Table of Contents:

1. Developmental Milestones 4. Safety Teaching

2. Growth Milestones 5. Vital Sign Ranges
3. Assessment

Growth & Development

TABLE 1. DEVELOPMENTAL MILESTONES AT A GLANCE

1. Developmental Milestones
Failure to meet milestones suggests a developmental y 2 months
delay (cerebral palsy, Down syndrome).
Social: Social smile
Gross motor skills: y 4 months
y Develops from head to toe
Gross motor: Head lag disappears
y Head control  Sitting  Walking y Fine motor: Holds rattle (palmar grasp)

Child Health
y Reflexes: Tonic neck (“fencing”) reflex disappears.
Fine motor skills:
y Positive tonic neck reflex: When infant’s head
y Clumsy at first, then more refined and controlled
is turned to the side, arm and leg extend in
y Palmar grasp  Pincer grasp  Holds utensils
the same direction the head is turned.
Milestones by age (TABLE 1): y Infants are unable to roll over until fencing
y 1 month reflex disappears.

Speech: Coos (“ooh”)
y Gross motor: Head lag present.
y To assess: Pull the infant to a sitting position
and watch for head to fall back.

 In normal speech and social development,  In normal motor development, head lag disappears
infants have a social smile by 2 months and by 4 months; infants sit unsupported by 9 months
make cooing sounds (“ooh”) by 4 months. and walk with one hand held by 12 months.

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FIGURE 1. MOTOR DEVELOPMENT

1. Developmental Milestones, Continued

y 6 months y 18 months

Gross motor: Rolls over both ways y Beyond 18 months, motor skills develop from
y Fine motor: Transfers objects from one hand toe to head (FIGURE 1).
to another y Gross motor: Runs
y Reflexes: Moro (“startle”) reflex disappears. y Speech: Speaks 10+ words
y Positive Moro reflex: Lift the infant, allowing
infant’s head to fall back; the infant’s arms 2. Growth Milestones
should quickly extend then flex.
Weight

Social: Separation anxiety and stranger danger y Doubles birth weight by 6 months
(clings to caregivers around strangers) y Triples birth weight by 12 months

Speech: Babbles (“ma,” “da”)

Fontanels
y 9 months
y Posterior closes by 3 months.

Gross motor: Sits unsupported
y Anterior closes by 18 months.

Fine motor: Pincer grasp (“9” for 9 months)

Child Health
y 12 months While developing, young children have:

Gross motor: Walks with one hand held y risk for infection (due to immature
y Fine motor: Holds cup and spoon immune and respiratory systems)
y Reflexes: Babinski disappears, changing from
risk for fluid and electrolyte imbalance
extension  flexion (due to immature kidneys and a greater body
surface-to-mass ratio)
y Positive Babinski reflex: When the lateral sole

Dehydration in young children causes sunken
of infant’s foot is stroked from heel to base of
fontanels and an absence of tears when crying.
toes, toes should extend (should flex after
12 months).
y Speech: Says first words

 Birth weight should double by 6 months and triple by 12 months.

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3. Assessment 4. Safety Teaching
Varies by age:
y 0-1 year: Infants
TABLE 3. SAFETY TEACHING
y 1-3 years: Toddlers
y 3-6 yrs: Preschoolers SIDS y Sleep on back until 1 year old
y 6-12 yrs: School-age children (“back to sleep”).
y 12-18 yrs: Adolescents
Car Seat
Car seats should be in the back
Young children (infants, toddlers, and preschoolers) fear
seat and kept rear-facing
strangers, injury, and pain. To build trust:
for a minimum of 1 year and
until the child outgrows the

TABLE 2. ASSESSING YOUNG CHILDREN manufacturer’s height and
weight limits.
Involve Infants/toddlers:
caregivers. y Talk to caregivers first. Drowning y Supervise near all water
y Ask caregivers to hold the (even a bucket).
child during assessment.
Aspiration Infants/toddlers:
Start with y Auscultate lung sounds y No small toys (marbles)
least invasive while sleeping. y Cut up bigger, round foods
assessments y Save most invasive (grapes and hotdogs).
first. equipment for last
(rectal thermometer). Poisons/ y Lock up medicines and
toxins household cleaners.
Relax and Infants: y Do not call medicines “candy.”
distract with age- y Play peek-a-boo.
appropriate play. y Use a rattle.
5. Vital Sign Ranges
Toddlers/preschoolers:
BP increases with age (TABLE 4).
y Let them play with new
equipment one at a time. Heart rate and respirations:
y Demonstrate procedures on y HR and RR decrease with age.
a doll.
y Smaller organs work harder to oxygenate and
perfuse body.
Communicate. y Use simple language y Adolescents’ vitals are similar to adults’.
(“BP cuff will ‘hug’ your arm.”). y Assessment techniques:
y Be honest (don’t say that

Child Health
y Count apical pulse and RR for 1 min in young
painful procedures
children (can be irregular).
“won’t hurt”).
y Invasive assessments canHR and RR.
y Offer choices (“Red or blue
bandage?”).

Treat school-age children and adolescents like

young adults.
y Ask if they want caregiver present.
y Explain procedures.

 Car seats should be rear-facing in the back seat  To assess young children, ask caregivers for
for a minimum of 1 year and until a child outgrows help, use play, and start with the least invasive
the manufacturer’s height and weight limits. assessments first.

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5. Vital Sign Ranges, Continued
Temperature
FIGURE 2. WONG-BAKER ‘FACES’ PAIN SCALE
y ≤5 years: axillary or rectal preferred
y Except during chemotherapy and rectal surgery
y >5 years: oral preferred
y Except in epiglottitis and oral surgery
Pain
y Preverbal and nonverbal children: Face, Legs, Activity,
Cry, Consolability (FLACC) scale
y Children ≥3 years: FACES scale (FIGURE 2)

TABLE 4. NORMAL PEDIATRIC VITAL SIGNS

Age Range HR RR Systolic BP Diastolic BP

(beats/min) (breaths/min) (mm Hg) (mm Hg)

Infant 1-12 months 9 0-19 0 30-60 70-100 45-65

Toddler 1-3 years 80-140 20-35 9 0-105 55-70

Pre-school 3-6 years 70-120 20-30 9 5-110 60-75

School age 6-12 years 60-110 15-25 100-120 60-75

Adolescent 12+ years 55-100 12-20 110-135 65-85

 In normal speech and social development, infants

 The car seat for a 6-month-old should be kept
have a social smile by ___ months and make cooing
in the ______ seat and positioned (rear or
sounds (“ooh”) by ___ months.
forward?)-facing.
 In normal motor development, head lag disappears

Child Health
by ___ months, infants can sit unsupported by ___  When assessing a sleeping 9-month-old, the
months and walk with one hand held by ___ months. nurse should first assess (lung sounds
or temperature?).
 Birth weight should double at ___ months and triple
at ___ months.
Answers: 1. 2 months, 4 months 2. 4 months, 9 months, 12 months 3. 6 months, 12 months 4. back seat, rear-facing 5. lung sounds

References: Attributions:
Hockenberry, M., Duffy, E.A., & Gibbs, K. (2024). Wong’s nursing
y Gross Motor Development: Created with BioRender.com
care of infants and children (12th ed.). Elsevier.
y Wong-Baker FACES Pain Scale: Created with BioRender.com
Keenan-Lindsay, L., Sams, C., & O’Connor, C. (2022). Perry’s
maternal child nursing care in Canada (3rd ed.). Elsevier
Health Sciences (US).
McKinney, E., Mau, K., Murray, S., James, S., Nelson, K., Ashwill,
J., & Caroll, J. (2022). Maternal-child nursing (6th ed.).
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