The eight stages, the ages that get asked about, and the growth numbers worth memorizing.
| By | What has happened |
|---|---|
| 6 months | Birth weight has doubled |
| 12 months | Birth weight has tripled; length is up about 50% |
| 2 years | About half of adult height; the anterior fontanelle is closed |
| 2–3 months | The posterior fontanelle closes |
The anterior fontanelle closes between 12 and 18 months. A fontanelle that closes far too early, or one that is still wide open at two years, both need investigating.
Each stage is a conflict. The nursing question is nearly always “what does this age need from me while they are in the hospital?”
| Age | Conflict | What they need in the hospital |
|---|---|---|
| 0–1 infant | Trust vs mistrust | Consistent caregivers; the parent present; needs met quickly |
| 1–3 toddler | Autonomy vs shame & doubt | Choices — two options, both acceptable. Routines and a comfort object |
| 3–6 preschool | Initiative vs guilt | Let them help. Correct magical thinking — they think illness is a punishment |
| 6–12 school age | Industry vs inferiority | Let them finish things and keep up with school; explain how equipment works |
| 12–18 adolescent | Identity vs role confusion | Privacy, peers and control. Talk to them, not only the parent |
| Young adult | Intimacy vs isolation | Relationships, partner involvement |
| Middle adult | Generativity vs stagnation | Being useful; contributing; work and family roles |
| Older adult | Integrity vs despair | Life review; being listened to |
| Age | Motor | Language | Social |
|---|---|---|---|
| 2 mo | Lifts head when prone | Coos | Social smile |
| 4 mo | Rolls front to back | Laughs | Reaches for people |
| 6 mo | Sits with support → alone | Babbles | Stranger anxiety begins |
| 9 mo | Crawls, pulls to stand | “Mama” to anyone | Object permanence — peekaboo works |
| 12 mo | Walks; pincer grasp | 1–3 real words | Separation anxiety at its peak |
| 2 yr | Runs, kicks a ball, climbs | 2-word phrases; ~50% understandable | Parallel play, and “no” |
| 3 yr | Rides a tricycle; copies a circle | 3-word sentences; ~75% understandable | Takes turns badly but tries |
| 4 yr | Hops on one foot; copies a square | Fully understandable to a stranger | Associative play; imaginary friends |
| 5 yr | Skips; copies a triangle; ties laces | Tells a full story; prints their name | Cooperative play with rules |
Keep the parent there. Same nurse where possible, feed on their schedule, swaddle, dim the lights. Give injections vastus lateralis.
Two choices, both fine. Keep routines and the comfort object. Expect regression in the hospital — tell the parents it is normal. Prepare them just before a procedure, not hours ahead.
“You did not cause this.” Magical thinking makes them think illness is punishment. Let them handle safe equipment. Prepare them about an hour ahead.
Explain how it works. They want the reason and the equipment. Let them keep up with school and finish things. Prepare a few days ahead.
Privacy, peers, control. Interview them without the parent for part of the visit. Body image is a real clinical concern. Prepare a week or more ahead.