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4.2 Developmental Stages: Infancy through Older Adult

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NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

4.2 Developmental Stages: Infancy through Older Adult

Key Takeaways Explain This Topic AI

Infants double birth weight by 6 months and triple it by 12 months; posterior fontanel closes by 2-3 months, anterior by 12-18 months

Toddler safety priorities include poisoning prevention, drowning prevention, and fall protection - leading causes of injury death in this age group

School-age children (6-12 years) master rules, develop friendships, and engage in cooperative play; privacy becomes increasingly important

Adolescents need privacy, peer connection, and gradual autonomy; risk-taking behaviors (substance use, sexual activity) require non-judgmental education

Older adults face physiological changes (decreased renal function, altered drug metabolism) and psychosocial challenges (retirement, loss, chronic illness)

Last updated: January 2026

Developmental Stages Overview

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

  • Infancy (Birth to 1 Year)
  • Erikson: Trust vs. Mistrust

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

Physical Milestones

  • Age Milestone
  • 2-3 months Head control, social smile, coos
  • 4-5 months Rolls over (front to back first)
  • 6-8 months Sits without support, transfers objects
  • 9 months Pincer grasp (thumb and finger), crawls
  • 12 months Walks with support, says 1-2 words
  • 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
  • Toddler (1-3 Years)
  • Erikson: Autonomy vs. Shame and Doubt

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

Characteristics

  • Feature Description
  • Language 2-word phrases by 2 years; vocabulary explodes
  • Play Parallel play (alongside, not with others)
  • Behavior Negativism, ritualism, temper tantrums
  • Thinking Egocentric (Piaget's Preoperational)
  • 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:

  • Poisoning - Lock up medications and cleaning products
  • Drowning - Never leave unattended near water
  • Falls - Gate stairs, supervise closely
  • Burns - Lower water heater to 120°F, keep pot handles turned in
  • Motor vehicle accidents - Use car seat correctly
  • 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."
  • 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
  • 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
  • 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)
  • 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
  • Older Adult (65+ Years)
  • Erikson: Integrity vs. Despair

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

Physiological Changes

  • System Changes
  • Cardiovascular Decreased cardiac output, increased BP
  • Respiratory Decreased lung capacity, weaker cough
  • Renal Decreased GFR, slower drug excretion
  • Musculoskeletal Decreased bone density, muscle mass
  • Neurological Slower processing, sensory changes
  • Integumentary Thinner skin, decreased healing
  • 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