NCLEX-RN cheat sheet · Growth and development
Growth and development
Milestones, Erikson and Piaget, feeding, sleep and safety from birth to 17
AI-checkedChecked by AI against current guidelines, with spot-checks by a registered nurse.
Development runs head to toe, and from the center outward. A missed milestone means talking with the provider: problems found early respond best to help.
Download the free PDF: Growth and development, 2 pages
Two printable pages, free. No sign-up.
At a glance
Milestones, birth to 2
| Age | Expect |
|---|---|
| 2 mo | Lifts head on tummy; smiles at voices; calms when picked up |
| 4 mo | Head steady without support; brings hands to mouth; coos |
| 6 mo | Rolls front to back; sits leaning on hands; starts to know strangers |
| 9 mo | Sits without support; passes toys hand to hand; looks for hidden things. Stranger anxiety is normal |
| 1 yr | Pulls to stand and cruises; picks things up with thumb and finger; says mama and dada |
| 18 mo | Walks alone; scribbles; eats with a spoon; about 3 words besides mama and dada |
| 2 yr | Runs, kicks a ball, walks up stairs; word pairs |
Screening: Development at 9, 18 and 30 months; autism at 18 and 24 months.
Growth
- Birth weight about doubles by 5 months and triples by 1 year: a 7 lb newborn is about 21 lb at one.
- Fontanelles: posterior closes by about 2 months, anterior by about 18 months.
- Head circumference at every well visit: unusual growth can point to a developmental problem.
- Growth charts show the trend: a child normally follows the same percentile line. Weight falling behind height may mean too few calories.
- By 2, about half of adult height. Growth slows in the second year.
- School age: growth slows; children slim down and gain strength. Baby teeth start falling out around 6.
- Puberty: growth spurt, hands and feet first, then arms and legs, then the trunk.
Erikson and Piaget
| Age | Erikson | Piaget | What you see, what helps |
|---|---|---|---|
| Infant, to 12 months | Trust vs mistrust | Sensorimotor (birth to 2): learns through the senses; object permanence by about 9 months | Food, warmth, safety and comfort that come reliably build trust |
| Toddler, 1 to 3 | Autonomy vs shame and doubt | Sensorimotor to 2, then preoperational | No, tantrums, testing limits. Offer simple choices: the red book or the blue one? |
| Preschool, 3 to 5 | Initiative vs guilt | Preoperational (2 to 7): words and symbols, but not logical yet | Magical thinking; may think illness is a punishment. Reassure: it isn't their fault |
| School age, 6 to 11 | Industry vs inferiority | Concrete operational (7 to 11): logical about real things; conservation | Want to accomplish things, and compare themselves with peers. Praise effort |
| Teen, 12 and up | Identity vs role confusion | Formal operational (from about 12): abstract ideas | Peers central; risk-taking. Talk openly; independence within limits |
Safety by age
| Teach | |
|---|---|
| Safe sleep, to age 1 | On the back, every sleep, even preterm babies and babies with reflux. Firm, flat, level surface with only a fitted sheet. Share a room, not a bed, for at least the first 6 months. Car seats and swings aren't for sleep |
| Infant car seat | Rear-facing, in the back seat, never in front of an active airbag. Harness snug, chest clip at nipple level, no bulky coat |
| Harness, then booster | Forward-facing harness until its height or weight limit. Then a booster in the back until the adult belt fits: back against the seat, knees bending naturally, lap belt on the upper thighs, shoulder belt across the chest, and they keep that fit the whole trip |
| Home | Water heater at 120 °F or lower. Never leave a baby alone in the bath: a baby can drown in an inch of water. Lock up medicines; button batteries out of reach |
| Play and sport | Helmets; swimming lessons and life jackets. Possible concussion: stop playing right away and get checked promptly |
| Teens | Motor vehicle crashes are the leading cause of accidental death: clear rules against texting while driving. Firearms locked, unloaded, stored apart from ammunition |
Preschool milestones
| Age | Expect |
|---|---|
| 3 | Uses a fork; draws a circle when shown; strangers understand their speech most of the time |
| 4 | Rides a tricycle; catches a big ball; holds a pencil between fingers and thumb. Most dress and use the toilet on their own |
| 5 | Hops on one foot, skips, writes some letters, counts to 10, knows name and address |
Play: Alone, then side by side (parallel), then sharing, then working together on a game.
Sleep needs
| Age | Per day |
|---|---|
| Toddler | 11 to 14 hours, naps included. Routines help |
| Preschool | 10 to 13 hours. Nightmares and night terrors are common |
| School age | 9 to 12 hours, and at least an hour of physical activity every day |
| Teen | 8 to 10 hours. The body clock shifts later, so many are short on sleep |
Feeding
- Breast milk alone for about the first 6 months, continuing alongside food to at least a year. Breastfed babies need vitamin D drops.
- Formula is iron-fortified, used until 12 months. Never heat a bottle in the microwave: hot spots burn.
- Solids at about 6 months, when the baby can sit with support, control the head, and swallow instead of pushing food out. One single-ingredient food every 3 to 5 days.
- No honey before age 1: infant botulism.
- Choking: supervise every meal, feed sitting up, cut round foods and hot dogs into pieces under half an inch. Anything that fits through a toilet paper tube is a hazard until about age 3.
- Appetite drops as growth slows. Offer healthy food again and again and let the child decide how much. No clean-plate rule, no food as reward or punishment.
Screen, report and treat
- Lazy eye (amblyopia): correct the underlying vision problem first, often with glasses. Patching or atropine may follow.
- Report squinting or head tilting. Screens: about an hour a day of good children's programs.
- Scoliosis signs: an uneven shoulder or hip, or a rib hump on bending forward. Report them. Screening isn't universal: the USPSTF finds too little evidence to screen teens 10 to 18 without symptoms.
- Teething usually starts at 4 to 7 months. Clean the mouth twice a day; see a dentist by age 1.
Priority and safety calls
- A missed milestone needs follow-up: a 9-month-old who doesn't hold her head steady (expected by 4 months) is reported to the provider.
- ★ Watch teens for depression, anxiety and eating disorders. A teen who seems very sad: ask directly about suicidal thoughts.
- Preschool fears like monsters: work with the fantasy, like a magic spray, rather than arguing with logic.
- Never leave a child alone in a car: the temperature inside can rise fast enough to kill.
- Prevent falls: a hand on the baby on the changing table, safety straps, a stationary activity center instead of a walker.
How the NCLEX tests it
- Weight doubles by 5 months and triples by a year. Follow the growth chart's trend.
- Erikson: trust, autonomy, initiative, industry, identity. Piaget: sensorimotor, preoperational, concrete, formal.
- Safe sleep traps: side-sleeping for reflux, tummy sleeping, an inclined surface, crib bumpers.
- Feeding traps: honey before age 1, whole grapes, and arguing with a toddler instead of offering a choice.
- Traps: reasoning away a preschooler's magical fears, a clean-plate rule, a seat belt too soon, playing on after a head injury.
Practice it next
This sheet comes from Growth and development: birth to 2 years and Growth and development: ages 3 to 17 in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- The anterior fontanelle closes by about ___ months.
Show answer
18 - A baby has object permanence by about ___ months.
Show answer
9 - No honey before age 1, because of the risk of infant ___.
Show answer
botulism - A preschooler is in Erikson's stage of initiative versus ___.
Show answer
guilt - Teens need ___ hours of sleep a day.
Show answer
8 to 10 - Set the water heater at ___ °F or lower.
Show answer
120
Sources
- NICHD Safe to Sleep, Ways to Reduce Baby's Risk
- NHTSA, Car Seats and Booster Seats
- National Eye Institute, Amblyopia (Lazy Eye)
- CDC, About Sleep
- USPSTF, Adolescent Idiopathic Scoliosis: Screening
- Open RN, Health Promotion, 13.3 Stages of Child Development
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.