Welcome to the bed. We'll go ahead and give you
the story. This is all going to happen super
fast. Welcome to the emergency room. Welcome
back to The Deep Dive. Today we are opening up
a file that creates a very specific kind of anxiety
for nursing students and frankly, new parents
alike. We are talking about the preschooler,
that distinct somewhat chaotic window between
ages three and six. It is such a deceptive age
group, and I think deceptive because, you know,
on the surface they look like they've got it
together. Right. They're adorable, they're starting
to talk in full sentences, they're funny, they
can dress themselves mostly. Mostly, yes. But
when you dig into the safety data and the developmental
psychology, which is exactly what we're doing
today, you realize this is a terrifyingly dangerous
window of time. It's... Arguably the most contradictory
stage of human development I mean you have a
child who is physically capable of almost anything
climbing fences opening locked doors striking
matches. Oh, yeah But cognitively, they're living
in a complete fantasy world. They have zero reliable
judgment. And that's the tension. That's exactly
the tension we are going to explore. We've pulled
together a massive stack of sources for this.
We're looking at the 2025 CDC immunization schedules,
the latest clinical presentations from Wolters
Kluwer on growth and development. And, of course,
those incredibly dense chapters on health promotion
and safety from the standard pediatric nursing
text. The ones everyone dreads. The ones with
all the lists. And if you look at those texts,
the sheer volume of dos and don'ts for this age
group is just, it's overwhelming. You have lists
of milestones, lists of poisons, lists of vaccine
schedules. It's enough to make a student want
to just drop out. Which brings us to our mission
for this deep dive. We are applying the 80 -20
rule. We are not going to just read the lists.
We are going to try to understand the operating
system of the three - to six -year -old. Right.
Because if you understand how they think, and
that's all Piagia, and what drives them emotionally,
which is Ericsson, you don't need to memorize
the safety lists. You can predict them. You can
predict them. They just become obvious. So. Whether
you are a nursing student trying to survive a
PEDS exam or a clinician trying to explain to
a parent why their four -year -old is lying about
eating a cookie while literally holding the cookie,
this is for you. Let's do it. Let's start with
the hardware, the big picture developmental theme.
Physically, this child is just transformed. It's
a dramatic shift. If you picture a toddler in
your mind, you're picturing that Potbelly look
totally the sway back the whole thing exactly
they have that sway back their legs are short
They have this wide stance just to stay upright.
They are top -heavy They look like they're about
to tip over at any second but by age three or
four that silhouette completely changes the pot
belly just like It vanishes it stretches out
and the growth rate actually slows down significantly
compared to infancy They are gaining, you know
about four to five pounds a year and growing
maybe two and a half to three inches Which is
much less than infancy? Much less. But the quality
of the tissue changes. That's the key. They lose
the baby fat. They gain abdominal muscle. The
spine straightens out. They become slender, upright,
and kind of graceful. And that physical change
isn't just aesthetic. It's functional. I mean,
that loss of bulk and gain of muscle is what
unlocks that explosion in motor skills we're
about to talk about. Exactly. You can't hop on
one foot if you have a massive center of gravity
and weak abs. The physical maturation allows
the neurological development to really shine.
OK, so let's frame the core conflict before we
get into the specific milestones, because looking
at the sources, this feels like the setup for
a disaster movie. It essentially is. It really
is. Here is the conflict. On one side, you have
Erickson's stage of initiative. The child wants
to do everything. I do it myself. I do it myself.
That's the mantra. They have the energy and the
motor skills to interact with the world. aggressively.
So they have the go button, they are ready to
launch. They have the go button firmly, permanently
pressed down. But on the other side, cognitively,
they're in what Piaget calls the pre -operational
stage. They lack logic. They lack judgment. They
cannot predict cause and effect. So they have
a high -performance engine, a heavy foot on the
gas, and absolutely no steering wheel or brakes.
That is the perfect analogy, it's dead on. And
that gap, that chasm between what they can do
and what they understand is where every single
safety risk we discussed today comes from. Let's
break that down then. Let's go to what this child
can do versus cannot do. The exams love to ask
about the difference between a three -year -old
and a five -year -old. It seems granular, but
there's a pattern to it. There is. Let's look
at gross motor skills first. We can call this
the go phase. So the theme here is balance and
just... smoothing out the coordination. Let's
start at three years old. The classic marker
is the tricycle. Three wheels for three years.
Easy enough. Yep. And I always see questions
about stairs here. Tubblers do that marking time
thing where they put both feet on one step before
moving to the next. Right, the shuffle up. The
shuffle up? Yeah. But a three -year -old has
the balance to alternate feet going up the stairs.
Left, right, left, right. Going down is harder.
Gravity. Yeah, because of the visual depth perception
and gravity. So they might still two -foot it
on the way down. They can also stand on one foot,
but only for a few seconds. They're still a little
wobbly. OK, so that is age three. Now, move to
age four. What's the upgrade? Age four is about
agility. Yeah. Now they can hop on one foot reliably.
They can throw a ball overhand. I mean, actually
throwing it, not just showing it forward. A real
throw. A real throw. And here's a big one for
sports readiness. They can catch a bounced ball.
That seems simple, but it's actually a huge neurological
leave, isn't it? It's massive. Yeah. I mean,
think about it. To catch a bounced ball, you
have to track the trajectory, predict where it
will come up, and time your hand closure. A three
-year -old would just let it hit them in the
chest. Exactly. It hits them in the chest, and
then they pick it up. A four -year -old can actually
interact with the moving object. They can move
backward and forward with a lot more agility.
And then we hit age five, the kindergartener.
The five -year -old is physically school ready.
The hallmark here is skipping. Skipping is surprisingly
technical. I feel like we take it for granted.
It is highly technical. It's a hop and a step
in a rhythmic pattern on alternating legs. It
requires cross -body coordination. If you see
a question on an exam about a child skipping,
jumping rope, or doing somersaults, that is a
five -year -old skill. And bikes. They can also
usually ride a bike without training wheels,
and they can learn complex movements like swimming
strokes or skating. So if I'm looking at a clinical
scenario and the child is clumsily running but
falling a lot, that's a toddler. If they are
hopping and catching, that's four. If they are
skipping and skating, five. Precisely. It's a
clear trajectory of balance and complexity. Now,
let's look at fine motor skills. This is the
precision phase. And this seems to link directly
to school readiness markers. Absolutely. 100%.
We track this mostly through drawing and dressing.
At three years old, they are still refining.
They can copy a circle. You said copy, not just
draw. That's an important distinction. Very.
It means if you show them a circle, they can
reproduce it. They can also build a tower of,
say, nine or 10 blocks. But they can't do corners
yet, like a square. Not really. That comes at
age four. At four, they can copy a square. and
a square requires you to stop your pencil, turn
90 degrees, and continue. That is impulse control
in motor form. And four is also the age of scissors,
right? I feel like that's a huge deal. Yes. Using
scissors successfully is a major benchmark. It
requires using the thumb against the other fingers,
that's differentiation, and holding the paper
with the other hand. A lot of coordination. It
is. If a child cannot use scissors by age four
or five, that is a red flag for an occupational
therapy evaluation. It's a major school readiness
skill. What about drawing people? This is always
a funny progression to watch. Ah, the tadpole
person. Yes. That's typically age four. It's
a head with legs coming directly out of the chin.
Usually two to four body parts total. It's hilarious.
But it shows they are starting to represent the
human form. And by five. By five, we see a body.
They draw a trunk, arms, legs, maybe a neck.
Usually six or more body parts. And geometrically,
they can copy a triangle or a diamond. Why is
the diamond so much harder than the square? It's
the diagonals. Crossing the midline and understanding
diagonal relationships is much harder for the
brain than just vertical and horizontal lines.
And the big one for five -year -olds. Oh, yeah.
The five -year -old can tie their shoes. Which
is practically origami with string. It is. It's
highly complex dexterity. If a five -year -old
is tying their shoes, their fine motor development
is right on track. I want to pause on the cannot
do for a second because we see this child tying
shoes, skipping, cutting with scissors, and we
assume they are practically tiny adults. We do.
It's a huge mistake. But the sources highlight
a major deficit in their understanding of time
and context. And this is where the nurse gets
into trouble. You ask a four -year -old, did
you take your medicine at 9 a .m.? We might not.
They have no idea what 9 0 a .m. is. They don't
understand abstract time at all. They understand
events. So how do you talk to them? How do you
get a real answer? You have to relate it to their
routine. Did you take your medicine after breakfast,
or we will go home when cartoons are over, or
when mommy comes back from work? You have to
anchor time to their concrete reality. And what
about the context piece? They can dress themselves,
but they can't choose the clothes, right? Correct.
They have the motor skill to button the shirt,
but they lack the judgment to know that a swimsuit
is not appropriate for a snowstorm. They can't
conceptualize it. Right. They cannot conceptualize
cold as a weather pattern. They only know how
they feel right now in the heated living room.
That brings us perfectly into the mind of the
preschooler, Piaget's preoperational stage. I
have to say, reading through the source material
on this, their logic is just, it's fascinating.
It's like they are living in a dream state. Here's
what Piaget calls magical thinking. And it is
literal. They believe their thoughts are all
powerful. This is probably the defining characteristic
of the pre -operational stage. Give us a clinical
example of how that plays out. Okay, so say a
five -year -old gets really angry at his younger
brother. He thinks in a moment of pure rage,
I wish you would just disappear. The next day,
the brother gets appendicitis and is rushed to
the hospital. Oh no! The preschooler believes,
I mean genuinely believes, that his thought caused
the illness. Wow. So they are carrying around
this massive secret guilt. Huge guilt. They think
they are powerful wizards who hurt people with
their minds. A nurse has to actively debrief
that. You have to say, your brother is sick because
of a germ or a problem in his tummy, not because
you were mad at him. You have to absolve them
of that magical responsibility. That's incredibly
important. And it's not just thoughts, it's objects
too. This idea of animism. Right. They attribute
life and intention to inanimate objects. If they
trip over a toy, the toy is mean. He tried to
trip them. But hospital, that must be terrifying.
It is. An IV pump isn't just a machine beeping,
it's a robot screaming at them. An MRI machine
is a monster with a gaping mouth. They don't
see technology. They see creatures. Which explains
why they're so afraid of the equipment. Exactly.
You can't just say it's a machine. Yeah. That
doesn't work. You have to introduce it like a
pet or a toy to demystify it. The sources also
talk a lot about centration. This is the famous
juice experiment. This really defines their inability
to reason. If you take two identical glasses
of juice and you pour one into a tall, skinny
glass, the preschooler will swear the tall glass
has more juice. Even though they just watched
you pour it from the identical glass? Even though
they watched it. It doesn't matter. Because they
can only center on one variable at a time. They
focus on the height of the liquid and completely
ignore the width. They literally cannot process
two dimensions simultaneously. And that inability
to process two things at once has huge safety
implications. It's the root of so many accidents.
Think about crossing the street. To cross safely,
you have to process the distance of the car and
the speed of the car. Two variables. Two variables.
The preschooler centers on one. The car is far
away. They completely ignore the speed, so they
step out. They physically cannot calculate the
intercept. Then there is transduction. This sounds
technical, but the examples are actually quite
funny until they interfere with care. Transduction
is just faulty logic. It's reasoning from particular
to particular without understanding the general
principle. I ate soup and then I got a fever.
Therefore, soup causes fevers. Or in a nursing
context. The nurse in the yellow scrub top gave
me a shot. You are wearing a yellow scrub top,
therefore you are going to hurt me. You are guilty
by association of color. Exactly. You're prejudged.
And you cannot reason them out of it with logic.
You can't say, no, I'm a different nurse and
yellow is just a color. That logic doesn't land.
So what do you do? You have to change the variable.
Look, I don't have a needle. I have a sticker.
You have to prove it concretely. Show, don't
tell. And finally, egocentrism. I think we all
know some adults who never quite grew out of
this, but for a preschooler, It's a hard cognitive
limit. It's not selfishness. That's a key distinction.
It's not a moral failing. It's an inability to
see any perspective other than their own. The
classic example is the child on the phone with
grandma. Grandma asks, did you have a good day?
And the child just nods their head. And then
they get frustrated that grandma doesn't respond.
Right. Because in their mind, I can see me nodding,
so grandma must be able to see me nodding. They
assume everyone sees, hears, and feels exactly
what they do. So if they are hiding behind a
really thin pole and they can't see you, then
you can't see them, which makes hide seek with
a preschooler hilarious, but also incredibly
dangerous in a parking lot. They think they are
invisible just because they close their eyes.
OK, let's shift gears to the emotional engine
driving this car. What they're trying to achieve,
according to Erickson, the stage is initiative
versus guilt. What is the child actually trying
to do here? They are trying to assert power and
control over their world. They do it through
play and other social interaction. Initiative
is that burning desire to plan something, to
undertake a task, to make something happen. I
do it. I do it. It's that simple. They want to
dress themselves. They want to pour the milk,
even if it spills everywhere. They want to be
the doctor in the play scenario. It is a vital
developmental need. They are energetic learners,
and they feel a massive sense of accomplishment
when they succeed. And the guilt side of that
equation, where does that come from? This happens
when that initiative is constantly crushed. If
a parent is always hovering, saying, no, you'll
spill it, let me do it, or you put your shoes
on the wrong feet, you're so messy, the child
starts to internalize that. They begin to feel
that their activity, their drive to try, is bad.
So it's not just I made a mistake, it's my desire
to try is wrong. That's the core of it. And that
leads to a fearful, passive child. who is afraid
to try new things. Now, there is a nuance here.
Some guilt is necessary. They need to learn that
their initiative has limits. You can't just hit
your brother because you have the initiative
to do so. Right. That's where a conscience comes
from. Exactly. Developing a conscience relies
on a healthy dose of guilt. But the balance has
to tip way over toward initiative. The ultimate
goal is a sense of purpose. Yes. The outcome
should be a sense of purpose. I can make things
happen, and I can do it well. So clinical application.
You have a four -year -old who needs a checkup.
How do you support their initiative in that setting?
You give them jobs. You don't just examine them.
You say, OK, can you hold this stethoscope for
me? Or which ear should I look in first? You
decide. Or can you help me take the wrapper off
this band -aid? You make them a partner in the
exam. You empower them. You turn them into the
assistant. It feeds that hunger for initiative
and it distracts them from the fear. It turns
a passive, scary event into an active, accomplished
event. Okay, let's bring this all together. The
80 -20 synthesis. We've got the magical thinking
brain, the initiative -driven heart, and the
high -performance motor skills. How does this
combination create the specific safety risks
we see in the ER? Let's talk about why this creates
these safety risks. It is the perfect storm.
Let's look at water safety first. Drowning is
a leading cause of death for this age group.
Why? Well, the motor skills are there. They can
definitely climb the pool fence. Right. They
have the agility. No problem there. But why do
they jump in? Magical thinking. They might genuinely
believe they are a mermaid today. And what do
mermaids do? They breathe underwater. They breathe
underwater. Or they think, I can swim with my
floaties on. So they assume they can swim without
them too, right? That's transduction faulty logic.
It is. I floated yesterday with wings, so I will
float today without wings. They don't understand
that the variable of the floaties was the actual
cause. That is just terrifying. It is. You cannot
teach a four -year -old to be water safe reliably.
Supervision, constant supervision, is the only
defense because their logic will betray them
every single time. They might know the rule,
don't go near the pool, but if their ball rolls
in, centration kicks in. They only see the ball.
They focus on the ball, they forget the rule,
and they fall in. Okay, what about firearms?
The sources were very specific about this age
group. This intersects with their inability to
understand concepts like dead or permanent. To
a preschooler, death is reversible. Like in cartoons.
Exactly. They see it in cartoons all the time.
The coyote gets crushed by an anvil, turns into
an accordion, and in the next scene, he's totally
fine. So if they find a gun. Their initiative
says, play with this. Their magical thinking
says, it's a toy. And their cognitive limit says,
if I shoot it, my friend will just get back up.
They do not understand the permanence of the
action. So the nursing education to parents can't
be teach your child not to touch. Absolutely
not. That relies on impulse control they do not
have. The education has to be lock it and unload
it. It has to be engineering controls. You have
to remove the risk entirely. Let's talk about
poisoning. This links right back to centration,
doesn't it? Directly. A pill is small, round,
and brightly colored. A skittle is small, round,
and brightly colored. The child centers on the
appearance. It looks like candy, therefore it
is candy. And because of initiative, they want
to eat it now. They won't ask permission. They
have terrible impulse control. Even if you told
them yesterday not to touch the medicine cabinet,
the immediate visual stimulus of that candy overrides
the memory of the rule. What about burns? This
was another big category. This is a failure to
understand abstract qualities. Hot is invisible.
You can't see the temperature of bath water.
They have the motor skill to turn the faucet
handle. Initiative says, I'll draw my own bath.
But they have no concept that water can burn
skin in seconds. So again, we rely on engineering,
not education. Yes. You set the home water heater
to 120 degrees Fahrenheit, which is 49 Celsius.
So if the child turns the hot water all the way
on, you want to buy yourself time before a scald
burn happens. You cannot rely on the child to
test the water. And finally, pedestrian safety.
We touched on this with the speed of the car,
but there's an egocentrism angle to it, too.
Oh, for sure. It's the I see you, you see me
fallacy. If a child runs into the street after
a ball and they look at the car, they assume
the driver sees them. Because they can see the
driver. Exactly. They also assume the car can
stop instantly, like they can. They don't understand
momentum or braking distance. It really is like
they are operating on a different set of physical
laws. They are operating on cartoon physics.
And parents need to know that. You cannot trust
a preschooler near a street, even if they promise
to look both ways. Their brain literally cannot
process the data correctly. Quick note on car
seats before we move on. The guidelines have
shifted a bit over the years, but what's the
current standard? So forward -facing with a harness
until they outgrow the weight or height limits
of that seat. Then, usually around age 4 or 40
pounds, they transition to a booster seat. And
they stay in that booster for a long time. A
long time. Until they are 4 feet 9 inches tall,
which is usually somewhere between 8 and 12 years
old. And the back seat is always safest. Always.
Non -negotiable. Airbags in the front seat can
be fatal for a preschooler. Okay, let's move
to something a bit lighter. Play. Play is the
work of the child, as they say. How does it change
from the toddler years? Why this leads to this
type of play? So toddlers do what we call parallel
play. They're playing next to each other, but
basically ignoring each other. Right, in their
own little worlds. Completely. Preschoolers graduate
to associative play. Define that for us. They
play together, in a loose group. They might be
swapping blocks or chasing each other around.
But there are no rigid rules. It's unorganized.
So they aren't playing a game of soccer with,
like, positions and a goalie? No. If you watch
preschool soccer, it's a swarm of bees following
the ball. That's associative play in action.
They don't have the cognitive bandwidth for offense
versus defense or complex rules. That's for school
-age kids, which we call cooperative play. And
this is the peak age for imitative or dramatic
play. Oh, absolutely. Dressing up, playing house,
doctor, firefighter. This is pure Erickson. They
are trying on adult roles. They are practicing
reality. It is crucial for their emotional development
to act out these scenarios. It helps them process
what they see in the world. The sources also
mention imaginary friends. I feel like parents
often worry about this. They think, is my kid
hallucinating? It is so normal and so healthy.
It's a creative projection. It allows them to
practice conversation, but it also helps them
externalize their fear. How so? The child might
say, I'm not scared of the dark. But my friend
Bobo is terrifyingly scared. It allows them to
express the emotion without owning the vulnerability.
It's a brilliant coping mechanism. That's smart.
So, exam check. What are the appropriate toys
for this age? You want to think initiative and
motor skills. So, tricycles, wagons, jungle gyms
for gross motor. Right. Blocks. Puzzles with
large pieces for fine motor. and then dress up
clothes, puppets, dolls for that dramatic play.
And what should we avoid? What's a common exam
distractor? Complex board games. They hate rules
and they hate losing. Because they are egocentric.
Yes. If they lose, they feel it as a personal
attack or they'll just cheat because they make
up the rules as they go to ensure they win. It
almost always leads to tears. Stick to open -ended
play where there are no clear winners or losers.
Let's go back into the hospital room, how nurses
use this knowledge on exams and in clinicals.
We talked about the fear of equipment like the
MRI monster, but there's a very specific fear
called fear of mutilation. This is a big one,
a really big one. They have a very poor understanding
of body integrity. They think their skin is basically
a sack that holds everything in. So a needle
puncture. Is a leak. They genuinely fear that
if you poke them with a needle, all their insides
might leak out. They think they might deflate
like a balloon. This sounds ridiculous to an
adult, but for them, it's a primal terror. So
what is the magic bullet intervention here? The
band -aid. The band -aid. It's that simple. To
a preschooler, a band -aid is not a sterile dressing.
It is a seal. It fixes the hole. It keeps the
magic inside. So even if the shot didn't bleed
at all? Doesn't matter. put a Band -Aid on it,
a fun one if you have it, it is psychological
PPE. If you give a shot and leave the hole open,
you might trigger a full blown panic attack because
they think their body is now compromised. And
therapeutic play fits in here too, right? Especially
before a procedure. Yes, it's critical. If you
need to listen to their heart, let them listen
to the teddy bear's heart first, or let them
listen to your heart. It demystifies the monster.
It gives them initiative. I'm the doctor now.
It gives them a sense of control over a very
scary situation. Let's touch on nutrition. This
is often where parents get very, very stressed.
My kid won't eat. We call this physiological
anorexia. It sounds really clinical and scary,
but it just means their appetite drops because
their growth rate has slowed way down. They don't
need the massive amount of calories they needed
as infants. So they aren't starving themselves.
No. They're just regulating. And they become
very picky. Food fads are extremely common. I'll
need chicken nuggets for three weeks. or, I won't
eat anything green. So how should a nurse advise
a parent to handle that? Because it's very stressful.
The key is, do not force feed. Force feeding
creates a power struggle, and it creates guilt,
which is the negative outcome of Erickson's stage.
The rule is, parents decide what is served and
when. The child decides if they eat and how much.
You control the environment, not the child. Exactly.
If they don't eat their broccoli at dinner, they
won't starve. They will eat it the next meal.
and keep portions small. A tablespoon per year
of age is a good rule of thumb. Okay, sleep,
another battlefield. The exams love to test the
difference between nightmares and night terrors.
These are not the same thing. Not at all. They're
completely different neurological events. Let's
break them down. Let's start with nightmares.
Okay. Nightmares happen in REM sleep. That's
dream sleep. The child wakes up fully. They are
crying. They are scared. And most importantly,
they remember the dream. They can tell you, a
bear was chasing me. So the intervention is comfort.
Yes. You hold them. You validate their fear.
You say, that sounds so scary, but you are safe
now. Monsters aren't real. Use a nightlight.
Reassure them. Now, night terrors, these are
different. Totally different. These happen in
deep, non -REM sleep. The child might sit up,
scream, thrash around, their eyes might even
be open. But, and this is the absolute key, they
are not awake. They are asleep, even while screaming.
They are completely asleep. If you try to talk
to them, they look right through you. If you
try to hold them, they might fight you. They
are disoriented and can't be consoled. And the
next morning... They have zero memory of it.
They wake up happy and refreshed. Meanwhile,
the parents are traumatized and haven't slept
all night. So the intervention for night terrors
is completely counterintuitive. It is. You do
not wake them. You will just confuse and agitate
them more. You just sit by the bed, make sure
they don't fall out or hit their head, and you
wait for it to pass. They will settle back down
on their own. That is hard advice for a parent
to follow when their kid is screaming like that.
It's one of the hardest things to do. But waking
them... actually prolongs the episode and scares
them because they wake up to terrified parents
hovering over them. Finally, let's hit the hard
data. Immunizations. The four to six year booster
cluster. These are the kindergarten shots. Right.
They need to boost the immunity they got as babies
before they enter the Petri dish of elementary
school. We have a mnemonic for this one in the
sources. Very deep. VDIM. It helps you remember
the four key shots they get in this window. Walk
us through it. So V is for Varicella, the chickenpox
vaccine. This is the second dose. D is for DTaP,
diphtheria, tetanus, and pertussis. This is the
fifth dose in that series. I is for IPV inactivated
polio vaccine. That's the fourth dose. And M
is for MMR measles, mumps, and rubella. The second
dose. Very dim. Varicella, DTaP, IPV, MMR. And
there's one more, right? The annual one? The
flu shot. Now, for this age group, you have a
choice. You can do the shot, the inactivated
vaccine, or you can do the nasal spray, the live
attenuated one, LAIV. Kids obviously prefer the
spray, but there are rules. There are. The spray
is a live virus, so you cannot give it to a child
who is immunocompromised or has asthma. If they
have any history of wheezing, you have to stick
to the shot. That's a classic exam trick question.
Got it. OK, we have covered a massive amount
of ground here, from tadpole people drawings
to the philosophy of death in cartoons. this
up with our 80 -20 summary box. If the listener
walks away with only four concepts that will
answer most of the questions, what are they?
Here is the cheat sheet. This is what you need
to know. If you know they are magical thinkers
from Piaget... You know why they think they cause
their sibling's illness, and while you absolutely
cannot trust them near a pool, they think they
can fly or breathe underwater. Okay, number two.
Number two. If you know they are driven by initiative
from Erickson, you know to let them hold the
stethoscope and help dress themselves to prevent
anxiety and guilt, you turn the exam into a job
they can perform. Number three. Number three,
if you know they fear mutilation, you know that
a bandaid is more important to the child than
the actual medicine. It seals the leak. It is
the most critical tool you have. And number four.
And number four, if you know they engage in associative
play, you know they will play near others and
share toys, but they are not ready for the complex
rules of board games or team sports. don't pick
Monopoly as the right toy. It really does all
connect. When you stop just memorizing the lists
and start looking at the developmental logic
behind it, the answers just, they appear. That's
the goal. That's the whole point. Understanding
the why makes the what obvious. I want to leave
everyone with a final thought to chew on. We
talked about the preschooler as a contradiction.
And I was thinking, they are basically little
scienti -