Erikson's Psychosocial Stages
Each stage presents a conflict — successful resolution builds a healthy personality. Know the stage, age range, and what nursing care supports resolution.
- Trust vs. MistrustBirth – 18 mo
- Does the world meet my needs consistently? Respond promptly to crying. Consistent caregiving. Comfort during procedures. Do NOT let infant cry without responding.
- Autonomy vs. Shame & Doubt18 mo – 3 yr
- Can I do things myself? Allow choices (2 safe options). Encourage self-feeding, toileting. Avoid shaming accidents. Toddlers say "NO" — this is NORMAL.
- Initiative vs. Guilt3 – 6 yr
- Is it OK to do things and be active? Let child ask questions, explore, play. Explain procedures. Praise efforts. Allow them to help with simple tasks.
- Industry vs. Inferiority6 – 12 yr
- Am I good at things? Praise accomplishments. Let child participate in care. Teach about condition. Encourage school and activities.
- Identity vs. Role Confusion12 – 18 yr
- Who am I? Provide privacy. Include in decisions. Encourage peer interaction. Address body image concerns. Maintain confidentiality.
If a question describes a toddler refusing care or saying "no" — the answer relates to autonomy. If it's a school-age child wanting to know how to do a dressing change themselves — that's industry. Erikson is the most commonly tested developmental theorist on the NCLEX-PN.
? A toddler says "NO" to every nursing intervention. Which Erikson stage explains this, and what should the nurse do?
Every key point in this guide fits on one free printable page. Jump to the free cheatsheet PDF →
Piaget's Cognitive Stages
Piaget describes how children think — important for understanding how to teach patients and families at developmentally appropriate levels.
- SensorimotorBirth – 2 yr
- Learns through senses and movement. Object permanence develops ~8–9 months. Keep favorite toy in sight. Simple, concrete interactions. Minimize separation from caregivers.
- Preoperational2 – 7 yr
- Egocentric (world revolves around them). Magical thinking. Can't understand cause/effect yet. Use simple words, dolls, play. Don't explain illness as punishment. Concrete language only.
- Concrete Operational7 – 11 yr
- Logical thinking about real objects. Understands cause/effect. Conservation develops. Simple explanations of procedures. Show equipment. Let them handle supplies.
- Formal Operational12+ yr
- Abstract thinking, hypothetical reasoning. Can understand consequences. Explain rationale, long-term effects. Include in teaching. Discuss compliance and future planning.
"Sensory Play Creates Future" — Sensorimotor, Preoperational, Concrete, Formal. A 4-year-old thinking their illness is punishment for being bad = Preoperational (magical thinking) — reassure them it is NOT their fault.
Developmental Milestones
Know the age at which key milestones are reached — delay is a red flag requiring referral.
Infant Milestones (Birth – 12 Months)
- 2 months
- Lifts head briefly when prone; social smile, coos, tracks objects with eyes.
- 4 months
- Head control steady, rolls front to back; laughs, reaches for objects, recognizes faces.
- 6 months
- Sits with support, rolls both ways; babbles, transfers objects hand to hand, stranger anxiety begins.
- 9 months
- Sits alone, pulls to stand; pincer grasp begins, "mama/dada" (non-specific), strong stranger anxiety.
- 12 months
- Walks with one hand held, cruises furniture; pincer grasp refined, 1–3 words with meaning, waves bye-bye.
Growth Pattern — Key Numbers
- Birth weight doubles by 5–6 months, triples by 12 months
- Birth length increases 50% by 12 months (average 20 inches → 30 inches)
- Head circumference: grows ~2 cm/month first 3 months, then slows
- Posterior fontanel: closes by 2–3 months
- Anterior fontanel: closes by 12–18 months
Toddler Milestones (1–3 Years)
- 15 months: walks alone, 4–6 words, stacks 2 blocks
- 18 months: runs, 10 words, scribbles, uses spoon (messy)
- 2 years: runs well, 50+ words, 2-word phrases, kicks a ball, parallel play
- 3 years: rides tricycle, 3-word sentences, dresses with help, associative play
Preschool / School-Age (3–12 Years)
- 4 years: hops on one foot, tells stories, cooperative play, draws a person with 4+ parts
- 5 years: skips, ties shoes, counts to 10, prints letters
- 6–12 years: logical thinking, team sports, reads, understands rules
No social smile by 3 months. No babbling by 12 months. No single words by 16 months. Loss of previously acquired skills at any age. These require immediate developmental evaluation.
Vital Signs by Age
Pediatric normals are different from adults — and they vary with age. Know the trends: as age increases, HR and RR decrease, BP increases.
- NewbornHR · RR · Systolic
- 110–160 bpm · 30–60 br/min · 60–90 mmHg
- Infant (1–12 mo)HR · RR · Systolic
- 100–160 bpm · 25–40 br/min · 70–100 mmHg
- Toddler (1–3 yr)HR · RR · Systolic
- 90–150 bpm · 20–30 br/min · 80–110 mmHg
- Preschool (3–6 yr)HR · RR · Systolic
- 80–140 bpm · 20–25 br/min · 80–110 mmHg
- School-age (6–12 yr)HR · RR · Systolic
- 70–120 bpm · 18–22 br/min · 90–120 mmHg
- Adolescent (12–18 yr)HR · RR · Systolic
- 60–100 bpm · 12–20 br/min · 100–130 mmHg
In children, tachycardia is the FIRST sign of shock — not hypotension. Children compensate well and maintain BP until late in decompensation. If you see a high HR in a sick child — treat it as shock until proven otherwise. Also: always take temp axillary in newborns, rectal is most accurate in infants.
Pain Assessment in Children
Children cannot always verbalize pain — use age-appropriate tools.
Pain Assessment Tools by Age
- NIPSPreterm – 1 yr
- Neonatal Infant Pain Scale. Scores facial expression, cry, breathing, arm/leg movement, and state of arousal. 0–7 scale.
- FLACC Scale2 mo – 7 yr
- Face, Legs, Activity, Cry, Consolability. Each 0–2. Total 0–10. Used for non-verbal children.
- FACES Pain Scale3–8 yr
- Six cartoon faces from happy to crying. Child points to face that matches their pain.
- Numeric Scale (0–10)8+ yr
- Same as adult scale. Child must understand number concepts.
Behavioral Cues of Pain in Infants
- Tightly closed eyes or wide-open eyes
- Furrowed brow, clenched fists ("guarding")
- Rigid body, pulling away from touch
- High-pitched cry or no cry (may be too exhausted)
Pain is the 5th vital sign — assess it every time. Never assume a quiet child is pain-free. Non-nutritive sucking (pacifier) and breastfeeding during procedures reduce pain in infants. Sucrose solution (sweet water) is also evidence-based for infant procedural pain.
Effects of Hospitalization
Children respond to hospitalization differently based on developmental stage — nursing care must be tailored accordingly.
- Infantmain fear
- Separation from caregiver, pain. Encourage parent presence at all times. Consistent caregivers. Minimize painful procedures. Use pacifier/sucrose.
- Toddlermain fear
- Separation anxiety (#1 fear). Loss of control. Allow transitional objects (blanket, toy). Explain in simple terms. Offer 2-option choices. Maintain routine as much as possible.
- Preschoolmain fear
- Bodily harm, mutilation, punishment. Explain procedures simply and just before (not too early). Use play therapy. Reassure illness is NOT punishment.
- School-agemain fear
- Loss of control, peer separation, missing school. Explain rationale. Allow participation. Encourage video calls with friends. Maintain school work.
- Adolescentmain fear
- Loss of independence, body image, peer acceptance. Provide privacy. Include in decisions. Allow peers to visit. Maintain confidentiality from parents when appropriate.
Separation Anxiety — 3 Phases (Toddlers)
A toddler in the despair phase may look calm to staff, but this is NOT adjustment — it signals the child feels abandoned. Always encourage parent rooming-in. If asked "what is the best roommate for a hospitalized adolescent?" → choose someone closest in age with a similar condition.
? A hospitalized toddler suddenly stops crying, seems calm, and interacts with nurses. Why is this concerning?
Frequently Asked Questions
Common student questions on this topic.
What are Erikson's stages of psychosocial development for children?
When should a child meet major motor milestones?
What is the recommended immunization schedule for the first year?
How do you assess pain in a non-verbal child?
What is the leading cause of death in children by age group?
What are the signs of SIDS risk and how is it prevented?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Growth & Development Cheatsheet
One-page PDF — free download.