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 --> 00:00:47.289 fast. Welcome to the emergency room. Welcome 00:00:47.289 --> 00:00:51.020 back to the deep dive. Today we are... calibrating 00:00:51.020 --> 00:00:53.500 the time machine for a very specific frequency. 00:00:53.880 --> 00:00:55.960 We aren't going back to diapers and sleepless 00:00:55.960 --> 00:01:00.299 nights, and we aren't quite landing in the angsty 00:01:00.299 --> 00:01:02.159 door slamming drama of high school just yet. 00:01:02.280 --> 00:01:05.200 No, we are aiming for that sweet spot, the era 00:01:05.200 --> 00:01:08.519 of scraped knees, trading cards, the smell of 00:01:08.519 --> 00:01:11.140 pencil shavings, and that overwhelming burning 00:01:11.140 --> 00:01:14.769 desire to just fit in and follow the rules. We're 00:01:14.769 --> 00:01:16.549 talking about the school -aged child, roughly 00:01:16.549 --> 00:01:20.069 ages 6 to 12. And for the nursing students and 00:01:20.069 --> 00:01:22.349 pros listening to this, I know the immediate 00:01:22.349 --> 00:01:24.769 reflex is to just groan. You're thinking, great, 00:01:24.870 --> 00:01:27.750 another list of milestones, another chart of 00:01:27.750 --> 00:01:29.989 vital signs to memorize. Which is exactly the 00:01:29.989 --> 00:01:32.189 trap we are going to bypass today. It's just 00:01:32.189 --> 00:01:34.989 not effective. That is the mission. We are applying 00:01:34.989 --> 00:01:37.790 the 80 -20 rule to this, this whole stack of 00:01:37.790 --> 00:01:40.349 pediatric textbooks, CDC schedules, developmental 00:01:40.349 --> 00:01:42.810 theories. We want to kill the rote memorization. 00:01:43.269 --> 00:01:45.090 We want to get to the cognitive engine that's 00:01:45.090 --> 00:01:46.790 running inside a nine -year -old's head. Because 00:01:46.790 --> 00:01:49.569 if you understand the why, if you understand 00:01:49.569 --> 00:01:52.230 how their brain is wiring itself during this 00:01:52.230 --> 00:01:55.030 specific window, you don't have to memorize the 00:01:55.030 --> 00:01:57.230 safety risks. You don't have to memorize the 00:01:57.230 --> 00:01:59.090 communication strategies. You can just predict 00:01:59.090 --> 00:02:01.290 them. You can predict them. You can derive them. 00:02:01.430 --> 00:02:03.510 You'll be able to derive the answer on the exam 00:02:03.510 --> 00:02:07.709 just by asking, OK, what would a concrete operational 00:02:07.709 --> 00:02:10.969 kid who is obsessed with competence do in this 00:02:10.969 --> 00:02:13.590 situation? That's the goal right there. We want 00:02:13.590 --> 00:02:17.009 to move from what to why. So set the scene for 00:02:17.009 --> 00:02:19.530 us. We've left the chaotic, you know, the me 00:02:19.530 --> 00:02:22.110 centered world of the toddler and preschooler. 00:02:22.110 --> 00:02:25.710 We aren't quite in the hormonal hurricane of 00:02:25.710 --> 00:02:28.770 the teenager years yet. How do we characterize 00:02:28.770 --> 00:02:31.629 this period? I like to call it the calm before 00:02:31.629 --> 00:02:34.110 the storm. Or if you want to be a little more 00:02:34.110 --> 00:02:37.969 clinical, the era of the mini adult. Mini adult. 00:02:38.009 --> 00:02:40.610 I like that. Yeah, because developmentally, this 00:02:40.610 --> 00:02:43.810 is a time of massive organization. The physical 00:02:43.810 --> 00:02:45.969 growth actually slows down, which surprises people. 00:02:46.310 --> 00:02:49.349 But the social and cognitive worlds just, they 00:02:49.349 --> 00:02:51.030 explode. So they're not shooting up in height, 00:02:51.090 --> 00:02:53.610 but their world is getting bigger. So much bigger. 00:02:53.909 --> 00:02:56.409 They move from the family unit being their entire 00:02:56.409 --> 00:02:59.330 universe to... To the school. The school and 00:02:59.330 --> 00:03:01.129 peers, they become the dominant influencers. 00:03:01.370 --> 00:03:03.750 It's a huge shift. It's the shift from, look 00:03:03.750 --> 00:03:07.050 at me, Mom, to look at what I can do, Coach. 00:03:07.469 --> 00:03:09.909 That is the critical pivot. And it brings us 00:03:09.909 --> 00:03:13.099 to our first big pillar. physical development. 00:03:13.340 --> 00:03:15.219 Okay, let's talk about the hardware. Compared 00:03:15.219 --> 00:03:18.379 to an infant who, you know, doubles their weight 00:03:18.379 --> 00:03:21.280 in months or a team shooting up six inches in 00:03:21.280 --> 00:03:24.319 a summer, this stage feels like watching paint 00:03:24.319 --> 00:03:26.740 dry. It is slow and steady. We are looking at 00:03:26.740 --> 00:03:28.919 a weight gain of roughly two to three kilograms. 00:03:29.039 --> 00:03:32.189 That's about 47 pounds per year. And height is 00:03:32.189 --> 00:03:35.030 about five centimeters or two inches per year. 00:03:35.050 --> 00:03:37.849 It's just consistent. So we lose that cute pot 00:03:37.849 --> 00:03:40.509 -bellied toddler look? Oh, completely. That aesthetic 00:03:40.509 --> 00:03:43.569 vanishes. They shed the baby fat, the legs elongate, 00:03:43.689 --> 00:03:45.310 their center of gravity shifts, and they become 00:03:45.310 --> 00:03:47.509 so much more graceful. Right. Look thinner, leaner, 00:03:47.590 --> 00:03:49.770 more athletic. But there is a plot twist coming 00:03:49.770 --> 00:03:51.610 at the end of the stage, right? The textbooks 00:03:51.610 --> 00:03:55.289 call it prepubescence. Yes. And this is a huge 00:03:55.289 --> 00:03:57.949 area for anticipatory guidance for parents. And 00:03:57.949 --> 00:04:01.050 for nurses, prepubescence usually starts in the 00:04:01.050 --> 00:04:03.830 two years preceding puberty. And here's where 00:04:03.830 --> 00:04:06.650 we see a significant gender split that can cause 00:04:06.650 --> 00:04:09.969 a lot of social friction. How so? Well, toward 00:04:09.969 --> 00:04:12.349 the end of the school age period, let's say around 00:04:12.349 --> 00:04:16.410 10 to 12 years old, girls often begin to surpass 00:04:16.410 --> 00:04:20.009 boys in both height and weight. The growth spurt 00:04:20.009 --> 00:04:22.329 for girls typically hits before the boys. Oh, 00:04:22.329 --> 00:04:24.629 I remember that vividly from middle school. All 00:04:24.629 --> 00:04:26.310 the girls were suddenly looking down at the boys, 00:04:26.350 --> 00:04:28.610 and let's just say nobody was happy about it. 00:04:28.629 --> 00:04:31.410 It's a genuine source of distress. Body image 00:04:31.410 --> 00:04:33.230 issues don't just start in high school. They 00:04:33.230 --> 00:04:35.769 start right here. If you have an 11 -year -old 00:04:35.769 --> 00:04:38.310 girl who is suddenly a head taller than all the 00:04:38.310 --> 00:04:40.910 boys and carrying more weight because of prepubescence, 00:04:41.250 --> 00:04:43.589 that impacts her self -esteem in a big way. So 00:04:43.589 --> 00:04:45.970 what's our role there? As nurses, we have to 00:04:45.970 --> 00:04:48.449 normalize that. We have to tell them and their 00:04:48.449 --> 00:04:50.430 parents, this is exactly what your body is supposed 00:04:50.430 --> 00:04:52.750 to be doing. It's healthy, it's normal. What 00:04:52.750 --> 00:04:55.329 about what's happening, you know, under the hood, 00:04:55.769 --> 00:04:58.310 internally? The immune system is finally maturing. 00:04:58.790 --> 00:05:01.009 So they generally get fewer infections than toddlers, 00:05:01.149 --> 00:05:02.709 although because they are in school, they are 00:05:02.709 --> 00:05:06.170 exposed to a wider variety of bugs. But I really 00:05:06.170 --> 00:05:07.949 want to focus on the musculoskeletal system. 00:05:07.990 --> 00:05:10.889 This is a common exam trap. The bones. The bones. 00:05:11.269 --> 00:05:14.430 They're ossifying, so they are hardening. But... 00:05:14.480 --> 00:05:17.480 And this is the key. They are not fully mineralized 00:05:17.480 --> 00:05:20.600 yet. They aren't as dense as adult bones. Which 00:05:20.600 --> 00:05:23.920 means they break differently. Exactly. They are 00:05:23.920 --> 00:05:26.040 prone to what we call green stick fractures. 00:05:26.259 --> 00:05:29.970 Think of a young green branch on a tree. If you 00:05:29.970 --> 00:05:32.810 bend it, it doesn't snap clean in two. It sort 00:05:32.810 --> 00:05:36.129 of splinters and cracks on one side. That is 00:05:36.129 --> 00:05:38.870 a classic school -age fracture. Their muscles 00:05:38.870 --> 00:05:41.470 are still immature relative to their activity 00:05:41.470 --> 00:05:43.829 level, so they can literally pull the bone apart 00:05:43.829 --> 00:05:45.829 if they go too hard in sports. So they're writing 00:05:45.829 --> 00:05:48.290 checks their bones can't quite cash yet. That's 00:05:48.290 --> 00:05:49.889 a perfect way to put it. They have all the energy 00:05:49.889 --> 00:05:52.149 in the world, but not the density to back it 00:05:52.149 --> 00:05:55.100 up. Okay, so let's pivot to the can do versus 00:05:55.100 --> 00:05:57.660 the cannot do. This is the bread and butter of 00:05:57.660 --> 00:05:59.939 clinical assessment. What are they capable of? 00:06:00.279 --> 00:06:02.160 The motor skills are just night and day compared 00:06:02.160 --> 00:06:05.060 to a preschooler. Fine motor skills especially 00:06:05.060 --> 00:06:08.220 just explode. This is the age where the nervous 00:06:08.220 --> 00:06:11.180 system myelination really reaches the fingertips. 00:06:11.379 --> 00:06:13.500 So they can do more detailed things with their 00:06:13.500 --> 00:06:16.209 hands. Way more. They move from printing letters 00:06:16.209 --> 00:06:19.310 to cursive writing. They could sew. They can 00:06:19.310 --> 00:06:21.870 build those complex Lego models with the tiny, 00:06:21.889 --> 00:06:24.370 tiny pieces. They can play musical instruments 00:06:24.370 --> 00:06:27.089 like the piano or violin because that independent 00:06:27.089 --> 00:06:30.250 finger dexterity is finally there. And self -care. 00:06:30.410 --> 00:06:32.430 Are we done helping them brush their teeth? Mostly, 00:06:32.589 --> 00:06:35.050 yes. They can brush and floss effectively. And 00:06:35.050 --> 00:06:36.629 speaking of teeth, we can't skip what some people 00:06:36.629 --> 00:06:39.230 call the ugly duckling phase. The gap -toothed 00:06:39.230 --> 00:06:41.810 smile. It's the rite of passage. They start losing 00:06:41.810 --> 00:06:44.589 their primary teeth around age six. By the end 00:06:44.589 --> 00:06:47.189 of this period, age 12, they'll have 28 of their 00:06:47.189 --> 00:06:50.110 32 permanent teeth. But because the permanent 00:06:50.110 --> 00:06:51.870 teeth are so much bigger than the baby teeth 00:06:51.870 --> 00:06:54.250 they replace, the face can look a bit crowded 00:06:54.250 --> 00:06:57.110 or disproportionate for a while. So they can 00:06:57.110 --> 00:06:59.810 ride bikes, play team sports, floss their teeth, 00:07:00.230 --> 00:07:03.269 and play the clarinet. They sound pretty capable. 00:07:03.790 --> 00:07:06.509 What can't they do? What is the fatal flaw in 00:07:06.509 --> 00:07:09.970 this system? The fatal flaw is abstract reasoning. 00:07:10.170 --> 00:07:13.360 Break that down for us. They cannot reason about 00:07:13.360 --> 00:07:16.480 hypotheticals or nuances or future consequences 00:07:16.480 --> 00:07:19.060 without a concrete example right in front of 00:07:19.060 --> 00:07:22.139 them. They just lack adult level judgment. Okay, 00:07:22.199 --> 00:07:24.379 so give me an example. They can ride a bike really 00:07:24.379 --> 00:07:28.259 fast, but they cannot accurately judge the velocity 00:07:28.259 --> 00:07:30.560 and distance of an oncoming car. So they see 00:07:30.560 --> 00:07:32.480 the car, they see the street, but they can't 00:07:32.480 --> 00:07:34.180 run that little physics simulation in their head 00:07:34.180 --> 00:07:36.439 to say that car will be here in three seconds, 00:07:36.459 --> 00:07:38.790 which is not enough time. Precisely. They know 00:07:38.790 --> 00:07:41.629 the rule is, look both ways. But if a ball rolls 00:07:41.629 --> 00:07:44.189 into the street, the abstract concept of future 00:07:44.189 --> 00:07:47.009 danger just evaporates against the concrete reality 00:07:47.009 --> 00:07:49.730 of, I need to get my ball. The immediate tangible 00:07:49.730 --> 00:07:52.490 object wins every single time. And that connects 00:07:52.490 --> 00:07:54.709 us directly to the cognitive architecture. We're 00:07:54.709 --> 00:07:57.310 entering the realm of Piaget. We are. Piaget's 00:07:57.310 --> 00:08:00.569 concrete operational stage, roughly ages 7 to 00:08:00.569 --> 00:08:03.490 11. I always remember concrete because they are 00:08:03.490 --> 00:08:06.389 literally hard -headed about facts. Things are 00:08:06.389 --> 00:08:09.480 what they are. That works. And the hallmark of 00:08:09.480 --> 00:08:13.300 this stage is the shift from the magical thinking 00:08:13.300 --> 00:08:16.480 of the preschooler, where they think their thoughts 00:08:16.480 --> 00:08:21.199 cause events, to logical thinking. But. There's 00:08:21.199 --> 00:08:24.879 a huge but here. A massive but. It is logic that 00:08:24.879 --> 00:08:27.759 can only be applied strictly to tangible things, 00:08:28.139 --> 00:08:29.959 things they can see and touch and manipulate. 00:08:30.300 --> 00:08:32.940 The classic example here is conservation. We 00:08:32.940 --> 00:08:35.059 have to talk about the water glasses. This is 00:08:35.059 --> 00:08:37.100 the defining experiment, really. If you take 00:08:37.100 --> 00:08:39.879 a short, wide glass of water and pour it into 00:08:39.879 --> 00:08:41.820 a tall, skinny glass in front of a four -year 00:08:41.820 --> 00:08:43.720 -old, they will tell you there is more water 00:08:43.720 --> 00:08:45.879 now because the level is higher. Right. They're 00:08:45.879 --> 00:08:48.779 locked on that one -dimension height. But the 00:08:48.779 --> 00:08:51.159 school -aged child, they'll laugh at you. They 00:08:51.159 --> 00:08:53.139 understand the principle of conservation. They 00:08:53.139 --> 00:08:55.320 know that matter doesn't change amount just because 00:08:55.320 --> 00:08:57.399 it changes shape. They can say, you just poured 00:08:57.399 --> 00:08:59.399 it. It's the same water. So why does that matter 00:08:59.399 --> 00:09:01.080 for a nurse? I mean, why should we care about 00:09:01.080 --> 00:09:03.919 water glasses? It matters. because it proves 00:09:03.919 --> 00:09:06.139 they can hold a concept in their head and reverse 00:09:06.139 --> 00:09:09.720 the process. Reversibility is a massive cognitive 00:09:09.720 --> 00:09:13.320 leap. It allows them to understand math. If two 00:09:13.320 --> 00:09:15.259 plus three is five, then five minus three must 00:09:15.259 --> 00:09:18.240 be two. Oh, I see. And it allows them to understand 00:09:18.240 --> 00:09:21.639 illness trajectories. I am sick now, but if I 00:09:21.639 --> 00:09:23.840 take this medicine, I will go back to being healthy. 00:09:24.320 --> 00:09:27.500 It's not a permanent state. This ability to classify 00:09:27.500 --> 00:09:30.049 and organize. It seems to spill over into their 00:09:30.049 --> 00:09:32.409 hobbies, too. Oh, absolutely. Is there anything 00:09:32.409 --> 00:09:35.370 more school -age than a collection? Rocks, stamps, 00:09:35.830 --> 00:09:38.690 baseball cards, Pokemon cards. My nephew has 00:09:38.690 --> 00:09:40.629 binders and binders full of them. And notice 00:09:40.629 --> 00:09:42.970 how they organize them. It's not random at all. 00:09:43.429 --> 00:09:46.009 They group them by type, by color, by value, 00:09:46.230 --> 00:09:49.590 by power level. This is classification and serialization. 00:09:49.870 --> 00:09:51.830 It's a cognitive workout for them. So it's not 00:09:51.830 --> 00:09:54.730 just hoarding. No. They are exercising their 00:09:54.730 --> 00:09:57.370 new ability to create order out of chaos. They 00:09:57.370 --> 00:10:00.029 love order. They love rules. They love rules. 00:10:00.490 --> 00:10:02.669 To a fault. This brings us to the psychological 00:10:02.669 --> 00:10:05.070 engine that's driving all this behavior. Eric 00:10:05.070 --> 00:10:08.309 Erickson. Industry versus inferiority. This is 00:10:08.309 --> 00:10:10.769 the absolute heartbeat of the school -age child. 00:10:11.610 --> 00:10:13.909 Define industry for us, because it sounds like 00:10:13.909 --> 00:10:16.269 they're, you know, gonna work in a factory. It 00:10:16.269 --> 00:10:19.350 basically means competence. It's the drive to 00:10:19.350 --> 00:10:23.059 do things well. to produce results, to be useful. 00:10:23.519 --> 00:10:25.799 A toddler wants to play with blocks just to see 00:10:25.799 --> 00:10:28.600 them crash. A school -age kid wants to build 00:10:28.600 --> 00:10:31.019 a castle that actually looks like a castle. They 00:10:31.019 --> 00:10:32.960 don't just want to participate. They want the 00:10:32.960 --> 00:10:35.779 gold star. They want the A. Exactly. They want 00:10:35.779 --> 00:10:39.220 to learn how things work. Success to them looks 00:10:39.220 --> 00:10:43.009 like tangible validation. winning the game, earning 00:10:43.009 --> 00:10:45.690 the badge and scouts, getting an A on the spelling 00:10:45.690 --> 00:10:48.509 test, or finally mastering a level in a video 00:10:48.509 --> 00:10:51.730 game. And the flip side of that coin is inferiority. 00:10:52.169 --> 00:10:54.429 Inferiority happens if they cannot meet the standards 00:10:54.429 --> 00:10:57.129 set by adults or their peers or even themselves. 00:10:57.870 --> 00:11:00.570 If a child constantly fails, or worse, if they 00:11:00.570 --> 00:11:02.190 are told their best effort isn't good enough, 00:11:02.570 --> 00:11:04.929 they develop this deep sense of inadequacy. This 00:11:04.929 --> 00:11:07.350 feels like a huge nursing and parenting tip right 00:11:07.350 --> 00:11:10.230 here. It is the most important one. We have to 00:11:10.230 --> 00:11:13.169 focus on the effort, not just the outcome. If 00:11:13.169 --> 00:11:16.009 a child has a chronic illness or a disability 00:11:16.009 --> 00:11:17.990 that prevents them from excelling at sports, 00:11:18.970 --> 00:11:21.830 we have to help them find their industry somewhere 00:11:21.830 --> 00:11:24.429 else. So find their strength. Find their strength. 00:11:24.730 --> 00:11:26.679 Maybe they can't run the fastest. But they can 00:11:26.679 --> 00:11:29.360 be the best at drawing or they can master the 00:11:29.360 --> 00:11:31.879 rules of a game better than anyone else. They 00:11:31.879 --> 00:11:33.980 need to feel good at something. I want to connect 00:11:33.980 --> 00:11:36.940 this industry and rule following to their moral 00:11:36.940 --> 00:11:39.440 development. You mentioned they love rules. This 00:11:39.440 --> 00:11:42.440 is Kohlberg's conventional stage, specifically 00:11:42.440 --> 00:11:45.759 the law and order orientation. To a school age 00:11:45.759 --> 00:11:49.340 child, rules are absolute. They are not guidelines. 00:11:49.519 --> 00:11:52.440 They are black and white. You are a good child 00:11:52.440 --> 00:11:54.620 if you follow the rules and a bad child if you 00:11:54.620 --> 00:11:56.860 break them. But there's a paradox here that always 00:11:56.860 --> 00:11:59.259 confuses students. The sources mention that cheating 00:11:59.259 --> 00:12:01.740 actually peaks between ages 6 and 8. If they 00:12:01.740 --> 00:12:04.120 love rules so much, why are they sliding extra 00:12:04.120 --> 00:12:06.620 cash from the monopoly bank? Isn't that fascinating? 00:12:07.159 --> 00:12:10.059 It is the direct clash between Ericsson and PHA. 00:12:10.740 --> 00:12:13.379 They have this desperate need for industry to 00:12:13.379 --> 00:12:16.259 win to be the best. But they are still young 00:12:16.259 --> 00:12:18.679 enough that losing feels like a total failure 00:12:18.679 --> 00:12:22.120 of their self -worth. It's devastating. So they 00:12:22.120 --> 00:12:24.549 cheat to preserve their sense of industry. It's 00:12:24.549 --> 00:12:26.470 not that they are sociopaths. It's that they 00:12:26.470 --> 00:12:29.210 can't handle the emotional weight of losing yet. 00:12:29.529 --> 00:12:32.490 Exactly. Their desire to be the winner overrides 00:12:32.490 --> 00:12:34.629 their desire to follow the rule. And the best 00:12:34.629 --> 00:12:36.929 way to handle it isn't to shame them because 00:12:36.929 --> 00:12:39.830 that just triggers inferiority, but to gently 00:12:39.830 --> 00:12:42.029 enforce the rules and teach them how to lose 00:12:42.029 --> 00:12:44.429 gracefully. You say we play by the rules so the 00:12:44.429 --> 00:12:47.070 game is fair for everyone, not you are a liar. 00:12:47.570 --> 00:12:50.090 OK, let's move to safety. We've built this profile. 00:12:50.670 --> 00:12:53.570 A kid who is physically capable, thinks logically 00:12:53.570 --> 00:12:56.509 but not abstractly, loves rules, and wants to 00:12:56.509 --> 00:12:58.370 prove they're competent. How does that create 00:12:58.370 --> 00:13:00.549 specific dangers? It creates what I call the 00:13:00.549 --> 00:13:02.990 independence gap. Their physical skills allow 00:13:02.990 --> 00:13:05.230 them to move far away from their parents on bikes, 00:13:05.509 --> 00:13:07.970 skateboards, at friends' houses, but their judgment 00:13:07.970 --> 00:13:10.070 just hasn't caught up. Let's look at the number 00:13:10.070 --> 00:13:13.789 one risk. Motor vehicles. Still the leading cause 00:13:13.789 --> 00:13:16.730 of accidental death for this age. The rule is 00:13:16.730 --> 00:13:19.610 simple. Backseat until age 13. No exceptions. 00:13:20.489 --> 00:13:22.409 But the nuance here, and that thing you'll get 00:13:22.409 --> 00:13:25.129 tested on, is the booster seat. Right. The sources 00:13:25.129 --> 00:13:28.009 were very specific on this. When can they get 00:13:28.009 --> 00:13:31.230 out of the booster? The metric is 4 feet 9 inches 00:13:31.230 --> 00:13:34.450 tall, which is about 145 centimeters, or typically 00:13:34.450 --> 00:13:36.929 between 8 and 12 years old. Why that specific 00:13:36.929 --> 00:13:39.309 height? I mean, why can't a 4 foot 5 kid just 00:13:39.309 --> 00:13:41.389 use the regular belt? It seems close enough. 00:13:41.549 --> 00:13:44.190 It's all about simple anatomy. Seat belts are 00:13:44.190 --> 00:13:46.590 designed for adult skeletons. They're designed 00:13:46.590 --> 00:13:49.049 to sit across the sturdy pelvic bones and the 00:13:49.049 --> 00:13:52.830 collarbone. On a smaller child, without a booster, 00:13:53.309 --> 00:13:55.370 the lap belt rides up onto the soft abdomen. 00:13:55.649 --> 00:13:57.870 Right over the liver, the spleen, the intestine. 00:13:58.210 --> 00:14:00.769 Exactly. In a crash, that belt becomes a knife. 00:14:01.470 --> 00:14:03.330 It can cause what's called seatbelt syndrome, 00:14:04.049 --> 00:14:05.870 massive internal organ damage, or even spinal 00:14:05.870 --> 00:14:09.029 injuries, and the shoulder belt. If it hits their 00:14:09.029 --> 00:14:11.250 face or neck, they'll just tuck it behind their 00:14:11.250 --> 00:14:13.769 back, leaving their torso completely unprotected. 00:14:14.029 --> 00:14:16.210 So the booster just lifts them up so the belt 00:14:16.210 --> 00:14:18.389 hits the bones where it's supposed to. That's 00:14:18.389 --> 00:14:20.750 all it does. And that is the kind of concrete 00:14:20.750 --> 00:14:23.149 explanation a school -aged child needs, by the 00:14:23.149 --> 00:14:25.509 way. Don't just say, it's safe. You have to explain 00:14:25.509 --> 00:14:28.350 why. Say, the belt will hurt your tummy if you 00:14:28.350 --> 00:14:31.129 are too small. So this seat helps it fit right. 00:14:31.549 --> 00:14:34.350 Spot on. You have to appeal to their logic. Always. 00:14:34.620 --> 00:14:36.639 What about bikes and sports? We know they need 00:14:36.639 --> 00:14:39.399 helmets. Helmets are absolutely non -negotiable. 00:14:39.720 --> 00:14:43.340 But here is the nursing challenge. Pure pressure. 00:14:43.860 --> 00:14:46.399 By age 10 or 11, wearing a helmet might not look 00:14:46.399 --> 00:14:49.399 cool. And we're back to industry versus inferiority. 00:14:49.720 --> 00:14:51.759 If I wear a helmet, I look like a baby, and that 00:14:51.759 --> 00:14:54.799 makes me feel inferior. You nailed it. So the 00:14:54.799 --> 00:14:57.399 nurse has to advocate for the coolness of safety 00:14:57.399 --> 00:15:00.000 gear, or at least the absolute necessity of it. 00:15:00.320 --> 00:15:02.559 You appeal to their industry. You say something 00:15:02.559 --> 00:15:05.590 like, Your brain is the computer that helps you 00:15:05.590 --> 00:15:08.549 play video games and score goals in soccer. If 00:15:08.549 --> 00:15:10.730 you damage the computer, you can't play. You 00:15:10.730 --> 00:15:13.429 have to protect the hardware. I like that. Let's 00:15:13.429 --> 00:15:16.129 talk about firearms. The sources had a very specific 00:15:16.129 --> 00:15:19.529 script for this age group. Yes. And it's so important 00:15:19.529 --> 00:15:22.830 because even if you don't own guns, your child's 00:15:22.830 --> 00:15:26.649 friend might. The script is, stop, don't touch, 00:15:27.070 --> 00:15:29.929 leave the area, tell an adult. Why is that so 00:15:29.929 --> 00:15:32.389 critical for them? Because of their curiosity. 00:15:32.649 --> 00:15:35.210 That industry drive to see how things work. A 00:15:35.210 --> 00:15:38.070 gun is an incredibly tempting object to investigate. 00:15:38.730 --> 00:15:40.970 They know it's dangerous, theoretically, but 00:15:40.970 --> 00:15:43.549 that concrete desire to hold it and see it is 00:15:43.549 --> 00:15:46.070 so much stronger. And fire and water. It's the 00:15:46.070 --> 00:15:49.789 same driver. Curiosity plus a massive overestimation 00:15:49.789 --> 00:15:52.049 of their ability. A nine -year -old might think, 00:15:52.049 --> 00:15:54.190 I can swim across that lake, because they did 00:15:54.190 --> 00:15:56.370 two laps in the pool yesterday. They don't understand 00:15:56.370 --> 00:15:59.049 stamina limits. So the rule is never swim alone. 00:15:59.340 --> 00:16:02.019 And for fire, they are fascinated by it. They 00:16:02.019 --> 00:16:04.299 need concrete fire escape plans practiced at 00:16:04.299 --> 00:16:06.899 home, not just a lecture about don't touch matches. 00:16:07.399 --> 00:16:09.399 Okay, let's switch gears to play. We talked about 00:16:09.399 --> 00:16:11.940 collections, but how do they play with others? 00:16:12.200 --> 00:16:14.159 So toddlers play next to each other. We call 00:16:14.159 --> 00:16:16.220 that parallel play. School age kids play with 00:16:16.220 --> 00:16:18.059 each other. It's cooperative play. And it has 00:16:18.059 --> 00:16:21.360 rules. And because of that law and order moral 00:16:21.360 --> 00:16:24.980 stage, it is almost always organized play with 00:16:24.980 --> 00:16:27.690 very strict rules. So we're talking board games, 00:16:27.830 --> 00:16:31.370 card games, team sports. Yes. They love knowing 00:16:31.370 --> 00:16:33.389 the rules and holding others accountable to them. 00:16:33.429 --> 00:16:35.549 You'll hear a lot of, you didn't pass go. You 00:16:35.549 --> 00:16:38.389 can't collect $200. Team sports seem to be the 00:16:38.389 --> 00:16:40.889 perfect storm for this age. They really are. 00:16:41.029 --> 00:16:44.389 They satisfy the need for exercise, social interaction, 00:16:44.649 --> 00:16:46.669 and that drive for industry. They learn division 00:16:46.669 --> 00:16:50.190 of labor, I play defense, you play offense. But 00:16:50.190 --> 00:16:53.330 then, as a coach or a parent, you have to watch 00:16:53.330 --> 00:16:55.990 for that winning -at -all -cost mentality, which 00:16:55.990 --> 00:16:57.730 can really hurt the self -esteem of the kids 00:16:57.730 --> 00:17:00.169 who aren't the star athletes. There was also 00:17:00.169 --> 00:17:02.350 a note about solitary play. It's not all social 00:17:02.350 --> 00:17:04.170 all the time, right? No, and that's very healthy. 00:17:04.450 --> 00:17:07.009 This is when you see the start of journaling, 00:17:07.470 --> 00:17:09.750 diaries with little locks on them and quiet reading. 00:17:10.150 --> 00:17:12.670 They're developing an inner life. They're starting 00:17:12.670 --> 00:17:15.329 to value privacy. Which is a perfect segue to 00:17:15.329 --> 00:17:17.829 a clinical application. How do we treat this 00:17:17.829 --> 00:17:19.910 patient when they walk into the clinic or the 00:17:19.910 --> 00:17:23.190 hospital? The first rule is treat them as the 00:17:23.190 --> 00:17:25.819 patient. not just an accessory to the parent. 00:17:26.359 --> 00:17:29.119 Speak to them directly. Ask them questions about 00:17:29.119 --> 00:17:32.099 what's going on. How do you leverage their developmental 00:17:32.099 --> 00:17:34.799 stage to make the exam easier? You use their 00:17:34.799 --> 00:17:37.880 industry. You ask them to help you. Can you hold 00:17:37.880 --> 00:17:40.579 this band -aid for me? Can you hold the stethoscope 00:17:40.579 --> 00:17:43.319 still on your chest while I listen? They love 00:17:43.319 --> 00:17:45.960 feeling competent and useful. If you make them 00:17:45.960 --> 00:17:48.259 part of the team, they are so much less likely 00:17:48.259 --> 00:17:51.099 to fight you. And for procedures, how do you 00:17:51.099 --> 00:17:53.900 explain things? Remember, they are concrete thinkers. 00:17:54.579 --> 00:17:57.000 Abstract medical jargon is terrifying because 00:17:57.000 --> 00:18:00.039 they imagine the absolute worst. Don't say, we're 00:18:00.039 --> 00:18:02.180 going to take some blood. Why not? Because that 00:18:02.180 --> 00:18:03.940 sounds like you're taking it away forever. To 00:18:03.940 --> 00:18:06.339 a concrete thinker, that implies a permanent 00:18:06.339 --> 00:18:09.019 loss of body fluid. They might literally think 00:18:09.019 --> 00:18:11.019 they're going to deflate or run out. That's a 00:18:11.019 --> 00:18:12.660 great point. So what do you say instead? You 00:18:12.660 --> 00:18:14.779 say, I need to put this small needle in your 00:18:14.779 --> 00:18:17.319 arm to get a tiny sample of your blood to check 00:18:17.319 --> 00:18:19.319 your health. It will feel like a quick pinch, 00:18:19.319 --> 00:18:22.140 and then it's all over. Show them the equipment. 00:18:22.440 --> 00:18:24.279 Let them touch the alcohol wipe. Let them see 00:18:24.279 --> 00:18:26.099 the band -aid you're going to use. Make it concrete. 00:18:26.160 --> 00:18:28.519 Make it concrete. Remove the mystery. It reduces 00:18:28.519 --> 00:18:32.660 their anxiety tenfold. And privacy. Huge. Modesty 00:18:32.660 --> 00:18:35.359 really kicks in around age six or seven. Always 00:18:35.359 --> 00:18:37.599 knock on the door, give them a gown, and make 00:18:37.599 --> 00:18:40.240 sure it's closed. Do not just expose them like 00:18:40.240 --> 00:18:42.940 you might a toddler. They are very, very aware 00:18:42.940 --> 00:18:44.940 of their bodies and any differences from their 00:18:44.940 --> 00:18:47.660 peers. If you respect their privacy, you earn 00:18:47.660 --> 00:18:50.039 their trust. Let's talk pain assessment. This 00:18:50.039 --> 00:18:52.700 is a classic exam topic. Which scale do we use? 00:18:53.000 --> 00:18:56.779 It depends on the exact age, but generally. For 00:18:56.779 --> 00:18:59.240 the younger school age kid, maybe up to about 00:18:59.240 --> 00:19:02.059 age seven, we're still using the faces scale. 00:19:02.680 --> 00:19:04.960 Point to the face that shows how much you hurt. 00:19:05.240 --> 00:19:07.740 But once they hit that concrete operational stage, 00:19:07.960 --> 00:19:10.420 Once they understand serialization and number 00:19:10.420 --> 00:19:13.500 concepts, usually around 8, 7, or 8, they can 00:19:13.500 --> 00:19:16.400 use the numeric scale from 0 to 10. They understand 00:19:16.400 --> 00:19:19.539 that 8 is more than 4. A preschooler doesn't 00:19:19.539 --> 00:19:22.099 really grasp that magnitude. And the sources 00:19:22.099 --> 00:19:24.579 mention the Outcher Scale. Yes, the Outcher Scale 00:19:24.579 --> 00:19:27.140 is great. It uses photographs of real children's 00:19:27.140 --> 00:19:29.599 faces in pain rather than cartoons, which can 00:19:29.599 --> 00:19:32.039 be more relatable. It's good for ages 3 to 13. 00:19:32.720 --> 00:19:34.640 But the key takeaway for you is that unlike a 00:19:34.640 --> 00:19:37.339 preschooler, a school -aged child can tell you 00:19:37.339 --> 00:19:39.619 where it hurts and what it feels like. They have 00:19:39.619 --> 00:19:42.039 the words for it. They can distinguish sharp 00:19:42.039 --> 00:19:45.460 from dull or running. They can be a really good 00:19:45.460 --> 00:19:47.920 historian if you ask the right questions. Now 00:19:47.920 --> 00:19:50.619 everyone's favorite topic, vital signs. We need 00:19:50.619 --> 00:19:53.480 to spot the trends for exams. The trend is your 00:19:53.480 --> 00:19:56.599 friend here. It's simple. As the child grows, 00:19:57.059 --> 00:19:59.299 the heart rate and respiratory rate go down and 00:19:59.299 --> 00:20:01.140 the blood pressure goes up. And why is that happening 00:20:01.140 --> 00:20:03.539 physiologically? The heart is getting larger 00:20:03.539 --> 00:20:06.579 and the muscle is getting stronger. It pumps 00:20:06.579 --> 00:20:08.859 more blood with each beat that's increased stroke 00:20:08.859 --> 00:20:11.200 volume. So it doesn't need to beat as fast to 00:20:11.200 --> 00:20:13.359 circulate oxygen. That's why the rate drops. 00:20:13.660 --> 00:20:15.140 Okay, give us the numbers to have in our heads 00:20:15.140 --> 00:20:17.630 for the exam. The heart rate slows to roughly 00:20:17.630 --> 00:20:21.049 60 to 110 beats per minute. Respirations slow 00:20:21.049 --> 00:20:23.990 down to 20 to 25. And you'll notice their breathing 00:20:23.990 --> 00:20:26.390 becomes more diaphragmatic. They use their belly 00:20:26.390 --> 00:20:28.930 muscles less and their chest muscles more, like 00:20:28.930 --> 00:20:30.970 an adult. And blood pressure is creeping up. 00:20:31.190 --> 00:20:33.589 Blood pressure rises, yeah. Cystolic will be 00:20:33.589 --> 00:20:36.430 roughly 96 to 106, but it really depends on their 00:20:36.430 --> 00:20:38.579 height and gender. Okay, stick a pin in that. 00:20:38.680 --> 00:20:41.619 Let's talk vaccines. There is a massive milestone 00:20:41.619 --> 00:20:44.519 visit in this era, the 11 to 12 year old visit. 00:20:44.700 --> 00:20:47.000 This is a money question on exams. You have to 00:20:47.000 --> 00:20:49.900 know this. At 11 or 12 years old, you are looking 00:20:49.900 --> 00:20:52.480 at three major vaccines. Okay, what are they? 00:20:52.880 --> 00:20:56.880 One, Tdap. This is the booster for tetanus, diphtheria, 00:20:56.960 --> 00:21:00.170 and pertussis. Note, the P is for Pertussis whooping 00:21:00.170 --> 00:21:02.630 coughs, which is crucial because the immunity 00:21:02.630 --> 00:21:06.789 from childhood shots wanes. Meningococcalo, menasiwi. 00:21:06.950 --> 00:21:09.630 This is the first dose. This prevents meningitis, 00:21:09.710 --> 00:21:11.809 which is so important as they head toward camps, 00:21:11.950 --> 00:21:14.210 dorms, and college where they live in close quarters. 00:21:14.630 --> 00:21:18.289 HPV, human papillomavirus. The HPV vaccine often 00:21:18.289 --> 00:21:20.390 brings up questions from parents because it's 00:21:20.390 --> 00:21:23.049 linked to sexual activity. How should a nurse 00:21:23.049 --> 00:21:26.049 explain it to a hesitant parent? You frame it 00:21:26.049 --> 00:21:28.410 as cancer prevention. Because that's what it 00:21:28.410 --> 00:21:31.130 is. You say, this vaccine prevents cancers caused 00:21:31.130 --> 00:21:34.869 by the HPV virus later in life. And you explain 00:21:34.869 --> 00:21:37.410 that it's recommended to start at 11 or 12 because 00:21:37.410 --> 00:21:39.410 the immune response is strongest at this age. 00:21:39.630 --> 00:21:41.690 It's actually better than if you wait until they're 00:21:41.690 --> 00:21:44.069 16 or 18. And the dosing schedule is different 00:21:44.069 --> 00:21:47.210 too, right? Yes. Great point. If they start before 00:21:47.210 --> 00:21:50.069 age 15, it's only a two -dose series. If they 00:21:50.069 --> 00:21:51.910 wait until after 15, it becomes a three -dose 00:21:51.910 --> 00:21:54.269 series. So there's a real clinical benefit to 00:21:54.269 --> 00:21:56.650 doing it on time. And don't forget the annual 00:21:56.650 --> 00:21:59.900 flu shot. Never forget the annual flu shot. Health 00:21:59.900 --> 00:22:01.859 screenings. What are we looking for in school 00:22:01.859 --> 00:22:04.539 -aged kids specifically? Two big ones. First 00:22:04.539 --> 00:22:07.039 is scoliosis. We screen for curvature of the 00:22:07.039 --> 00:22:09.099 spine because this is the age of growth of births, 00:22:09.119 --> 00:22:11.440 especially for girls, and that's when scoliosis 00:22:11.440 --> 00:22:13.559 can worsen really rapidly. Okay, and the second? 00:22:13.700 --> 00:22:16.460 And second is vision. We're looking for amblyopia 00:22:16.460 --> 00:22:20.019 or lazy eye and other refractive errors. What 00:22:20.019 --> 00:22:22.359 are the signs a teacher or a parent might notice? 00:22:23.099 --> 00:22:25.319 Things like squinting. complaining of headaches, 00:22:25.480 --> 00:22:28.440 holding books too close to their face. And think 00:22:28.440 --> 00:22:31.000 about how this connects back. If they can't see 00:22:31.000 --> 00:22:33.819 the board, they can't learn. If they can't learn, 00:22:33.960 --> 00:22:35.920 they feel incompetent. They fail at industry. 00:22:36.339 --> 00:22:38.680 It all connects. I love how you tied that back. 00:22:38.819 --> 00:22:41.619 It's a holistic system. OK, we have covered a 00:22:41.619 --> 00:22:44.519 mountain of info. Let's try to optimize this 00:22:44.519 --> 00:22:47.259 for memory. Let's look at the patterns. If you 00:22:47.259 --> 00:22:49.559 know they are concrete thinkers, you know they 00:22:49.559 --> 00:22:52.099 need concrete explanations and concrete safety 00:22:52.099 --> 00:22:54.740 gear like helmets and seat belts. Right. If you 00:22:54.740 --> 00:22:56.900 know they're driven by industry, you know they 00:22:56.900 --> 00:22:58.819 want to help you in the clinic and that their 00:22:58.819 --> 00:23:02.200 biggest fear is failure or inferiority. And if 00:23:02.200 --> 00:23:04.519 they love rules? If you know they love rules, 00:23:04.799 --> 00:23:07.259 you know they love organized games and they despise 00:23:07.259 --> 00:23:09.519 cheating. Unless, of course, they're the ones 00:23:09.519 --> 00:23:11.819 doing it to win. Do you have a mnemonic for us? 00:23:11.839 --> 00:23:15.460 Yeah. Try the three C's of school age. One. Concrete 00:23:15.460 --> 00:23:18.660 thinking, that's Piaget. Two, cooperative play, 00:23:19.019 --> 00:23:22.599 teams and rules. Three, conservation. They know 00:23:22.599 --> 00:23:24.859 the water is the same amount. I like that. Short, 00:23:25.180 --> 00:23:28.480 sweet, and to the point. And here is the 80 -20 00:23:28.480 --> 00:23:32.460 summary box to take home with you. If you understand 00:23:32.460 --> 00:23:36.579 that the school -aged child is a mini -adult 00:23:36.579 --> 00:23:39.900 driven by a need for competence, that's industry, 00:23:40.420 --> 00:23:43.559 within a strict world of rules, but limited by 00:23:43.559 --> 00:23:47.119 concrete reasoning, You can predict almost everything. 00:23:47.359 --> 00:23:49.279 Everything falls into place from there. You can 00:23:49.279 --> 00:23:52.519 predict their play, team sports, their fears, 00:23:52.960 --> 00:23:55.819 loss of control, failure, and their safety risks. 00:23:56.319 --> 00:23:59.980 Judging traffic, curiosity about firearms. So 00:23:59.980 --> 00:24:02.079 treat them like rational partners who just need 00:24:02.079 --> 00:24:04.680 visual proof, not abstract theories. That is 00:24:04.680 --> 00:24:06.720 the golden nugget right there. And just a final 00:24:06.720 --> 00:24:08.960 thought to chew on. We spent six years teaching 00:24:08.960 --> 00:24:11.059 these kids to follow rules, to sit still, to 00:24:11.059 --> 00:24:13.480 be good, to organize their collections so perfectly. 00:24:13.519 --> 00:24:15.700 And then? And then puberty hits. The hormones 00:24:15.700 --> 00:24:18.220 flush the cistern, the brain literally rewires 00:24:18.220 --> 00:24:20.279 for abstract thought, and all that rigid rule 00:24:20.279 --> 00:24:22.039 following gets blown to pieces in adolescence. 00:24:22.440 --> 00:24:24.279 So appreciate the school -aged child while they 00:24:24.279 --> 00:24:26.559 are here. It's the orderly, industrious calm 00:24:26.559 --> 00:24:30.400 before the swarm. On that ominous note, next 00:24:30.400 --> 00:24:32.720 time you see a 10 -year -old perfectly organizing 00:24:32.720 --> 00:24:35.319 their LEGO bricks by color, just give them a 00:24:35.319 --> 00:24:37.700 high five for industry. Thanks for diving in 00:24:37.700 --> 00:24:38.440 with us. See you next time.