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 --> 00:00:47.890 fast. Welcome to the emergency room. Okay, picture 00:00:47.890 --> 00:00:50.530 the scenario. You are sharing your home with 00:00:50.530 --> 00:00:54.689 a scientist. A very small very determined scientists. 00:00:55.750 --> 00:00:58.929 This scientist, they conduct these dangerous 00:00:58.929 --> 00:01:02.509 physics experiments on your furniture every single 00:01:02.509 --> 00:01:05.569 waking hour. They have absolutely zero sense 00:01:05.569 --> 00:01:08.390 of self -preservation and they actively resent 00:01:08.390 --> 00:01:10.849 any assistance you try to offer. And crucially, 00:01:11.069 --> 00:01:13.049 this scientist is likely wearing a diaper and 00:01:13.049 --> 00:01:16.140 stands about What, 30 inches tall? Exactly. We 00:01:16.140 --> 00:01:18.680 are diving deep into the toddler years today, 00:01:19.239 --> 00:01:22.579 ages one to three. The fun zone. Right. We often 00:01:22.579 --> 00:01:24.359 hear that phrase terrible twos, but when you 00:01:24.359 --> 00:01:26.219 look at the stack of research we have on the 00:01:26.219 --> 00:01:28.859 desk here, the textbook chapters on growth and 00:01:28.859 --> 00:01:31.099 development, the lecture slides on physiology, 00:01:31.099 --> 00:01:34.439 and the absolute beast that is the CDC's 2025 00:01:34.439 --> 00:01:36.480 immunization schedule calling it terrible just 00:01:36.480 --> 00:01:39.219 feels a bit lazy. It's reductive, isn't it? It 00:01:39.219 --> 00:01:41.459 frames the child as the villain when what we're 00:01:41.459 --> 00:01:43.859 actually looking at is a clash. It is, I would 00:01:43.859 --> 00:01:46.260 argue, the most explosive collision in human 00:01:46.260 --> 00:01:48.159 development. A collision between... Between a 00:01:48.159 --> 00:01:50.980 body that can suddenly move. I mean, really, 00:01:51.180 --> 00:01:54.140 move, run, climb, access the whole world, and 00:01:54.140 --> 00:01:57.760 a brain that has absolutely no logic, no judgment, 00:01:58.200 --> 00:02:00.980 and, you know... zero impulse control. That is 00:02:00.980 --> 00:02:02.879 the mission for this deep dive. We're stripping 00:02:02.879 --> 00:02:05.319 away all the generic parenting advice, and we're 00:02:05.319 --> 00:02:08.439 talking directly to the learner. Whether you're 00:02:08.439 --> 00:02:11.039 a nursing student sweating over the NCLEX and 00:02:11.039 --> 00:02:13.860 trying to memorize milestones, or a parent just 00:02:13.860 --> 00:02:16.240 trying to deconstruct why your kid had a meltdown 00:02:16.240 --> 00:02:18.259 because you gave them the wrong blue cup. Yeah. 00:02:18.419 --> 00:02:20.659 This is for you. We are going to use the 80 -20 00:02:20.659 --> 00:02:23.250 rule here. In nursing education, we talk about 00:02:23.250 --> 00:02:25.270 this all the time. Instead of just memorizing 00:02:25.270 --> 00:02:27.750 charts in a vacuum, we're gonna focus on the 00:02:27.750 --> 00:02:31.069 core concepts that explain everything else. Specifically, 00:02:31.229 --> 00:02:32.849 we're gonna look at the collision between Jean 00:02:32.849 --> 00:02:35.750 Piaget, who explains how they think, and Eric 00:02:35.750 --> 00:02:37.629 Erickson, who explains how they feel. Because 00:02:37.629 --> 00:02:39.870 if you understand those two things, the thinking 00:02:39.870 --> 00:02:41.969 and the feeling, everything else just falls into 00:02:41.969 --> 00:02:44.270 place. Everything. The safety risks, the way 00:02:44.270 --> 00:02:46.849 they play, the potty training struggles, it all 00:02:46.849 --> 00:02:48.990 stops being this random chaos and starts looking 00:02:48.990 --> 00:02:52.909 like, well, logic. Flawed toddler logic, but 00:02:52.909 --> 00:02:55.009 logic nonetheless. Exactly. So let's start with 00:02:55.009 --> 00:02:57.289 the big picture, the developmental headline. 00:02:58.069 --> 00:03:00.310 We're calling this phase the Autonomous Explorer. 00:03:00.610 --> 00:03:03.849 Right. And if you remember infancy, the whole 00:03:03.849 --> 00:03:07.199 theme was trust and dependence. The baby needed 00:03:07.199 --> 00:03:11.219 you for literally everything. Toddlerhood is 00:03:11.219 --> 00:03:13.860 the violent swing to the opposite side of that 00:03:13.860 --> 00:03:16.280 pendulum. Complete opposite. The defining theme 00:03:16.280 --> 00:03:19.159 is the struggle between that old dependence and 00:03:19.159 --> 00:03:21.659 this desperate burning need for independence. 00:03:22.240 --> 00:03:24.759 This is Erickson's stage of autonomy versus shame 00:03:24.759 --> 00:03:27.900 and doubt. The era of me do it. Precisely. Me 00:03:27.900 --> 00:03:29.439 do it. Yeah. They want to control their body, 00:03:29.560 --> 00:03:31.439 their environment, everything. But here's the 00:03:31.439 --> 00:03:33.479 fascinating biological context that I think often 00:03:33.479 --> 00:03:36.050 gets missed. OK. While their desire to move is 00:03:36.050 --> 00:03:38.789 speeding up, their actual physical growth is 00:03:38.789 --> 00:03:41.409 hitting the brakes hard. And this is a huge shift 00:03:41.409 --> 00:03:43.610 from that first year, right? In infancy, I mean, 00:03:43.849 --> 00:03:45.669 growth is just explosive. They triple their birth 00:03:45.669 --> 00:03:48.229 weight. They do. It's incredible. But watch what 00:03:48.229 --> 00:03:50.909 happens between age one and age three. The growth 00:03:50.909 --> 00:03:53.349 velocity just creates this massive deceleration. 00:03:53.909 --> 00:03:56.729 If you look at the textbook sources, a toddler 00:03:56.729 --> 00:04:00.310 only gains about four to six pounds per year. 00:04:00.479 --> 00:04:03.120 Wow. And height -wise, it's only about three 00:04:03.120 --> 00:04:05.460 inches a year. That's a crawl compared to the 00:04:05.460 --> 00:04:07.919 baby phase. And this leads to a specific phenomenon 00:04:07.919 --> 00:04:10.460 that, I mean, it freaks parents out constantly. 00:04:10.500 --> 00:04:12.719 It's called physiologic anorexia. And the name 00:04:12.719 --> 00:04:15.599 itself sounds so clinical, so scary. Yeah, it 00:04:15.599 --> 00:04:17.540 sounds like an eating disorder. Exactly. But 00:04:17.540 --> 00:04:20.720 it's just normal biology. Because that growth 00:04:20.720 --> 00:04:23.800 engine has idled down, their metabolic need for 00:04:23.800 --> 00:04:26.680 calories just plummets. They simply aren't as 00:04:26.680 --> 00:04:28.160 hungry as they were when they were six months 00:04:28.160 --> 00:04:30.120 old. So the parents are sitting there at the 00:04:30.120 --> 00:04:32.540 dinner table. They're watching their kid eat 00:04:32.540 --> 00:04:34.579 like one bite of a hot dog and push the plate 00:04:34.579 --> 00:04:36.680 away. And they just panic. Total panic. They 00:04:36.680 --> 00:04:38.959 think he's starving. He's going to wither away. 00:04:38.959 --> 00:04:43.500 Right. And the nurse's role here is so, so crucial. 00:04:43.759 --> 00:04:45.600 You have to reframe that. You have to explain, 00:04:45.620 --> 00:04:48.139 look, this isn't a behavior problem. It's an 00:04:48.139 --> 00:04:50.000 efficiency problem. They just don't need the 00:04:50.000 --> 00:04:52.740 fuel. And if you force it, if you force feed 00:04:52.740 --> 00:04:55.439 them here, thinking you're solving a nutrition 00:04:55.439 --> 00:04:59.199 problem. You are actually creating a psychological 00:04:59.199 --> 00:05:03.100 battle over autonomy. And guess what? The toddler 00:05:03.100 --> 00:05:06.680 will win that battle every single time. We've 00:05:06.680 --> 00:05:09.040 talked about the chassis of this little vehicle. 00:05:09.360 --> 00:05:12.019 They don't look like miniature adults yet. They 00:05:12.019 --> 00:05:15.720 have this very specific kind of comical. Oh, 00:05:15.720 --> 00:05:17.660 yeah. We're looking at the classic pot belly 00:05:17.660 --> 00:05:20.899 and sway back. In medical terms, we call it lordosis, 00:05:21.279 --> 00:05:23.379 that inward curve of the spine. And parents often 00:05:23.379 --> 00:05:24.860 worry about this. They see the belly sticking 00:05:24.860 --> 00:05:26.540 out, and they think it's, I don't know, bloating 00:05:26.540 --> 00:05:28.459 or dietary issues or something. But if you look 00:05:28.459 --> 00:05:31.360 at the physiology slides, it's purely muscular. 00:05:31.800 --> 00:05:33.720 The abdominal musculature is just incredibly 00:05:33.720 --> 00:05:36.019 weak at this stage. It hasn't tightened up enough 00:05:36.019 --> 00:05:38.279 to hold the contents of the abdomen flat. Like 00:05:38.279 --> 00:05:41.360 a girdle. Exactly. That muscular girdle doesn't 00:05:41.360 --> 00:05:45.009 really form until around age three. gravity takes 00:05:45.009 --> 00:05:47.569 over, the belly protrudes, and then the back 00:05:47.569 --> 00:05:49.769 has to curve to compensate for the weight. And 00:05:49.769 --> 00:05:51.889 there is one other physical feature we absolutely 00:05:51.889 --> 00:05:54.810 have to flag because it becomes a major physics 00:05:54.810 --> 00:05:57.720 problem later on, the head. The head is the hazard. 00:05:58.379 --> 00:06:01.339 By age two, a toddler's head is already 90 % 00:06:01.339 --> 00:06:04.779 of its adult size. 90 % on a body that is what, 00:06:05.100 --> 00:06:07.180 a fifth of the size of an adult? That's insane. 00:06:07.379 --> 00:06:09.459 It is. They are massively top -heavy. Their center 00:06:09.459 --> 00:06:11.459 of gravity is so much higher than yours or mine, 00:06:11.540 --> 00:06:13.319 it's right around the chest level. And this isn't 00:06:13.319 --> 00:06:15.779 just a cosmetic note. No, this dictates how they 00:06:15.779 --> 00:06:18.319 move, how they fall. When a toddler trips, They 00:06:18.319 --> 00:06:19.839 don't have the mechanics to catch themselves 00:06:19.839 --> 00:06:22.259 easily. The weight of that head just acts like 00:06:22.259 --> 00:06:24.360 a pendulum and pulls them straight down. Which, 00:06:24.439 --> 00:06:26.439 as you said, foreshadows our safety discussion 00:06:26.439 --> 00:06:28.879 later regarding drowning and falls. But before 00:06:28.879 --> 00:06:31.540 we get there, let's map out this danger zone. 00:06:31.660 --> 00:06:34.300 This is the gap between what they can do versus 00:06:34.300 --> 00:06:37.459 what they cannot do. This gap is everything. 00:06:37.720 --> 00:06:39.500 It is where the accidents happen. It's where 00:06:39.500 --> 00:06:42.560 all the E .R. visits come from. Developmentally, 00:06:42.660 --> 00:06:45.279 their motor skills are skyrocketing. But their 00:06:45.279 --> 00:06:49.569 judgment, it is basically Non -existent. Let's 00:06:49.569 --> 00:06:51.889 walk through the can -do milestones, then. If 00:06:51.889 --> 00:06:54.069 we're looking at a 15 -month -old, what are we 00:06:54.069 --> 00:06:56.629 seeing? Okay, at 15 months, the walk is usually 00:06:56.629 --> 00:07:00.189 established, but it's that specific toddler gait. 00:07:00.389 --> 00:07:02.509 Feet are wide apart to create a broad base of 00:07:02.509 --> 00:07:05.009 support, and the arms are held up in high guard 00:07:05.009 --> 00:07:07.769 for balance. They look like they're surrendering. 00:07:07.970 --> 00:07:09.949 They do. It's very cute. They can also creep 00:07:09.949 --> 00:07:12.449 upstairs, usually on hands and knees. And fine, 00:07:12.709 --> 00:07:15.370 motor -wise, they are messy. They can use a cup, 00:07:15.689 --> 00:07:17.670 but they'll spill it. They can use a spoon, but 00:07:17.670 --> 00:07:19.370 they'll rotate it upside down right before it 00:07:19.370 --> 00:07:22.250 gets to their mouth. Classic. Then we hit 18 00:07:22.250 --> 00:07:24.329 months, and this feels like a really significant 00:07:24.329 --> 00:07:26.990 jump in the literature. 18 months is the shift 00:07:26.990 --> 00:07:30.430 from wobbly to mobile. Now, they are running. 00:07:30.949 --> 00:07:33.610 It's clumsy for sure, and they fall a lot. But 00:07:33.610 --> 00:07:35.689 they're fast. They can jump in place with both 00:07:35.689 --> 00:07:38.410 feet. They can throw a ball overhand. Which means 00:07:38.410 --> 00:07:41.430 they have an aim. Oh, boy. Exactly. And there 00:07:41.430 --> 00:07:43.730 is a critical exam note for 18 months regarding 00:07:43.730 --> 00:07:46.920 anatomy. The anterior fontanel. The soft spot 00:07:46.920 --> 00:07:49.519 on top of the head. Correct. The posterior one 00:07:49.519 --> 00:07:51.660 in the back, that closes really early, usually 00:07:51.660 --> 00:07:54.120 by two months old, but the anterior fontanel, 00:07:54.300 --> 00:07:56.660 that big diamond shape on top, must be closed 00:07:56.660 --> 00:07:59.420 by 18 months. And if it isn't? If you're examining 00:07:59.420 --> 00:08:02.579 an 18 month old and it is still soft or bulging 00:08:02.579 --> 00:08:07.100 or sunken, that is a big red flag for a neurological 00:08:07.100 --> 00:08:10.240 issue or a hydration problem. It should be hard 00:08:10.240 --> 00:08:12.639 bone by now. Got it. Closed by 18 months. Okay, 00:08:12.639 --> 00:08:14.930 now let's fast forward to the big one. The terrible 00:08:14.930 --> 00:08:18.949 two mark. 24 months. Two years old. This is the 00:08:18.949 --> 00:08:21.670 era of the doorknob. The doorknob. It sounds 00:08:21.670 --> 00:08:23.769 so trivial, but that changes everything, doesn't 00:08:23.769 --> 00:08:25.930 it? It changes the entire safety profile of the 00:08:25.930 --> 00:08:28.850 home. Before this, a closed door was a wall. 00:08:29.209 --> 00:08:32.129 Now it's just a delay. They can turn knobs, which 00:08:32.129 --> 00:08:34.330 means the bathroom is accessible, the garage 00:08:34.330 --> 00:08:36.710 is accessible, the front door is suddenly accessible. 00:08:36.950 --> 00:08:38.590 Combine that with the fact that they can now 00:08:38.590 --> 00:08:40.750 walk up and down stairs, usually placing two 00:08:40.750 --> 00:08:42.570 feet on each step, right? Right, two feet on 00:08:42.570 --> 00:08:44.289 each step. You've got a creature that can breach 00:08:44.289 --> 00:08:46.730 almost any containment you've set up. And by 00:08:46.730 --> 00:08:49.750 36 months, age three... They're just refining 00:08:49.750 --> 00:08:51.990 all of this. Totally. We're riding a tricycle. 00:08:52.009 --> 00:08:53.629 They're balancing on one foot. They can even 00:08:53.629 --> 00:08:56.029 copy a circle. So looking at that whole list, 00:08:56.049 --> 00:08:58.629 they are mobile. They can climb, open doors, 00:08:58.769 --> 00:09:01.710 throw things, and run. That's the can do. What 00:09:01.710 --> 00:09:04.509 is the cannot do? This is the scary part. They 00:09:04.509 --> 00:09:07.029 cannot reason, cause, and effect effectively. 00:09:07.730 --> 00:09:10.809 They cannot differentiate between a safe liquid, 00:09:11.090 --> 00:09:14.110 like say, apple juice, and a poison, like floor 00:09:14.110 --> 00:09:17.049 cleaner. Their taste discrimination is still 00:09:17.049 --> 00:09:21.360 really poor. OK. And most importantly, they cannot 00:09:21.360 --> 00:09:24.700 inhibit impulses. Let's unpack that impulse control 00:09:24.700 --> 00:09:27.799 piece for a second, because parents get so, so 00:09:27.799 --> 00:09:30.240 frustrated here. They say, I told him no five 00:09:30.240 --> 00:09:31.879 minutes ago, and he looked right at me and did 00:09:31.879 --> 00:09:34.000 it again. And the parent assumes defiance. They 00:09:34.000 --> 00:09:36.460 think it's a power struggle. But physiologically, 00:09:37.039 --> 00:09:39.580 the neural pathways in the prefrontal cortex, 00:09:39.659 --> 00:09:41.360 the ones that are supposed to say stop, don't 00:09:41.360 --> 00:09:43.919 touch. They just aren't myelinated yet. They 00:09:43.919 --> 00:09:45.799 aren't connected. So they might know the rule. 00:09:46.080 --> 00:09:48.200 They might. They might intellectually know the 00:09:48.200 --> 00:09:50.740 rule. But when the impulse strikes, the action 00:09:50.740 --> 00:09:53.080 happens faster than the brain can pump the brakes. 00:09:53.899 --> 00:09:55.659 They literally cannot stop themselves. So it's 00:09:55.659 --> 00:09:57.899 not just stubbornness. It's a wiring issue. A 00:09:57.899 --> 00:10:00.820 developmental limitation. Expecting a two -year 00:10:00.820 --> 00:10:03.279 -old to have reliable impulse control is like 00:10:03.279 --> 00:10:05.600 expecting them to do calculus. The hardware just 00:10:05.600 --> 00:10:08.960 isn't there yet. That explains so much. Okay, 00:10:09.019 --> 00:10:11.340 let's dig deeper into that brain. We talked about 00:10:11.340 --> 00:10:13.220 the motor skills, now let's talk about the mind. 00:10:13.860 --> 00:10:16.460 Piaget. Jean Piaget. He's the key to understanding 00:10:16.460 --> 00:10:19.539 the cognitive side of all this. Toddlers are 00:10:19.539 --> 00:10:22.299 in this big transition from the sensor motor 00:10:22.299 --> 00:10:25.379 stage, which is infancy, learning through touch 00:10:25.379 --> 00:10:28.580 and taste, into the pre -operational stage, which 00:10:28.580 --> 00:10:31.210 goes from about age two to seven. But in that 00:10:31.210 --> 00:10:33.529 transition, between 12 and 24 months, there's 00:10:33.529 --> 00:10:36.289 this fascinating phase called tertiary circular 00:10:36.289 --> 00:10:39.350 reactions, which sounds like a term from a sci 00:10:39.350 --> 00:10:41.649 -fi movie. It does, but it's just a fancy way 00:10:41.649 --> 00:10:44.470 of saying active experimentation. This is the 00:10:44.470 --> 00:10:45.830 little scientist that you were talking about 00:10:45.830 --> 00:10:47.750 at the beginning. So give us an example of how 00:10:47.750 --> 00:10:52.169 this looks in the wild. OK, so a baby might drop 00:10:52.169 --> 00:10:55.029 a spoon by accident and be surprised by the clang 00:10:55.029 --> 00:10:57.990 it makes. A toddler drops the spoon on purpose. 00:10:58.379 --> 00:11:00.100 Then they pick it up and throw it hard to see 00:11:00.100 --> 00:11:02.500 what happens. Then they push the whole bowl off 00:11:02.500 --> 00:11:04.879 the highchair tray. They're gathering data. That's 00:11:04.879 --> 00:11:07.700 all it is. They aren't trying to be bad. They're 00:11:07.700 --> 00:11:10.340 testing variables. If I drop this, does it make 00:11:10.340 --> 00:11:12.340 a loud noise? Does it bounce? Does mommy pick 00:11:12.340 --> 00:11:14.399 it up? What happens to mommy's face when I do 00:11:14.399 --> 00:11:17.039 it for the tenth time? They're learning about 00:11:17.039 --> 00:11:20.419 gravity and sociology all at once. So it's active 00:11:20.419 --> 00:11:23.799 learning through trial and, well... A lot of 00:11:23.799 --> 00:11:26.639 error. And a lot of mess. Right. And what about 00:11:26.639 --> 00:11:29.179 object permanence? That's fully established now, 00:11:29.179 --> 00:11:31.779 correct? It is. They know the object exists even 00:11:31.779 --> 00:11:34.440 when it's hidden. In infancy, you know, out of 00:11:34.440 --> 00:11:37.220 sight was out of mind. Now, they know the cookie's 00:11:37.220 --> 00:11:39.679 in the jar and the jar's in the cabinet. They 00:11:39.679 --> 00:11:42.059 can hold that image of the object in their mind. 00:11:42.259 --> 00:11:44.399 Which explains the persistence. They know the 00:11:44.399 --> 00:11:46.960 goal is there even if they can't see it. And 00:11:46.960 --> 00:11:49.740 clinically, this is why separation anxiety persists. 00:11:50.120 --> 00:11:52.059 They know the parent exists in the other room 00:11:52.059 --> 00:11:55.019 or at work, and they want to be there. The concept 00:11:55.019 --> 00:11:57.759 of you doesn't disappear when you walk out the 00:11:57.759 --> 00:12:00.120 door. Now, as we move into that pre -operational 00:12:00.120 --> 00:12:02.700 thinking, usually post -age too, we see some 00:12:02.700 --> 00:12:04.620 really distinct thought patterns that define 00:12:04.620 --> 00:12:07.460 this age. And the biggest one is egocentrism. 00:12:07.759 --> 00:12:10.860 This is the one that gets so misunderstood. When 00:12:10.860 --> 00:12:13.480 we say a toddler is egocentric, we don't mean 00:12:13.870 --> 00:12:16.230 they're arrogant or selfish in the adult sense 00:12:16.230 --> 00:12:18.549 of the word. It's not a character flaw. No, it's 00:12:18.549 --> 00:12:21.429 a cognitive limitation where they literally cannot 00:12:21.429 --> 00:12:23.629 see the world from another person's perspective. 00:12:23.789 --> 00:12:26.350 The classic example is the TV, right? Yeah. A 00:12:26.350 --> 00:12:28.669 toddler stands directly in front of the TV while 00:12:28.669 --> 00:12:31.370 you're watching it. You say, hey, move. I can't 00:12:31.370 --> 00:12:35.210 see. They don't move. Why? Because they can see 00:12:35.210 --> 00:12:38.549 the TV just fine. And if they can see it, They 00:12:38.549 --> 00:12:41.570 genuinely assume you can see it too. They cannot 00:12:41.570 --> 00:12:44.269 compute that your visual field is different from 00:12:44.269 --> 00:12:47.429 theirs. That is just wild. And it applies to 00:12:47.429 --> 00:12:49.389 feelings too, I'd imagine. If they're happy, 00:12:49.649 --> 00:12:52.110 everyone must be happy. Precisely. If they're 00:12:52.110 --> 00:12:54.090 sad, the whole world is sad. This is why they 00:12:54.090 --> 00:12:56.750 can't effectively empathize yet. They might pat 00:12:56.750 --> 00:12:58.409 your back if you're crying because they've seen 00:12:58.409 --> 00:13:00.850 you do it, but they don't intellectually grasp 00:13:00.850 --> 00:13:04.049 your separate individual pain. Then we have animism. 00:13:04.269 --> 00:13:07.730 This is attributing life and feelings to inanimate 00:13:07.730 --> 00:13:10.289 objects. The bad table. This is my favorite. 00:13:10.710 --> 00:13:13.350 The toddler runs, bumps into a coffee table, 00:13:13.669 --> 00:13:15.730 hurts their knee and immediately turns around 00:13:15.730 --> 00:13:20.090 and scolds the table. Bad table. In their mind, 00:13:20.210 --> 00:13:22.590 the table did it on purpose. It's an aggressor. 00:13:22.730 --> 00:13:24.929 This has to have huge implications for health 00:13:24.929 --> 00:13:27.289 care and nursing. Massive. Think about a blood 00:13:27.289 --> 00:13:30.909 pressure cuff or an IV pump. To an adult, it's 00:13:30.909 --> 00:13:34.330 a tool. To a toddler operating with animism, 00:13:34.710 --> 00:13:37.750 that machine is a monster that is intentionally 00:13:37.750 --> 00:13:40.470 squeezing your arm. It's alive and it's mean. 00:13:40.769 --> 00:13:42.590 So how do you handle that? What's the nursing 00:13:42.590 --> 00:13:45.009 intervention? You have to demystify it. Yeah. 00:13:45.149 --> 00:13:47.029 You have to play into their reality. You let 00:13:47.029 --> 00:13:48.649 them touch the equipment. You talk to the equipment. 00:13:49.129 --> 00:13:50.929 OK, Mr. Cuff is just going to give your arm a 00:13:50.929 --> 00:13:53.470 little hug now. Yeah. You have to engage with 00:13:53.470 --> 00:13:55.210 their world, not try to pull them into yours. 00:13:55.269 --> 00:13:57.330 And then there's magical thinking. This is the 00:13:57.330 --> 00:13:59.710 belief that their thoughts can cause real world 00:13:59.710 --> 00:14:03.559 events. It's very powerful and honestly very 00:14:03.559 --> 00:14:05.799 dangerous for their emotional state. Give us 00:14:05.799 --> 00:14:09.159 a scenario. Okay. Let's say a toddler is jealous 00:14:09.159 --> 00:14:12.080 of a new baby sibling. They have a moment of 00:14:12.080 --> 00:14:14.740 intense anger and think, I wish the baby would 00:14:14.740 --> 00:14:17.879 just go away. The next day, the baby gets a little 00:14:17.879 --> 00:14:20.320 fever and has to go to the doctor. The toddler 00:14:20.320 --> 00:14:22.600 believes they did that. Oh, wow. They think their 00:14:22.600 --> 00:14:24.740 thought caused the illness. They think their 00:14:24.740 --> 00:14:28.200 thought was a weapon. This creates immense unspoken 00:14:28.200 --> 00:14:31.240 guilt. And as caregivers, we have to explicitly 00:14:31.240 --> 00:14:33.779 reassure them, you didn't make the baby sick. 00:14:34.080 --> 00:14:36.740 Germs made the baby sick. You have to break that 00:14:36.740 --> 00:14:38.799 magical link for them. So we have a child who 00:14:38.799 --> 00:14:40.919 thinks tables are alive, their thoughts are powerful 00:14:40.919 --> 00:14:44.100 magic, and everyone sees exactly what they see. 00:14:44.279 --> 00:14:46.419 Correct. That is the operating system of a two 00:14:46.419 --> 00:14:48.759 year old. It's a trip. Now let's layer Ericsson 00:14:48.759 --> 00:14:50.820 on top of that, the emotional engine. We said 00:14:50.820 --> 00:14:53.399 it's autonomy versus shame and doubt. Right. 00:14:53.600 --> 00:14:56.490 The goal is control. They are realizing they 00:14:56.490 --> 00:14:58.409 are a separate person from the parent, and they 00:14:58.409 --> 00:15:00.850 want to drive the bus. And their weapon of choice 00:15:00.850 --> 00:15:04.289 is negativism. The almighty power of no. And 00:15:04.289 --> 00:15:05.950 listener, if you take one thing away, please 00:15:05.950 --> 00:15:09.049 internalize this. No is not disrespect at this 00:15:09.049 --> 00:15:11.990 age. It is an assertion of self. Explain that 00:15:11.990 --> 00:15:15.629 more. If I ask you, do you want to eat? And you 00:15:15.629 --> 00:15:18.529 say yes. You are agreeing with me. You are following 00:15:18.529 --> 00:15:21.929 my lead. But if you say no, you are standing 00:15:21.929 --> 00:15:24.490 apart. You are an individual with your own will. 00:15:24.779 --> 00:15:27.899 So even if they are starving and want that cookie, 00:15:28.840 --> 00:15:32.120 they might say no. Constantly. They will refuse 00:15:32.120 --> 00:15:34.539 something they desperately want just to prove 00:15:34.539 --> 00:15:37.320 they have the agency to refuse it. It's a declaration 00:15:37.320 --> 00:15:39.399 of independence. So how do you hack that? How 00:15:39.399 --> 00:15:41.899 do you parent or nurse a machine that just runs 00:15:41.899 --> 00:15:45.679 on no? You never, ever ask a yes -no question 00:15:45.679 --> 00:15:48.460 if you need a specific outcome. Do not ask, do 00:15:48.460 --> 00:15:50.539 you want to get dressed? You're just handing 00:15:50.539 --> 00:15:52.919 them a loaded gun. So what do you do instead? 00:15:53.179 --> 00:15:55.250 You use the Force choice. You say, it's time 00:15:55.250 --> 00:15:56.629 to get dressed. You want to wear the red shirt 00:15:56.629 --> 00:15:58.929 or the blue shirt? You frame the eponymy within 00:15:58.929 --> 00:16:01.070 your goal. Exactly. You give them the illusion 00:16:01.070 --> 00:16:03.049 of control. They get to pick the color, but you 00:16:03.049 --> 00:16:04.950 control the ultimate outcome. They get dressed. 00:16:05.389 --> 00:16:07.809 It satisfies their Ericksonian need for autonomy 00:16:07.809 --> 00:16:10.690 without completely derailing your morning. And 00:16:10.690 --> 00:16:13.769 what about ritualism, this need for really strict 00:16:13.769 --> 00:16:16.549 routines? Think about how scary the world is 00:16:16.549 --> 00:16:19.370 when you are small, you have no judgment, and 00:16:19.370 --> 00:16:21.450 you think tables are out to get you. It's absolutely 00:16:21.450 --> 00:16:25.419 chaotic. Ritualism is the anchor in that storm. 00:16:25.879 --> 00:16:28.720 The same bedtime story read the exact same way, 00:16:28.960 --> 00:16:31.600 the same cup, the same order of putting on pajamas 00:16:31.600 --> 00:16:34.000 every single night. It provides a sense of safety 00:16:34.000 --> 00:16:36.480 and predictability in a world that feels random 00:16:36.480 --> 00:16:39.539 and overwhelming. If you break the ritual, you 00:16:39.539 --> 00:16:41.620 break their sense of security. This has to be 00:16:41.620 --> 00:16:44.600 huge in the hospital. Oh, it's number one. If 00:16:44.600 --> 00:16:47.080 a kid is admitted, the single best thing a nurse 00:16:47.080 --> 00:16:49.970 can do is ask the parents. about their home rituals. 00:16:50.590 --> 00:16:53.250 What cup does he use? Does he sleep with a specific 00:16:53.250 --> 00:16:55.889 blanket? What song do you sing? And then you 00:16:55.889 --> 00:16:58.169 try to replicate that structure as much as humanly 00:16:58.169 --> 00:17:00.279 possible. And when the stress gets too high, 00:17:00.559 --> 00:17:02.580 say, a new sibling arrives or they get sick, 00:17:02.679 --> 00:17:05.480 we see regression. Right. They go backward. A 00:17:05.480 --> 00:17:07.660 potty -trained child starts wetting the bed again. 00:17:07.900 --> 00:17:10.259 A child who speaks in full sentences goes back 00:17:10.259 --> 00:17:13.079 to pointing and using baby talk. And the advice 00:17:13.079 --> 00:17:16.140 there is... Don't punish it. It's a defense mechanism. 00:17:16.579 --> 00:17:18.880 They're just retreating to a time when they felt 00:17:18.880 --> 00:17:22.039 safer back to infancy. If a new baby arrives 00:17:22.039 --> 00:17:25.039 and the toddler suddenly wants a bottle... Don't 00:17:25.039 --> 00:17:27.240 shame them for it, but you also don't want to 00:17:27.240 --> 00:17:28.779 reinforce it too much. So you don't give them 00:17:28.779 --> 00:17:31.420 the bottle. The best practice is to sort of ignore 00:17:31.420 --> 00:17:34.240 the regression. You don't make a big scene about 00:17:34.240 --> 00:17:37.180 the baby talk, but you lavish praise on the age 00:17:37.180 --> 00:17:39.700 -appropriate behavior. Wow, look at you helping 00:17:39.700 --> 00:17:41.740 me with the diaper. You are such a big helper. 00:17:42.579 --> 00:17:45.160 You validate the growth, not the retreat. Okay, 00:17:45.160 --> 00:17:47.740 so we have the mine, which is Piaget, and the 00:17:47.740 --> 00:17:50.380 drive, which is Erickson. Now let's connect this 00:17:50.380 --> 00:17:53.079 all to safety. This is the cause and effect segment 00:17:53.079 --> 00:17:56.799 of the deep dive. Why do toddlers get hurt in 00:17:56.799 --> 00:17:59.500 such specific ways? This is where we apply what 00:17:59.500 --> 00:18:02.500 we call the unsafe explorer model. We have to 00:18:02.500 --> 00:18:04.680 link the cognitive limitation directly to the 00:18:04.680 --> 00:18:07.960 physical risk. Let's start with aspiration and 00:18:07.960 --> 00:18:10.720 choking. The classic grapes and hot dogs. Right. 00:18:11.099 --> 00:18:13.759 The cause here is a mix of sensory exploration. 00:18:14.460 --> 00:18:16.140 That's PHA again. They put everything in their 00:18:16.140 --> 00:18:18.019 mouth to learn about it. And simple anatomy. 00:18:18.799 --> 00:18:21.400 Their airways are tiny. About the width of their 00:18:21.400 --> 00:18:24.619 pinky finger. So coins, batteries, hard candy, 00:18:24.900 --> 00:18:27.700 nuts. They explore, they inhale by accident, 00:18:28.200 --> 00:18:30.920 and they choke. What about drowning? This links 00:18:30.920 --> 00:18:32.779 right back to our physics lesson about the head, 00:18:32.900 --> 00:18:34.940 doesn't it? It connects directly to that top 00:18:34.940 --> 00:18:38.359 -heavy concept. A toddler's curious. They see 00:18:38.359 --> 00:18:40.440 a toilet or maybe a five -gallon bucket of cleaning 00:18:40.440 --> 00:18:43.160 water on the floor. They lean over to see what's 00:18:43.160 --> 00:18:45.940 inside. Curiosity leads the way. And their center 00:18:45.940 --> 00:18:48.619 of gravity shifts past the pivot point. They 00:18:48.619 --> 00:18:51.460 tip forward and because their head is so disproportionately 00:18:51.460 --> 00:18:54.400 heavy, they fall in head first. Now here's the 00:18:54.400 --> 00:18:56.500 absolute tragedy of it. They can't get out. They 00:18:56.500 --> 00:18:58.400 do not have the upper body and neck strength 00:18:58.400 --> 00:19:01.099 to push themselves back up. They are like a turtle 00:19:01.099 --> 00:19:03.700 on its back. So they can drown in a tiny amount 00:19:03.700 --> 00:19:06.380 of water. Inches. They can drown in a toilet 00:19:06.380 --> 00:19:08.440 bowl because they physically cannot lift that 00:19:08.440 --> 00:19:11.140 heavy head against gravity to get air. That's 00:19:11.140 --> 00:19:13.619 why bathroom doors must be kept closed or latched 00:19:13.619 --> 00:19:16.619 at all times. That is a chilling visual, but 00:19:16.619 --> 00:19:20.740 it makes the risk so incredibly clear. What about 00:19:20.740 --> 00:19:24.140 burns? This is locomotion plus a lack of cause 00:19:24.140 --> 00:19:26.700 and effect. They can climb onto a chair, reach 00:19:26.700 --> 00:19:29.259 the stove and grab a pot handle. They see the 00:19:29.259 --> 00:19:31.160 handle, they want to explore it. They don't have 00:19:31.160 --> 00:19:33.779 the cognitive link that says handle equals very 00:19:33.779 --> 00:19:35.759 hot liquid that will hurt me. So the guideline 00:19:35.759 --> 00:19:38.680 is always pot handles turned inward. That's right. 00:19:39.119 --> 00:19:41.920 And water heaters need to be set to below 120 00:19:41.920 --> 00:19:43.920 degrees Fahrenheit because remember the doorknob 00:19:43.920 --> 00:19:46.579 skill. They can turn on faucets now. If the water 00:19:46.579 --> 00:19:48.759 comes out at 140 degrees, they can get a third 00:19:48.759 --> 00:19:51.240 degree burn in seconds, long before they can 00:19:51.240 --> 00:19:53.359 react and pull their hand away. Right. The motor 00:19:53.359 --> 00:19:55.339 skill outpaces the judgment again. That leads 00:19:55.339 --> 00:19:57.460 us directly to poisoning. It's the same skill 00:19:57.460 --> 00:19:59.559 set. They can open the cabinet under the sink, 00:20:00.039 --> 00:20:02.180 and because of that poor taste discrimination, 00:20:02.680 --> 00:20:04.519 they won't necessarily spit out a chemical just 00:20:04.519 --> 00:20:06.619 because it tastes bad. They'll just swallow it. 00:20:06.720 --> 00:20:09.079 So everything high up and locked. High and locked. 00:20:09.339 --> 00:20:12.440 And finally, motor vehicle injuries. This is 00:20:12.440 --> 00:20:14.940 a big one for parent education because the guidelines 00:20:14.940 --> 00:20:17.599 have shifted over the years and not everyone 00:20:17.599 --> 00:20:20.480 is up to date. The rule is rear -facing until 00:20:20.480 --> 00:20:23.480 at least age two or until they max out the seat's 00:20:23.480 --> 00:20:26.289 height and weight limits. So why? It's physics 00:20:26.289 --> 00:20:29.190 again. We have a heavy head and very, very weak 00:20:29.190 --> 00:20:32.849 neck muscles. In a forward -facing crash, the 00:20:32.849 --> 00:20:35.130 body is held back by the straps, but the head 00:20:35.130 --> 00:20:38.150 flies forward violently. The neck muscles can't 00:20:38.150 --> 00:20:40.410 stop that momentum, and you risk what's called 00:20:40.410 --> 00:20:43.490 internal decapitation or a severe spinal injury. 00:20:44.069 --> 00:20:47.130 Internal decapitation. That is a terrifying phrase. 00:20:47.250 --> 00:20:50.180 It is, but it explains the why. A rear -facing 00:20:50.180 --> 00:20:52.299 seat creates a shell that cradles and supports 00:20:52.299 --> 00:20:55.039 the head and neck. The seat itself absorbs the 00:20:55.039 --> 00:20:57.740 force of the crash, not the child's tiny spine. 00:20:57.920 --> 00:21:00.259 It's not a parenting style choice. It's pure 00:21:00.259 --> 00:21:02.539 anatomy and physics. Okay, let's pivot to something 00:21:02.539 --> 00:21:04.480 a little later. Play. We know they're little 00:21:04.480 --> 00:21:06.740 scientists, but how do they interact with other 00:21:06.740 --> 00:21:08.880 little scientists? They really don't. At least 00:21:08.880 --> 00:21:11.079 not cooperatively. The style of play for this 00:21:11.079 --> 00:21:13.299 age group is called parallel play. Playing alone, 00:21:13.500 --> 00:21:16.079 but together. Perfect way to put it. Imagine 00:21:16.079 --> 00:21:19.390 two toddlers sitting on a rug. They're both playing 00:21:19.390 --> 00:21:21.349 with the blocks. They're sitting maybe two feet 00:21:21.349 --> 00:21:24.109 apart, but they are not building a castle together. 00:21:24.390 --> 00:21:26.690 They are each building their own separate tower, 00:21:27.390 --> 00:21:30.190 completely ignoring each other, yet somehow finding 00:21:30.190 --> 00:21:33.029 comfort in the other's presence. And this links 00:21:33.029 --> 00:21:36.769 back to egocentrism. 100%. They literally cannot 00:21:36.769 --> 00:21:39.390 understand the concept of sharing or having common 00:21:39.390 --> 00:21:42.529 goals yet. To share, you have to understand that 00:21:42.529 --> 00:21:45.529 the other person wants the toy and has feelings 00:21:45.529 --> 00:21:49.299 about it. The toddler just sees My toy. So forcing 00:21:49.299 --> 00:21:52.500 them to share is just a losing battle. It's developmentally 00:21:52.500 --> 00:21:54.539 inappropriate. You can model it. You can encourage 00:21:54.539 --> 00:21:58.319 taking turns, but you cannot expect true cooperative 00:21:58.319 --> 00:22:00.400 play. They are just not wired for it yet. What 00:22:00.400 --> 00:22:02.279 about the toys themselves, then? What should 00:22:02.279 --> 00:22:04.940 we be buying or, you know, recommending for this 00:22:04.940 --> 00:22:07.680 age? We want toys that support their big developmental 00:22:07.680 --> 00:22:10.900 tasks. For locomotion and that drive for autonomy, 00:22:11.400 --> 00:22:13.900 push -pull toys are absolute gold. You know, 00:22:13.960 --> 00:22:16.059 those little lawnmowers that pop or vacuums they 00:22:16.059 --> 00:22:18.660 can push around? It rewards the walking. Exactly. 00:22:19.039 --> 00:22:21.740 For fine motor skills, we look at blocks. And 00:22:21.740 --> 00:22:24.400 the data shows a really clear progression. At 00:22:24.400 --> 00:22:26.440 18 months, they should be able to stack maybe 00:22:26.440 --> 00:22:29.440 three to four blocks. By 24 months, it's up to 00:22:29.440 --> 00:22:31.799 six to seven blocks. That's a pretty specific 00:22:31.799 --> 00:22:34.299 metric. It is, and it's a great simple way to 00:22:34.299 --> 00:22:36.480 track their fine motor control and hand -eye 00:22:36.480 --> 00:22:39.519 coordination. Also, thick crayons and finger 00:22:39.519 --> 00:22:42.220 paints. Anything tactile. And I saw something 00:22:42.220 --> 00:22:44.319 in the notes about pounding toys, like those 00:22:44.319 --> 00:22:46.539 little wooden benches with the hammers and pegs. 00:22:46.619 --> 00:22:48.900 Oh, those are fantastic. They're great for releasing 00:22:48.900 --> 00:22:51.799 aggressive energy. Toddlers have so much frustration. 00:22:52.180 --> 00:22:54.279 Remember that gap between what they want to do 00:22:54.279 --> 00:22:56.539 and what their body can actually do. Pounding 00:22:56.539 --> 00:22:58.759 a peg allows them to release that frustration 00:22:58.759 --> 00:23:02.400 safely without. hitting their sibling. It's therapeutic 00:23:02.400 --> 00:23:04.559 hammering. I like it. It really is. It channels 00:23:04.559 --> 00:23:07.759 that very normal aggressive impulse into a safe 00:23:07.759 --> 00:23:09.980 and appropriate activity. Okay, let's bring all 00:23:09.980 --> 00:23:12.660 of this home now for the learner. Whether you 00:23:12.660 --> 00:23:15.579 are a nurse, a student, or a super prepared parent, 00:23:16.039 --> 00:23:18.579 how do we apply this? Let's look at some key 00:23:18.579 --> 00:23:21.440 exam topics and clinical scenarios. Let's start 00:23:21.440 --> 00:23:24.380 with the holy grail of toddlerhood, toilet training. 00:23:24.640 --> 00:23:29.200 The ultimate struggle. So when is a child ready? 00:23:29.579 --> 00:23:31.940 Exam writers love this question because it's 00:23:31.940 --> 00:23:34.279 not just about age. You can't just memorize age, 00:23:34.599 --> 00:23:37.700 too It requires a convergence of three different 00:23:37.700 --> 00:23:41.960 domains physical cognitive and motor Okay, break 00:23:41.960 --> 00:23:45.279 that down for us. So physically they need voluntary 00:23:45.279 --> 00:23:47.880 sphincter control this usually happens after 00:23:47.880 --> 00:23:50.559 they are walking well sometime around 18 to 24 00:23:50.559 --> 00:23:54.049 months a key sign is that they're staying dry 00:23:54.049 --> 00:23:56.609 for at least two hours at a time during the day. 00:23:57.150 --> 00:23:59.630 If their diaper is wet every 30 minutes, the 00:23:59.630 --> 00:24:02.250 bladder capacity just isn't there yet. And cognitively. 00:24:02.450 --> 00:24:04.529 They have to be able to recognize the urge before 00:24:04.529 --> 00:24:06.930 the event. They need to connect the feeling of 00:24:06.930 --> 00:24:09.730 a full bladder to the act of needing to go to 00:24:09.730 --> 00:24:12.390 the potty. If they only tell you after they've 00:24:12.390 --> 00:24:14.289 already gone in their diaper, they aren't quite 00:24:14.289 --> 00:24:16.529 cognitively ready. And the motor aspect. This 00:24:16.529 --> 00:24:18.369 is the one people always forget. They have to 00:24:18.369 --> 00:24:20.130 be able to remove their own clothing. If they 00:24:20.130 --> 00:24:22.109 can't pull their pants down by themselves, they 00:24:22.109 --> 00:24:23.650 aren't ready for independence on the toilet. 00:24:24.009 --> 00:24:26.470 So if a parent asks, he's 18 months, should I 00:24:26.470 --> 00:24:29.990 start? The answer is? The answer is more questions. 00:24:30.549 --> 00:24:32.650 Is he waking up dry from his naps? Does he tell 00:24:32.650 --> 00:24:34.829 you when he needs to go? Can he handle his own 00:24:34.829 --> 00:24:38.170 pants? If the answer to those is no, then you 00:24:38.170 --> 00:24:41.329 wait. Forcing it too early just leads to frustration 00:24:41.329 --> 00:24:44.230 and shame. And there's Erickson again. Next topic, 00:24:44.690 --> 00:24:48.390 nutrition and those infamous food jags. Ah, yes. 00:24:48.619 --> 00:24:51.920 The all -beige food diet. The dinosaur nugget 00:24:51.920 --> 00:24:54.740 phase. A food jag is when a toddler will eat 00:24:54.740 --> 00:24:57.599 only one specific food for days, sometimes weeks 00:24:57.599 --> 00:24:59.940 at a time, and then suddenly refuse to ever touch 00:24:59.940 --> 00:25:02.420 it again. It drives parents absolutely insane. 00:25:02.500 --> 00:25:04.980 It does. But the strategy comes right back to 00:25:04.980 --> 00:25:08.200 autonomy. Do not force feed. That creates a power 00:25:08.200 --> 00:25:10.839 struggle you will lose. You provide healthy choices, 00:25:11.140 --> 00:25:13.359 keep offering variety, and you completely ignore 00:25:13.359 --> 00:25:15.579 the refusal. Remember, because of physiologic 00:25:15.579 --> 00:25:17.759 anorexia, they will not starve themselves. What 00:25:17.759 --> 00:25:20.200 about milk? This is a very specific guideline. 00:25:20.740 --> 00:25:23.619 Whole milk from 12 to 24 months. No exceptions 00:25:23.619 --> 00:25:25.819 unless there's a medical reason. Why whole milk 00:25:25.819 --> 00:25:28.640 specifically? Because their brain is still myelinating 00:25:28.640 --> 00:25:31.940 at a rapid rate. Myelin is the fatty sheath that 00:25:31.940 --> 00:25:34.299 covers all the nerves and speeds up processing. 00:25:35.000 --> 00:25:37.460 You need dietary fat to build that crucial brain 00:25:37.460 --> 00:25:40.240 architecture. After age two, you can switch to 00:25:40.240 --> 00:25:43.839 low -fat or skim. And juice? Limited. Severely. 00:25:44.359 --> 00:25:47.250 Four to six ounces a day, max. It's essentially 00:25:47.250 --> 00:25:49.849 sugar water with no fiber. It fills them up so 00:25:49.849 --> 00:25:51.970 they don't eat real food. And it's a huge driver 00:25:51.970 --> 00:25:53.990 for cavities. OK, brace yourselves. We have to 00:25:53.990 --> 00:25:56.730 talk about the pokes, the vaccine schedule. The 00:25:56.730 --> 00:25:59.809 12 to 15 month visit. This is the heavy hitter. 00:25:59.970 --> 00:26:03.690 Yeah, looking at the CDC 2025 chart here, there 00:26:03.690 --> 00:26:05.750 are a lot of acronyms. It can be overwhelming. 00:26:05.930 --> 00:26:08.109 There are. But for the one year visit, try to 00:26:08.109 --> 00:26:10.089 group them. We often use a little pattern recognition 00:26:10.089 --> 00:26:13.069 trick or a mnemonic. Harry's Vax MD or something 00:26:13.069 --> 00:26:14.869 similar. Walk us through that. What are the core 00:26:14.869 --> 00:26:16.950 ones? OK. So the big ones you're almost always 00:26:16.950 --> 00:26:20.529 giving at this visit are H for Hib, P for PCV. 00:26:20.569 --> 00:26:23.170 That's the pneumococcal one. You have M for MMR 00:26:23.170 --> 00:26:25.529 measles, mumps, rubella, and V for varicella. 00:26:25.650 --> 00:26:28.589 That's chicken pox. And finally, A for hep A. 00:26:28.950 --> 00:26:32.890 The first goes to hepatitis A. So Hib, PCV, MMR, 00:26:33.390 --> 00:26:36.529 varicella, and hep A. That's potentially five 00:26:36.529 --> 00:26:39.279 shots right there. It can be. And usually the 00:26:39.279 --> 00:26:41.400 D -Tap booster comes a little later, around 15 00:26:41.400 --> 00:26:43.940 to 18 months, but sometimes it gets grouped in 00:26:43.940 --> 00:26:46.579 depending on the clinic's schedule. But the core 00:26:46.579 --> 00:26:49.519 one -year milestones are definitely MMR, varicella, 00:26:49.920 --> 00:26:52.279 and that first HEPA. Why do MMR and varicella 00:26:52.279 --> 00:26:54.819 happen now? Why not earlier? It's all about maternal 00:26:54.819 --> 00:26:57.460 antibodies. The immunity the baby got from mom 00:26:57.460 --> 00:26:59.779 in the womb starts to wear off right around the 00:26:59.779 --> 00:27:02.319 first birthday. If we give the vaccine too early, 00:27:02.700 --> 00:27:04.839 mom's leftover antibodies might just attack the 00:27:04.839 --> 00:27:07.720 vaccine virus and neutralize it before the baby's 00:27:07.720 --> 00:27:09.480 own immune system can learn from it. So you have 00:27:09.480 --> 00:27:10.980 to wait for that window to open? You have to 00:27:10.980 --> 00:27:13.140 wait for that window. And HEPA is a two -dose 00:27:13.140 --> 00:27:15.960 series, right? Correct. The first dose at 12 00:27:15.960 --> 00:27:17.700 months, and then the second dose has to be at 00:27:17.700 --> 00:27:20.119 least six months later. It's a lot for a little 00:27:20.119 --> 00:27:23.119 leg. It is. But you have to remember the why. 00:27:23.900 --> 00:27:26.059 Toddlers are exploring the world, putting everything 00:27:26.059 --> 00:27:28.799 in their mouths. It's a huge hepos risk. They're 00:27:28.799 --> 00:27:31.359 starting to play near other kids. That's MMR 00:27:31.359 --> 00:27:34.180 and varicella risk. This is exactly when their 00:27:34.180 --> 00:27:36.200 immunity shield needs to be fully activated. 00:27:36.440 --> 00:27:39.450 One last clinical scenario. Sibling rivalry. 00:27:39.970 --> 00:27:42.390 We touched on regression, but what is the practical 00:27:42.390 --> 00:27:44.789 advice you give to parents? It's the dethroning 00:27:44.789 --> 00:27:48.430 of the king or queen. The toddler feels displaced. 00:27:48.750 --> 00:27:50.650 Their entire sense of autonomy is threatened 00:27:50.650 --> 00:27:54.049 by this new creature. So the fix is inclusion. 00:27:54.240 --> 00:27:56.319 You give them a job. You give them a job. You 00:27:56.319 --> 00:27:57.960 are the big helper. Can you please get me a diaper? 00:27:58.039 --> 00:28:00.519 Can you pick out the baby socks? You have to 00:28:00.519 --> 00:28:03.500 validate their new important role. And boundaries. 00:28:03.740 --> 00:28:05.980 Yes. Practically, you do not let them use the 00:28:05.980 --> 00:28:07.759 new baby's equipment. Don't let them drink from 00:28:07.759 --> 00:28:09.900 the baby's bottle. Even if they ask, it just 00:28:09.900 --> 00:28:11.940 reinforces the regression. You want to keep their 00:28:11.940 --> 00:28:14.539 big kid status elevated. Oh, that's for the baby. 00:28:14.900 --> 00:28:16.740 You get to use a big boy cup. That makes perfect 00:28:16.740 --> 00:28:19.140 sense. OK, we have covered a massive amount of 00:28:19.140 --> 00:28:22.099 ground from the closure of the anterior fraternal 00:28:22.099 --> 00:28:25.049 to the existential crisis. of a table being bad. 00:28:25.329 --> 00:28:28.349 It's a really dense, critical period of development. 00:28:28.630 --> 00:28:30.869 So let's wrap this all up with our 80 -20 summary 00:28:30.869 --> 00:28:34.009 box. If the listener remembers nothing else from 00:28:34.009 --> 00:28:37.490 this entire deep dive, what is the core concept? 00:28:38.609 --> 00:28:41.670 If you can understand that a toddler is an egocentric, 00:28:42.109 --> 00:28:44.769 autonomous explorer who desperately wants to 00:28:44.769 --> 00:28:47.029 do everything themselves but lacks the cognitive 00:28:47.029 --> 00:28:49.890 judgment to do it safely, you can answer almost 00:28:49.890 --> 00:28:52.109 any question you'll ever face. Let's bullet point 00:28:52.109 --> 00:28:55.720 that one more time. Okay. They say no to a certain, 00:28:55.880 --> 00:28:59.619 that's autonomy. They play beside other kids, 00:28:59.759 --> 00:29:02.339 not with them because they can't see the other's 00:29:02.339 --> 00:29:05.180 point of view. That's egocentrism. They get hurt 00:29:05.180 --> 00:29:07.400 because their motor skills are way faster than 00:29:07.400 --> 00:29:09.740 their brain. That's the impulse control gap. 00:29:09.859 --> 00:29:12.059 And they fall apart when stressed. And they regress 00:29:12.059 --> 00:29:14.279 when stressed because those rituals provide the 00:29:14.279 --> 00:29:16.019 safety they need to be brave enough to explore 00:29:16.019 --> 00:29:18.839 in the first place. See? It's not just chaos, 00:29:19.039 --> 00:29:21.420 it's logic. Absolutely, it all connects. Before 00:29:21.420 --> 00:29:23.400 we sign off, I want to leave you with one final 00:29:23.400 --> 00:29:25.980 thought to chew on. We talked about animism, 00:29:26.160 --> 00:29:28.500 the idea that the table is bad because it hit 00:29:28.500 --> 00:29:31.359 me. Think about what that does to a child's early 00:29:31.359 --> 00:29:35.140 understanding of justice and blame. If an inanimate 00:29:35.140 --> 00:29:38.299 object can be guilty, how does that shape how 00:29:38.299 --> 00:29:41.240 they view the world? And to take it deeper in 00:29:41.240 --> 00:29:44.259 a hospital, if a syringe causes pain, is the 00:29:44.259 --> 00:29:47.519 syringe itself evil? Is the nurse holding it 00:29:47.519 --> 00:29:50.480 bad? It really highlights why building trust 00:29:50.480 --> 00:29:53.380 and using therapeutic play is so vital in pediatrics. 00:29:53.500 --> 00:29:56.000 You're literally battling a worldview where everything 00:29:56.000 --> 00:29:58.339 is alive and potentially out to get them. That's 00:29:58.339 --> 00:29:59.960 heavy stuff for a kid who just wants a cookie. 00:30:00.559 --> 00:30:03.700 Well that is our deep dive on the toddler. Exhausting, 00:30:03.940 --> 00:30:06.220 exhilarating, and the ultimate scientists testing 00:30:06.220 --> 00:30:09.000 the laws of physics and sociology every single 00:30:09.000 --> 00:30:11.180 hour. Thanks for listening and good luck with 00:30:11.180 --> 00:30:13.259 your own little scientists. Stay safe out there.