Age
Infant
(birth to 1 year)
Theorist
Erikson: Trust versus
mistrust stage
8-10mo stranger/
separation anxiety
Characteristics
Evidence
Nursing Applications
The baby establishes a sense of
trust when basic needs are met.
 Looks at and interacts with
primary caregiver
 Smiles at and reaches for primary
caregiver
 Cries when taken away from
caregiver
 Hold the hospitalized baby often.
 Offer comfort after painful procedures.
 Meet the baby’s needs for food and
hygiene.
 Encourage parents to room in.
 Manage pain effectively with use of
pain medications and other measures.
 Use reflexes to receive stimulation
which paves way for learning
 Repetitive actions to gain pleasure
 Becomes aware of environment
around them and responds to it
 Uses learned behaviors to obtain
objects, create sound, and engage
in pleasurable activities
 Use crib mobiles, manipulative toys,
wall murals, and bright colors to
provide interesting stimuli and
comfort.
 Use toys to distract the baby during
procedures and assessments.
 Potty learning
 Attempting to do things themselves
“me do”
 Says “no” to just about anything
 Beginning of being bossy during
play
 Puts own clothes on; maybe not
correctly
 Self feed with supervision
 May regress in stressful situations
(like hospital)
 Allow self-feeding opportunities.
 Encourage child to remove and put on
own clothes, brush teeth, or assist
with hygiene. If immobilization for a
procedure is necessary, proceed
quickly, providing explanations and
comfort.
If basic needs are not met then
child will learn to mistrust
others.
Piaget: Sensorimotor
stage
The baby learns from
movement and sensory input.
~9mo-1yr understand object
permanence (knowledge that
something exists even when out
of sight)
Toddler
(1–3 years)
Erikson: Autonomy
versus shame and
doubt stage
Increased motor
abilities and
independence
The child is increasingly
independent in many spheres of
life.
If they can’t control the things
they want to or are criticized
they start to feel shame/doubt
Piaget: Sensorimotor
stage (end);
preoperational stage
(beginning)
The child shows increasing
curiosity and explorative
behavior. Language skills
improve.
 Ensure safe surroundings to allow
opportunities to manipulate objects.
 Name objects and give simple
explanations.
Age
Preschooler (3–6
years)
Theorist
Erikson: Initiative
versus guilt stage
Refines gross & fine
motor and language
skills
School age (6–12
years)
Middle school: 10-12
yrs
Grow intellectual
skills, physical ability,
independence
Characteristics
The child likes to initiate
play activities.
If their initiations are not
successful or are criticized
they feel guilt and a lack of
purpose
Piaget:
Preoperational
stage (2-4 years old)
The child is increasingly
verbal but some limitations
in thought processes.
Causality is often confused,
so the child may feel
responsible for causing an
illness.
Erikson: Industry
versus inferiority
stage
The child gains a sense of
self-worth from
involvement in activities.
If they do not accomplish
what is expected develop
feelings of inferiority
Evidence
Pre-opreational (2-4 yrs)
 Thinks by using words as symbols
but logic not yet well developed
 Vocab and comprehension increased
but child is egocentric
 Unable to see things from another
person’s perspective
 When explaining things to them
name objects and give simple
explanations
Nursing Applications
 Encourage parent involvement in care
 Plan for playtime and offer a variety of
materials to choose from
 Offer medical equipment for play to
lessen anxiety about strange objects.
 Assess children’s concerns as expressed
through their drawings.
 Use drawings & stories to explain care
 Allow the child to talk, ask questions,
make choices, and accept their
expressions
 Offer explanations about all procedures
and treatments.
 Clearly explain that the child is not
responsible for causing an illness in self
or family member.
 Cognitive growth facilitated by
reading, crafts, word puzzles,
schoolwork
 Takes pride in accomplishments in
school, sports, home, community
 Explain treatments and procedures
 Encourage the child to continue
schoolwork while hospitalized.
 Encourage the child to bring favorite
pastimes to the hospital.
 Assess child’s knowledge before teaching
 Allow child to select rewards following
procedures
 Teach techniques such as counting or
visualization to manage situations
 Help the child adjust to limitations on
favorite activities.
 Involve parent and child in decisions
School age (6–12
years)
Middle school: 10-12
yrs
Theorist
Piaget: Concrete
operational stage
Grow intellectual
skills, physical ability,
independence
Characteristics
Evidence
The child is capable of
mature thought when
allowed to manipulate and
see objects.
Intuitive part of preoperational (4-7 yrs)
 Relies on transductive reasoning
(draws conclusions from one fact to
another; if a child disobeys a parent
and then falls and breaks their arm,
they may ascribe the broken arm to
Cause/effect and reasoning.
the bad behavior)
Conservation (matter
 Cause/effect relationships often
doesn’t change even when
unrealistic or a result of magical
form is altered)
thinking
 Centration and animism (animal
qualities attributed to everyday items
– stethoscope like a snake)
Concrete Operations (7-11 yrs)
 More accurate understanding of
cause/effect relationships
 Can reason well if concrete objects
used in teaching or experimentation
 Concept of conservation evolves
(same sandwich if cut in 2 vs 4)
 Begin to understand and respect
another person’s viewpoint
Adolescent (12–18
years)
Mature cognitive
thought, formation of
identity, influence of
peers
Erikson: Identity
versus role
confusion stage
The adolescent’s search for
self-identity leads to independence from parents and
reliance on peers.
If they are unable to
develop a strong sense of
self, experience confusion
in one or more life roles.
 Thought processes more complex,
new sense of identity or self is
established
 Self, family, peer group, community
all examined and redefined
 Increasing communication time with
peer group
 Apply abstract thought and analysis
in conversations at home/school
Nursing Applications
 Assess a child’s concerns expressed
through drawings
 Accept the child’s choices and expression
of feelings (don’t tell them not to be
scared)
 Offer explanations about all procedures
and treatments
 Clearly explain that the child is not
responsible for causing an illness in self
or family member
 Give clear instructions about details of
treatment.
 Show the child equipment that will be
used in treatment.
 Provide a separate recreation room for
teens who are hospitalized.
 Take health history and perform
examinations without parents present.
 Introduce adolescents to other teens with
the same health problem.
Piaget: Formal
operational stage
The adolescent is capable of
mature, abstract thought.
Can consider different
alternatives and outcomes
Age
Physical Growth
 Fully mature intellectual thought has
now been attained
 Can use rational thought, reasoning is
deductive and beginning to be
futuristic
 Give clear and complete information
about health care and treatments.
 Offer both written and verbal
instructions.
 Continue to provide education about the
disease to the adolescent with a chronic
illness, as mature thought now leads to
greater understanding.
Fine Motor Ability
Gross Motor Ability
Sensory Ability
 Inborn reflexes such as startle and
rooting are predominant activity
 May lift head briefly if prone
 Alerts to high-pitched voices
 Comforts with touch
 Moro reflex fading in strength
 Can turn from side to back and
then return
 Decrease in head lag when pulled
to sitting position; sits with head
held in midline with some bobbing
 When prone, holds head and
supports weight on forearms
 Head held steady when sitting
 No head lag when pulled to sitting
 Turns from abdomen to back by 4
months and then back to abdomen
by 6 months; sit with support
 When held standing supports much
of own weight
 Prefers to look at faces
and black- and-white
geometric designs
 Follows objects in line of
vision
 Follows objects 180
degrees
 Turns head to look for
voices and sounds
 Start to see in color
around 3 mo (cones and
rods are developed)
 Most inborn reflexes are gone
 Sits alone steadily without support by 8 months
 Likes to bounce on legs when held
in standing position
 Responds readily to
sounds
 Recognizes own name
and responds by looking
and smiling
 Enjoys small and complex objects at play
 Understands words such
as “no” and “cracker”
Birth to 1
month
Gains 140–200 g (5–7 oz)/week
Grows 1.5 cm (1/2 in.) in first month
Head circumference increases 1.5 cm
(1/2 in.)/month
 Holds hand in fist but reflex, not
purposeful
 Draws arms and legs to body
when crying
2–4 months
Gains 140–200 g (5–7 oz)/week Grows
1.5 cm (1/2 in.)/month
Head circumference increases 1.5 cm
(1/2 in.)/month
Posterior fontanelle closes
Ingests 120 mL/kg/24 hr (2 oz/ lb/24
hr)
 Holds rattle and other objects
when placed in hand
 Looks at and plays with own
fingers
 Brings hands to midline
4–6 months
Gains 140–200 g (5–7 oz)/week
Doubles birth weight at 5–6 months
Grows 1.5 cm (1/2 in.)/month
Head circumference increases 1.5 cm
(1/2 in.)/month
Teeth may begin erupting by 6 months
Ingests 100 mL/kg/24 hr (1.5 oz/lb/24
hr)
6–8 months
Gains 85–140 g (3–5 oz)/week Grows 1
cm (3/8 in.)/month
Growth rate slower than first 6 months
 Grasps rattles and other objects
at will; drops them to pick up
another offered object
 Mouths & manipulates
 Holds feet and pulls to mouth
 Holds bottle
 Grasps with whole hand
(palmar grasp)
 Bangs objects held in hands
 Transfers objects from one hand
to the other
 Beginning pincer grasp at times
8–10 months
Gains 85–140 g (3–5 oz)/week
Grows 1 cm (3/8 in.)/month
 Picks up objects
 Uses pincer grasp well
 Crawls or pulls whole body along
floor by arms
 Creeps by using hands and knees to
keep trunk off floor
 Examines complex visual
images
 Watches the course of a
falling object – they can
see a lot better now
10–12
months
Age
Gains 85–140 g (3–5 oz)/week
Grows 1 cm (3/8 in.)/month
Head circumference equals chest
circumference
Triples birth weight by 1 year
 May hold crayon or pencil and
make mark on paper
 Places objects into containers
through holes
Physical Growth
 Pulls self to standing and sitting by
10 months
 Recovers balance when sitting
 May say one word in
addition to “mama” and
“dada”
 More social
 Stands alone
 Walks holding onto furniture
 Sits down from standing
 Plays peek-a-boo and
patty cake
 Interactive games and
object permeance
Fine Motor Ability
Gross Motor Ability
Sensory Ability
1–2 years
Gains 227 g (8 oz) or more per month
Grows 9–12 cm (3.5–5 in.) during this
year
Anterior fontanelle closes
 By end of second year, builds a
tower of four blocks and knocks
it over
 Scribbles on paper
 Can undress self
 Throws a ball
 Turn pages in a book
 Runs
 Shows growing ability to walk and
finally walks with ease
 Walks up and down stairs a few
months after learning to walk with
ease
 Likes push-and-pull toys
2–3 years
Gains 1.4–2.3 kg (3–5 lb)/year Grows
5–6.5 cm (2–2.5 in.)/year
 Draws a circle and other
rudimentary forms
 Can hold a crayon properly
 Learns to pour
 Learning to dress self
 Jumps
 Kicks ball
 Throws ball overhand
3-6 years
Gains 1.5–2.5 kg (3–5 lb)/year
Grows 4-6 cm (1.5–2.5 in.)/year
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 Throws a ball overhand
 Climbs well
 Rides a bike
 Visual acuity continues
to improve
 Can focus on and learn
letters and numbers
 Rides a 2-wheeler
 Jumps rope
 Rollers skates or ice skates
 Can read
 Able to concentrate for
longer periods on
activities by filtering out
surrounding noises
6-12 years
Gains 1.4–2.2 kg (3–5 lb)/year
Grows 4-6 cm (1.5–2.5 in.)/year
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Uses scissors
Draws circle, square, cross
Draws a 6-part person
Enjoys art projects (pasting,
stringing beads, using clay)
Learns to tie shoes
Buttons clothes
Brushes teeth
Uses spoon, fork, knife
Eats 3 meals with snacks
Enjoys craft projects
Plays card and board games
 Visual acuity 20/50
12-18 years
Females gain 7–25 kg (15–55 lb)
Females grow 2.5-20 cm (2-8 in.)
Males gain 7-29.5 kg (15-65 lb)
Males grow 11-30 cm (4-12 in)
Erikson
 Skills are well developed
 New sports activities attempted
and muscle development continues
 Some lack of coordination common
during growth spurt
 Fully developed