Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Assessing individuals for developmental levels is multidimensional. Factors to be considered are the diversity of influences from various
cultures, family patterns, daily health patterns, and living situations. When assessing developmental stages, chronological age is a
reference point, but individual differences must be evaluated. The process of development is fluid and flexible; therefore, hospitalization
and illness may contribute to regression in any of the stages.
Infancy (Birth to 12 months)
Developmental
Traits and Skills
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Building trust and
security
Develops a sense of
trust if needs are met
consistently and with
some predictability
Begins to recognize
familiar objects and
persons
Around 6 months
advances to turning,
rolling over, progresses
to crawling, bringing
hand to mouth
Potential
Reactions to
Hospitalizations
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Separation
anxiety at 9-10
months
Fear of strangers
and unfamiliar
situations at 7-8
months
Assessments/
Health Concerns
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Posterior fontanel closes by 2 months
Birth weight should double by 6 months and
triple in a year
 Normal VS:
Temp = 36.7 C
Resp = 30-60 min.
Pulse = 100-160 , asleep 80-160
BP = 60-90/20-60
Glascow Coma Score- Scale for 0-2 yrs.
Color Coded: 4-8 months Pink/ Red-8 (6-10
kg)
Common Health Concerns
 Accidents such as falls, choking, drowning,
burns, auto
 At risk for heat and fluid loss (hypothermia
and dehydration)
 Complications from congenital abnormalities
 Assess pain- use Oucher or FLACC scales
 Falls Scale- Humpty Dumpty
Care Guidelines
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Cuddle, hug, rock
Involve parents; encourage
parents to assist in care
Limit the number of strangers
caring for the infant
Give familiar objects to the
infant
Use distraction, such as a
pacifier or bottle
“Sweet-ease” can be placed
on pacifier
Keep siderails up at all times
Main focus of education is
parents
The Pediatric Service follows
patients under the age of 18
The pediatric admission
assessment tool “Birth
through 6 years” is utilized by
nursing staff
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Toddler (>1-3 Years)
Developmental
Traits and Skills
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Increased motor and
cognitive skills lead to
exploration of the total
environment
Responds better to
visual than spoken cues
Asserts independence
and develops a sense of
will
Can speak in 3-4 word
sentences by the age of
3
Discovers ability to
explore and manipulate
environment
Attached to security
objects and toys
Potential Reactions to
Hospitalizations
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May have difficulty
sleeping due to
separation from family
Temper tantrums
Skills may regress
May fear the dark and
being left alone
Assessments /
Health Concerns

Anterior fontanel closes by 18 months
Normal VS:
Temp = 37 C
Resp = 24-40
Pulse = 90-150
BP = minimum 70 systolic
Color Coded: 1 yr.- Purple 10 kg;
2 yr.- Yellow 13 kg
Common Health Concerns
 Accidents are the most common cause of
injury (MVC, burns, drownings)
 Upper respiratory infections
 Communicable diseases
Care Guidelines
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Set limits
Allow choices if possible
Explain procedures shortly
before beginning the procedure
Give simple directions during
procedures, one thing at a time
Use distraction techniques
during procedures
Give permission to express
feelings
Involve parents
Follow home routines if
possible
Maintain a safe environment
Main focus of education is the
parents
The Pediatric Service follows
patients under the age of 18
The pediatric admission
assessment tool “Birth through
5 years” is utilized by nursing
staff
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Preschooler (3-6 Years)
Developmental
Traits and Skills
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Increasing gross and
fine motor skills allow
more independence
Socialization, siblings
and peers become more
significant
Negotiating decisions
and conflicts
Starting to recognize
and develop gender
differences
Magical thinking
Inquisitive
Potential Reactions to
Hospitalizations
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May be physically
aggressive
Tests limits
Skills may regress
May negotiate decisions
Fears bodily injury and
mutilation
May believe that some
misdeed caused the
injury
Assessments /
Health Concerns
Care Guidelines
 Begins to lose baby teeth
 Normal VS
Temp = 37 C
Resp = 22-34
Pulse = 70-110, asleep 60-90
BP = 76-122/46-84
Color Coded: White- 4 yr 16 kg
Blue- 6yr 20 kg
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Common Health Concerns
 Accidents (MVC, falls, burns,
drownings)
 Upper respiratory infections
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Explain procedures simply
Demonstrate use of equipment
using dolls and puppets
Encourage the child to
verbalize
Praise for good behavior
Offer badges of courage for
cooperation (Band-Aids,
stickers, toys)
Focus on one thing at a time
Give permission to express
feelings
Maintain safety
Reassure that being in the
hospital is not punishment
Main focus of education is on
parents
The Pediatric Service follows
patients under the age of 18
The pediatric admission
assessment tool “Birth through
6 years” is utilized by nursing
staff
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
School Age (7-12 Years)
Developmental
Traits and Skills
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Developing selfconcept
Strives to challenge
themselves, proud of
achievements
May desire to have
assigned tasks to
complete
Prefers friends to
family
Rule bound
Functions in the present
Starts to think
abstractly and to reason
Likes quiet as well as
active games
Potential Reactions to
Hospitalizations
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Separation from family,
friends, usual activities
Boredom
Loneliness
Hostility
Fear of loss of control
and bodily injury
Assessments /
Health Concerns

Care Guidelines
Secondary sexual characteristics begin
to develop
 Hand-eye coordination is well
established
 Normal VS:
Temp = 37 C
Resp = 18-30
Pulse = 70-120
BP = 80-120 /60-80
Color Coded- Orange- 8yr 26kg
White-10yr 32kg
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Common Health Concerns
 Accidents (MVC, falls, drownings)
 Respiratory conditions
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Encourage play
Let child make some
choices
Emphasize areas of control
Explain procedures in
advance
Clearly define and
reinforce behavior limits
Protect child’s privacy
Use correct terminology
and make explanations
concrete
Assess need for assistance
with continuing
schoolwork
The Pediatric Service
follows patients under the
age of 18
The pediatric admission
assessment tool “School
Age / Adolescent” is
utilized by nursing staff
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Adolescence (13 -17)
Developmental
Traits and Skills
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Preoccupation with self
and physical changes
Belonging to peer
group important and
valued
Longs for independence
but still somewhat
dependent
Broad range of feelings
and expression
More need for privacy
Advent of sexual
activity and
experimentation
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Potential Reactions to
Hospitalizations
Assessments /
Health Concerns
Care Guidelines
Loss of peer group
contact
Loss of control and
dependency
Accepts criticism or
advice reluctantly
May demonstrate
frustration,
overconfidence, or noncompliance
Bodily appearance may
threaten identity
 Sexual maturation occurs
 Increase in muscle mass
 Normal VS: (same as adult)
Temp = 37 C
Respirations = 18-30
Pulse = 70-120
BP = 90-140/60-90
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Common Health Concerns
 Risk taking behavior: driving,
substance abuse
 Depression and suicide
 Traumatic injuries
 Peer pressure, gang activity
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Support privacy at all
times - even from the
parents when the
adolescent desires
Involve in planning and
decision-making
Supplement explanations
with rationale
Encourage contact with
peers
Ensure confidentiality
Provide information
directly to the patient
Clarify guardianship, next
of kin, emancipated minor
status
The Pediatric Service
follows patients under the
age of 18
The pediatric admission
assessment tool “School
Age/Adolescent” is
utilized by nursing staff
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Early Adulthood (18-45 Years)
Developmental
Traits and Skills
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Establishes intimate
relationships
Establishes own beliefs
and philosophy for
living
Focus on career goals
and building a family
Time for achievement
of independence
Begins to express
concerns for health
Achievement oriented
Potential Reactions to
Hospitalizations
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Challenged with
assuming a posture of
dependency
May fear the lifechanging effects of
chronic
disease/disability
May fear loss of job
income related to illness
May have concerns
about who will care for
children during
hospitalization
Assessments /
Health Concerns
Care Guidelines
 Assess for substance abuse
Few significant changes are seen except
those associated with pregnancy
 Normal VS:
Temp = 37 C
Resp = 12 - 24
Pulse = 60-100
BP = 90-140 / 60-90
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Common Health Concerns
 Motor vehicle crashes
 Work-related trauma
 Suicide / depression
 Homicide
 Substance abuse
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Involve individual and
significant other in plan
of care as appropriate
Allow for as much
decision-making as
possible
Explore impact of
hospitalization on
work, family, children
Assess for compliance
with on-going health
assessments
Assess ability to read if
printed materials are be
used in patient
education
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Middle Adulthood (45-65 Years)
Developmental
Traits and Skills
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Reexamination and
reevaluation of life
goals and competency
May consider changes
in career patterns and
personal relationships
Focus on the inner self,
concern with selfdevelopment
Awareness of mortality
Interested in the welfare
of society as a whole
May need to care for
aging parents
Potential Reactions to
Hospitalizations
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Recognition of
limitations
Stresses related to
dependency of illness
and its effect on family
May fear the lifechanging effects of
chronic
disease/disability
May fear loss of
job/income related to
illness or injury
May have concerns
about who will care for
other family members
during hospitalization.
This may include
children as well as aging
parents
Assessments / Health Concerns
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May experience initial stages of
chronic illnesses such as
cardiovascular disease
 Normal VS: (same as early adult)
Temp = 37C
Respirations = 12-24
Pulse = 60-100
BP = 90-140/60-90
Common Health Concerns
 Cardiovascular diseases
 Increased incidence of cancer
 Chronic respiratory diseases
 Hypertension
Care Guidelines
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Allow choices
Provide decisionmaking opportunities
related to care
Encourage as much
self-care as possible
Explore relation of
illness/disease to
career
Harborview Medical Center
Age Specific Competencies For Clinical Staff
Developmental Characteristics / Care Guidelines Chart
Late Adulthood (65-75) / Geriatric (75 and older)
Developmental
Traits and Skills
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Health concerns
increase
Adaptation to the
physical changes
associated with aging
May face changes in
level of independence
and finances associated
with retirement
Coping with losses:
physical, personal, and
social
Potential Reactions to
Hospitalizations
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May experience feelings
of isolation
May have fears related
to declining health
May fear death or
dependence
Older geriatric patients
with severe health
problems may fear not
being able to return to
their home
Assessments/ Health Concerns
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Decreased acuity of senses
Multi-system physiologic
compensatory mechanisms may be
blunted
 Normal VS:
Temp = 37C
Respiration's = 12-24
Pulse = 60-100
BP = 110-140/60-90
Care Guidelines
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Common Health Concerns
 Increased risk of CVA
 Increased risk of falls and related
injuries
 Increased cardiovascular and
respiratory problems
 Increase in complications related to
trauma
 More likely to experience adverse
drug reactions
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Involve family with care
Provide a safe
environment
Assess for hearing loss
and visual impairment
Be attentive to
maintaining skin integrity
Monitor for the effects of
polypharmacy
Allow ample time for
decision-making and
physical activities
Assess ability to live
independently
Explore support systems
The Geriatric Service
follows patients over the
age of 75