Chapter 7: Health Promotion During Early Childhood

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Welcome back to the Deep Dive.

We are shifting gears today.

We spent a lot of time recently on the high acuity, critical care side of things, you know, the tubes, lines, and alarms.

But today we are looking at something that is arguably just as complex but in a totally different way.

We are looking at the transition from, well, from babyhood to childhood.

It is a massive shift.

We are diving deep into chapter seven of Maternal Child Nursing, sixth edition.

The title is Health Promotion During Early Childhood.

But, you know, if you are a nursing student or a practitioner, you probably know this as the toddler and preschooler unit.

Right.

And if you are cramming for an exam or just need a solid refresher on pediatric milestones because you've got a rotation coming up, consider this your last minute lecture.

I love that framing, the last minute lecture.

It puts the pressure on us to be concise but thorough.

So let's set the stage.

We aren't talking about helpless newborns anymore, but these aren't independent school -aged kids either.

Not at all.

We are looking at a very specific, very dynamic window here.

We are.

We are covering two distinct but deeply connected phases.

First, you have the toddler years, that's ages 12 to 36 months.

Right.

Then you have the preschool period, which runs from ages three to five years.

So essentially from the first wobbly steps up until they walk into the kindergarten classroom.

Exactly.

And the mission for this deep dive is to bridge that gap.

It is a massive leap biologically and psychologically.

You go from a child who is totally dependent on parents for everything, feeding, dressing, emotional regulation, to a child who is fighting for autonomy, developing a vivid imagination and learning the complex rules of interacting with the world.

And for the nurses listening, why is this specific chapter so critical?

I mean, aside from the obvious need to pass the boards, why does this matter for daily practice?

It's critical because this is the prime time for health promotion and anticipatory guidance.

This age range is statistically an age of high risk.

You have safety risks because they are mobile but don't understand danger.

You have behavioral challenges that can tear families apart if they aren't managed.

Think temper tantrums and biting.

Yeah.

And you have crucial developmental milestones that need to be hit.

The nurse is the guide who helps parents navigate everything from why is my child throwing a tantrum in the grocery store to is this car seat actually going to save my child's life?

It's the nurse as the coach, basically.

Precisely.

You aren't just treating a patient, you are coaching a family system through a very turbulent time.

Let's unpack the road map.

We are going to follow the chapter structure pretty closely to keep this logical.

We'll start with physical growth and motor development, the nuts and bolts.

Then we will move into the really fascinating cognitive and psychosocial changes, the how they think part.

My favorite part.

And we'll finish with the meat and potatoes of health, maintenance, nutrition, sleep, discipline, and the huge topic of safety.

Sounds like a solid plan.

Okay, starting with the overview of growth and development.

The text draws a really interesting contrast between these two phases.

It calls the toddler years tumultuous and the preschool years relatively tranquil.

That feels like a very specific choice of words.

It's the tale of two cities of childhood.

The toddler years are characterized by that intense struggle for autonomy.

You've got the terrible twos, right?

And it's loud, it's messy, it's emotional.

Oh, yeah.

They want to do everything themselves, but they physically can't, so they get frustrated.

But then, as they slide into the preschool years, ages three to five things settle down.

They gain social maturity, their language explodes so they can tell you what they want instead of screaming.

They become imaginative.

So the parents get a bit of a breather.

A little bit.

But the nurse's job actually gets more complex in some ways because the developmental goals shift.

The text highlights the healthy people 2030 objectives here.

We aren't just measuring height and weight.

We're looking at broader public health goals, increasing developmental screening, reducing obesity, improving sleep,

and this is a big one, reducing ear infections and injuries.

Speaking of screening, I saw a distinction in the source material that I think often trips people up.

The difference between developmental surveillance and developmental screening, they sound like the same thing.

They do, but in practice, they are very different.

Surveillance is what you do at every single visit.

It's taking a history, asking parents how are things going,

observing the child while you talk.

It's flexible and continuous.

Kind of an informal check -in.

Exactly.

Screening, on the other hand, is using a standardized validated tool to actually test development against a data set.

Like a checklist or a scoring system?

Right.

The American Academy of Pediatrics says you should do formal screening at nine, 18, and 30 months.

This helps catch delays early.

But the text suggests there is a gap in compliance here.

A massive gap.

The research cited shows that only roughly 30 percent of providers actually administered a developmental screening tool.

Wow.

More than half didn't do screening or proper surveillance.

That is concerning.

That means a lot of developmental delays.

Yeah.

Autism, speech delays, motor issues are slipping through the cracks until it's much harder to treat.

Exactly.

Nurses need to know that relying on observation or clinical intuition isn't enough.

You can't just eyeball development.

You need the tools.

Let's move to the physical changes, the physiology.

Yeah.

If you look at a toddler versus a preschooler, they look completely different.

Oh, yeah.

It's almost like a different species.

It really is.

In the toddler years, growth actually slows down significantly compared to infancy.

Okay.

In that first year of life, they're tripling their birth weight.

But toddlers,

they gain only about five pounds a year and grow about three inches a year.

It's a stair -step growth pattern, not a linear curve.

And they have that specific look, the toddler silhouette.

The pot belly.

Yes, the pot belly.

I think parents often worry about this.

Is it just because they eat too many crackers?

No, it's entirely physiological.

It's due to immature abdominal muscles.

They just aren't strong enough to hold everything in tight yet.

Huh.

Plus, they have an exaggerated lumbar curve lordosis, so their sway back pushes the tummy out.

And their legs might look a bit bowed.

And flat feet.

Flat feet, too, because of a plantar fat pad.

That pad usually disappears around age two.

Now, compare that to the preschooler.

Right.

By age three or four, they slim down.

The trunk lengthens.

The baby fat declines.

They become agile.

They stop looking like babies and start looking like little kids.

Exactly.

Musculoskeletally, the hips and knees mature.

Here is a fun fact for the assessment.

Knock knees, where the knees touch, but the ankles don't, are actually common in three -year -olds.

Really?

Yes.

But they usually self -correct by age four or five.

That's a good don't panic tip for parents.

What about the head?

We measure heads religiously in babies.

We do.

But in codlers, brain growth slows down relative to body growth.

By age two, the head is already 90 % of its adult size.

The big milestone here is the fontanels.

The soft spots.

The anterior fontanel, the soft spot on top, should be closed by 18 months.

And if it's not closed by 18 months?

That's a red flag.

Could be nutritional, could be hormonal, could be hydrocephalus.

It needs investigation.

Let's talk about moving.

Motor development.

The text calls walking the crowning achievement of the toddler period.

It changes everything.

Once they can walk, the world opens up, and so does the danger.

What's the specific timeline we need to memorize?

Well, most children walk alone by 15 months.

They walk with a wide stance, that toddler gait, for balance.

Right.

By 18 months, they are running, though they fall a lot because their upper body is still a bit heavy compared to their legs.

And here's a scary one.

By 15 months, they are avid climbers.

Chairs, tables, bookshelves.

Nothing is safe.

That's why safety education is so huge at the 15 -month visit.

Can't just put things up high anymore because they can get to up high.

And what about fine motor skills?

I feel like this is where the messiness of mealtime comes in.

Oh, absolutely.

Fine motor control is about the small muscles.

And 18 -month -olds can hold a cup, but they're going to spill it because they lack wrist rotation.

Okay.

A two -year -old can use a spoon, but they generally turn it upside down before it hits their mouth.

So if a parent complains that their two -year -old is a messy eater, the nurse says?

Congratulations, your child is normal.

It requires practice.

They can build a tower of six to seven blocks by age two, but dressing is a struggle.

I can imagine.

A 24 -month -old can remove clothing, which they love to do, and maybe put on a simple shirt, but they cannot differentiate front from back.

Now, jump to the preschooler.

They seem much more coordinated.

Much more.

We see a refinement of neuromuscular control.

Right.

A four -year -old can throw a ball overhand.

A five -year -old can jump rope or skate.

They can balance on one foot.

And regarding fine motor skills, the text mentions this is when handedness gets established.

Right.

Left -handed versus right -handed.

It's usually established by age four.

And I want to highlight a specific nursing tip here.

If you have a left -handed child in the hospital or clinic, give them left -handed scissors or tools.

Don't force them to use their right hand.

Does that still happen?

Do people force the right hand?

It happens less than it used to, but sometimes it's just a lack of resources.

Using right -handed scissors with a left hand is incredibly frustrating and hinders their coordination development.

Good catch.

Okay, I want to get into the brain.

Cognitive development.

This is heavy on Piaget.

We are moving from the sensorimotor stage to the preoperational stage.

This is often where students get confused.

Help us decode this.

So the toddler starts at the tail end of the sensorimotor

between 12 and 18 months.

Their learning is defined by tertiary circular reactions, which is a fancy term for active experimentation.

It's all trial and error.

They drop a toy to see where it goes.

They pull a tablecloth to see what falls off.

It's like they're a little physicist testing gravity and cause and effect.

Exactly.

They aren't trying to be destructive.

They're gathering data.

And by 19 to 24 months, object permanence is firmly established.

They know you exist even when you leave the room,

which doesn't necessarily make them happy while you're leaving, but they understand the concept that you haven't vanished into the void.

And this leads to domestic mimicry.

I love this term.

It's cute, but it's also a sign of high -level cognitive development.

They watch you sweep the floor, and they try to sweep.

They see you shave or put on makeup, and they imitate it.

It shows they're beginning to use symbols in memory.

They're internalizing the world around them.

Yep.

But then we hit the preschool years, the preoperational stage.

This spans from age two to seven.

The text breaks this down into the preconceptual phase, two to four, and the intuitive phase, four to seven.

This is where the thinking gets really fascinating and, frankly, kind of weird.

How so?

It is weird.

It's magical.

The text breaks down the characteristics of preoperational thinking in table 7 .1, and every nurse needs to memorize these because they dictate how you talk to a child.

If you explain a surgery to a four -year -old like you would an adult, you will terrify them.

Let's run through the key characteristics.

First up, egocentrism.

This is the big one.

It doesn't mean they are selfish in the adult sense of, I don't care about you.

Right.

It means they literally cannot see another person's perspective.

If a toddler takes a toy,

they aren't trying to be mean.

They want it, so they take it.

They assume everyone thinks, sees, and feels exactly what they do.

So asking a three -year -old, how do you think that made Johnny feel,

is essentially a useless question.

Completely useless.

They can't process it.

Next,

animism.

Attributing life to inanimate objects.

If a toddler trips over a table, they might scold the table for hitting them.

To them, the table did it on purpose.

So in a hospital.

In the hospital.

This is huge.

A blood pressure cuff isn't just a machine.

It might be a monster that is biting their arm.

That explains so much fear in pediatric wards.

What about irreversibility?

This means they can't reverse a process in their head.

If a child takes a puzzle apart, they can't visualize how to put it back together.

Or if you tell them to walk back home the way they came, they might get lost because they can't reverse the sequence of left turn, then right turn.

Wow.

And magical thinking.

This is the most clinically relevant one.

They believe their thoughts cause events.

If they were angry at their brother, and then their brother gets sick.

They think they caused it.

They might genuinely believe their anger caused the illness.

That is heartbreaking.

Yes.

And it means nurses have to be very careful to explicitly reassure children that they didn't cause their sickness, or their sibling's sickness, or their parent's divorce.

They internalize guilt for things they have no control over.

The last one is centration.

Focusing on only one aspect of a situation at a time.

If you give a preschooler three instructions at once, put on your socks, get your shoes, and grab your coat, they will likely only hear coat.

They can't multitask instructions?

No, they can't hold multiple variables.

You have to give directions one at a time.

Put on your socks, wait, now put on your shoes.

It's all starting to make sense.

Todd also mentions transductive reasoning.

Right.

Reasoning from particular to particular.

Adults use deduction or induction.

Kids use transduction.

If a child usually has a nap after lunch, and one day they don't have lunch, they might reason that they can't have a nap.

Because the sequence is broken.

Exactly.

They don't understand the general logic.

They just link specific events that happened together in the past.

Moving on to language, you called it an explosion earlier.

It really is.

In toddlers, there is this massive gap between receptive language, what they understand, and expressive language, what they can say.

Which explains the frustration and the tantrums.

Yes.

Imagine understanding everything everyone is saying about you.

Put on your shoes, we're going to the park.

But you can only say park or no shoe.

It's maddening.

Yeah, I can see that.

The vocabulary jumps from about 30 words at 18 months to over 300 words by age two.

And no is the favorite word.

It's a power word.

It's about setting a boundary.

It's their first real taste of control.

Then in the preschool years, the vocabulary goes up to over 2100 words by age five.

They can speak in full sentences.

And this is where we see self -talk.

Monologues.

You'll see preschoolers playing and just narrating their entire life, or talking to imaginary friends.

Is that normal?

It's healthy.

It's practice.

They are trying out words and sentence structures.

What about bad language?

The text mentions that four -year -olds might start using profanity.

They do it for attention, or because they're imitating adults.

They rarely understand what the word means.

They just know it gets a reaction.

So what's the advice?

The advice here is simple.

Ignore it.

If you gasp or laugh or yell, you reinforce it.

If you ignore it, the word loses its power.

And stuttering.

Very common in preschoolers.

Their minds are working faster than their mouths.

They're trying to say a complex sentence, and the motor coordination of the tongue can't keep up.

What's the takeaway for parents, then?

The key takeaway is, do not correct them.

Do not finish their sentences.

Do not say, slow down.

Just listen to the idea, not the delivery.

It usually resolves on its own.

Let's get into the emotional side.

Psychosocial development.

We are looking at Erickson.

This is the framework for understanding their internal conflicts.

For the toddler, the stage is autonomy versus shame and doubt.

The classic me do it.

Exactly.

They want to assert their will.

They want to put on their own shoes, pour their own milk.

But the conflict is that their skills aren't fully developed, so they fail often.

If they're constantly criticized for making a mess,

shame.

Or if the parent does everything for them, doubt.

They develop a sense of inadequacy.

So the parent has to walk a tightrope, let them try, but support them so they don't fail too hard.

Right.

The text mentions negativism here again.

The no.

It's an assertion of independence.

It's not just stubbornness.

It's them proving they're separate from the parent.

And to cope with all this chaos.

In New Autonomy, toddlers use ritualism.

They need the same cup, the same bedtime story.

Every single night.

It provides security.

I can't control the world, but I can control which cup I use.

And here is a nursing priority.

If a toddler is in the hospital, try to maintain those home rituals.

That makes so much sense.

If they have a specific blanket,

or a specific way they like to be tucked in, document it and do it.

It reduces the trauma of hospitalization significantly.

Separation anxiety peaks again here too, right?

It does.

Even though they know you exist, object permanence, they are terrified you won't come back.

This is where transitional objects come in.

The blankie.

The teddy bear.

Never underestimate the power of the blankie.

It bridges the gap between dependence and autonomy.

Smells like home.

It feels safe.

Then we move to the preschooler.

Erickson's stage shifts to initiative versus guilt.

Now it's not just about doing it themselves.

It's about planning and executing.

Learning how to do things.

They want to help cook.

They want to build a fort.

See, the initiative.

The initiative is that drive to create and accomplish.

And the guilt.

The guilt comes if they overstep their abilities, or if they made to feel like a nuisance.

If a child tries to wash the dishes and breaks a plate and the parent yells, you're so clumsy, get out of here, the child develops guilt about their initiative.

They stop trying.

I want to touch on play because the text has a specific progression of play types that mirrors the social development.

Yes.

Toddlers engage in parallel play.

Which is?

They play side by side.

They might have the same toys, two kids playing with drugs in the same sandbox,

but they aren't playing together.

There is no shared goal.

They're in their own little bubbles next to each other.

And preschoolers?

They move to associative and cooperative play.

They interact.

They share.

Mostly.

They learn rules.

You build the tower, I'll drive the truck.

And we see a lot of symbolic or dramatic play.

Like the kitchen sets or medical kits?

Exactly.

The text describes a child playing with a kitchen set.

That's symbolic play.

It's essential for processing reality.

A child might play doctor to process a scary medical visit.

Right.

They give the shot to the doll to regain control over this situation.

Which segues perfectly into moral development.

Holberg.

Yeah.

Preschoolers are at the pre -conventional level.

It's very basic morality.

Good behavior is simply what gets a reward.

Bad behavior is what gets punished.

That's it.

That's it.

Their conscience is very primitive.

It's external, driven by parents' rules.

So they don't really understand why hitting is wrong, just that it leads to a timeout.

Precisely.

If they hit and don't get caught, in their mind, it wasn't bad.

One other aspect of development the text touches on here is gender identity.

Yes.

Usually by age three, children are aware of their gender.

They also become very curious about bodies.

The text notes that exploratory behaviors like masturbation are normal at this age.

And the advice for parents?

Is to not shame the child, but to redirect them gently, teaching them that these are private behaviors.

Okay.

Let's get practical.

Health promotion and maintenance.

We've covered the developmental theory.

Now let's talk about the daily grind.

Nutrition is always a battleground with this age group.

It is.

Parents often freak out because their toddler, who ate everything as a baby, suddenly stops eating.

The text calls this physiologic anorexia.

It sounds scary, but it's normal.

Remember we said growth slows down?

Right.

Because growth slows, they need fewer calories per pound.

Their appetite naturally drops.

And they get picky.

Food jags.

Eating only chicken nuggets for three days straight.

Or only eating white foods.

The advice.

Don't force feed.

Don't make it a battle.

Just offer the food.

Offer healthy options.

And if they don't eat, they don't eat.

No healthy child will starve themselves.

The text gives a rule of thumb for serving sizes that I think is really helpful, because parents usually over -serve.

It's one tablespoon of solid food per year of age.

That's not much.

No.

So a two -year -old only needs two tablespoons of peas,

two tablespoons of rice.

It's much less than parents think.

If you put a huge adult -sized portion in front of them, they get overwhelmed and refuse to eat anything.

What about milk?

I feel like toddlers live on milk.

And that's a danger.

We call it milk anemia.

If a child drinks too much milk, more than two to three cups a day, two things happen.

Okay.

One, the milk fills them up so they don't eat iron -rich solid foods.

Two, calcium actually interferes with iron absorption.

So you get these chubby, pale toddlers with severe iron deficiency anemia.

And juice.

Limited.

Four to six ounces a day, max.

It's mostly sugar and contributes to obesity and cavities.

Speaking of cavities, let's talk dental health.

First dental visit should be by age one.

And here is a key for parents.

You have to do the brushing.

They can't do it themselves, effectively?

No.

Toddlers lack the manual dexterity.

You can let them try, but you have to do the finish -up scrub.

What's the guidance on fluoride toothpaste?

I know this changed recently.

It did.

For children under three, use a smear.

Literally the size of a grain of rice.

For children over three, a pea -sized amount.

Got it.

And watch out for bottle wrap.

Never, ever put a child to bed with a bottle of milk or juice.

The sugar sits on the teeth all night and destroys the enamel.

Sleep.

We touched on this in the overview, but let's get into the weeds.

Sleep requirements drop slightly.

Toddlers need about 11 -14 hours.

Preschoolers about 10 -13.

But the problems increase.

Bedtime resistance is huge.

Why is that?

It comes back to autonomy.

They don't want to stop playing.

And they have fears.

Monsters, the dark.

The intervention is the bedtime routine.

Quiet time, bath, story, bed.

Consistency.

The text highlights a classic exam topic.

Nightmares versus night terrors.

Can you distinguish them clearly?

This is crucial.

A nightmare is a scary dream.

It happens in REM sleep, which is lighter sleep.

Okay.

The child wakes up.

They are scared.

And most importantly, they remember the dream.

They need comfort.

You go in, you hug them, you reassure them.

In a night terror.

Totally different.

It happens in deep, non -REM sleep.

The child might scream, thrash around, their eyes might be open, but they are not awake.

They're not awake.

No.

They are unresponsive to you.

And the next morning,

they do not remember it at all.

So what do you do as a parent?

Do not wake them.

It is very hard to watch, but you just ensure they are physically safe so they don't fall out of bed and let it pass.

If you wake them, they will be disoriented and because they were just ripped out of deep sleep.

Discipline.

The text is very clear on the purpose of discipline.

It's to teach self -control, not just to punish behavior.

For toddlers, it suggests distraction and ignoring tantrums.

But for preschoolers, it introduces the timeout.

The rule is one minute per year of age.

So a three -year -old gets a three -minute timeout.

But equally important is the time in.

What's that?

Praising good behavior when they are in trouble.

If you only pay attention when they are bad, you reinforce the bad behavior.

And consistency is the most important factor.

If hitting gets a timeout today but is ignored tomorrow, the child is confused.

The rules have to be clear and immediate.

Exactly.

Now we are entering the danger zone.

Safety.

The text states explicitly that unintentional injury is the leading cause of death in this age group.

It is.

They are mobile, curious, and lack judgment.

Let's hit the anticipatory guidance priorities.

Car safety.

This is non -negotiable.

Rear -facing is safest.

The American Academy of Pediatrics now advises keeping them rear -facing as long as possible until they max out the height or weight limits of their specific car seat.

So that's usually well past age two.

Why is rear -facing so much safer?

It protects the head, neck, and spine.

In a frontal crash, the most common type of rear -facing seat cradles the child.

In a forward -facing seat, the head snaps forward, risking spinal cord injury.

Okay, so once they outgrow that, they go forward -facing with a harness.

What about booster seats?

The text shows figure 7 .6 regarding this.

This is for when they outgrow the forward -facing seat, usually around age four or five.

But they need to stay in a booster until they are four feet nine inches tall.

Why is the booster essential?

Because seat belts are designed for adults.

Without a booster, the lap belt sits on the child's soft abdomen.

In a crash, that belt cuts into the internal organs.

The liver, the spleen, the bowel.

The booster lifts the child up so the belt sits low on the strong pelvic bones.

It prevents internal organ damage.

Toddlers reach for everything.

Turn pot handles in on the stove so they can't grab them.

Set water heaters to 120 degrees F, 49 degrees C.

That's specific.

It only takes seconds for a child to get a third degree burn at higher temperatures.

And for preschoolers, start teaching stop, drop, and roll.

Poisoning.

This is a big one for toddlers who explore with their mouths.

The text gives a specific number.

1 -800 -222 -1222.

That's poison control.

Parents should put that in their phone.

Call them first before calling 911 unless the child is unconscious or not breathing.

And do we induce vomiting?

I remember years ago everyone had syrup of Ipecac.

No.

That's old advice.

Throw the Ipecac away.

Depending on what they swallowed, like bleach or acid vomiting, can actually cause more damage coming back up.

Burning the esophagus a second time.

So always call first.

Always.

Call a hotline.

They will tell you exactly what to do.

And obviously lock cabinets high up.

And a big one.

Do not call medicine candy to get them to take it.

Why not?

They will find it later and eat the whole bottle thinking it's treats.

Water safety.

Drowning is a leading killer.

The standard is touch supervision.

What does that mean?

It means an adult should be within arm's reach.

Not reading a book on the patio while the kid is in the pool.

Arms reach.

And keep toilet lids down.

Toddlers are top heavy.

If they lean in to play with the water, they can fall in head first and they aren't strong enough to push themselves back out.

That is a terrifying image, but a necessary warning.

Let's wrap up with a few selected issues in care.

The first one is every parent's nightmare.

Toilet training.

The golden rule here.

Readiness is key.

You cannot force it.

If you try before they are ready, it will be a long, frustrating failure.

What are the signs of readiness?

First, physical readiness.

They need voluntary sphincter control.

This happens due to myelination of the spinal cord around 18 -24 months.

So before that, they literally can't control it.

Correct.

If the nerves aren't myelinated, they physically cannot hold it.

A sign is if they can stay dry for two hours at a time.

And psychological readiness.

They have to want to please you.

They have to be impatient with wet diapers.

They have to be able to communicate, I need to go.

And bowel usually comes before bladder.

Yes.

It's more predictable.

And nighttime bladder control can take years longer, sometimes up to age four or five.

Bedwetting is normal for a long time.

Sibling rivalry.

We talked about the toddler getting jealous when a new baby arrives.

It's a huge disruption to their world.

Regression is the big sign.

Regression how?

A toilet -trained toddler might start wetting their pants.

They might ask for a bottle.

The intervention is to include them.

Give them a baby doll to take care of while you take care of the real baby.

Like you take care of your baby.

I'm changing the baby's diaper.

You change your doll's diaper.

And ensure they get private time with parents so they don't feel replaced.

Finally, school readiness.

How do we know a five -year -old is ready for kindergarten?

It's not just about age.

Box 7 .5 in the text lists the checklist.

It's about developmental maturity.

Can they separate from parents without a major meltdown?

Can they follow multi -step instructions?

Can they go to the bathroom independently?

Do they have the attention span to sit for a short story?

It's a holistic assessment.

Not just can they count to 10.

Exactly.

Social and emotional readiness is just as important as cognitive readiness.

This has been a massive deep dive.

We've gone from the clumsy pot -bellied toddler discovering gravity to the imaginative storytelling preschooler learning to interact with society.

It's an incredible journey.

It's the foundation of the person they will become.

If we had to boil this down to the absolute nursing priorities for the learner, the things they absolutely cannot forget, what are they?

I'd say three pillars.

First, safety preventing those injuries through anticipatory guidance, car seats, poisons, burns.

Second, nutrition navigating the pickiness, preventing anemia, and establishing healthy habits.

And third, support guiding parents through the tantrums, the toileting, and the sleep issues.

You are their coach.

You normalize the chaos for them.

I love that.

Normalize the chaos.

Now, before we sign off, leave us with the final thought.

We talked a lot about magical thinking in preschoolers, how they believe their thoughts cause reality, and how they view machines as living things.

My question for the listener is this.

Knowing that, how does that concept change how you explain a medical procedure?

If you are about to give a four -year -old a shot or take their blood pressure or put them in a CT scanner, how do you explain it so their magical brain doesn't interpret it as a punishment for being bad or an attack by a monster?

That ability to translate medicine into their magical language,

that is the art of pediatric nursing.

That is a great thing to mull over.

It's about empathy at a developmental level.

Thank you for joining us on this deep dive into early childhood.

Happy studying.

This has been the Last Minute Lecture Team.

See you next time.