11.700 like college dorms. Okay, let's quickly hit the 00:18:11.700 --> 00:18:14.740 absolute contraindications, the never ever give 00:18:14.740 --> 00:18:16.940 situations. There are a few you have to know 00:18:16.940 --> 00:18:19.539 cold. First, a severe allergic reaction, you 00:18:19.539 --> 00:18:22.480 know, anaphylaxis, to a previous dose is an absolute 00:18:22.480 --> 00:18:24.799 contraindication. Obvious but critical. Right. 00:18:25.200 --> 00:18:27.779 Second, and this is specific to DTaP or Tdap, 00:18:28.240 --> 00:18:31.400 if a child had encephalopathy, a severe brain 00:18:31.400 --> 00:18:34.259 issue, like a coma or prolonged seizures, within 00:18:34.259 --> 00:18:36.680 seven days of a previous dose, they should not 00:18:36.680 --> 00:18:38.940 get any more pertussis -containing vaccines. 00:18:39.059 --> 00:18:42.059 Okay, that's very specific. And third, for the 00:18:42.059 --> 00:18:45.420 live vaccines, which are MMR and varicella, they 00:18:45.420 --> 00:18:48.039 are absolutely contraindicated in anyone who 00:18:48.039 --> 00:18:50.640 is severely immunocompromised or who is pregnant. 00:18:50.960 --> 00:18:53.799 Got it. And what if a patient is just way behind 00:18:53.799 --> 00:18:56.269 schedule on everything? Do you start over? No, 00:18:56.430 --> 00:18:58.490 that's the golden rule. You never need to restart 00:18:58.490 --> 00:19:00.390 a series. You just pick up where they left off 00:19:00.390 --> 00:19:03.130 and follow the minimum interval guidelines. That's 00:19:03.130 --> 00:19:05.849 a huge relief. Yeah. Okay, let's pivot from shots 00:19:05.849 --> 00:19:09.240 to play. which for this age group is basically 00:19:09.240 --> 00:19:11.880 their work. It's totally their work. It's how 00:19:11.880 --> 00:19:15.259 they achieve industry. And play shifts from the 00:19:15.259 --> 00:19:17.839 parallel play of toddlers to being primarily 00:19:17.839 --> 00:19:20.339 cooperative and competitive. They want games 00:19:20.339 --> 00:19:23.319 with rules. They love games with rules. It reflects 00:19:23.319 --> 00:19:26.039 their new cognitive ability to handle logic and 00:19:26.039 --> 00:19:28.339 sequencing. It's not just about the fun of the 00:19:28.339 --> 00:19:30.640 action anymore. It's about the challenge of winning 00:19:30.640 --> 00:19:32.920 according to the structure. What are the benefits 00:19:32.920 --> 00:19:34.640 of that kind of structured play? Oh, they're 00:19:34.640 --> 00:19:36.579 huge. Physically, it's It helps with fitness, 00:19:36.740 --> 00:19:38.660 weight management, but psychosocially, this is 00:19:38.660 --> 00:19:41.039 where they learn teamwork, leadership, compromise, 00:19:41.160 --> 00:19:44.140 negotiation. They learn that to succeed as a 00:19:44.140 --> 00:19:46.700 group, everyone has to follow the rules. So what 00:19:46.700 --> 00:19:48.619 are some age -appropriate recommendations a nurse 00:19:48.619 --> 00:19:51.200 can make? Well, organized sports are fantastic. 00:19:51.579 --> 00:19:54.079 But so are things like simple board games or 00:19:54.079 --> 00:19:56.680 card games, activities that involve collecting 00:19:56.680 --> 00:19:59.960 and organizing, like stamps or cards, or building 00:19:59.960 --> 00:20:02.920 complex models. Anything that requires skill, 00:20:03.059 --> 00:20:05.559 planning, and following a set of rules is Perfect. 00:20:06.180 --> 00:20:08.140 So synthesizing this section, what's the takeaway? 00:20:08.380 --> 00:20:11.500 All right. What nurses watch for? A lack of interest 00:20:11.500 --> 00:20:14.220 in these cooperative or competitive games. A 00:20:14.220 --> 00:20:16.599 child who can't seem to follow rules or who avoids 00:20:16.599 --> 00:20:18.880 all group activities might be struggling with 00:20:18.880 --> 00:20:21.880 social skills, or it could be a sign of low self 00:20:21.880 --> 00:20:25.099 -esteem. that inferiority piece again. And what 00:20:25.099 --> 00:20:27.579 exam writers love to test. They hammer the 11 00:20:27.579 --> 00:20:31.000 to 12 year old vaccine schedule. Tdap, HPV, men 00:20:31.000 --> 00:20:34.920 in ACWI, know those. And know the absolute contraindications, 00:20:34.960 --> 00:20:37.099 especially the Tdap and pregnancy rule versus 00:20:37.099 --> 00:20:39.259 the live vaccines and pregnancy rule. Finally, 00:20:39.279 --> 00:20:41.400 one easy way to remember this age group. They 00:20:41.400 --> 00:20:45.259 need their THM, Tdap, HPV, men ACWI before they 00:20:45.259 --> 00:20:47.079 become teens. And their play is all about learning 00:20:47.079 --> 00:20:49.200 the rules, rules, rules. All right. Our final 00:20:49.200 --> 00:20:53.559 section. And it is a big one. Safety. We've set 00:20:53.559 --> 00:20:56.339 the stage perfectly. They're capable, they're 00:20:56.339 --> 00:20:59.160 logical in a concrete way, they're independent. 00:20:59.640 --> 00:21:02.380 But their judgment is still immature. Their ability 00:21:02.380 --> 00:21:05.720 to think about abstract risk and long -term consequences 00:21:05.720 --> 00:21:08.980 just isn't there yet. And that creates a perfect 00:21:08.980 --> 00:21:11.400 storm for unintentional injuries. Which you said 00:21:11.400 --> 00:21:13.380 earlier is the leading cause of death in this 00:21:13.380 --> 00:21:16.880 age group. It is, tragically. So the anticipatory 00:21:16.880 --> 00:21:19.680 guidance we provide as nurses here is life -saving. 00:21:19.829 --> 00:21:22.529 It's not optional. Let's start with the one that 00:21:22.529 --> 00:21:26.230 is on every single exam. Car and pedestrian safety. 00:21:26.970 --> 00:21:30.029 And the infamous booster seat rule. Yes. If you 00:21:30.029 --> 00:21:31.950 remember one thing from this section, remember 00:21:31.950 --> 00:21:34.849 this. A child needs to be in a booster seat until 00:21:34.849 --> 00:21:37.150 they are at least four feet nine inches tall. 00:21:37.289 --> 00:21:40.789 That's 144 .8 centimeters. Four foot nine. And 00:21:40.789 --> 00:21:42.289 this is typically somewhere between eight and 00:21:42.289 --> 00:21:44.269 12 years old. So it's not about age, it's about 00:21:44.269 --> 00:21:46.549 height. It is 100 % about height. Let's talk 00:21:46.549 --> 00:21:48.029 about the physics of why that matters. Please 00:21:48.029 --> 00:21:50.819 do. When a child is shorter than four foot nine, 00:21:51.380 --> 00:21:53.700 the adult lap belt doesn't sit on their strong 00:21:53.700 --> 00:21:56.900 hip bones. It rides up onto their soft abdomen. 00:21:57.500 --> 00:22:00.799 In a crash, that belt can cause catastrophic 00:22:00.799 --> 00:22:02.960 internal injuries to the organs and the spine. 00:22:03.220 --> 00:22:06.519 That's horrifying. It is. The booster seat simply 00:22:06.519 --> 00:22:08.960 elevates them so the lap belt stays low on the 00:22:08.960 --> 00:22:11.339 hips and the shoulder belt crosses the chest 00:22:11.339 --> 00:22:13.819 and shoulder, not their neck or their face. The 00:22:13.819 --> 00:22:16.539 belt has to engage the skeleton, not the soft 00:22:16.539 --> 00:22:18.259 tissue. And they should always be in the back 00:22:18.259 --> 00:22:20.960 seat until what age? Until age 13. No exceptions. 00:22:21.279 --> 00:22:24.299 Okay. That is crystal clear. Now, what about 00:22:24.299 --> 00:22:27.140 when they're outside the car? Pedestrian safety. 00:22:27.319 --> 00:22:29.380 They're walking to a friend's house alone for 00:22:29.380 --> 00:22:31.900 the first time. But their brain isn't fully ready 00:22:31.900 --> 00:22:34.460 for that task. They can pare it back the rule, 00:22:34.579 --> 00:22:37.019 look left, right, then left again. But what they 00:22:37.019 --> 00:22:40.359 can't do, especially under age 10, is accurately 00:22:40.359 --> 00:22:43.339 judge the speed and distance of an oncoming car. 00:22:43.559 --> 00:22:46.460 So they see the car, but they have no real concept 00:22:46.460 --> 00:22:49.299 of how fast it's closing in. Exactly. Their concrete 00:22:49.299 --> 00:22:51.400 thinking doesn't handle that kind of complex 00:22:51.400 --> 00:22:54.339 real -time calculation well. So they need continued 00:22:54.339 --> 00:22:57.039 supervision when crossing busy streets. Okay, 00:22:57.039 --> 00:23:00.450 let's move to sports and bikes. Again, their 00:23:00.450 --> 00:23:02.849 coordination is better, but the risk is still 00:23:02.849 --> 00:23:05.269 there. The risk is high because they're attempting 00:23:05.269 --> 00:23:08.730 more daring things. So for bicycle safety, two 00:23:08.730 --> 00:23:11.589 things are non -negotiable. One, the bike has 00:23:11.589 --> 00:23:13.710 to fit. They should be able to sit on the seat 00:23:13.710 --> 00:23:15.589 and have the balls of their feet touch the ground. 00:23:15.789 --> 00:23:19.630 And two, helmets every single time for any real 00:23:19.630 --> 00:23:23.269 sport. Bikes, scooters, skateboards, you name 00:23:23.269 --> 00:23:25.930 it, a helmet is mandatory. Plus other padding 00:23:25.930 --> 00:23:28.630 for knees and elbows. And this goes back to protecting 00:23:28.630 --> 00:23:30.589 those vulnerable growth plates we talked about. 00:23:30.630 --> 00:23:33.730 It does. The equipment helps absorb and distribute 00:23:33.730 --> 00:23:36.029 the force of a fall, protecting not just their 00:23:36.029 --> 00:23:38.769 head, but their entire immature skeletal structure. 00:23:38.930 --> 00:23:41.190 OK, let's talk about risks inside the home. Fire 00:23:41.190 --> 00:23:43.609 safety. This is a great place to leverage their 00:23:43.609 --> 00:23:45.990 concrete thinking. They can learn and practice 00:23:45.990 --> 00:23:48.660 a plan. So what do you teach? Every home needs 00:23:48.660 --> 00:23:50.700 working smoke detectors, check the batteries 00:23:50.700 --> 00:23:54.259 twice a year, and, crucially, you have to create 00:23:54.259 --> 00:23:57.160 and physically practice a fire escape plan with 00:23:57.160 --> 00:23:59.640 a designated meeting spot outside. They need 00:23:59.640 --> 00:24:02.200 to walk through the steps. Yes. And they need 00:24:02.200 --> 00:24:04.819 to know the concrete actions. Stop, drop, and 00:24:04.819 --> 00:24:08.559 roll. Call 911. And any chores involving heat, 00:24:08.740 --> 00:24:11.769 like cooking, still need adult supervision. What 00:24:11.769 --> 00:24:13.710 about water safety? They're becoming stronger 00:24:13.710 --> 00:24:15.589 swimmers. But supervision is still the number 00:24:15.589 --> 00:24:18.630 one rule. Never swim alone. Ever. And they need 00:24:18.630 --> 00:24:20.829 to be taught never to dive into water if they 00:24:20.829 --> 00:24:22.990 don't know how deep it is. That's a huge risk 00:24:22.990 --> 00:24:25.630 for spinal cord injuries. And parents need to 00:24:25.630 --> 00:24:28.609 know CPR. OK, and then the big two that require 00:24:28.609 --> 00:24:31.769 locking things up? Toxins and firearms. Right. 00:24:31.930 --> 00:24:34.569 All poisons, chemicals, cleaning supplies need 00:24:34.569 --> 00:24:37.210 to be in a locked cabinet. And for firearms, 00:24:37.390 --> 00:24:40.109 the teaching has to be incredibly specific and 00:24:40.109 --> 00:24:42.730 direct. It's a rule. The firearms and the ammunition 00:24:42.730 --> 00:24:44.930 must be stored separately, and both must be in 00:24:44.930 --> 00:24:47.130 locked containers. And you teach the child a 00:24:47.130 --> 00:24:50.029 very simple concrete rule. If you see a gun, 00:24:50.150 --> 00:24:52.349 you do not touch it. You leave the area, you 00:24:52.349 --> 00:24:54.930 find an adult immediately. No ambiguity there. 00:24:55.109 --> 00:24:57.650 None in. Let's shift to the modern risks. The 00:24:57.650 --> 00:25:00.230 screen is their new playground. It is, and it's 00:25:00.230 --> 00:25:02.589 where they go to find social connection and a 00:25:02.589 --> 00:25:04.950 sense of competence, so we have to manage it. 00:25:05.190 --> 00:25:07.549 Parents need to set firm time limits and monitor 00:25:07.549 --> 00:25:11.349 the content. And a huge safety tip. Keep computers 00:25:11.349 --> 00:25:13.789 and gaming consoles in a common area of the house. 00:25:13.990 --> 00:25:16.450 Not in the bedroom. Not in the bedroom where 00:25:16.450 --> 00:25:18.849 supervision is impossible. And what are the key 00:25:18.849 --> 00:25:22.180 internet safety rules you teach? Never. Ever 00:25:22.180 --> 00:25:24.599 share personal information, your full name, your 00:25:24.599 --> 00:25:27.519 school, your address. Never agree to meet someone 00:25:27.519 --> 00:25:30.539 in person that you've only met online. And teach 00:25:30.539 --> 00:25:32.920 them that if a message ever makes them feel weird 00:25:32.920 --> 00:25:35.839 or sad or scared, they show an adult right away. 00:25:36.420 --> 00:25:39.099 OK, and let's end with the two major psychosocial 00:25:39.099 --> 00:25:42.039 risks that just devastated child's sense of industry, 00:25:42.619 --> 00:25:45.109 abuse and bullying. These have to be part of 00:25:45.109 --> 00:25:47.750 every single nursing assessment. For abuse, you're 00:25:47.750 --> 00:25:49.269 looking for injuries that don't match the story 00:25:49.269 --> 00:25:51.809 or big behavioral changes like a child who suddenly 00:25:51.809 --> 00:25:53.910 starts wetting the bed again or refusing to go 00:25:53.910 --> 00:25:56.490 to school. And bullying. It's the ultimate attack 00:25:56.490 --> 00:25:59.710 on their competence. It is. Bullying, whether 00:25:59.710 --> 00:26:02.529 it's physical or verbal or online, it's designed 00:26:02.529 --> 00:26:05.029 to make the victim feel worthless. It is the 00:26:05.029 --> 00:26:07.430 direct cause of inferiority for so many kids. 00:26:07.789 --> 00:26:10.230 It can lead to anxiety, depression, a total withdrawal 00:26:10.230 --> 00:26:12.269 from the world. So how do you screen for it when 00:26:12.269 --> 00:26:14.470 they're often too ashamed to talk about it? You 00:26:14.470 --> 00:26:17.890 have to ask directly, but gently. How are things 00:26:17.890 --> 00:26:20.910 at school? Who do you sit with at lunch? Is anyone 00:26:20.910 --> 00:26:23.789 ever mean to you? And you have to screen both 00:26:23.789 --> 00:26:26.349 ways. It's important to remember that the child 00:26:26.349 --> 00:26:28.730 who is doing the bullying is often also struggling 00:26:28.730 --> 00:26:30.890 with feelings of inferiority and is trying to 00:26:30.890 --> 00:26:33.769 feel powerful. They need help, too. That brings 00:26:33.769 --> 00:26:36.069 us all full circle. OK, let's wrap up this vital 00:26:36.069 --> 00:26:38.240 section. What nurses watch for? You're looking 00:26:38.240 --> 00:26:40.940 for patterns, frequent injuries, unexplained 00:26:40.940 --> 00:26:44.799 behavioral changes, lying, stealing, school refusal. 00:26:45.319 --> 00:26:47.779 These are often signs of a deeper stressor, like 00:26:47.779 --> 00:26:50.220 bullying or abuse that is crushing their sense 00:26:50.220 --> 00:26:52.859 of industry. And what exam writers love to test. 00:26:53.069 --> 00:26:55.869 The car safety rules. They will test you on that 00:26:55.869 --> 00:26:58.589 4 '9 height requirement and the backseat until 00:26:58.589 --> 00:27:01.789 13 rule. And they love scenarios that force you 00:27:01.789 --> 00:27:03.890 to connect the child's growing independence with 00:27:03.890 --> 00:27:06.589 their growing risk for accidents. And finally, 00:27:06.710 --> 00:27:09.349 one easy way to remember this age group's safety 00:27:09.349 --> 00:27:11.910 needs. Their confidence is growing, but their 00:27:11.910 --> 00:27:14.630 judgment isn't. So safety is about protecting 00:27:14.630 --> 00:27:16.769 them from that gap. Think of it as keeping them 00:27:16.769 --> 00:27:19.700 safe. screening for bullying, activity matched 00:27:19.700 --> 00:27:22.519 to ability, firearm safety, and the elevation 00:27:22.519 --> 00:27:25.220 rule for car seats four foot nine. Hashtag tag 00:27:25.220 --> 00:27:27.579 outro. So that was our deep dive into the school 00:27:27.579 --> 00:27:29.420 -age child. We've really tried to frame this 00:27:29.420 --> 00:27:31.880 whole era through that critical lens of industry 00:27:31.880 --> 00:27:35.059 versus inferiority because that drive for competence 00:27:35.059 --> 00:27:37.480 explains so much of their behavior. Right. We 00:27:37.480 --> 00:27:39.480 saw that their bodies are actually slowing down 00:27:39.480 --> 00:27:41.140 and becoming more efficient. That means a lower 00:27:41.140 --> 00:27:43.660 heart rate, lower respiratory rate, but a climbing 00:27:43.660 --> 00:27:46.880 blood pressure. And don't forget that key milestone. 00:27:47.559 --> 00:27:50.279 The immune system matures around age 10. And 00:27:50.279 --> 00:27:53.960 developmentally, their mind is making huge leaps. 00:27:54.220 --> 00:27:56.779 They're in that concrete operational stage, which 00:27:56.779 --> 00:27:59.319 means they can think logically, they've mastered 00:27:59.319 --> 00:28:02.099 conservation, but they still can't grasp those 00:28:02.099 --> 00:28:05.180 big abstract ideas about the future. So remember 00:28:05.180 --> 00:28:07.500 those high yield screening areas for your practice. 00:28:08.119 --> 00:28:10.180 You absolutely have to screen for vision problems 00:28:10.180 --> 00:28:13.079 like amblyopia. You have to assess for psychosocial 00:28:13.079 --> 00:28:15.839 issues like bullying. And please hammer home 00:28:15.839 --> 00:28:18.579 that four foot nine rule for car safety. And 00:28:18.579 --> 00:28:20.859 just as a final clinical pearl, remember how 00:28:20.859 --> 00:28:23.559 powerful that drive for industry is. When you 00:28:23.559 --> 00:28:25.559 have a school -aged child as a patient, make 00:28:25.559 --> 00:28:27.680 them a partner. Give them a job to do no matter 00:28:27.680 --> 00:28:30.339 how small. It's not just a distraction. It's 00:28:30.339 --> 00:28:32.440 about preserving their fundamental sense of self 00:28:32.440 --> 00:28:35.160 -worth while they're sick. And that leads us 00:28:35.160 --> 00:28:37.019 to our final thought for you to take with you. 00:28:37.230 --> 00:28:39.809 We know this age group can understand rules and 00:28:39.809 --> 00:28:41.890 immediate consequences because of their concrete 00:28:41.890 --> 00:28:44.710 thinking. As nurses, so often we teach by just 00:28:44.710 --> 00:28:47.349 giving orders, you need to do this. But given 00:28:47.349 --> 00:28:50.329 their intense desire for industry, for mastery, 00:28:50.450 --> 00:28:52.349 for being part of the team, how can we change 00:28:52.349 --> 00:28:55.869 that? How can we leverage that new logical brain 00:28:55.869 --> 00:28:58.829 to engage them in real shared decision making, 00:28:59.130 --> 00:29:01.089 especially with things like managing a chronic 00:29:01.089 --> 00:29:03.890 illness, moving beyond just telling them what 00:29:03.890 --> 00:29:06.690 to do to building a partnership based on competence? 00:29:06.880 --> 00:29:10.119 What new doors does this era of industry really 00:29:10.119 --> 00:29:12.299 open for your nursing practice? That's a great 00:29:12.299 --> 00:29:14.140 question to think about as you head to the bedside. 00:29:14.220 --> 00:29:15.819 Thanks for diving deep with us. See you next 00:29:15.819 --> 00:29:15.920 time.