Developmental Stages Overview

Nurses must understand the physical, cognitive, and psychosocial characteristics of each life stage to provide appropriate care and anticipatory guidance.

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Infancy (Birth to 1 Year)

Erikson: Trust vs. Mistrust

The primary task is developing trust through consistent, responsive caregiving.

Physical Milestones

Growth Parameters

• Birth weight doubles by 6 months
• Birth weight triples by 12 months
• Length increases 50% by 12 months
• Posterior fontanel closes by 2-3 months
• Anterior fontanel closes by 12-18 months

Safety Priorities

SIDS Prevention ("Back to Sleep"):

• Place infant on BACK to sleep
• Firm, flat sleep surface
• No loose bedding, pillows, or toys
• Room-sharing without bed-sharing recommended

Choking Prevention:

• No small objects (coins, balloons, toys with small parts)
• Cut food into small pieces
• No hard candy, popcorn, grapes, or hot dogs until age 4

Car Seat:

• Rear-facing until age 2 or until reaching weight/height limits

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Toddler (1-3 Years)

Erikson: Autonomy vs. Shame and Doubt

Toddlers assert independence through choices, saying "No," and temper tantrums.

Characteristics

Toilet Training Readiness (18-24 months)

Signs of readiness:

• Stays dry for 2+ hours
• Shows interest in the toilet
• Can follow simple instructions
• Indicates when wet or soiled
• Can pull pants up and down

Nursing tip: Never force toilet training - it should be child-led.

Safety Priorities

Leading Causes of Death: Injuries, including:

1. Poisoning - Lock up medications and cleaning products
2. Drowning - Never leave unattended near water
3. Falls - Gate stairs, supervise closely
4. Burns - Lower water heater to 120°F, keep pot handles turned in
5. Motor vehicle accidents - Use car seat correctly

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Preschool (3-6 Years)

Erikson: Initiative vs. Guilt

Preschoolers explore, ask "why," and develop imagination.

Cognitive Characteristics (Piaget: Preoperational)

• Magical thinking - Believes thoughts cause events
• Animism - Inanimate objects are alive
• Egocentrism - Cannot see others' perspectives
• Transductive reasoning - Links unrelated events ("I was bad, so Grandma got sick")

Play

• Associative play (plays with others but not organized)
• Dramatic/imaginary play flourishes
• May have imaginary friends (normal)

Safety Considerations

• Teach body safety ("good touch, bad touch")
• Stranger awareness
• Bike helmet use
• Supervision near water and traffic

Common Fears

• The dark
• Monsters
• Being alone
• Loud noises
• Medical procedures

Nursing tip: Preschoolers fear bodily harm. Use bandages after injections - they worry about "leaking."

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School-Age (6-12 Years)

Erikson: Industry vs. Inferiority

Focus on achievement, competence, and skill-building.

Cognitive Development (Piaget: Concrete Operational)

• Logical thinking about concrete objects
• Understands conservation
• Can classify and organize
• Follows rules

Social Development

• Cooperative play (organized games with rules)
• Same-sex friendships dominate
• Peer acceptance increasingly important
• Comparison to peers (can feel inferior)

Physical Changes

• Steady growth (2-3 inches/year)
• Permanent teeth replace primary teeth
• Prepubescent changes begin (age 10-12)

Nursing Considerations

• Provide explanations and choices
• Maintain privacy during examinations
• Use concrete, honest information
• Encourage participation in care

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Adolescence (12-18 Years)

Erikson: Identity vs. Role Confusion

Establishing personal identity is the central task.

Physical Development (Puberty)

Females:

• Breast development (thelarche) - first sign
• Growth spurt peaks
• Menarche (average age 12.5 years)

Males:

• Testicular enlargement - first sign
• Growth spurt later than females
• Voice changes, facial hair

Cognitive Development (Piaget: Formal Operational)

• Abstract thinking
• Hypothetical reasoning
• Future orientation
• Idealism

Psychosocial Characteristics

• Peer group is paramount
• Body image concerns common
• Risk-taking behaviors increase
• Sense of invincibility ("It won't happen to me")

Health Education Priorities

Provide non-judgmental education about:

• Substance use (alcohol, drugs, tobacco, vaping)
• Sexual health and contraception
• STI prevention
• Mental health (depression, anxiety, suicide risk)
• Nutrition and body image

Nursing Approach

• Respect confidentiality (within legal limits)
• Interview adolescent alone for part of visit
• Use open-ended questions
• Avoid judgment
• Provide privacy during examinations

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Young Adult (18-35 Years)

Erikson: Intimacy vs. Isolation

Building close relationships and partnerships.

Characteristics

• Physical peak performance
• Career establishment
• Partnership and family formation
• Financial independence

Health Focus

• Healthy lifestyle habits
• Family planning
• Stress management
• Preventive care (screenings begin)

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Middle Adult (35-65 Years)

Erikson: Generativity vs. Stagnation

Contributing to society and guiding the next generation.

Characteristics

• "Sandwich generation" - caring for children and aging parents
• Career peaks and potential career changes
• Physical changes (presbyopia, hearing changes, menopause)
• Chronic disease risk increases

Health Focus

• Chronic disease prevention and management
• Cancer screenings become priority
• Cardiovascular health
• Lifestyle modifications

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Older Adult (65+ Years)

Erikson: Integrity vs. Despair

Life review - accepting life as meaningful vs. feeling regret.

Physiological Changes

Medication Considerations

• Decreased renal function prolongs drug half-life
• Decreased hepatic function slows drug metabolism
• Increased body fat affects drug distribution
• Polypharmacy increases interaction risk

Psychosocial Considerations

• Retirement adjustment
• Loss of spouse and friends
• Relocation decisions
• Chronic illness adaptation
• End-of-life planning

Nursing Priorities

• Fall prevention
• Medication safety
• Maintaining independence
• Social connection
• Advance directive discussions