Pediatric Developmental Milestones & Hospitalization Stressors

When should an infant double their birth weight?

By 6 months

When should an infant triple their birth weight?

By 12 months

At what age does the posterior fontanel close?

2-3 months

At what age does the anterior fontanel close?

12-18 months

When does stranger anxiety typically peak?

Around 6-8 months

Erikson stage for infancy:

Trust vs. Mistrust

Erikson stage for toddlerhood:

Autonomy vs. Shame & Doubt

Erikson stage for preschoolers:

Initiative vs. Guilt

Erikson stage for school-age:

Industry vs. Inferiority

Erikson stage for adolescents:

Identity vs. Role Confusion

Piaget stage for infants:

Sensorimotor

Piaget stage for toddlers & preschoolers:

Preoperational

Piaget stage for school-age:

Concrete Operational

Piaget stage for adolescents:

Formal Operational

What type of play do toddlers exhibit?

Parallel play

What type of play do preschoolers exhibit?

Associative / Dramatic play

What type of play do school-age children exhibit?

Cooperative / Competitive play

Major stressor for toddlers during hospitalization:

Separation anxiety / Loss of routine

Major stressor for preschoolers:

Fear of bodily harm / mutilation (magical thinking)

Major stressor for school-age children:

Loss of control / Fear of pain

Major stressor for adolescents:

Loss of privacy / Peer separation / Loss of independence

When does object permanence develop?

8-12 months

6-month gross motor:

Rolls both ways / sits with support

9-month gross motor:

Crawls / pulls to stand

12-month gross motor:

Walks with assistance

12-month fine motor:

Pincer grasp

Speech milestone at 2 years:

Two-word phrases

Why do preschoolers fear bodily harm?

Magical thinking

Which age group regresses the most in the hospital?

Infants & toddlers

How to promote industry in school-age?

Give tasks / allow helping with own care

Primary cause of stress for infants in the hospital

Separation from parents and sensory overload

Why do toddlers regress during hospitalization?

Loss of routine and independence → regression common

Best way to minimize stress in toddlers in the hospital

Maintain routine and allow choices

Best way to prepare a preschooler for a procedure

Use simple explanations, demonstrate on a doll first

Privacy for adolescents in hospital

Provide modesty, knock before entering, allow independence

Purpose of therapeutic play

Allows expression of feelings and reduces stress

Best pain scale for infants

NIPS or CRIES

Pain scale for 2 months-7 years

FLACC

Pain scale for school-age children

FACES or numeric

Nonpharmacologic pain relief for toddlers

Distraction (bubbles, toys, music), comfort measures

What is atraumatic care?

Minimizing pain and stress while supporting family presence

How to reduce stress during toddler assessment

Perform on parent's lap, let them handle equipment

How to reduce stress during preschool assessment

Explain steps, allow touching equipment, provide Band-Aid after

How to reduce stress during adolescent assessment

Respect privacy and give control when possible

Best communication strategy for adolescents about procedures

Honest, detailed explanations and choices

Why maintain daily routines?

Lowers anxiety and prevents regression

Role of parents during hospitalization

Primary source of comfort and security

Toy safety concerns in the hospital

Avoid small parts and latex balloons

Why prep time must match developmental level

Reduces fear from misunderstandings and imagination

How does temperament impact hospitalization response?

Different temperaments cope differently → nursing approach adjusts to child