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Growth & Development
Milestones

Master the predictable patterns of physical, cognitive, and psychosocial development from infancy through adolescence.

NCLEX-RN

Growth vs. Development

Growth is the measurable, quantitative increase in physical size: height, weight, and head circumference. Development is the qualitative increase in skill and complexity of function.

Growth
Measured in numbers. A toddler gaining weight or growing taller.
Development
Measured in ability. A child learning to walk, talk, or share.

Why Milestones Matter

Milestones are predictable behaviors most children achieve by a certain age. Nurses use them to screen for normal development and to catch delays early, when intervention is most effective.

The Three Domains

Physical Motor skills Gross & fine Body growth Cognitive Thinking Language Problem solving Psychosocial Emotions Trust Identity All three develop together across each age stage

Erikson's Psychosocial Stages

Erik Erikson described development as a series of conflicts the person must resolve at each stage. Each conflict is named by its two opposing outcomes.

1
Infant (0–1 yr): Trust vs. Mistrust — needs met consistently builds trust.
2
Toddler (1–3 yr): Autonomy vs. Shame & Doubt — gaining independence.
3
Preschool (3–6 yr): Initiative vs. Guilt — exploring and asserting.

Erikson's Older Stages

4
School-age (6–12 yr): Industry vs. Inferiority — mastering tasks & skills.
5
Adolescent (12–18 yr): Identity vs. Role Confusion — forming sense of self.

Erikson vs. Piaget

Both describe stages, but in different domains. Erikson covers psychosocial growth, while Piaget covers cognitive growth — how thinking matures.

Erikson
Emotional & social conflicts. "Trust," "Autonomy," "Identity."
Piaget
Cognitive stages: Sensorimotor → Preoperational → Concrete → Formal.

How to Apply on the Exam

1
Identify the child's age stated in the question stem first.
2
Match the age to its expected developmental stage and milestones.
3
Compare the described behavior to what is normal for that age.
4
Decide if it is normal, ahead, delayed, or a safety concern.

Infant Motor Milestones

2 mo Lifts head 4 mo Rolls over 6 mo Sits w/ support 9 mo Crawls 12 mo Walks Motor skills follow cephalocaudal order

Example 1: Infant

A nurse assesses a 6-month-old. The parent asks which skill is normal at this age.

Example 2: Toddler

A 2-year-old says "No!" to everything and insists on doing things alone. The parent is worried.

Example 3: Preschooler

A 4-year-old hospitalized for surgery believes his illness is punishment for being "bad."

Common Mistakes

✕ Mixing stage models
Confusing Erikson (psychosocial) with Piaget (cognitive). Know which model the question targets.
✕ Ignoring the age
Answering before reading the exact age. The age determines the expected milestone.
✕ Pathologizing normal
Treating normal behaviors like toddler negativism or magical thinking as problems.

Stage Summary

Age Erikson Key Behavior
0–1 yrTrust vs. MistrustStranger anxiety
1–3 yrAutonomy vs. Shame & DoubtNegativism, ritualism
3–6 yrInitiative vs. GuiltMagical thinking
6–12 yrIndustry vs. InferiorityMastering skills
12–18 yrIdentity vs. Role ConfusionPeer identity

Question 1 of 5

According to Erikson, the central psychosocial conflict of the infant (0–1 year) is:

Question 2 of 5

Which gross motor skill should a nurse expect a healthy 12-month-old to demonstrate?

Question 3 of 5

A 2-year-old repeatedly says "No" and insists on the same bedtime routine each night. The nurse explains this is:

Question 4 of 5

A hospitalized 4-year-old states his illness is punishment for misbehaving. This best reflects:

Question 5 of 5

An adolescent strongly values fitting in with peers and experiments with different styles. According to Erikson, this reflects:

Key Takeaways

1
Growth is quantitative size; development is qualitative skill.
2
Development is orderly: cephalocaudal and proximodistal.
3
Match age to stage: memorize Erikson's conflicts by age range.
4
Recognize normal behaviors (negativism, magical thinking) vs. delays.