DEVELOPMENTAL MILESTONES



|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Gains weight/height rapidly (doubles |Responds to light and sound. |Manipulates objects in the |Significant persons are parents or |Involve parents in procedures. |

|weight/length by 50% in 6 months. | |environment. |primary caregivers. |Keep parent in infant’s line of |

| |Towards the middle of the year | | |vision. |

|Starts as a nose breather (2-4 |progresses to raising head, turning, |Recognizes bright objects and |Develops a sense of trust and security|Limit the number of strangers caring |

|months). |rolling over, and bringing hand to |progresses to recognizing familiar |if needs are met consistently and with|for the infant. |

| |mouth. |objects and persons. |a degree of predictability. |Give familiar objects to the infant. |

|Towards the end of the first year: | | | |Cuddle and hug the infant. |

|primitive reflexes diminish |Towards the end of the year progresses|Towards the end of the year, speaks 2 |Fears unfamiliar situations. |Use distraction (pacifier, bottle, |

|Fontanel closes, anterior 12-18 |to crawling, standing alone, walking |words, mimics sounds. | |etc.) |

|months; posterior, at 2 months. |with assistance and grasping strongly.| |Smiles, repeats actions that elicit |Keep crib siderails up at all times. |

|Teething starts; 1 year, 8 teeth. | |Obeys simple commands and understands |response from others, i.e., waves |Make sure toys do not have removable |

|Regular bladder and bowel pattern |Repeats actions to fine-tune learning.|meaning of several words. |goodbye, plays pat-a-cake. |parts and check for safety approval. |

|develops. | | | |Have a bulb syringe available in case |

| |Begins to develop a sense of object |Seeks novel experiences. |7-8 months; fear of strangers. |there is a need for suctioning. |

|Temperature: axillary = 97.9-98°F. |permanence. | | |Ask parents about immunization |

| | |Learns by imitation. |9-10 months; separation anxiety. |history. |

|HR: apical = 120-140 beats/min. |Reactions move from reflexive to | | |Encourage parents to assist in care. |

| |intentional. | | |If teaching procedures, provide |

|Respirations: 30-60 breaths/min. | | | |opportunities for parents/caregiver to|

| | | | |return demonstrate. |

|BP: | | | |Allow time for parents/caregivers to |

|Weight Systolic Diastolic | | | |ask questions. |

|3kg 60-80 35-55 | | | |Assess for and provide support in |

|2-3kg 50-70 27-45 | | | |managing pain. Use oral route if |

|1-2kg 40-60 20-35 | | | |possible. |

INFANCY: BIRTH TO 1 YEAR

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Learning bladder and bowel control. |Responds better to visual rather than |Develops concepts by use of language. |Significant persons are parents. |Use firm direct approach. |

| |spoken cues. | | |Use distraction techniques. |

|Abdomen protrudes. | |Sees things only from own point of |Discovers ability to explore and |Give one direction at a time. |

| |Walks independently, progressing to |view (egocentric). |manipulate environment. |Prepare child shortly before a |

|Decreased appetite and growth. |running, jumping, and climbing. | | |procedure. |

| | |Able to group similar items. |Asserts independence (autonomy) and |Allow choices when possible. |

|Temporary teeth erupt; all 20 |Feeds self. | |develops a sense of will, has temper |Emphasize those aspects that require |

|deciduous teeth by 2-1/2-3 years. | |Constructs 3-4 word sentences. |tantrums. |the child’s cooperation. |

| |Loves to experiment. | | |Provide favorite, age-specific foods. |

|Physiologic systems mature. | |Has a short attention span. |Understands ownership (“mine”). |Allow for rest periods after eating |

| |Goal directed behavior. | | |based on home routines to the degree |

|Grows 2-2-1/2 inches and 4-6 lbs. | |Beginning memory. |Attached to security objects and toys.|possible. |

|yearly. |Fully formed sense of object | | |Skills may regress due to |

| |permanence. |Ties words to actions, can understand |Knows own gender and differences of |illness/hospitalization. |

|Elimination: 18 mos. bowel control; | |simple directions and requests. |gender. |Emphasize the importance of mother |

|2-3 years daytime bladder control. | | | |(parent) staying with child at night. |

| | | |Able to put toys away. |Follow home routines if possible. |

|Temperature = 99°F +/- 1° | | | |Set limits. |

| | | |Plays simple games, enjoys being read |Give permission to express feelings. |

|Pulse = 105 +/- 35 | | |to, plays alone. |Maintain safety at all times. |

| | | | | |

|Respirations = 20 – 35/min | | | | |

| | | | | |

|B.P. = 80-100 mmHg systolic 60-64 mmHg| | | | |

|Diastolic | | | | |

TODDLER: 1-3 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Gains weight and grows in height |Skips and hops. |Major cognitive skill is conversation.|Significant persons are parents, |Explain procedures, unfamiliar |

|2-2-1/2 inches a year. | | |siblings, peers. |objects. |

| |Roller skates, jumps rope. |Understands that the amount of | |Demonstrate use of equipment. |

|Becomes thinner and taller. | |something is the same irregardless of |Increasing independence and beginning |Encourage child to verbalize. |

| |Dresses/undresses independently. |shape or number of pieces. |to assert self, likes to boast and |Use doll/puppets for explanations when|

|Temperature = 98.6° +/- 1°. | | |tattle. |performing procedures. |

| |Prints first name. |Able to classify objects, enjoys doing| |Involve the child whenever possible. |

|Pulse = 80-100/min. | |puzzles. |Masters new tasks and acquires new |Maintain safety at all times. |

| |Draws person with 6 major parts. | |skills. |Provide rest periods. |

|Respirations: 30/min +/- 5. | |Understands numbers, can count. | |Assess and manage pain |

| |Throws and catches a ball (5 years). | |Behavior is modified by rewards and |Offer distractions, e.g. count to 20 |

|BP = 90/60 mmHg +/- 15 mmHg. | |Constructs sentences, questions things|punishment. |Allow to choose the site for an |

| | |“Why?” | |injection. |

| | | |Plays cooperatively, able to live by |Offer a badge of courage (stickers, |

| | |Knows own phone number and address. |rules, capable of sharing. |etc.) |

| | | | |Focus on one thing at a time. |

| | |Attention span is short. |May be physically aggressive. |Give permission to express feelings. |

| | | | |Praise for good behavior. |

| | |Ritualistic. |Learns appropriate social manners. |Limit movement restrictions. |

| | | | | |

| | |Magical thinking. |5 year old: uses sentences, knows | |

| | | |colors, numbers, alphabet. | |

PRE-SCHOOL: 3-6 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Permanent teeth erupt. | Cares for pets. |Capable of logical operation with |Significant persons are peers, family,|Explain procedures, in advance using |

| | |concrete things. |teachers. |correct terminology. |

|Starts puberty. |Draws, paints. | | |Explain equipment. |

| | |Comprehends and can tell time. |Prefers friends to family. |Allow child to have some control. |

|Growth is slow and regular. |Makes useful articles. | | |Provide privacy. |

| | |Starts to think abstractly and to |Works hard to be successful in what |Assess and manage pain: |

|May experience “growing” pains because|Assists in household chores. |reason, can handle and classify |he/she does. |may understand use of PCA |

|of stretching of muscles with the | |problems, able to test hypotheses. | |Parent controlled analgesia may be |

|growth of long bones. |Likes quiet as well as active games. | |Belonging and gaining approval of peer|appropriate if unable to understand |

| | |Proud of school accomplishments. |group is important. |PCA. |

|May experience fatigue. |8 years old: awkward, nervous energy. | | |Medicate to prevent pain, e.g., |

| | |Enjoys reading. |Behavior is controlled by |around-the-clock. |

|Temperature = 98.6°F +/- 1° | | |expectations, regulations and |Assess response after and prior to |

| | |Starts to view things from different |anticipation of praise or blame. |next dose. |

|Pulse = 60-70/min. | |perspectives. | |Promote independence. |

| | | |Intention is considered when judging |Continue school. |

|Respirations: 18-21/min. | |Increased attention span and cognitive|behavior. |Clearly define and reinforce behavior |

| | |skills. | |limits. |

|BP = 94-112 mmHg systolic and 56-60 | | |Explores neighborhood. |Use visual aids; be concrete and |

|mmHg diastolic. | |Functions in the present. | |specific. |

| | | |Uses phone. |Relate to child’s abilities. |

| | |Rule bound. | |Major fear is loss of control. |

| | | |Plays games with rules. | |

SCHOOL AGE: 6-12 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Rapid growth of skeletal size, muscle |Awkward in gross motor activity. |Increased ability to use abstract |Interested and confused by own |Supplement explanations with |

|mass, adipose tissue and skin. | |thought and logic. |development. |rationale. |

| |Easily fatigued. | | |Encourage questions regarding fears. |

|Maturation of the reproductive system;| |Able to handle hypothetical situations|Often critical of own features and |Provide privacy. |

|development of primary and secondary |Fine motor skills are improving. |or thought. |concerned with physical appearance. |Involve in planning and decision |

|sexual characteristics. | | | |making. |

| |Early adolescence: may need more rest |Ability to use introspection. |“Chum” and belonging to peer group are|Allow adolescent to maintain control. |

|Onset of menarche in girls and |and sleep. | |important and valued; may criticize |Provide essential teaching based on |

|nocturnal emissions in boys. | |Develops more internal growth of |parents. |how the individual learns best. |

| | |self-esteem. | |Provide information on pain control |

|Vital signs approximate those of the | | |Interested in the opposite sex; |methods, assessment scale, schedule |

|adult. | |Beginning development of occupational |achieving female/male social role. |for pain management, need to ask for |

| | |identity (what I want to be). | |pain medication as soon as pain |

| | | |Accepts criticism or advice |begins, need to provide information on|

| | | |reluctantly. |degree of pain relief, types of pain |

| | | | |medications, and methods for pain |

| | | |Longs for independence but also |reduction. |

| | | |desires dependence. |Do not talk about the individual in |

| | | | |front of the individual. |

| | | |Achieves new and more mature |Present explanations in a logical |

| | | |relations. |manner; use visual aids; provide other|

| | | | |materials for review. |

| | | |Develops physical activities that are | |

| | | |socially determined. | |

| | | | | |

| | | |Identity is threatened by | |

| | | |hospitalization as adolescents are | |

| | | |concerned about bodily changes and | |

| | | |appearances. | |

ADOLESCENCE: 12-18 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Growth of skeletal systems continues |Visual changes in accommodation and |Mental abilities reach their peak |Searching for and finding a place for |Involve individual/significant other |

|until age 30. |convergence. |during the twenties (reasoning, |self in society. |in plan of care. |

| | |creative imagination, information | | |

|Skin begins to lose moisture. |Some loss in hearing, especially high |recall and verbal skills). |Initiating a career, finding a mate, |Explore impact of |

| |tones. | |developing loving relationships, |hospitalization/illness to work/job, |

|Muscular efficiency is at its peak | | |marriage, establishing a family, |family, children. |

|between 20-30 years. | | |parenting. | |

| | | | |Watch for body language as a cue for |

|GI system decreases secretions after | | |Begins to express concerns for health.|feelings. |

|age 30. | | | |Allow for as much decision-making as |

| | | |Achievement oriented; working up the |possible. |

| | | |career ladder. |Assess for potential stresses related |

| | | | |to multiple roles of the young adult. |

| | | |Moves from dependency to |Assess and manage pain based on |

| | | |responsibility. |patient needs and response. |

| | | | |Use a preventative approach. |

| | | |Responsible for children and aging |Titrate to effect and monitor |

| | | |parents. |response. |

| | | | |PCA |

| | | | |Provide information on pain control |

| | | | |methods, assessment scale, schedule |

| | | | |for pain management, need to ask for |

| | | | |pain medication as soon as pain |

| | | | |begins, providing information of |

| | | | |degree of pain relief, types of pain |

| | | | |medication, and methods. |

| | | | |Provide essential teaching based on |

| | | | |how the individual learns best. |

EARLY ADULTHOOD: 19-45 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Bone mass begins to decrease. |Slowing of reflexes. |Mood swings. |Future oriented or self-absorbed. |Allow choices if possible. |

| | | | |Explore relation of illness/disease to|

|Loss of skeletal height; calcium loss |Muscle activity may increase or |Decrease short-term memory or recall. |May experience empty nest syndrome |body image and career. |

|especially after menopause. |decrease. | |expressed positively or negatively. |Provide decision-making opportunities |

| | |Re-evaluation of current life style | |related to care. |

|Decreased muscle strength and mass if |Visual changes, especially |and value system. |Working way up career ladder. |Encourage as much self-care as |

|not used; endurance declines. |farsightedness. | | |possible. |

| | |Synthesis of new information is |Adjustment to changes in body image. |Provide information on pain control |

|Loss of skin elasticity, dry skin, |Noticeable loss of hearing and taste. |decreased. | |methods, assessment scale, schedule |

|increased appearance of wrinkles. | | |Mid-life crisis. |for pain management, need to ask for |

| |Muscles and joints respond more |Decrease in mental performance speed. | |pain medication as soon as pain |

|Decreased renal functioning, metabolic|slowly. | |Children leave home; re-establish as |begins, providing information of |

|rate, heat/cold tolerance, prone to | | |couple. |degree of pain relief, types of pain |

|infection. |Decreased balance and coordination. | | |medication, and methods. |

| | | |Recognition of limitations. |Provide essential teaching based on |

|Receding hairline in males, more |More prolonged response to stress. | | |how the individual learns best. |

|facial hair in females. | | |Adjustment to possibility of | |

| | | |retirement and life-style | |

| | | |modification. | |

| | | | | |

| | | |Measuring accomplishment against | |

| | | |goals. | |

MIDDLE ADULT: 46-65 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Decreased tolerance to heat/cold. |Decreased visual acuity. |Decline depends upon earlier cognitive|Retirement. |Explore individual’s support system. |

| | |abilities, general health and | |Explore related existing conditions. |

|Decreased peripheral circulation. |Hearing loss. |involvement in society. |Death of spouse and friends; |Involve family with care. |

| | | |acceptance of death. |Provide adequate nutrition. |

|Declining cardiac/renal function. |Decreased sensitivity of taste buds |Sharing wisdom with others. | |Keep environment safe, e.g., SR up, |

| |and smells. | |Adapting to change of social role. |bed sown, wheels locked. |

|Decreased response to stress and | |Decrease in memory, slowing of mental | |Turn/assist every 2 hours. |

|sensory stimuli. |Decreased tolerance to pain. |functions. |Developing supportive relationships. |Assess skin integrity frequently. |

| | | | |Monitor bowel eliminates every 24 |

|Atrophy of reproductive organs. |Hesitant to respond; skills declining.| |Pursuing second career, interest, |hours. |

| | | |hobbies, community activities, leisure|Continue with pain assessment and |

|Loss of teeth leading to changes in | | |activities. |management. Narcotics with long |

|food intake. | | | |half-life may cause problems with side|

| | | |Coming to terms with accomplishments. |effects, e.g., confusion, |

|More skeletal changes. | | | |constipation. |

| | | |Concern for health increases. |Use adjuvant analgesics with caution, |

| | | | |increases side effects. |

| | | |Grandparenthood. |Apply lotion to skin immediately after|

| | | | |bathing. |

| | | | |Be aware of possible need for a warmer|

| | | | |environment (increase room |

| | | | |temperature, need for an extra |

| | | | |blanket). |

LATE ADULT: 66-79 YEARS

|PHYSICAL |MOTOR/SENSORY |COGNITIVE |PSYCHOSOCIAL |INTERVENTION |

| |ADAPTATION | | | |

|Decreased oil in skin; decreased |Decreased mobility. |Decline depends upon earlier cognitive|Death of spouse/friends. |Provide a safe environment. |

|perspiration. | |abilities, general health and | |Provide adequate fluid. |

| |Stronger stimulation is needed for all|involvement in society. |Introspection and life review. |May need to divide sleep periods |

|Increased wrinkles. |senses to experience sensation. | | |between day and night. |

| | |Motivation is an important component |Acceptance of death. |Assess skin integrity frequently. |

|Loss of fat layers on limbs and face. |Decreased ability to respond to |of performance. | |Use tape sparingly on fragile skin. |

| |stimuli. | |Establish a physical living |Remove tape/bandaids carefully. |

|Bones become more prominent, stiff | |Slower in learning. |arrangement. |Handle body more with the palms of |

|joints. |Decreased sense of balance, depth | | |your hands rather than with fingers. |

| |perception, sensitivity to light touch|Drop in performance. |Decreased authority and mobility. |May need smaller, more frequent meals.|

|Changes in skin pigmentation. |and vibration. | | |Provide frequent perineal care; keep |

| | | | |clean and dry. Use barrier cream if |

|Thinning of hair. |Paresthesia. | | |appropriate. |

| | | | |Reposition every 2 hours without fail.|

|Shrinkage in intervertebral disc. |Less deep sleep, easily aroused. | | |Monitor bowel elimination every 24 |

| | | | |hours. |

|Increase susceptibility to infection. |Development of cataracts is common. | | |Monitor and assess for pain every 2-4 |

| | | | |hours. Follow previous pain |

|Increase susceptibility to high blood | | | |assessment and management guidelines. |

|pressure. | | | |Encourage self-care. |

| | | | |Provide opportunities for |

|Decreased G.I. absorption rate, | | | |decision-making related to care. |

|decreased cardiac output, decreased | | | |Assess resources for discharge. |

|airway capacity. | | | | |

| | | | | |

|Male – prosthetic hypertrophy. | | | | |

LATE, LATE ADULT (OLD, OLD): 80 AND UP YEARS

N: Syllabus/Fresh/Fall/RNSG 1523/ Developmental Milestones Reviewed 06/11

Reviewed 06/12

Reviewed 03/13

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