Growth &

Development

Stages
● Infants
● Toddlers
● Preschoolers
● School age
● Adolescents
● Young Adults
● Middle Adults
● Old Adults
Theories to know
Erikson

Psychosocial development

Piaget

Cognitive development

Infants
● Erikson's stages of psychosocial development
○ Trust vs. mistrust: Birth - 18 months
● Piaget's stages of Cognitive development
○ Sensorimotor: Birth - 2 years
Trust Mistrust
● Not responding to babies
● Meeting nourishment
hungry cues
needs
● Not meeting the infants
● Feeding, bathing, and
needs
comforting the child
● Inconsistency in
● Responding to infant cries
responding to infant
● When trust is gained this
● When mistrust occurs
leads to the feeling of
infant may have higher
safety and security
levels of anxiety

Sensorimotor
● 0 - 2 years
● Knowledge gained through senses and motor movement
● Learn through:
○ Sucking
○ Grasping
○ Looking
○ Listening
● Start to understand cause and effect
● Object permanence is gained - 9 months
 During illness
● *During hospitalization consistent caregivers is important
● You are focused on developing trust!
● Meeting the infants needs consistently

● Holds head up during tummy time

● Posterior fontanelle should close!
 Between 6 and 12
months; I start to crawl!

From birth to 6 months:

● Baby is growing about ½ to 1 inch a month

● Gaining 5-7 oz per week.
● Birth weight should be doubled by 5 months.

At 9 months; I can sit

without support!
 At 12 months; I can stand
up, without support!

From 6 to 12 months:

● Baby is growing about ⅜ in per month

● Gaining about 3 to 5 oz per week.
● Birth weight should be tripled by 12 months.

● Walks unsupported
● Anterior fontanelle should close!
 Reflexes

Assessing Reflexes
● Reflexes, or lack thereof, can indicate abnormalities with the nervous system

● Many present as newborns (normal) and diminish at expected ages

● Abnormalities in newborn period:

○ Absent developmental reflexes

○ Asymmetric

○ Persist beyond anticipated age at which they should diminish

Moro Reflex (startle)
● How to elicit
○ Hold newborn semi sitting
○ Allow head and neck to fall backward (supported) at
least 30 degrees
○ Same response can be elicited by a loud noise or
clapping
● Positive reflex:
○ Newborn extends and abducts arms, followed by a
flexion and adduction
● Age range:
○ Present at birth
○ Absent by 6 months
○ Persistent response after 6 months could indicate
neurologic abnormality

Babinski sign (plantar reflex)

● How to elicit
○ Using a safe but hard, pointy object (like a pen
cap), stroke the newborn’s foot from the heel,
up the lateral side (toward the pinky toe) then
across the ball of the foot toward the big toe
● Positive reflex
○ Newborn’s toes hyperextend and fan out
● Age range
○ Present as newborn
○ Absent by 1 year old
○ Absence as newborn could indicate neurologic
abnormality
● Assessed on adults to determine
presence or extent of central nervous
system disease if positive reflex
Palmar grasp reflex
● How to elicit
○ Place finger in the palm of newborn’s palm
● Positive reflex
○ Newborn wraps/curls fingers around the
finger in the palm
● Age range
○ Present as newborn
○ Diminishes around 3-4 months

Rooting reflex
● How to elicit
○ Stroke the newborn’s cheek or corner of the mouth
with finger or nipple
● Positive reflex
○ Newborn turns head toward finger or nipple and
opens mouth
● Age range
○ Present as newborn
○ Diminishes by 3-4 months, but could remain for up
to 1 year
Education on infants
● Communication: nonverbals such as touch are essential
● Car Seat Safety
○ Rear Facing until at least 2 years of age
○ Use of a 5 point harness car seat
○ Retainer clip - at armpit level
○ Shoulder straps at or below the level of the shoulder
● Safe Sleep
○ Firm mattress with tight fitted sheet
○ Put on back to sleep
○ Pacifier may be used
○ Avoid stuffened animals or blanket in crib
● Weight
○ Double birth weight by 5 months.
○ Triple birth weight by one year.

Immunizations
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Birth: Hep B

2 months: Hep B, Rotavirus, DTaP, Hib, PCV13, IPV

4 months: Rotavirus, DTaP, Hib, PCV13, IPV

6 months: Hep B, Rotavirus, DTaP, Hib, PCV13, IPV

12 months: Hib, PCV13, MMR, VAR, Hep A

● Influenza yearly starting at 6 months

Toddlers
● Erikson stage:
○ Autonomy vs. Shame and Doubt - 18mo-3 years
● Piaget stage:
○ Preoperational stage - begins at age 2

Autonomy Shame and Doubt

● Becoming potty trained ● Punished for mistakes
● Choosing own clothes ● Doubting the child
● Dressing self ● When the child isn’t
● Food choices allowed to make
● Allow for independence independent choices
● Success at this stage ● Failure in this stage
allows child to become leads to self doubt
partially independent
Preoperational Stage
● 2 - 7 years
● Think symbolically but not able to use logic yet
○ Uses symbols/gestures to represent an event
● Typically child will focus on just one area of a situation
● Egocentric viewpoint
○ struggles to see things from others perspective
● To help develop
○ Hands on activities
○ Use actions along with words
○ Visual Aids

During illness
● Help them develop autonomy!
● Provide choices when possible
● Allow toddler to have favorite toy from home
Play
● Parallel play
○ Children play adjacent to each other, but do not try to influence one another's behavior.
● Symbolic play
○ The ability of children to use objects, actions or ideas to represent other objects, actions, or
ideas as play.

● Kicks a ball
● Runs
Education for toddlers
● Communication
○ Show toy medical equipment and allow toddler to handle
○ Demonstrate using a doll or favorite toy
○ Talk in simple terms
● Safety
○ Avoid popcorn, grapes, and hotdogs
○ Ensure water heater is set to 120 degrees F or below
○ Use backburners while cooking on the stove
○ May go forward facing in the car seat at age 2

Immunizations
15 months: DTaP

18 months: Hep A

Every year: Influenza

Preschoolers
● Erikson stage
○ Initiative vs. Guilt - 3-5 years
● Piaget stage
○ Still preoperational unil 7 years

Initiative
Guilt
● Planning and
● Judgement
accomplishing tasks
● Criticism
● Caregivers
● Over dependence on
○ Model good behavior
others
○ Allow child to make
● Failure of this stage leads
own choices
to lack of confidence and
○ Set safe boundaries
feelings of guilt
● When successful helps
child develop a sense of
purpose.
Play
● Cooperative play
○ Play that involves the division of efforts among children in order to reach a common goal.
● Magical thinking
○ The belief that one's own thoughts, wishes, or desires can influence the external world.

During illness
● Focus on helping the child develop initiative - a sense of purpose.
○ Allow child to make own choices
○ Set safe boundaries
● Regression may occur
● Bring in favorite toy
● Do not yet have a concept of time
○ Do not understand: “I am going to give you your medicine in five minutes.”
○ Easier to understand: “When this TV show finishes you are going to take your medicine.”
● Plays with other kids
● Draws
● Dresses self
● Uses a fork

● Plays pretend
● Can name colors
● Catches a ball
● Can un-do buttons
Education for preschoolers
● Communication
○ Allow to handle medical equipment
○ Answer questions
○ Explain procedures
● Safety
○ Bike/Street safety
○ Remain forward facing in car seat until height or weight limit is
reached then transition to booster.
● Immunizations
○ 4 years old: DTaP, IPV, MMR, VAR, yearly influenza vaccine

School Age
● Erikson stage
○ Industry vs. Inferiority: 5-13 years
● Piaget stage
○ Concrete operational stage: 7-11 years
Industry Inferiority
● Form self - concept ● Perfection
● Balance achievements ● Lack in confidence
● Reinforce effort/practice ● Focus on failures
● Focus on: ● Struggle with boundaries
○ Academics ● Failure leads to child
○ Competition
feelings like they are
○ Social life
● Success leads to the child inferior to others
being able to reach
personal goals and builds
confidence

Concrete Operational
● 7 - 11 years
● Starts to think logically and organized
● Understand that actions can be reversed
● Conservation
○ When an item changes shape/size it is still the same thing
● Focus on multiple parts of an issue
During illness
● At this stage, social interaction with peers prioritized over family
● Want to feel success - industry
○ Allow child to be included in care
○ Encourage friends to visit

Education for School Age

● Communication
○ Limit setting
○ Encourage thinking
○ Use visuals
○ Support child’s independence
● Safety
○ Fear decreases
○ Encourage helmet use
● Immunizations:
○ 11 years old: Tdap, Meningococcal, HPV (after age 9)
○ Annual Influenza
Adolescents
● Erikson stage
○ Identity vs. confusion: 13-21 years
● Piaget stage
○ Formal operational stage: 12+years

Identity Role- Confusion

● Who am I? ● Not allowed to explore
● Differentiates self ● Unsure of self
● Develops mental and ● Lack self confidence
physical health ● When unsuccessful at this
● Set goals/ try new things stage individual is unable to
● Able to relate to others commit and may struggle
● When successful with this with confusion about their
stage they have a strong future
sense of identity and
commit to their value
Formal Operational
● 12 years old - adulthood
● Has logical thought and deductive reasoning
○ Starts to think abstractly
○ Reason about hypothetical problems
● Can use trial and error for problem solving
● Start to think more about others thoughts
● Use organized thought process

During illness
● Looking to establish their own identity
○ Emphasis on contact with peers
● Give Privacy
● Talk about adolescents interests
Education for Adolescents
● Communication
○ Give Privacy
○ Talk about adolescents interests
○ Adolescent may be more focused with body image
● Safety
○ Seat belt usage
○ Motor vehicle accidents
○ Higher risk taking
● Immunizations
○ 16 years old: Meningococcal
○ Annual Influenza

Young Adults
● Erikson stage:
○ Intimacy vs. Isolation: 21 - 39 years
Intimacy Isolation
● Close relationships ● Distancing
● Start families ○ Isolate self
● Develop ability to/accept ● Fear of commitment
love ● Prior abuse
○ Physically ● Failure of this stage leads
○ Emotionally to poor health and poor
● Ability to care for others social/romantic
● Success at this stage allows relationships
for supportive social and
personal relationships

Middle Adults
● Erikson stage:
○ Generativity vs. stagnation: 40-65 years
Generativity Stagnation
● Make contributions to ● Self Centered
society ● Less life satisfaction
○ Volunteer ● Doesn’t seek out
○ Mentor children
opportunities
● Leave a legacy
● Unable to resolve midlife
● Pride in accomplishments
crisis
● Take on responsibilities
● Failure of this stage leads
● Finding a purpose for life
to uninterest in the people
● Success at this stage leads
and environment around
to unconditional support of
them
the community and society.

Old Adults
● Erikson stage:
○ Integrity vs. Despair: 65+ years
Integrity Despair
● Sense of fulfillment ● Depression
● Proud of achievements ● Regret
● Few regrets ● Feeling life had little
● Ability to focus on the good meaning
● Success at this stage leads ● Lack gratitude
to wisdom ● Failure at this stage leads to
○ Composure wishing they could have
○ Peace of mind
second chances

Education for Old Adults

● Safety
○ Avoid throw rugs
○ Well lit stairs
○ Grab bars in bathroom
● Monitor Medications closely
○ Keep updated medication list
● Assess for neglect and abuse
○ More common in dependent older adults
● Immunizations: yearly influenza and pneumococcal at 65 years of
age