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 --> 00:00:46.850 fast. Welcome to the emergency room. Welcome 00:00:46.850 --> 00:00:49.789 back to The Deep Dive. Today we are opening up 00:00:49.789 --> 00:00:53.090 a file that creates a very specific kind of anxiety 00:00:53.090 --> 00:00:57.490 for nursing students and frankly, new parents 00:00:57.490 --> 00:01:00.240 alike. We are talking about the preschooler, 00:01:00.640 --> 00:01:04.189 that distinct somewhat chaotic window between 00:01:04.189 --> 00:01:07.329 ages three and six. It is such a deceptive age 00:01:07.329 --> 00:01:09.250 group, and I think deceptive because, you know, 00:01:09.269 --> 00:01:10.750 on the surface they look like they've got it 00:01:10.750 --> 00:01:13.189 together. Right. They're adorable, they're starting 00:01:13.189 --> 00:01:15.209 to talk in full sentences, they're funny, they 00:01:15.209 --> 00:01:17.989 can dress themselves mostly. Mostly, yes. But 00:01:17.989 --> 00:01:21.510 when you dig into the safety data and the developmental 00:01:21.510 --> 00:01:23.810 psychology, which is exactly what we're doing 00:01:23.810 --> 00:01:27.290 today, you realize this is a terrifyingly dangerous 00:01:27.290 --> 00:01:30.400 window of time. It's... Arguably the most contradictory 00:01:30.400 --> 00:01:32.400 stage of human development I mean you have a 00:01:32.400 --> 00:01:34.760 child who is physically capable of almost anything 00:01:34.760 --> 00:01:37.200 climbing fences opening locked doors striking 00:01:37.200 --> 00:01:40.040 matches. Oh, yeah But cognitively, they're living 00:01:40.040 --> 00:01:43.060 in a complete fantasy world. They have zero reliable 00:01:43.060 --> 00:01:45.859 judgment. And that's the tension. That's exactly 00:01:45.859 --> 00:01:48.079 the tension we are going to explore. We've pulled 00:01:48.079 --> 00:01:50.400 together a massive stack of sources for this. 00:01:50.959 --> 00:01:54.859 We're looking at the 2025 CDC immunization schedules, 00:01:55.420 --> 00:01:57.819 the latest clinical presentations from Wolters 00:01:57.819 --> 00:02:00.420 Kluwer on growth and development. And, of course, 00:02:00.519 --> 00:02:02.879 those incredibly dense chapters on health promotion 00:02:02.879 --> 00:02:05.579 and safety from the standard pediatric nursing 00:02:05.579 --> 00:02:07.739 text. The ones everyone dreads. The ones with 00:02:07.739 --> 00:02:09.960 all the lists. And if you look at those texts, 00:02:10.539 --> 00:02:13.599 the sheer volume of dos and don'ts for this age 00:02:13.599 --> 00:02:17.500 group is just, it's overwhelming. You have lists 00:02:17.500 --> 00:02:20.300 of milestones, lists of poisons, lists of vaccine 00:02:20.300 --> 00:02:22.800 schedules. It's enough to make a student want 00:02:22.800 --> 00:02:25.300 to just drop out. Which brings us to our mission 00:02:25.300 --> 00:02:27.919 for this deep dive. We are applying the 80 -20 00:02:27.919 --> 00:02:30.000 rule. We are not going to just read the lists. 00:02:30.139 --> 00:02:32.479 We are going to try to understand the operating 00:02:32.479 --> 00:02:34.439 system of the three - to six -year -old. Right. 00:02:34.539 --> 00:02:37.460 Because if you understand how they think, and 00:02:37.460 --> 00:02:40.020 that's all Piagia, and what drives them emotionally, 00:02:40.099 --> 00:02:42.419 which is Ericsson, you don't need to memorize 00:02:42.419 --> 00:02:44.539 the safety lists. You can predict them. You can 00:02:44.539 --> 00:02:47.379 predict them. They just become obvious. So. Whether 00:02:47.379 --> 00:02:49.580 you are a nursing student trying to survive a 00:02:49.580 --> 00:02:52.780 PEDS exam or a clinician trying to explain to 00:02:52.780 --> 00:02:55.439 a parent why their four -year -old is lying about 00:02:55.439 --> 00:02:58.199 eating a cookie while literally holding the cookie, 00:02:59.639 --> 00:03:02.400 this is for you. Let's do it. Let's start with 00:03:02.400 --> 00:03:05.099 the hardware, the big picture developmental theme. 00:03:05.840 --> 00:03:09.780 Physically, this child is just transformed. It's 00:03:09.780 --> 00:03:12.460 a dramatic shift. If you picture a toddler in 00:03:12.460 --> 00:03:16.090 your mind, you're picturing that Potbelly look 00:03:16.090 --> 00:03:18.590 totally the sway back the whole thing exactly 00:03:18.590 --> 00:03:20.229 they have that sway back their legs are short 00:03:20.229 --> 00:03:22.530 They have this wide stance just to stay upright. 00:03:22.710 --> 00:03:24.789 They are top -heavy They look like they're about 00:03:24.789 --> 00:03:27.330 to tip over at any second but by age three or 00:03:27.330 --> 00:03:29.909 four that silhouette completely changes the pot 00:03:29.909 --> 00:03:33.349 belly just like It vanishes it stretches out 00:03:33.349 --> 00:03:36.270 and the growth rate actually slows down significantly 00:03:36.270 --> 00:03:39.490 compared to infancy They are gaining, you know 00:03:39.490 --> 00:03:41.229 about four to five pounds a year and growing 00:03:41.229 --> 00:03:43.069 maybe two and a half to three inches Which is 00:03:43.069 --> 00:03:46.629 much less than infancy? Much less. But the quality 00:03:46.629 --> 00:03:49.210 of the tissue changes. That's the key. They lose 00:03:49.210 --> 00:03:52.069 the baby fat. They gain abdominal muscle. The 00:03:52.069 --> 00:03:54.650 spine straightens out. They become slender, upright, 00:03:55.250 --> 00:03:57.729 and kind of graceful. And that physical change 00:03:57.729 --> 00:04:00.210 isn't just aesthetic. It's functional. I mean, 00:04:00.409 --> 00:04:03.229 that loss of bulk and gain of muscle is what 00:04:03.229 --> 00:04:05.530 unlocks that explosion in motor skills we're 00:04:05.530 --> 00:04:08.000 about to talk about. Exactly. You can't hop on 00:04:08.000 --> 00:04:10.520 one foot if you have a massive center of gravity 00:04:10.520 --> 00:04:13.759 and weak abs. The physical maturation allows 00:04:13.759 --> 00:04:15.979 the neurological development to really shine. 00:04:16.459 --> 00:04:18.399 OK, so let's frame the core conflict before we 00:04:18.399 --> 00:04:20.360 get into the specific milestones, because looking 00:04:20.360 --> 00:04:22.879 at the sources, this feels like the setup for 00:04:22.879 --> 00:04:25.500 a disaster movie. It essentially is. It really 00:04:25.500 --> 00:04:28.180 is. Here is the conflict. On one side, you have 00:04:28.180 --> 00:04:30.660 Erickson's stage of initiative. The child wants 00:04:30.660 --> 00:04:32.620 to do everything. I do it myself. I do it myself. 00:04:32.699 --> 00:04:35.000 That's the mantra. They have the energy and the 00:04:35.000 --> 00:04:38.209 motor skills to interact with the world. aggressively. 00:04:38.589 --> 00:04:40.790 So they have the go button, they are ready to 00:04:40.790 --> 00:04:43.930 launch. They have the go button firmly, permanently 00:04:43.930 --> 00:04:47.509 pressed down. But on the other side, cognitively, 00:04:47.629 --> 00:04:49.670 they're in what Piaget calls the pre -operational 00:04:49.670 --> 00:04:52.910 stage. They lack logic. They lack judgment. They 00:04:52.910 --> 00:04:55.649 cannot predict cause and effect. So they have 00:04:55.649 --> 00:04:58.149 a high -performance engine, a heavy foot on the 00:04:58.149 --> 00:05:00.870 gas, and absolutely no steering wheel or brakes. 00:05:00.990 --> 00:05:04.810 That is the perfect analogy, it's dead on. And 00:05:04.810 --> 00:05:07.689 that gap, that chasm between what they can do 00:05:07.689 --> 00:05:10.730 and what they understand is where every single 00:05:10.730 --> 00:05:13.269 safety risk we discussed today comes from. Let's 00:05:13.269 --> 00:05:15.870 break that down then. Let's go to what this child 00:05:15.870 --> 00:05:18.790 can do versus cannot do. The exams love to ask 00:05:18.790 --> 00:05:20.329 about the difference between a three -year -old 00:05:20.329 --> 00:05:22.050 and a five -year -old. It seems granular, but 00:05:22.050 --> 00:05:23.990 there's a pattern to it. There is. Let's look 00:05:23.990 --> 00:05:25.750 at gross motor skills first. We can call this 00:05:25.750 --> 00:05:28.430 the go phase. So the theme here is balance and 00:05:28.430 --> 00:05:31.199 just... smoothing out the coordination. Let's 00:05:31.199 --> 00:05:33.240 start at three years old. The classic marker 00:05:33.240 --> 00:05:35.300 is the tricycle. Three wheels for three years. 00:05:35.459 --> 00:05:38.139 Easy enough. Yep. And I always see questions 00:05:38.139 --> 00:05:40.740 about stairs here. Tubblers do that marking time 00:05:40.740 --> 00:05:42.660 thing where they put both feet on one step before 00:05:42.660 --> 00:05:44.800 moving to the next. Right, the shuffle up. The 00:05:44.800 --> 00:05:47.019 shuffle up? Yeah. But a three -year -old has 00:05:47.019 --> 00:05:49.300 the balance to alternate feet going up the stairs. 00:05:49.500 --> 00:05:52.300 Left, right, left, right. Going down is harder. 00:05:52.459 --> 00:05:54.759 Gravity. Yeah, because of the visual depth perception 00:05:54.759 --> 00:05:56.620 and gravity. So they might still two -foot it 00:05:56.620 --> 00:05:59.019 on the way down. They can also stand on one foot, 00:05:59.079 --> 00:06:00.860 but only for a few seconds. They're still a little 00:06:00.860 --> 00:06:04.319 wobbly. OK, so that is age three. Now, move to 00:06:04.319 --> 00:06:07.319 age four. What's the upgrade? Age four is about 00:06:07.319 --> 00:06:10.259 agility. Yeah. Now they can hop on one foot reliably. 00:06:10.579 --> 00:06:12.819 They can throw a ball overhand. I mean, actually 00:06:12.819 --> 00:06:15.040 throwing it, not just showing it forward. A real 00:06:15.040 --> 00:06:17.920 throw. A real throw. And here's a big one for 00:06:17.920 --> 00:06:20.600 sports readiness. They can catch a bounced ball. 00:06:20.989 --> 00:06:24.310 That seems simple, but it's actually a huge neurological 00:06:24.310 --> 00:06:26.329 leave, isn't it? It's massive. Yeah. I mean, 00:06:26.350 --> 00:06:28.410 think about it. To catch a bounced ball, you 00:06:28.410 --> 00:06:30.850 have to track the trajectory, predict where it 00:06:30.850 --> 00:06:33.970 will come up, and time your hand closure. A three 00:06:33.970 --> 00:06:35.250 -year -old would just let it hit them in the 00:06:35.250 --> 00:06:37.009 chest. Exactly. It hits them in the chest, and 00:06:37.009 --> 00:06:39.649 then they pick it up. A four -year -old can actually 00:06:39.649 --> 00:06:42.230 interact with the moving object. They can move 00:06:42.230 --> 00:06:43.970 backward and forward with a lot more agility. 00:06:44.290 --> 00:06:48.189 And then we hit age five, the kindergartener. 00:06:48.480 --> 00:06:50.980 The five -year -old is physically school ready. 00:06:51.800 --> 00:06:55.540 The hallmark here is skipping. Skipping is surprisingly 00:06:55.540 --> 00:06:57.759 technical. I feel like we take it for granted. 00:06:57.980 --> 00:07:00.199 It is highly technical. It's a hop and a step 00:07:00.199 --> 00:07:03.079 in a rhythmic pattern on alternating legs. It 00:07:03.079 --> 00:07:05.500 requires cross -body coordination. If you see 00:07:05.500 --> 00:07:07.939 a question on an exam about a child skipping, 00:07:08.579 --> 00:07:11.199 jumping rope, or doing somersaults, that is a 00:07:11.199 --> 00:07:13.629 five -year -old skill. And bikes. They can also 00:07:13.629 --> 00:07:15.430 usually ride a bike without training wheels, 00:07:15.790 --> 00:07:18.269 and they can learn complex movements like swimming 00:07:18.269 --> 00:07:20.949 strokes or skating. So if I'm looking at a clinical 00:07:20.949 --> 00:07:23.949 scenario and the child is clumsily running but 00:07:23.949 --> 00:07:26.750 falling a lot, that's a toddler. If they are 00:07:26.750 --> 00:07:29.110 hopping and catching, that's four. If they are 00:07:29.110 --> 00:07:32.089 skipping and skating, five. Precisely. It's a 00:07:32.089 --> 00:07:34.699 clear trajectory of balance and complexity. Now, 00:07:34.699 --> 00:07:36.720 let's look at fine motor skills. This is the 00:07:36.720 --> 00:07:39.160 precision phase. And this seems to link directly 00:07:39.160 --> 00:07:41.800 to school readiness markers. Absolutely. 100%. 00:07:41.800 --> 00:07:44.079 We track this mostly through drawing and dressing. 00:07:44.480 --> 00:07:46.800 At three years old, they are still refining. 00:07:46.860 --> 00:07:49.600 They can copy a circle. You said copy, not just 00:07:49.600 --> 00:07:51.660 draw. That's an important distinction. Very. 00:07:52.060 --> 00:07:54.220 It means if you show them a circle, they can 00:07:54.220 --> 00:07:56.480 reproduce it. They can also build a tower of, 00:07:56.920 --> 00:07:58.860 say, nine or 10 blocks. But they can't do corners 00:07:58.860 --> 00:08:01.480 yet, like a square. Not really. That comes at 00:08:01.480 --> 00:08:04.930 age four. At four, they can copy a square. and 00:08:04.930 --> 00:08:07.050 a square requires you to stop your pencil, turn 00:08:07.050 --> 00:08:10.689 90 degrees, and continue. That is impulse control 00:08:10.689 --> 00:08:13.589 in motor form. And four is also the age of scissors, 00:08:13.709 --> 00:08:16.709 right? I feel like that's a huge deal. Yes. Using 00:08:16.709 --> 00:08:19.750 scissors successfully is a major benchmark. It 00:08:19.750 --> 00:08:22.110 requires using the thumb against the other fingers, 00:08:22.370 --> 00:08:24.810 that's differentiation, and holding the paper 00:08:24.810 --> 00:08:26.829 with the other hand. A lot of coordination. It 00:08:26.829 --> 00:08:29.649 is. If a child cannot use scissors by age four 00:08:29.649 --> 00:08:32.590 or five, that is a red flag for an occupational 00:08:32.590 --> 00:08:35.659 therapy evaluation. It's a major school readiness 00:08:35.659 --> 00:08:38.379 skill. What about drawing people? This is always 00:08:38.379 --> 00:08:40.500 a funny progression to watch. Ah, the tadpole 00:08:40.500 --> 00:08:42.899 person. Yes. That's typically age four. It's 00:08:42.899 --> 00:08:45.120 a head with legs coming directly out of the chin. 00:08:45.639 --> 00:08:49.399 Usually two to four body parts total. It's hilarious. 00:08:49.620 --> 00:08:51.980 But it shows they are starting to represent the 00:08:51.980 --> 00:08:54.980 human form. And by five. By five, we see a body. 00:08:55.179 --> 00:08:57.980 They draw a trunk, arms, legs, maybe a neck. 00:08:58.519 --> 00:09:01.480 Usually six or more body parts. And geometrically, 00:09:01.500 --> 00:09:04.179 they can copy a triangle or a diamond. Why is 00:09:04.179 --> 00:09:06.600 the diamond so much harder than the square? It's 00:09:06.600 --> 00:09:09.279 the diagonals. Crossing the midline and understanding 00:09:09.279 --> 00:09:11.559 diagonal relationships is much harder for the 00:09:11.559 --> 00:09:13.899 brain than just vertical and horizontal lines. 00:09:14.120 --> 00:09:16.100 And the big one for five -year -olds. Oh, yeah. 00:09:16.659 --> 00:09:19.019 The five -year -old can tie their shoes. Which 00:09:19.019 --> 00:09:22.379 is practically origami with string. It is. It's 00:09:22.379 --> 00:09:25.100 highly complex dexterity. If a five -year -old 00:09:25.100 --> 00:09:27.899 is tying their shoes, their fine motor development 00:09:27.899 --> 00:09:30.669 is right on track. I want to pause on the cannot 00:09:30.669 --> 00:09:33.789 do for a second because we see this child tying 00:09:33.789 --> 00:09:36.629 shoes, skipping, cutting with scissors, and we 00:09:36.629 --> 00:09:39.110 assume they are practically tiny adults. We do. 00:09:39.149 --> 00:09:41.470 It's a huge mistake. But the sources highlight 00:09:41.470 --> 00:09:44.409 a major deficit in their understanding of time 00:09:44.409 --> 00:09:46.549 and context. And this is where the nurse gets 00:09:46.549 --> 00:09:48.769 into trouble. You ask a four -year -old, did 00:09:48.769 --> 00:09:51.750 you take your medicine at 9 a .m.? We might not. 00:09:51.970 --> 00:09:54.149 They have no idea what 9 0 a .m. is. They don't 00:09:54.149 --> 00:09:56.309 understand abstract time at all. They understand 00:09:56.309 --> 00:09:58.539 events. So how do you talk to them? How do you 00:09:58.539 --> 00:10:01.759 get a real answer? You have to relate it to their 00:10:01.759 --> 00:10:05.059 routine. Did you take your medicine after breakfast, 00:10:05.500 --> 00:10:08.879 or we will go home when cartoons are over, or 00:10:08.879 --> 00:10:11.059 when mommy comes back from work? You have to 00:10:11.059 --> 00:10:14.620 anchor time to their concrete reality. And what 00:10:14.620 --> 00:10:16.600 about the context piece? They can dress themselves, 00:10:16.620 --> 00:10:18.940 but they can't choose the clothes, right? Correct. 00:10:19.159 --> 00:10:20.899 They have the motor skill to button the shirt, 00:10:20.980 --> 00:10:24.059 but they lack the judgment to know that a swimsuit 00:10:24.059 --> 00:10:26.350 is not appropriate for a snowstorm. They can't 00:10:26.350 --> 00:10:28.950 conceptualize it. Right. They cannot conceptualize 00:10:28.950 --> 00:10:31.730 cold as a weather pattern. They only know how 00:10:31.730 --> 00:10:33.850 they feel right now in the heated living room. 00:10:34.129 --> 00:10:36.590 That brings us perfectly into the mind of the 00:10:36.590 --> 00:10:40.409 preschooler, Piaget's preoperational stage. I 00:10:40.409 --> 00:10:42.370 have to say, reading through the source material 00:10:42.370 --> 00:10:45.929 on this, their logic is just, it's fascinating. 00:10:46.029 --> 00:10:48.190 It's like they are living in a dream state. Here's 00:10:48.190 --> 00:10:50.970 what Piaget calls magical thinking. And it is 00:10:50.970 --> 00:10:53.429 literal. They believe their thoughts are all 00:10:53.429 --> 00:10:57.139 powerful. This is probably the defining characteristic 00:10:57.139 --> 00:10:59.279 of the pre -operational stage. Give us a clinical 00:10:59.279 --> 00:11:02.360 example of how that plays out. Okay, so say a 00:11:02.360 --> 00:11:04.700 five -year -old gets really angry at his younger 00:11:04.700 --> 00:11:08.200 brother. He thinks in a moment of pure rage, 00:11:08.379 --> 00:11:11.299 I wish you would just disappear. The next day, 00:11:11.440 --> 00:11:13.440 the brother gets appendicitis and is rushed to 00:11:13.440 --> 00:11:16.799 the hospital. Oh no! The preschooler believes, 00:11:17.159 --> 00:11:20.649 I mean genuinely believes, that his thought caused 00:11:20.649 --> 00:11:23.070 the illness. Wow. So they are carrying around 00:11:23.070 --> 00:11:26.950 this massive secret guilt. Huge guilt. They think 00:11:26.950 --> 00:11:29.049 they are powerful wizards who hurt people with 00:11:29.049 --> 00:11:32.139 their minds. A nurse has to actively debrief 00:11:32.139 --> 00:11:34.600 that. You have to say, your brother is sick because 00:11:34.600 --> 00:11:36.840 of a germ or a problem in his tummy, not because 00:11:36.840 --> 00:11:39.279 you were mad at him. You have to absolve them 00:11:39.279 --> 00:11:41.759 of that magical responsibility. That's incredibly 00:11:41.759 --> 00:11:44.139 important. And it's not just thoughts, it's objects 00:11:44.139 --> 00:11:46.700 too. This idea of animism. Right. They attribute 00:11:46.700 --> 00:11:50.039 life and intention to inanimate objects. If they 00:11:50.039 --> 00:11:53.580 trip over a toy, the toy is mean. He tried to 00:11:53.580 --> 00:11:55.559 trip them. But hospital, that must be terrifying. 00:11:55.659 --> 00:11:58.159 It is. An IV pump isn't just a machine beeping, 00:11:58.220 --> 00:12:01.009 it's a robot screaming at them. An MRI machine 00:12:01.009 --> 00:12:03.549 is a monster with a gaping mouth. They don't 00:12:03.549 --> 00:12:06.289 see technology. They see creatures. Which explains 00:12:06.289 --> 00:12:08.730 why they're so afraid of the equipment. Exactly. 00:12:08.909 --> 00:12:11.169 You can't just say it's a machine. Yeah. That 00:12:11.169 --> 00:12:13.570 doesn't work. You have to introduce it like a 00:12:13.570 --> 00:12:17.269 pet or a toy to demystify it. The sources also 00:12:17.269 --> 00:12:19.789 talk a lot about centration. This is the famous 00:12:19.789 --> 00:12:23.210 juice experiment. This really defines their inability 00:12:23.210 --> 00:12:26.350 to reason. If you take two identical glasses 00:12:26.350 --> 00:12:29.610 of juice and you pour one into a tall, skinny 00:12:29.610 --> 00:12:32.809 glass, the preschooler will swear the tall glass 00:12:32.809 --> 00:12:35.049 has more juice. Even though they just watched 00:12:35.049 --> 00:12:36.909 you pour it from the identical glass? Even though 00:12:36.909 --> 00:12:38.649 they watched it. It doesn't matter. Because they 00:12:38.649 --> 00:12:41.210 can only center on one variable at a time. They 00:12:41.210 --> 00:12:43.470 focus on the height of the liquid and completely 00:12:43.470 --> 00:12:46.110 ignore the width. They literally cannot process 00:12:46.110 --> 00:12:48.429 two dimensions simultaneously. And that inability 00:12:48.429 --> 00:12:51.350 to process two things at once has huge safety 00:12:51.350 --> 00:12:53.929 implications. It's the root of so many accidents. 00:12:54.110 --> 00:12:56.649 Think about crossing the street. To cross safely, 00:12:56.929 --> 00:12:59.350 you have to process the distance of the car and 00:12:59.350 --> 00:13:01.490 the speed of the car. Two variables. Two variables. 00:13:01.929 --> 00:13:04.570 The preschooler centers on one. The car is far 00:13:04.570 --> 00:13:07.669 away. They completely ignore the speed, so they 00:13:07.669 --> 00:13:10.250 step out. They physically cannot calculate the 00:13:10.250 --> 00:13:13.570 intercept. Then there is transduction. This sounds 00:13:13.570 --> 00:13:15.549 technical, but the examples are actually quite 00:13:15.549 --> 00:13:18.990 funny until they interfere with care. Transduction 00:13:18.990 --> 00:13:22.320 is just faulty logic. It's reasoning from particular 00:13:22.320 --> 00:13:24.679 to particular without understanding the general 00:13:24.679 --> 00:13:27.620 principle. I ate soup and then I got a fever. 00:13:28.240 --> 00:13:31.580 Therefore, soup causes fevers. Or in a nursing 00:13:31.580 --> 00:13:34.179 context. The nurse in the yellow scrub top gave 00:13:34.179 --> 00:13:36.590 me a shot. You are wearing a yellow scrub top, 00:13:36.669 --> 00:13:39.370 therefore you are going to hurt me. You are guilty 00:13:39.370 --> 00:13:42.809 by association of color. Exactly. You're prejudged. 00:13:43.190 --> 00:13:45.330 And you cannot reason them out of it with logic. 00:13:45.590 --> 00:13:47.289 You can't say, no, I'm a different nurse and 00:13:47.289 --> 00:13:49.750 yellow is just a color. That logic doesn't land. 00:13:49.909 --> 00:13:51.750 So what do you do? You have to change the variable. 00:13:51.990 --> 00:13:53.549 Look, I don't have a needle. I have a sticker. 00:13:53.769 --> 00:13:56.429 You have to prove it concretely. Show, don't 00:13:56.429 --> 00:14:00.889 tell. And finally, egocentrism. I think we all 00:14:00.889 --> 00:14:02.990 know some adults who never quite grew out of 00:14:02.990 --> 00:14:06.419 this, but for a preschooler, It's a hard cognitive 00:14:06.419 --> 00:14:08.700 limit. It's not selfishness. That's a key distinction. 00:14:08.860 --> 00:14:12.419 It's not a moral failing. It's an inability to 00:14:12.419 --> 00:14:15.179 see any perspective other than their own. The 00:14:15.179 --> 00:14:17.100 classic example is the child on the phone with 00:14:17.100 --> 00:14:19.620 grandma. Grandma asks, did you have a good day? 00:14:19.960 --> 00:14:22.059 And the child just nods their head. And then 00:14:22.059 --> 00:14:23.779 they get frustrated that grandma doesn't respond. 00:14:23.980 --> 00:14:27.000 Right. Because in their mind, I can see me nodding, 00:14:27.120 --> 00:14:29.500 so grandma must be able to see me nodding. They 00:14:29.500 --> 00:14:32.379 assume everyone sees, hears, and feels exactly 00:14:32.379 --> 00:14:34.940 what they do. So if they are hiding behind a 00:14:34.940 --> 00:14:37.419 really thin pole and they can't see you, then 00:14:37.419 --> 00:14:39.879 you can't see them, which makes hide seek with 00:14:39.879 --> 00:14:43.320 a preschooler hilarious, but also incredibly 00:14:43.320 --> 00:14:45.980 dangerous in a parking lot. They think they are 00:14:45.980 --> 00:14:47.919 invisible just because they close their eyes. 00:14:48.059 --> 00:14:50.460 OK, let's shift gears to the emotional engine 00:14:50.460 --> 00:14:53.419 driving this car. What they're trying to achieve, 00:14:53.639 --> 00:14:57.179 according to Erickson, the stage is initiative 00:14:57.179 --> 00:14:59.919 versus guilt. What is the child actually trying 00:14:59.919 --> 00:15:03.250 to do here? They are trying to assert power and 00:15:03.250 --> 00:15:05.549 control over their world. They do it through 00:15:05.549 --> 00:15:08.350 play and other social interaction. Initiative 00:15:08.350 --> 00:15:11.769 is that burning desire to plan something, to 00:15:11.769 --> 00:15:14.090 undertake a task, to make something happen. I 00:15:14.090 --> 00:15:17.750 do it. I do it. It's that simple. They want to 00:15:17.750 --> 00:15:19.250 dress themselves. They want to pour the milk, 00:15:19.370 --> 00:15:21.289 even if it spills everywhere. They want to be 00:15:21.289 --> 00:15:24.450 the doctor in the play scenario. It is a vital 00:15:24.450 --> 00:15:27.029 developmental need. They are energetic learners, 00:15:27.029 --> 00:15:29.529 and they feel a massive sense of accomplishment 00:15:29.529 --> 00:15:32.629 when they succeed. And the guilt side of that 00:15:32.629 --> 00:15:35.129 equation, where does that come from? This happens 00:15:35.129 --> 00:15:38.269 when that initiative is constantly crushed. If 00:15:38.269 --> 00:15:40.669 a parent is always hovering, saying, no, you'll 00:15:40.669 --> 00:15:42.850 spill it, let me do it, or you put your shoes 00:15:42.850 --> 00:15:45.629 on the wrong feet, you're so messy, the child 00:15:45.629 --> 00:15:48.269 starts to internalize that. They begin to feel 00:15:48.269 --> 00:15:51.289 that their activity, their drive to try, is bad. 00:15:51.570 --> 00:15:54.769 So it's not just I made a mistake, it's my desire 00:15:54.769 --> 00:15:57.590 to try is wrong. That's the core of it. And that 00:15:57.590 --> 00:16:00.539 leads to a fearful, passive child. who is afraid 00:16:00.539 --> 00:16:03.679 to try new things. Now, there is a nuance here. 00:16:04.139 --> 00:16:06.700 Some guilt is necessary. They need to learn that 00:16:06.700 --> 00:16:08.940 their initiative has limits. You can't just hit 00:16:08.940 --> 00:16:10.559 your brother because you have the initiative 00:16:10.559 --> 00:16:12.320 to do so. Right. That's where a conscience comes 00:16:12.320 --> 00:16:14.879 from. Exactly. Developing a conscience relies 00:16:14.879 --> 00:16:17.539 on a healthy dose of guilt. But the balance has 00:16:17.539 --> 00:16:20.049 to tip way over toward initiative. The ultimate 00:16:20.049 --> 00:16:22.789 goal is a sense of purpose. Yes. The outcome 00:16:22.789 --> 00:16:25.070 should be a sense of purpose. I can make things 00:16:25.070 --> 00:16:28.370 happen, and I can do it well. So clinical application. 00:16:28.450 --> 00:16:30.129 You have a four -year -old who needs a checkup. 00:16:30.250 --> 00:16:33.769 How do you support their initiative in that setting? 00:16:33.870 --> 00:16:36.090 You give them jobs. You don't just examine them. 00:16:36.090 --> 00:16:38.230 You say, OK, can you hold this stethoscope for 00:16:38.230 --> 00:16:40.590 me? Or which ear should I look in first? You 00:16:40.590 --> 00:16:43.190 decide. Or can you help me take the wrapper off 00:16:43.190 --> 00:16:45.610 this band -aid? You make them a partner in the 00:16:45.610 --> 00:16:48.429 exam. You empower them. You turn them into the 00:16:48.429 --> 00:16:51.360 assistant. It feeds that hunger for initiative 00:16:51.360 --> 00:16:53.840 and it distracts them from the fear. It turns 00:16:53.840 --> 00:16:57.179 a passive, scary event into an active, accomplished 00:16:57.179 --> 00:16:59.320 event. Okay, let's bring this all together. The 00:16:59.320 --> 00:17:01.860 80 -20 synthesis. We've got the magical thinking 00:17:01.860 --> 00:17:04.640 brain, the initiative -driven heart, and the 00:17:04.640 --> 00:17:07.200 high -performance motor skills. How does this 00:17:07.200 --> 00:17:10.180 combination create the specific safety risks 00:17:10.180 --> 00:17:13.440 we see in the ER? Let's talk about why this creates 00:17:13.440 --> 00:17:15.500 these safety risks. It is the perfect storm. 00:17:15.619 --> 00:17:18.700 Let's look at water safety first. Drowning is 00:17:18.700 --> 00:17:20.660 a leading cause of death for this age group. 00:17:21.119 --> 00:17:23.519 Why? Well, the motor skills are there. They can 00:17:23.519 --> 00:17:25.599 definitely climb the pool fence. Right. They 00:17:25.599 --> 00:17:28.000 have the agility. No problem there. But why do 00:17:28.000 --> 00:17:31.059 they jump in? Magical thinking. They might genuinely 00:17:31.059 --> 00:17:33.180 believe they are a mermaid today. And what do 00:17:33.180 --> 00:17:35.140 mermaids do? They breathe underwater. They breathe 00:17:35.140 --> 00:17:37.960 underwater. Or they think, I can swim with my 00:17:37.960 --> 00:17:40.059 floaties on. So they assume they can swim without 00:17:40.059 --> 00:17:42.799 them too, right? That's transduction faulty logic. 00:17:42.920 --> 00:17:45.619 It is. I floated yesterday with wings, so I will 00:17:45.619 --> 00:17:48.740 float today without wings. They don't understand 00:17:48.740 --> 00:17:51.799 that the variable of the floaties was the actual 00:17:51.799 --> 00:17:55.680 cause. That is just terrifying. It is. You cannot 00:17:55.680 --> 00:17:58.140 teach a four -year -old to be water safe reliably. 00:17:59.059 --> 00:18:01.160 Supervision, constant supervision, is the only 00:18:01.160 --> 00:18:03.640 defense because their logic will betray them 00:18:03.640 --> 00:18:06.359 every single time. They might know the rule, 00:18:06.480 --> 00:18:08.859 don't go near the pool, but if their ball rolls 00:18:08.859 --> 00:18:11.380 in, centration kicks in. They only see the ball. 00:18:11.480 --> 00:18:13.220 They focus on the ball, they forget the rule, 00:18:13.279 --> 00:18:15.839 and they fall in. Okay, what about firearms? 00:18:16.160 --> 00:18:18.660 The sources were very specific about this age 00:18:18.660 --> 00:18:20.960 group. This intersects with their inability to 00:18:20.960 --> 00:18:24.319 understand concepts like dead or permanent. To 00:18:24.319 --> 00:18:27.680 a preschooler, death is reversible. Like in cartoons. 00:18:28.180 --> 00:18:30.200 Exactly. They see it in cartoons all the time. 00:18:30.279 --> 00:18:32.759 The coyote gets crushed by an anvil, turns into 00:18:32.759 --> 00:18:35.220 an accordion, and in the next scene, he's totally 00:18:35.220 --> 00:18:37.380 fine. So if they find a gun. Their initiative 00:18:37.380 --> 00:18:39.539 says, play with this. Their magical thinking 00:18:39.539 --> 00:18:42.440 says, it's a toy. And their cognitive limit says, 00:18:42.640 --> 00:18:44.900 if I shoot it, my friend will just get back up. 00:18:45.630 --> 00:18:47.849 They do not understand the permanence of the 00:18:47.849 --> 00:18:50.789 action. So the nursing education to parents can't 00:18:50.789 --> 00:18:53.130 be teach your child not to touch. Absolutely 00:18:53.130 --> 00:18:55.890 not. That relies on impulse control they do not 00:18:55.890 --> 00:18:58.890 have. The education has to be lock it and unload 00:18:58.890 --> 00:19:01.789 it. It has to be engineering controls. You have 00:19:01.789 --> 00:19:04.710 to remove the risk entirely. Let's talk about 00:19:04.710 --> 00:19:07.230 poisoning. This links right back to centration, 00:19:07.230 --> 00:19:10.950 doesn't it? Directly. A pill is small, round, 00:19:11.130 --> 00:19:14.049 and brightly colored. A skittle is small, round, 00:19:14.210 --> 00:19:16.450 and brightly colored. The child centers on the 00:19:16.450 --> 00:19:18.329 appearance. It looks like candy, therefore it 00:19:18.329 --> 00:19:20.569 is candy. And because of initiative, they want 00:19:20.569 --> 00:19:23.190 to eat it now. They won't ask permission. They 00:19:23.190 --> 00:19:25.569 have terrible impulse control. Even if you told 00:19:25.569 --> 00:19:27.549 them yesterday not to touch the medicine cabinet, 00:19:28.089 --> 00:19:31.829 the immediate visual stimulus of that candy overrides 00:19:31.829 --> 00:19:34.170 the memory of the rule. What about burns? This 00:19:34.170 --> 00:19:36.950 was another big category. This is a failure to 00:19:36.950 --> 00:19:40.490 understand abstract qualities. Hot is invisible. 00:19:40.670 --> 00:19:42.690 You can't see the temperature of bath water. 00:19:43.029 --> 00:19:45.109 They have the motor skill to turn the faucet 00:19:45.109 --> 00:19:47.549 handle. Initiative says, I'll draw my own bath. 00:19:47.970 --> 00:19:50.289 But they have no concept that water can burn 00:19:50.289 --> 00:19:53.990 skin in seconds. So again, we rely on engineering, 00:19:54.309 --> 00:19:57.529 not education. Yes. You set the home water heater 00:19:57.529 --> 00:20:01.490 to 120 degrees Fahrenheit, which is 49 Celsius. 00:20:02.029 --> 00:20:04.190 So if the child turns the hot water all the way 00:20:04.190 --> 00:20:06.849 on, you want to buy yourself time before a scald 00:20:06.849 --> 00:20:09.029 burn happens. You cannot rely on the child to 00:20:09.029 --> 00:20:11.619 test the water. And finally, pedestrian safety. 00:20:12.079 --> 00:20:13.660 We touched on this with the speed of the car, 00:20:13.720 --> 00:20:15.740 but there's an egocentrism angle to it, too. 00:20:15.819 --> 00:20:17.680 Oh, for sure. It's the I see you, you see me 00:20:17.680 --> 00:20:20.200 fallacy. If a child runs into the street after 00:20:20.200 --> 00:20:22.519 a ball and they look at the car, they assume 00:20:22.519 --> 00:20:24.460 the driver sees them. Because they can see the 00:20:24.460 --> 00:20:27.059 driver. Exactly. They also assume the car can 00:20:27.059 --> 00:20:29.740 stop instantly, like they can. They don't understand 00:20:29.740 --> 00:20:32.299 momentum or braking distance. It really is like 00:20:32.299 --> 00:20:34.480 they are operating on a different set of physical 00:20:34.480 --> 00:20:36.839 laws. They are operating on cartoon physics. 00:20:37.380 --> 00:20:39.910 And parents need to know that. You cannot trust 00:20:39.910 --> 00:20:42.609 a preschooler near a street, even if they promise 00:20:42.609 --> 00:20:46.069 to look both ways. Their brain literally cannot 00:20:46.069 --> 00:20:48.890 process the data correctly. Quick note on car 00:20:48.890 --> 00:20:50.869 seats before we move on. The guidelines have 00:20:50.869 --> 00:20:52.930 shifted a bit over the years, but what's the 00:20:52.930 --> 00:20:56.710 current standard? So forward -facing with a harness 00:20:56.710 --> 00:20:59.750 until they outgrow the weight or height limits 00:20:59.750 --> 00:21:03.710 of that seat. Then, usually around age 4 or 40 00:21:03.710 --> 00:21:06.650 pounds, they transition to a booster seat. And 00:21:06.650 --> 00:21:08.789 they stay in that booster for a long time. A 00:21:08.789 --> 00:21:11.329 long time. Until they are 4 feet 9 inches tall, 00:21:11.490 --> 00:21:13.750 which is usually somewhere between 8 and 12 years 00:21:13.750 --> 00:21:16.569 old. And the back seat is always safest. Always. 00:21:17.130 --> 00:21:19.569 Non -negotiable. Airbags in the front seat can 00:21:19.569 --> 00:21:21.630 be fatal for a preschooler. Okay, let's move 00:21:21.630 --> 00:21:24.029 to something a bit lighter. Play. Play is the 00:21:24.029 --> 00:21:26.609 work of the child, as they say. How does it change 00:21:26.609 --> 00:21:29.619 from the toddler years? Why this leads to this 00:21:29.619 --> 00:21:32.440 type of play? So toddlers do what we call parallel 00:21:32.440 --> 00:21:34.019 play. They're playing next to each other, but 00:21:34.019 --> 00:21:36.319 basically ignoring each other. Right, in their 00:21:36.319 --> 00:21:39.059 own little worlds. Completely. Preschoolers graduate 00:21:39.059 --> 00:21:42.140 to associative play. Define that for us. They 00:21:42.140 --> 00:21:44.420 play together, in a loose group. They might be 00:21:44.420 --> 00:21:46.440 swapping blocks or chasing each other around. 00:21:46.900 --> 00:21:49.660 But there are no rigid rules. It's unorganized. 00:21:49.779 --> 00:21:52.099 So they aren't playing a game of soccer with, 00:21:52.099 --> 00:21:55.619 like, positions and a goalie? No. If you watch 00:21:55.619 --> 00:21:58.319 preschool soccer, it's a swarm of bees following 00:21:58.319 --> 00:22:01.579 the ball. That's associative play in action. 00:22:02.160 --> 00:22:04.640 They don't have the cognitive bandwidth for offense 00:22:04.640 --> 00:22:07.920 versus defense or complex rules. That's for school 00:22:07.920 --> 00:22:10.160 -age kids, which we call cooperative play. And 00:22:10.160 --> 00:22:12.759 this is the peak age for imitative or dramatic 00:22:12.759 --> 00:22:15.480 play. Oh, absolutely. Dressing up, playing house, 00:22:15.839 --> 00:22:19.819 doctor, firefighter. This is pure Erickson. They 00:22:19.819 --> 00:22:22.240 are trying on adult roles. They are practicing 00:22:22.240 --> 00:22:24.819 reality. It is crucial for their emotional development 00:22:24.819 --> 00:22:27.720 to act out these scenarios. It helps them process 00:22:27.720 --> 00:22:29.579 what they see in the world. The sources also 00:22:29.579 --> 00:22:31.819 mention imaginary friends. I feel like parents 00:22:31.819 --> 00:22:33.440 often worry about this. They think, is my kid 00:22:33.440 --> 00:22:35.900 hallucinating? It is so normal and so healthy. 00:22:35.940 --> 00:22:38.500 It's a creative projection. It allows them to 00:22:38.500 --> 00:22:40.960 practice conversation, but it also helps them 00:22:40.960 --> 00:22:43.460 externalize their fear. How so? The child might 00:22:43.460 --> 00:22:46.970 say, I'm not scared of the dark. But my friend 00:22:46.970 --> 00:22:50.549 Bobo is terrifyingly scared. It allows them to 00:22:50.549 --> 00:22:52.910 express the emotion without owning the vulnerability. 00:22:53.049 --> 00:22:55.470 It's a brilliant coping mechanism. That's smart. 00:22:56.250 --> 00:22:58.670 So, exam check. What are the appropriate toys 00:22:58.670 --> 00:23:01.329 for this age? You want to think initiative and 00:23:01.329 --> 00:23:05.230 motor skills. So, tricycles, wagons, jungle gyms 00:23:05.230 --> 00:23:08.730 for gross motor. Right. Blocks. Puzzles with 00:23:08.730 --> 00:23:11.940 large pieces for fine motor. and then dress up 00:23:11.940 --> 00:23:14.259 clothes, puppets, dolls for that dramatic play. 00:23:14.400 --> 00:23:16.819 And what should we avoid? What's a common exam 00:23:16.819 --> 00:23:19.460 distractor? Complex board games. They hate rules 00:23:19.460 --> 00:23:22.079 and they hate losing. Because they are egocentric. 00:23:22.220 --> 00:23:24.559 Yes. If they lose, they feel it as a personal 00:23:24.559 --> 00:23:26.140 attack or they'll just cheat because they make 00:23:26.140 --> 00:23:28.819 up the rules as they go to ensure they win. It 00:23:28.819 --> 00:23:31.440 almost always leads to tears. Stick to open -ended 00:23:31.440 --> 00:23:33.819 play where there are no clear winners or losers. 00:23:34.059 --> 00:23:36.640 Let's go back into the hospital room, how nurses 00:23:36.640 --> 00:23:39.000 use this knowledge on exams and in clinicals. 00:23:39.160 --> 00:23:40.980 We talked about the fear of equipment like the 00:23:40.980 --> 00:23:43.680 MRI monster, but there's a very specific fear 00:23:43.680 --> 00:23:46.319 called fear of mutilation. This is a big one, 00:23:46.839 --> 00:23:49.480 a really big one. They have a very poor understanding 00:23:49.480 --> 00:23:52.480 of body integrity. They think their skin is basically 00:23:52.480 --> 00:23:54.779 a sack that holds everything in. So a needle 00:23:54.779 --> 00:23:58.609 puncture. Is a leak. They genuinely fear that 00:23:58.609 --> 00:24:01.009 if you poke them with a needle, all their insides 00:24:01.009 --> 00:24:02.849 might leak out. They think they might deflate 00:24:02.849 --> 00:24:05.029 like a balloon. This sounds ridiculous to an 00:24:05.029 --> 00:24:08.230 adult, but for them, it's a primal terror. So 00:24:08.230 --> 00:24:10.829 what is the magic bullet intervention here? The 00:24:10.829 --> 00:24:13.589 band -aid. The band -aid. It's that simple. To 00:24:13.589 --> 00:24:16.410 a preschooler, a band -aid is not a sterile dressing. 00:24:16.809 --> 00:24:19.690 It is a seal. It fixes the hole. It keeps the 00:24:19.690 --> 00:24:22.009 magic inside. So even if the shot didn't bleed 00:24:22.009 --> 00:24:24.420 at all? Doesn't matter. put a Band -Aid on it, 00:24:24.559 --> 00:24:27.819 a fun one if you have it, it is psychological 00:24:27.819 --> 00:24:31.680 PPE. If you give a shot and leave the hole open, 00:24:31.680 --> 00:24:34.480 you might trigger a full blown panic attack because 00:24:34.480 --> 00:24:36.420 they think their body is now compromised. And 00:24:36.420 --> 00:24:38.920 therapeutic play fits in here too, right? Especially 00:24:38.920 --> 00:24:42.740 before a procedure. Yes, it's critical. If you 00:24:42.740 --> 00:24:44.779 need to listen to their heart, let them listen 00:24:44.779 --> 00:24:46.900 to the teddy bear's heart first, or let them 00:24:46.900 --> 00:24:49.740 listen to your heart. It demystifies the monster. 00:24:50.099 --> 00:24:52.759 It gives them initiative. I'm the doctor now. 00:24:52.829 --> 00:24:55.609 It gives them a sense of control over a very 00:24:55.609 --> 00:24:58.029 scary situation. Let's touch on nutrition. This 00:24:58.029 --> 00:25:00.130 is often where parents get very, very stressed. 00:25:00.230 --> 00:25:02.630 My kid won't eat. We call this physiological 00:25:02.630 --> 00:25:05.789 anorexia. It sounds really clinical and scary, 00:25:05.789 --> 00:25:07.869 but it just means their appetite drops because 00:25:07.869 --> 00:25:10.470 their growth rate has slowed way down. They don't 00:25:10.470 --> 00:25:12.750 need the massive amount of calories they needed 00:25:12.750 --> 00:25:14.509 as infants. So they aren't starving themselves. 00:25:14.630 --> 00:25:17.630 No. They're just regulating. And they become 00:25:17.630 --> 00:25:20.970 very picky. Food fads are extremely common. I'll 00:25:20.970 --> 00:25:23.960 need chicken nuggets for three weeks. or, I won't 00:25:23.960 --> 00:25:27.299 eat anything green. So how should a nurse advise 00:25:27.299 --> 00:25:30.339 a parent to handle that? Because it's very stressful. 00:25:30.519 --> 00:25:33.579 The key is, do not force feed. Force feeding 00:25:33.579 --> 00:25:35.940 creates a power struggle, and it creates guilt, 00:25:36.299 --> 00:25:38.220 which is the negative outcome of Erickson's stage. 00:25:38.799 --> 00:25:41.619 The rule is, parents decide what is served and 00:25:41.619 --> 00:25:44.539 when. The child decides if they eat and how much. 00:25:44.680 --> 00:25:47.339 You control the environment, not the child. Exactly. 00:25:47.700 --> 00:25:49.839 If they don't eat their broccoli at dinner, they 00:25:49.839 --> 00:25:51.960 won't starve. They will eat it the next meal. 00:25:52.089 --> 00:25:55.069 and keep portions small. A tablespoon per year 00:25:55.069 --> 00:25:57.710 of age is a good rule of thumb. Okay, sleep, 00:25:58.369 --> 00:26:01.569 another battlefield. The exams love to test the 00:26:01.569 --> 00:26:03.930 difference between nightmares and night terrors. 00:26:04.299 --> 00:26:06.940 These are not the same thing. Not at all. They're 00:26:06.940 --> 00:26:09.039 completely different neurological events. Let's 00:26:09.039 --> 00:26:10.960 break them down. Let's start with nightmares. 00:26:11.099 --> 00:26:13.380 Okay. Nightmares happen in REM sleep. That's 00:26:13.380 --> 00:26:16.180 dream sleep. The child wakes up fully. They are 00:26:16.180 --> 00:26:18.660 crying. They are scared. And most importantly, 00:26:18.680 --> 00:26:21.539 they remember the dream. They can tell you, a 00:26:21.539 --> 00:26:24.700 bear was chasing me. So the intervention is comfort. 00:26:24.819 --> 00:26:27.799 Yes. You hold them. You validate their fear. 00:26:27.819 --> 00:26:30.839 You say, that sounds so scary, but you are safe 00:26:30.839 --> 00:26:33.720 now. Monsters aren't real. Use a nightlight. 00:26:33.920 --> 00:26:36.279 Reassure them. Now, night terrors, these are 00:26:36.279 --> 00:26:38.480 different. Totally different. These happen in 00:26:38.480 --> 00:26:41.519 deep, non -REM sleep. The child might sit up, 00:26:41.599 --> 00:26:43.700 scream, thrash around, their eyes might even 00:26:43.700 --> 00:26:46.940 be open. But, and this is the absolute key, they 00:26:46.940 --> 00:26:49.819 are not awake. They are asleep, even while screaming. 00:26:50.140 --> 00:26:52.980 They are completely asleep. If you try to talk 00:26:52.980 --> 00:26:54.759 to them, they look right through you. If you 00:26:54.759 --> 00:26:57.079 try to hold them, they might fight you. They 00:26:57.079 --> 00:26:59.519 are disoriented and can't be consoled. And the 00:26:59.519 --> 00:27:01.559 next morning... They have zero memory of it. 00:27:01.640 --> 00:27:04.599 They wake up happy and refreshed. Meanwhile, 00:27:04.759 --> 00:27:06.880 the parents are traumatized and haven't slept 00:27:06.880 --> 00:27:09.119 all night. So the intervention for night terrors 00:27:09.119 --> 00:27:11.579 is completely counterintuitive. It is. You do 00:27:11.579 --> 00:27:14.339 not wake them. You will just confuse and agitate 00:27:14.339 --> 00:27:16.559 them more. You just sit by the bed, make sure 00:27:16.559 --> 00:27:18.480 they don't fall out or hit their head, and you 00:27:18.480 --> 00:27:20.480 wait for it to pass. They will settle back down 00:27:20.480 --> 00:27:23.279 on their own. That is hard advice for a parent 00:27:23.279 --> 00:27:25.539 to follow when their kid is screaming like that. 00:27:25.700 --> 00:27:27.740 It's one of the hardest things to do. But waking 00:27:27.740 --> 00:27:31.059 them... actually prolongs the episode and scares 00:27:31.059 --> 00:27:34.019 them because they wake up to terrified parents 00:27:34.019 --> 00:27:36.119 hovering over them. Finally, let's hit the hard 00:27:36.119 --> 00:27:39.539 data. Immunizations. The four to six year booster 00:27:39.539 --> 00:27:42.480 cluster. These are the kindergarten shots. Right. 00:27:42.579 --> 00:27:44.539 They need to boost the immunity they got as babies 00:27:44.539 --> 00:27:47.519 before they enter the Petri dish of elementary 00:27:47.519 --> 00:27:49.940 school. We have a mnemonic for this one in the 00:27:49.940 --> 00:27:53.420 sources. Very deep. VDIM. It helps you remember 00:27:53.420 --> 00:27:55.859 the four key shots they get in this window. Walk 00:27:55.859 --> 00:27:58.970 us through it. So V is for Varicella, the chickenpox 00:27:58.970 --> 00:28:02.089 vaccine. This is the second dose. D is for DTaP, 00:28:02.130 --> 00:28:04.730 diphtheria, tetanus, and pertussis. This is the 00:28:04.730 --> 00:28:07.650 fifth dose in that series. I is for IPV inactivated 00:28:07.650 --> 00:28:10.029 polio vaccine. That's the fourth dose. And M 00:28:10.029 --> 00:28:13.509 is for MMR measles, mumps, and rubella. The second 00:28:13.509 --> 00:28:18.190 dose. Very dim. Varicella, DTaP, IPV, MMR. And 00:28:18.190 --> 00:28:20.869 there's one more, right? The annual one? The 00:28:20.869 --> 00:28:23.759 flu shot. Now, for this age group, you have a 00:28:23.759 --> 00:28:25.519 choice. You can do the shot, the inactivated 00:28:25.519 --> 00:28:28.299 vaccine, or you can do the nasal spray, the live 00:28:28.299 --> 00:28:31.180 attenuated one, LAIV. Kids obviously prefer the 00:28:31.180 --> 00:28:33.339 spray, but there are rules. There are. The spray 00:28:33.339 --> 00:28:35.819 is a live virus, so you cannot give it to a child 00:28:35.819 --> 00:28:38.359 who is immunocompromised or has asthma. If they 00:28:38.359 --> 00:28:39.839 have any history of wheezing, you have to stick 00:28:39.839 --> 00:28:42.079 to the shot. That's a classic exam trick question. 00:28:42.140 --> 00:28:44.619 Got it. OK, we have covered a massive amount 00:28:44.619 --> 00:28:47.460 of ground here, from tadpole people drawings 00:28:47.460 --> 00:28:51.119 to the philosophy of death in cartoons. this 00:28:51.119 --> 00:28:54.220 up with our 80 -20 summary box. If the listener 00:28:54.220 --> 00:28:56.299 walks away with only four concepts that will 00:28:56.299 --> 00:28:58.200 answer most of the questions, what are they? 00:28:58.519 --> 00:29:01.000 Here is the cheat sheet. This is what you need 00:29:01.000 --> 00:29:03.740 to know. If you know they are magical thinkers 00:29:03.740 --> 00:29:06.319 from Piaget... You know why they think they cause 00:29:06.319 --> 00:29:08.680 their sibling's illness, and while you absolutely 00:29:08.680 --> 00:29:11.099 cannot trust them near a pool, they think they 00:29:11.099 --> 00:29:13.720 can fly or breathe underwater. Okay, number two. 00:29:13.920 --> 00:29:16.559 Number two. If you know they are driven by initiative 00:29:16.559 --> 00:29:18.880 from Erickson, you know to let them hold the 00:29:18.880 --> 00:29:21.339 stethoscope and help dress themselves to prevent 00:29:21.339 --> 00:29:24.240 anxiety and guilt, you turn the exam into a job 00:29:24.240 --> 00:29:26.670 they can perform. Number three. Number three, 00:29:27.009 --> 00:29:29.470 if you know they fear mutilation, you know that 00:29:29.470 --> 00:29:31.490 a bandaid is more important to the child than 00:29:31.490 --> 00:29:34.690 the actual medicine. It seals the leak. It is 00:29:34.690 --> 00:29:37.309 the most critical tool you have. And number four. 00:29:37.630 --> 00:29:40.369 And number four, if you know they engage in associative 00:29:40.369 --> 00:29:42.809 play, you know they will play near others and 00:29:42.809 --> 00:29:45.369 share toys, but they are not ready for the complex 00:29:45.369 --> 00:29:48.460 rules of board games or team sports. don't pick 00:29:48.460 --> 00:29:51.240 Monopoly as the right toy. It really does all 00:29:51.240 --> 00:29:53.960 connect. When you stop just memorizing the lists 00:29:53.960 --> 00:29:56.259 and start looking at the developmental logic 00:29:56.259 --> 00:29:59.799 behind it, the answers just, they appear. That's 00:29:59.799 --> 00:30:01.839 the goal. That's the whole point. Understanding 00:30:01.839 --> 00:30:04.220 the why makes the what obvious. I want to leave 00:30:04.220 --> 00:30:06.579 everyone with a final thought to chew on. We 00:30:06.579 --> 00:30:08.420 talked about the preschooler as a contradiction. 00:30:09.259 --> 00:30:12.920 And I was thinking, they are basically little 00:30:12.920 --> 00:30:13.400 scienti -