🧔 Developmental Milestones & Erikson
What a child can do, what they fear, and how you talk to them — the two axes that decide most pediatric questions.
⭐ Erikson — the stage decides the answer
| Age | Stage | They need | Play |
|---|---|---|---|
| 0–18 mo Infant | Trust vs mistrust | Needs met consistently; parent present | Solitary |
| 18 mo–3 y Toddler | Autonomy vs shame | Limited choices, routine, control | Parallel |
| 3–6 y Preschool | Initiative vs guilt | Simple honest explanation; it is not a punishment | Associative |
| 6–12 y School age | Industry vs inferiority | Tasks, competence, achievement | Cooperative |
| 12–18 y Adolescent | Identity vs role confusion | Privacy, confidentiality, peers | Peer group |
Toddler resisting care → offer two acceptable choices. Never an open question.
“Do you want the pink cup or the blue cup?” — not “Will you take your medicine?”
🧠 What each age fears in the hospital
- Infant — separation from the parent
- Toddler — separation; loss of routine
- Preschooler — bodily harm and mutilation; thinks illness is punishment
- School age — loss of control, being left out
- Adolescent — being different; body image; separation from peers
Preschoolers have magical thinking — say plainly that nothing they did caused this, and use a plaster over any puncture, because they fear leaking out.
👶 Milestones by age
| Age | Motor | Social / language |
|---|---|---|
| 2 mo | Lifts head prone | Social smile |
| 4 mo | Rolls front to back | Laughs, coos |
| 6 mo | Sits with support, rolls both ways | Babbles; stranger anxiety begins |
| 9 mo | Sits alone, crawls, pincer grasp | “Mama/dada” non-specific |
| 12 mo | Walks; birth weight TRIPLES | 1–3 words; waves |
| 15 mo | Walks well, stacks 2 blocks | 3–5 words |
| 2 y | Runs, kicks a ball | 2-word phrases, ~50% intelligible |
| 3 y | Tricycle, stairs alternating | 3-word sentences, ~75% intelligible |
| 4 y | Hops, dresses self | ~100% intelligible |
| 5 y | Skips, ties laces | Prints name |
✅ The rules that let you work it out
- Weight DOUBLES by 6 months, TRIPLES by 12 months
- Posterior fontanelle closes by 2–3 months
- Anterior fontanelle closes by 12–18 months
- Words per phrase roughly matches age in years at 2 and 3
- Separation anxiety peaks 10–18 months; stranger anxiety starts ~6 months
A sunken fontanelle means dehydration. A bulging fontanelle means raised intracranial pressure.
💉 Communicating and pain
Pain scales by age
| Scale | Age | Based on |
|---|---|---|
| FLACC | Non-verbal, under 3 | Face, Legs, Activity, Cry, Consolability |
| FACES | About 3 and older | Child picks the face |
| Numeric 0–10 | About 8 and older | Self-report |
Children under-report pain to avoid injections. Behavior and physiology count as evidence.
🧠 Preparing a child for a procedure
- Toddler — explain just before; they have no sense of future time
- Preschooler — a few hours before; let them handle equipment; use play
- School age — a day or so before; give them a job to do
- Adolescent — days ahead; involve them in decisions; respect privacy
Never do painful procedures in the child’s bed — it must stay a safe place. Use the treatment room.
🎯 NCLEX traps
- Toddler = limited choices. Preschooler = it is not your fault
- Parallel play is normal for toddlers, not a problem
- Weight triples by 1 year
- Anterior fontanelle closes 12–18 months
- Adolescents get confidentiality
- Prepare younger children closer to the event, not earlier
Sources. Written from CDC Child Development, HealthyChildren.org (AAP), MedlinePlus and OpenStax A&P 2e (CC BY 4.0).