Developmental Stages

It is important to know and understand the developmental stages of infants and children. Knowing these ages, stages, common milestones and abilities allows the nurse to interact with the child appropriately, use play effectively, and teach the child in an understandable way. Knowing normal growth and development also equips the nurse to identify developmental lags which can aid parents and caregivers to intervene as necessary.

Development is sequential and directional. Cephalocaudal (head down...head control then trunk, then feet). Proximodistal (inside out, trunk to arms to fingers).

Prenatal life, fetus, or newborn:Can be infected by 'vertical transmission' from mother during pregnancy, through the placenta, during delivery or during breast feedingInfections transmitted this way include rubella, herpes, hepatitis B and C, HIVNewborns are particularly susceptible to Staphylococci and Escherichia coliMaternal antibodies decrease with timeThe newborn has an immature immune systemFrequent hand to mouth exploration of the environmentCaregiver kissing hands and feetIllness increases risk for fever, decrease in appetite and fluid intake
Diarrhea and dehydration

Newborn: first 28 days or 4 weeks
Maternal history
Birth history
Reflexes - moro, palmar, dance, tonic neck, rooting...gag, yawn, cough, blink, sneeze
Physical Characteristics - SGA, AGA, LGA, mongolian spots, stork bites
Thermoregulation heat loss - head, temperature low, sick
I&O - Stool (meconium) in 1st 24-48 hours, 6-8 wets/day
Education - follow up care, immunizations, car safety

What is...
The Period of Purple Crying

Purple Crying Picture.jpg

Infants: Birth to 1 year
Freud - Oral stage : comfort through oral stimulation : offer pacifier if NPO and not contraindicated, breast, bottle or Sweet Ease
Erikson - Trust versus Mistrust: Meet the care needs by holding, feeding, cleaning and comforting
Piaget - Sensorimotor: Use bright toys to distract and interest, object permanence...peek a boo ;)
Kohlberg - preconventional (birth - 7 years)

Trust versus Mistrust

A one year timeline...
2 months posterior fontanel closes, social smile
3 months head turns to locate sounds
4 months moro reflex disappears, child has steady head control
Grasps objects, rolls over, social, shows memory
5-6 months rolls from abdomen to back and back to abdomen, creeps, peek a boo, birth weight doubles at 6 months
After 6 months can remember pain
7 months transfers objects from hand to hand
8 months sits alone
7-9 months stranger anxiety, 10 months crawls,
10-12 pincer grasp, walks with assistance,
12 months says a few words, birth weight triples, length increases by 50%

Vital Signs:
T - 96.8 - 99.0; P - 90-130; R - 20-40; BP - 90/56

*This period of growth is characterized by rapid growth, change, and formation of trusting familiar relationships.

What are parenting/nursing challenges?
Education Health Promotion - vision, hearing, dental, teething, nutrition, weaning, pacifiers, normal growth
Sudden Infant Death Syndrome (SIDS)
Failure to thrive
Poisoning - lead, plants, medications and ??? Poison Control Center

Separation anxiety 4- 8 months
Child care
Safety - car seats, stairs, pets, tub drowning, electrical outlets, sunscreen, small objects

Hospital Nursing Plan of care for the first year?
May regress
Parental involvement in care
Teach family but speak to and console child!
Toys - mobiles, rattles, squeaky toys, picture books, balls, large soft colored blocks, activity boxes
Swaddling, soothing talk
Routines and rituals
Comfort items

Toddler: 1-3 years
USCU toddlers brain Melissa Balmain 944713_10201052538946736_120389713_n-1.jpg
Toddler Brain by Melissa Balmain

Freud - Anal: Satisfaction over control over body excretions: inquire about normal habits, support normal patterns, understand regression.
Erikson - Autonomy versus Shame: Allow child self-care with feeding, dressing, toiletry.
Piaget - Sensorimotor to Preoperational: Child increasingly curious and talkative: Name objects, give simple explanations, allow interaction and manipulation, provide co
Kohlberg: preconventional

Autonomy versus Shame/Doubt

Toddler Timeline...
12-18 months anterior fontanelle closes
Potbellied and bowlegged appearance
Physiologic anorexia
20 primary teeth
14-15 months walks alone, explores away from mother
18 months throws ball overhand
24 months kicks ball
2 years feeds self with spoon/cup
Toilet training begins, bowel and bladder control
2 years -2-3 word sentences
3 years 3-4 word sentences
Temper tantrums
Can name body parts

Vital Signs:
T - 97.5 - 98.6; P - 80-120; R - 20-30; BP - 92/55

*This developmental stage is characterized by gains in motor abilities, increased coordination, sensory skills, sense of self and independence. Parallel play.

What are parenting concerns/nursing challenges?
Parental education continues
Car Safety
Water Safety
Toy and gun safety
Rituals, regression
Temper tantrums
Sibling Rivalry
Toilet training
Exploration - safety
Fear intrusive activities

Hospital Nursing Plan of care for the toddler:
Simple brief explanations
Time concepts - back after nap...after snack, after Barney
Provide for routine and ritual
Separation from caregivers greatest threat, regression probable
Comfort by acknowledging child's routines and security items from home
Guided choices
Toys - stuffed animals, push-pull toys, toy telephones, story books with pictures
Allow protest, anticipate tantrums

Excellent links with examples:

Magical thinking of children

Piaget's preoperational ages 2-7

Preschooler: 3-6 years
Freud - Phallic stage - identifies with opposite sex parent then same sex, Oedipal, Electra: Be alert to child's preference for male or female nurses, involve parents.
Erikson - Initiative versus guilt: Child initiates play, offer a variety of materials for self expression, medical equipment models, observe drawings
Piaget - Preoperational - Verbal skills increase but thoughts are not complex. Egocentric. Idiosyncratic system for organization using transductive reasoning to link things. Animism. Causes for conditions or circumstances can be confused so offer simple explanations and help the child understand the illness is not their fault.
Kohlberg - preconventional

Initiative versus Guilt?

Preschooler Timeline:
Gains 5 lbs and 2-3 inches a year
Taller, more slender
At 3 can run, skip, hop, ride tricycle, use scissors
At 4 can use scissors, concrete egocentric thinking, aggressive
At 5 ties shoes, learns colors, shapes, vision 20/20, more independent
Sentences with 5-8 words
learns sexual identity, curious, imaginary playmates and fears

Vital signs:
T - 97.5 - 98.6; P - 70-110; R - 16-22; BP - 95/57

*This developmental stage is characterized by physiological, psychological, cognitive growth; increasing ability to care for selves and play 'with' other children.

Parenting concerns and nursing challenges
Misunderstanding of causative factors, guilt, mutilation
Sleep disturbances nightmares, night terrors
Teeth grinding

Hospital Nursing Plan of Care for the Preschooler:
*Fear of mutilation, invasive procedures and pain
*Bandaids to the rescue!
*Explain they did not cause, illness not from a thought or deed
Simple explanations of what will be fixed, models, pictures
Therapeutic play to resolve feelings about procedures
Toys - coloring books, puzzles, cutting and pasting, clay, blocks, dolls...
Accept regression, allow to express anger

School age: 6-12 years
Freud - Latency phase: Gender role adopted, awareness of society. Child places importance on privacy so provide gowns, covers, knock and explain treatments and procedures
Erikson - Industry versus inferiority: Encourage to continue school work, peer interactions and and hobbies
Piaget - Concrete operational: Child can understand objects and ideas which can be manipulated so give instructions, examples and models of equipment. Understands 'classification', 'conservation', and 'reversibility'.
Kohlberg - Conventional

School age Timeline:
Gains 4-6 lbs and 2-3 inches/year
Lose primary teeth, gain permanent
Can dress self, write script, tell time, understand past, present and future
Socialization increases, less egocentric
Understands cause and effect

Vital signs:
T - 97.5-98.6; P - 60-100; R - 16-20; BP - 107/64

*Understanding broadens, interested in reading, writing, academic achievement, love to please.

Parenting concerns and nursing challenges
Ambivalence about parental support
Body image
Limit setting

Hospital Nursing Plan of care for school age:
Fears injury, pain, disability, death
Maintain contact with peers, concerned with missing friends
Explain procedures, offer books, pictures, demonstrations
*Maintain privacy and modesty
Allow choices, participation and involvement in care, likes to please
Toys - card games, board games, video games, hobbies, puzzles,
Obtain assent and consent
Allow freedom of expression

Adolescent: 12-18 years
Freud - Genital stage: focus on genital functions/relationships: Take a private history, ensure privacy, separate teen recreation area, information on sexuality as needed.
Erikson - Identity versus role confusion: Provide opportunities to meet other teens with the same condition
Piaget - Formal operations. Able to think and reason abstractly, maturely: Offer verbal and written instructions with mature explanations
Kohlberg - Post conventional

Anatomy of a teenagers brain by Gary Olsen Dubuque Community School District.jpg
Anatomy of a teenagers brain by Gary Olsen Dubuque Community School District

Adolescent Timeline:
Girls growth spurts around 10-15
Boys growth spurt 14-17
Secondary sex characteristics develop and are guaged by Tanner Stages
Adult/abstract thinking and problem solving
Tendency to stay up late, sleep late
Strength and endurance increase
Enjoy sports, movies, music, games, parties, experiment with hair, makeup, lifestyles
Family conflicts

Vital Signs:
T - 97.5 - 98.6; P - 55-90; R - 12-20; BP - 121/70

Common parenting and nursing difficulties during adolescent years?
*Risk taking, peer dependence, increased independence lead to increased choices and safety issues - MVA, water safety, gangs, drugs, alcohol, violence, choices, sexual experimentation

Hospital Nursing Plan of Care for adolescents:
Maintain contact with peers and school activities
Teaching time / history without parents to increase interactivity, time for questions
Obtain assent
Parental consent
Teens major concern is body image and identity, fear being different
Allow own clothes, posters, bedding
Explain how things will affect them right here and now
Provide privacy
Allow favorite foods, friends
Loss of control may induce anger, withdrawal, un-cooperativeness
May feign bravery

Adolescent Risk Taking

Quizlet: Unit 1: iRAT, tRAT

How Old Am I (behaviors)? + Nursing explanations
Ages/Stages + Nursing actions

Erikson's developmental stages

Piaget's Developmental Theory

Kohlberg's Stages of Moral Development

Duvall's Family Development theory:
The family developmental or life cycle theory believes that the family is a social group that evolves and changes through specific stages. Each stage is characterized by different tasks. Duvall's (1977) theory is the most notable. This theory proposes the family progresses through 8 different family stages:

1. The beginning family
2. The childbearing family
3. Families with preschoolers
4. Families with school age children
5. Families with teens
6. Families launching young adults
7. Middle age parents
8. Families in the later years.

Do you recognize this developmental stage?

Nursing theorists which lend themselves to the study of pediatrics include:

Roy - The Adaptation Model

Neuman – The Systems Theory

King – The Theory of Goal Attainment


Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby Elsevier.

Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families (3rd ed.). New York, NY: Delmar Cengage Learning.

Videos located at:
Trust versus Mistrust:
Initiative versus Guilt: Jessica's daily affirmation:
Infancy -
Toddlers -
Preschoolers -
Schoolage -
Adolescence -
Adolescent risk:
Piaget -
Tantrum -