178

PART TWO

Content Review and Practice Questions

Table 9-4 Stages of Growth and Development

Age

Physical

Gross Motor

Fine Motor

Language

Play

0 to 4 Months

Posterior fontanel
closes at 2
months;
obligatory nose
breather

Lifts head when

prone; primitive
reflexes begin to
fade by 4
months; rolls
from back to
side at 4 months

By 4 months, can
grasp object and
bring to mouth

By 4 months,
laughs and
babbles

Smiles at 2
months; shows
excitement with
body

4 to 8 Months

Birth weight
doubles by 6
months; teeth
eruption
beginning

Head control;
can turn from
back to
abdomen; can
sit unsupported
by 8 months

Moves from
palmar grasp to
beginning
pincer grasp

Begins to imitate
sounds; can
make a few
vowel and
consonant
sounds

Begins to
recognize
strangers; object
permanence
beginning; plays
peek-a-boo

8 to 12 Months

Birth weight
triples by 12
months; head
and chest
circumference
equal; may have
six to eight
teeth

Begins to creep on
knees; by 12
months can
walk with hand
held; can sit
from standing
position

By 12 months can
release object,
can turn pages
of book

Can say three to

five words in
addition to
mama or
dada;
understands
simple
commands

Has object
permanence;
has transitional
object such as
security blanket

12 to 15 Months

Steady growth

Walks alone

Builds tower with

two cubes; uses
cup well

Says four to six

words; points to
express wants

Imitates
housework;
begins to
manage spoon;
has temper
tantrums

15 to 24 Months

Physiologic
anorexia;
anterior
fontanel closed
by 18 months

Runs but falls;

throws ball
overhand

Builds tower with

three to four
cubes; release
and reach
developed

Says 10 words; can

identify object
by pointing

Uses spoon well;

begins to take
off clothes

2 Years

One-half adult
height

Goes up and down

stairs; runs with
wide stance

Builds tower of six

to seven cubes;
can unscrew
lids

Has vocabulary of
300 words; uses
two- and threeword phrases

Parallel play;
dresses in
simple clothes

3 to 4 Years

Has 20 teeth; has

bladder and
bowel control

Jumps; rides
tricycle; can
skip and hop on
one foot by 4
years

Builds tower of 9
to 10 blocks; can
copy and circle

By 4 years has
1,500-word
vocabulary;
begins to name
colors

Dresses and feeds

self; fears are
beginning; play
becomes
associative;
imaginary
playmates
emerge

5 to 6 Years

May lose first

tooth;
permanent
teeth begin;
hand dominance
established

Skips and hops on

either foot;
jumps rope;
walks backward
heel to toe; can
count

Ties shoelaces;
uses scissors
and pencil; uses
knife to spread
jam

Vocabulary of
2,100 words;
uses six- to
eight-word
sentences with
all grammar
parts

Fears are
decreasing;
begins to use
rules; manners
developing

(Continued)

CHAPTER 9 Introduction to Nursing Care of Children

179

Table 9-4 Stages of Growth and Development (Continued)

Age

Physical

Gross Motor

Fine Motor

Language

Play

7 to 9 Years

Begins to grow 5
cm per year

Concept of time
developed;
describes
objects; begins
to collect

Uses table knife to

cut; helps with
routine housework

Reads books

Group play; more

social; very
modest

10 to 12 Years

Boys: Growth
slows
Girls: May begin
pubescent
changes

Uses telephone;
writes stories;
understands
there is a world
outside of home

Cooks or sews;
can care for pet;
can perform
own grooming

Reads for practical

information;
enjoys library
books

Friends important;
more diplomatic;
demonstrates
affection

12 to 18 Years

Rapid acceleration
in growth;
mature growth
by 17 to 20
years; develops
secondary sex
characteristics

Motor skills
mature

Fine motor skills

mature

Abstract thought;
enjoys
intellectual
ideas

Acceptance by
peers important;
seeks identity

c.

BP screening beginning at 2 years of

age
d. Hip dislocation assessment until 1 year
of age
e. Vision screening beginning at birth and
then again at 2 years of age
f. Dental visits beginning at 30 months of
age
2. Provide child and family teaching.
a. Common side effects: Redness and
swelling at injection site; drowsiness,
fever, rash, and diarrhea
b. Contraindications to administer vaccine, including:
(1) High fever
(2) Immunosuppression from
chemotherapy or long-term steroid
use: No live virus vaccines such as
measles, mumps, rubella, and
varicella
(3) Allergies to vaccine contents (e.g.,
eggs)
H. Pharmacologic and parenteral therapies: Table
9-5 shows the 2007 general immunization
guidelines approved by the American Academy
of Pediatrics, Advisory Committee on Immunization Practices (http://www.cdc.gov/nip/
recs/child-schedule.htm). Review the Web site
for updated information as needed. Scheduled
immunizations include the following:
1. Hepatitis A vaccine
2. Hepatitis B vaccine
3. Diphtheria and tetanus toxoid and acellular pertussis vaccine (DTaP) or tetanus

4.
5.
6.
7.
8.
9.

toxoid and diphtheria and acellular pertussis (Tdap)

Haemophilus influenzae type B (HIB) vaccine
Inactivated poliovirus vaccine (IPV)
Measles, mumps, rubella (MMR) vaccine
Varicella virus vaccine
Pneumococcal vaccine
Rotavirus vaccine

Table 9-5 Immunization Guidelines

Age

Immunization

Birth

Hepatitis B

1 to 4 Months

Hepatitis B

2 Months

DTaP, HIB, IPV, pneumococcal

(PCV), rotavirus

4 Months

DTaP, HIB, IPV, pneumococcal

(PCV), rotavirus

6 Months

DTaP, pneumococcal (PCV),

rotavirus

6 to 18 Months

Hepatitis B, IPV, influenzae (yearly)

12 to 15 Months

HIB, MMR, pneumococcal (PCV),

hepatitis A, varicella

15 to 18 Months

DTaP

4 to 6 Years

DTaP, IPV, MMR, varicella

11 to 18 Years

Tdap, meningococcal vaccine

(MCV4), HPV