Pediatric Milestones

NCLEX Review: Pediatric Developmental MilestonesKey NCLEX Principle

Always remember:

• Development progresses head to toe (cephalocaudal)

• Development progresses center to outward (proximodistal)

Infant Milestones (0–12 Months)

2 Months

Physical

• Lifts head when prone

• Opens hands

Cognitive/Social

• Social smile

• Coos

NCLEX Tip

Absence of social smile may need further evaluation.

4 Months

Physical

• Rolls front to back

• Good head control

Cognitive/Social

• Laughs

• Recognizes parents

6 Months

Physical

• Sits with support

• Rolls both directions

• Begins teething

Cognitive/Social

• Stranger anxiety begins

• Babbles

Nutrition

• Introduce solid foods

7 to 8 months

Infant sitting up leaning forward onto both hands

9 Months

Physical

• Crawls

• Pulls to stand

• Pincer grasp begins

• Infant holds a rattle by the handle

Cognitive/Social

• Peek-a-boo

• Object permanence starts

Safety

• Major choking risk age

12 Months

Physical

• Walks with assistance or independently

• Mature pincer grasp

Language

• 1–3 words

Social

• Waves bye-bye

Nutrition

• Whole milk introduced

• Wean from bottle

11-12 months

Infant places objects into a container

Toddler Milestones (1–3 Years)15 Months

Physical

• Walks independently

• Uses cup

• Stacks 2 blocks

Language

• 4–6 words

18 Months

Physical

• Runs clumsily

• Throws ball

• Attempts using a spoon

Language

• 10 words or more

NCLEX Red Flag

No walking by 18 months = concern.

2 Years

Physical

• Walks up/down stairs

• Kicks ball

Language

• 2-word sentences

Cognitive

• Parallel play

Psychosocial

According to Erik Erikson:

• Autonomy vs shame/doubt

NCLEX Tip

Temper tantrums are normal.

3 Years

Physical

• Rides tricycle

• Jumps

• Builds tower of 9-10 blocks

Language

• 3-word sentences

• Speech mostly understandable

Play

• Associative play begins

Preschool Milestones (4–5 Years)4 Years

Physical

• Catches ball

• Holds crayon between fingers and thumb

Language

• Tells stories

Cognitive

• Magical thinking common

Play

• Cooperative play begins

5 Years

Physical

• Skips

• Hops on one foot

• Laces shoes

Language

• Counts

• Knows colors

School Readiness

• Copies shapes

• Prints some letters

School-Age Child (6–12 Years)Development

• Increasing independence

• Peer approval important

• Concrete thinking develops

Psychosocial

According to Erik Erikson:

• Industry vs inferiority

Play

• Team sports

• Collections

• Rules important

NCLEX Tip

Hospitalization concern:

• Loss of control

• Missing school/friends

Adolescent Milestones (12–18 Years)

Physical

• Puberty

• Growth spurts

Cognitive

According to Jean Piaget:

• Formal operational thinking

• Abstract thought develops

Psychosocial

According to Erik Erikson:

• Identity vs role confusion

Nursing Priorities

• Privacy

• Peer relationships

• Body image

Play Types (VERY HIGH YIELD)

Piaget Cognitive Development

Erikson Psychosocial Stages

High-Yield NCLEX Pediatric SafetyInfants

• Rear-facing car seat

• No honey before 1 year

• Back to sleep

Toddlers

• Poison prevention

• Fall prevention

• Choking hazards

Preschool

• Water safety

• Helmet use

School-age

• Bicycle safety

• Stranger safety

Adolescents

• Substance abuse education

• Safe driving

• Sexual health education

Quick Memory Tricks2 Years

• “2-year-old uses 2-word sentences”

4 Years

• “4-year-old hops on 1 foot”

5 Years

• “5-year-old can dress self”

Stranger Anxiety

• Starts around 6 months

Separation Anxiety

• Peaks in toddler years

Common NCLEX Priority QuestionsHospitalized Toddler

Best intervention:

• Allow parental presence

• Maintain routines

Preschooler Procedure Prep

• Explain immediately before procedure

• Use simple words/play

School-Age Child

• Give choices when possible

Adolescent

• Respect confidentiality when appropriate