Ages & Stages

From Birth Through Old Age and Everything in Between

Childhood Development is focused on the skills and tasks children develop as they grown. Certain development milestones are expected at certain ages. There are different components within each stage of progress such as motor skills, physical changes and psychological development.

Knowing what developmental stage a child/adolescent/adult is in can help individualize care when the patient needs healthcare.

Famous Quotes on Aging

There is a fountain of youth: it is your mind, your talents, the creativity you bring to your life and the lives of the people you love. When you learn to tap this source, you will truly have defeated age.                            --Sophia Loren

Old age is not a disease--it is strength and survivorship, triumph over all kinds of vicissitudes and disappointments, trials and illnesses.  

              --Maggie Kuhn (American Social Activist 1905-1995)

Life is not a journey to arrive at the grave safely in a well-preserved body, but rather to skid in sideways, totally worn out, shouting "What a ride!"

                                             --Unknown

I don't want to get to the end of my life and find that I have just lived the length of it. I want to have lived the width of it as well. --Diane Ackerman (American author, poet and naturalist 1956- )

One day your life will flash before your eyes. Make sure it's worth watching.

                                           --Unknown

Infancy (Birth to 12 months)     Waaah!

Erikson Developmental Stage

Trust versus Mistrust

Developing trust is the first task of the ego and is never complete and finished. The concept of trust versus mistrust is present throughout a person's entire life. If this concept isn't addressed during infancy, the person may never be able to feel comfortable in the world. A person who develops a sense of mistrust may be unable to develop healthy lasting relationships with other people--or perhaps even themselves.

Normal Developmental Milestones

By the 1st birthday children should be able to stand while they are holding on to furniture. They may be able to teeter for a few seconds when standing alone, but will usually collapse on the floor. Infants babble repeatedly and deliberately drop toys to watch where they go.

By the age of 1, they can cooperate with dressing, wave goodbye and understand simple commands. 

Still developing visual acuity.

Physical

Fontanels close during the first year

Grows about 1 inch a month for the first few months then the growth rate slows to  about 1/2 inch per month

Stools become formed by the 1^st birthday

Motor & Sensory Skills

Progresses to where the head can be held steady & erect

Progresses to where objects can be grasped and held. Will hold and bang objects by the 1^st birthday.

At birth stares into space but by 1^st birthday points to objects 15-20 feet away. Can track objects as they move.

Has a poor sense of balance.

Psychosocial

At birth will smile randomly, but by 1^st birthday will jabber and say "Mama" and "Dada".

Begins to recognize what "No-no" means by their 1^st birthday.

Concerned only with self, likes to be the center of attention.

Show emotions and begins to show a fear of strangers

Likes music, peek-a-boo, patty cake and likes to play in water

Develops trust if needs are met with a consistent degree of predictability

Patient Care

Needs to see and be cared for by familiar people.

Staff assigned to care for this age of patient needs to be consistent.

Parents should be encouraged to touch and play with their child and how to work around any medical equipment. Use familiar objects and toys.

Needs to be hugged, coddled and held.

Continually assess and manage pain since the child can't say how they are feeling.

Safety

*Car seats for travel                                                            

* Keep safety caps on electrical outlets

*Keep medicine bottles closed with childproof cap                 

* Safety gates at stairways

* Toys should have no sharp edges or small parts                  

* Toys should be unbreakable

* Keep household supplies out of reach                                  

* Small objects & toys should be out of reach

*Guard from water accidents--can drown in a few inches of water              

* Lead-free toys and surroundings

NO!

Erikson Development Stage

Autonomy versus Shame & Doubt

The toddler now realizes they are a separate person with their own desires and abilities. "No!" become their favorite word and is a declaration of their desire for independence.

Normal Development

Likes set routines and becomes upset of there are changes in their activity pattern or their environment. Toddlers have a very low tolerance for frustration and pain. The hospital environment may provoke fear and terror. The child can separate from their parents but still depends on them for safety, security and approval.

Physical

Gains 4-6 pounds a year

Gets their full set of baby teeth. Learns to feed self using a fork and spoon. May try to use a knife.

May be potty trained by 36 months. May need help with wiping and may occasionally have an accident. Has 1-2 well-formed stools per day.

Sleeps 10-12 hours per might and may nap for 1-2 hours per day.

Motor & Sensory Skills

May throw temper tantrums

Jumps in place and jumps off of low objects. Can build with blocks and can copy a circle, square and cross. Tries to draw people.

Uses safe scissors, throws objects overhead and walks on tiptoe

Talks in 2-3 words combinations, follows 2 step commands,. Answers when questioned.

Can feed self and pour liquids from a pitcher.

Psychosocial

Negative behaviors are common. Establishes a routine. Has a limited understanding of time.

Has concrete fears of certain things. Separates from parents, learns some rules and begins to conform.

Begins to ask about the differences between boys and girls. (Usually by age 4)

Uses play to learn and express fears. Goes from playing alongside other children to playing with other children.

Likes having stories read to them, showing off their accomplishments and making up stories. Likes coloring, cutting, scribbling and painting.

Patient Care

Use a firm, direct approach. Give one direction at a time. Allow choices when possible. Prepare the child shortly before the procedure.

Continually assess and manage pain. Use distraction techniques. Emphasize the aspects of care that need the child's cooperation.

Provide favorite finger foods and foods that are appropriate for the age.

Emphasize the importance of the parent staying with the child at night. Encourage the parents to participate in the child's care and teach them how to work around the medical equipment.

Safety

Early Childhood 

(3 years to age 6)

Why?

Erikson Developmental Stage

Initiative versus guilt

Initiative adds to the independence of undertaking planning and accomplishing a task just for the sake of being active and on the go. Preschoolers learn through play--and play is their "work". Parents who inhibit their children's play or who chide them for being 'silly' can cause the child to feel guilty for playing.

Normal Development

Begin talking clearly and have a great imagination. Plays with others and fights with their siblings. They begin to learn to play in groups. Like to explore and do things on their own. They imitate adults.

 Developing food preferences, likes textured food and prefers to eat one food at a time. They are able to tolerate a brief separation from their parents if they are given an explanation of where they are and when they will return.

Physical

Gains 3-5 pounds a year and grows about 2-2 1/2 inches a year. Becomes taller and thinner.

Begins to lose baby teeth as their permanent teeth come in.

Bowel and bladder control is well established.

Sleeps 10-12 hours a night.

Motor & Sensory Skills

Jumps and climbs well. Can go up and down stairs using alternating feet without using the railing.

Uses scissors to cut out pictures. Can play games on the computer.

Dresses on their own. Can print their own name.

Repeats sentences of 10 syllables or more. Very talkative. Knows the days of the week and communicates in full sentences.

Psychosocial

Increasing independence. Begins to assert themselves and likes to tattle and boast. May be physically aggressive.

Significant people in their lives are their parents., siblings and peers.

Behavior is modified by reward and punishment.

Attention span is short and they may have magical thinking. Frequently asks "Why?"

Knows their own phone number, can live by rules and learns appropriate social behavior. Masters new skills.

Fears the loss of their parents. Child believes that something they have done has caused their parents to leave.

Fears pain.

Patient Care

Explain procedures, equipment and unfamiliar objects. Likes to see the equipment demonstrated.

Allow the child choices such as choosing the injection site. Reward with stickers.

Focus on one thing at a time and allow the child to express their feelings. Involve them in their own care.

Encourage the parents to stay at night.

Continually assess and manage pain. Use distractions to refocus attention.

The child's behavior may regress with illness or hospitalization.

Allow adequate rest periods.

Safety

*Car seats or seat belts when traveling

*Experimenting with independence can find the preschooler exploring matches, cupboards, refrigerators, plugging in appliances, new places

*Keep potentially dangerous objects out of reach

*Begins to understand actions can be dangerous

 (6-12 years old)

Erikson Developmental Stage

Industry versus Inferiority

In this stage the child develops the desire to complete a specific task and moves past the whims of carefree behavior of 'just' playing. The fundamentals of using technology are developed. How well a child does in school is an important part of their development process.

Normal Development

This age of child has lots of energy, is curious and competitive, impatient and restless. They develop a sense of accomplishment from their academic achievements. They often have a best friend and have a clique or group of friends--usually of the same sex. They prefer spending time with their friends to spending time with their family. Want control over their privacy and begin to question their parents.

Physical

Thee are wide variations in height and weight.

May start to develop secondary sex characteristics. Females may have their first period. Males increase muscle strength dramatically.

Permanent teeth are established.

Appetite increases to relation to the rapid growth.

Sleeps 8-10 hours a night but can vary widely.

Motor & Sensory Skills

Uses a knife and common tools, can draw, paint and make useful articles. Can tell time.

Capable of logical operation of things. Assists in household chores and can care for pets.

Starts to think abstractly and reason things out. Can handle some problems and starts to see things from a different point of view.

Has an increased attention span and cognitive skills.

Enjoys reading, likes quiet time, video games and sports.

Psychosocial

The significant person are the peers, family and teachers. Prefers friends to family. Belonging an gaining peer group approval (peer pressure) is very important.

Works hard to be successful and is proud of accomplishments in school.

Behavior is controlled by expectations, regulations and anticipation of praise and blame. Plays within the rules. Intention is considered when judging behavior.

Uses the phone and explores the neighborhood. Enjoys music and  Enjoys music and sports. Very verbal. Fears loss of control. Develops a sense of humor.

Patient Care

Explain procedures and use the correct terminology.

Allow the child to have some control. Must give the child privacy. Continue to promote independence.

Continually assess and manage pain. May be able to understand and use the PCA pump.

The child may regress with illness. May worry and demonstrate nervousness.

May have little understanding of anatomy, body functions and illness.

Safety

*Use seat belt for travel                   

* Accidents related to activities are common

* Peer pressure may encourage a child to act against their better judgment without consideration of the consequences                      

* Use of the internet should be monitored to ensure their safe use

Adolescence

 13-18 years old

Erikson Developmental Stage

Identity versus Role Diffusion

The adolescent is very concerned with how they appear to other people. They are often critical of their own appearance. This group has an "identity crisis" at some point in this stage of development. Most adolescents don't know where they are going, but they want to be on their way!

Normal Development

The adolescent is reaching puberty and developing secondary sex characteristics. They develop a group of friends of the same sex and become interested in the opposite sex. Dating begins and the teen begins to start considering their choice of career. They struggle with trying to be independent when they are still dependent on their parents.

Physical

There are wide variations in height and weight. Both males and females reach near adult proportions.

While the female shows little change in her height and weight, the males grow about 2-2 1/2 inches while putting on 20-35 pounds.

By this age, females have reached menarche while males may experience involuntary nocturnal sexual arousal.

Appetite varies in relation to growth and activity. May express concern over their weight.

Likely to have wisdom teeth erupt.

Sleeps 8-12 hours at night.

Motor & Sensory Skills

Increased mobility and independence. May have awkward gross motor movements, but their fine motor skills show improvement.

Near adult cognition. Capable of logical thought. Communicates clearly and effectively.

Able to use introspection. Develops more internal growth of self esteem. Can think more abstractly and can form their own opinions.

May have a limited understanding of body structures but may be reluctant to admit they do not know or understand.

Psychosocial

Decisions are often influenced by peers and significant adults though they are beginning to become more independent. Accepts criticism/advise reluctantly.

Adolescents are interested and confused about their own development They are critical of their own features and are concerned with their appearance.

Longs for independence, but also needs to remain dependent. Has more relationships and develops new relationships.

Being a part of a peer group is very important. Likes talking, music and socializing with peers. Dating, dancing, shopping, hanging out, driving care, motorcycles and 'souped' up cars is important.

Patient Care

Identity is threatened by hospitalization as adolescents are concerned about body appearance and changes.

Procedures should be explained logically with the correct terminology. Explain the rationale and encourage the teen to ask questions and voice fears and concern. Continually assess and manage pain.

Allow the adolescent to have control. Provide privacy and involve the teen in the planning and process. The teen may listen to their own parents but make their own decisions--keep in mind the legal age and sharing of information with the parents without the teen's consent.

Do not talk about the teen in front of the teen. Talk directly to the teen.

Safety

*Use seat belt for travel

*Peer pressure may encourage the teen to act against their better judgment without fully considering the consequences

*Accidents are the leading cause of death

*Suicide is the 3rd leading cause of death

*May feel pressure to have sex, smoke, or try illegal substances

Early Adulthood

19-45 years old

Erikson Stage of Development

Intimacy versus Isolation

At this stage the most important events are love relationships. Intimacy refers to a person's ability to relate to another human on a deep and personal level. A person who has not developed a sense of identity usually fears a deep and committed relationship and may retreat into isolation. The goal of this stage is to ensure emotional sustenance, sexual gratification and financial security.

Normal Development

A wide range of life experiences assist in the gradual development of adult intellectual capacities. Significant persons are the spouse or the significant other, their children, friends and their co-workers. These people form their own opinions and make their own decisions. They find themselves managing a growing number of responsibilities at home, work and in the community. The child rearing burden is the greatest at this time. They may also have the responsibility of caring for aging parents.

Physical

The growth of the skeleton continues until the age of 30. Physical strength is at its peak between 25-30.

This age group generally enjoys better health than children. They have fewer acute illnesses and have yet to experience the health problems that comes with middle age.

There is some increase in cognitive abilities.

The skin starts to lose moisture and there is a loss of elasticity. There is an increase in the appearance of wrinkles.

The GI system decreases secretions after the age of 30.

Motor & Sensory Skills

Most physical skills and abilities remain at a functional level if used regularly and exercised. 

Reasoning, creative imagination and judgment continue to develop throughout life.

There are changes in vision that may necessitate glasses or contact lenses.

Some hearing lose develops especially in the high tone range.

The older people in this age group start to acknowledge their developing limitations and develop an awareness of their own mortality.

Psychosocial

This is the time when career choices are made. Work is a major channel for energy, stamina and skill.

In searching for adult intimacy, young adults seek emotional fulfillment to replace the nuclear family of their youth.

Begin to express interest and concerns for personal health.

Patient Care

Procedures should be explained using the correct terminology.  Explain equipment. Use visual aids and be concrete and specific in your explanations.

Allow for as much decision making as possible. Involve the spouse if approved by the patient.

This group may fear their illness or disease may impact their employment, responsibilities and their role in the family unit. Allow the patient time to express their fear and concerns.

Continually assess and manage pain. Provide information on pain control methods.

Safety

*Use seat belt for travel                                                     

*May smoke, use alcohol or illegal  drugs

* Multiple roles may cause  stress increasing the potential for several

stress-related symptoms     

*May smoke, use alcohol or illegal drugs increasing the potential for several diseases or accidental death

Middle Adulthood

(46-65 years of age)

Erikson Developmental Stage

Generativity versus Stagnation

Generativity concerns the need to feel as if a person has contributed something of value to the next generation. Socially valued work is an expression of generativity. The main question facing this group is "Will I produce something of value with my life?" This age group faces the daunting uncertainty of which it is they really want out of life.

 Normal Development

There is an increased risk for heart disease. The basal metabolic rate decreases along with the need to eat fewer calories to avoid gaining weight. May find themselves with children coming back home and their elderly parents living with them as well. They are in the middle of the their life and in the middle of their career.

Physical

Experience wrinkles, a midriff bulge, and a receding hairline. Females tend to have more facial hair.

Bone mass begins to decrease and there is a loss of skeletal height especially with calcium loss after menopause. Muscles mass decreases and strength and endurance decreases if muscles are not used.

Menopause occurs between the ages of 45-55 for females. There is a loss of skin elasticity, dry skin and increased wrinkles.

Renal function begins to decrease. The metabolic rate falls and cold intolerance develops. Becomes more susceptible to infections.

May experience worsening of vision and need bifocals.

Motor & Sensory Skills

Most physical skills and abilities remain at a functional level if used regularly and exercised. Muscles and joints respond more slowly.

Reasoning, creative imagination judgment continue to develop throughout life. There is a decrease in the mental performance speed with decreased short-term memory or recall.

There is some hearing loss especially in the higher tones, but have a general hearing loss as well. Decreased taste. There is a decrease in balance and coordination.

Psychosocial

This age group is working their way up the career ladder. They measure  their accomplishments against their goals.

They begin to recognize their limitations. they are adjusting to the possibility of retirement and modifications to their lifestyle.

There is a period of adjustment to the changes in their body image. May experience a mid-life crisis or an empty nest syndrome.

There is concern about providing for themselves and the next generation.

They maintain contact with their children and are in the process of letting go of their authority over their adult children.

Patient Care

Explain procedures and equipment using the correct terminology. Use visual aids and be concrete and specific. Explain rationale and encourage questions.

Allow for as much decision-making as possible. Explore the impact of the hospitalization and illness on their work, home, family and children.

Continually assess and manage pain. Provide information of pain control methods.

Safety

* Seat belt for travel     

* May smoke, use alcohol and/or illegal

* Multiple roles may lead to stress leading to related symptoms

* May have major life changes such as the

the death of spouse, divorce, etc.

* At risk for coronary artery disease, diabetes, arthritis  and respiratory diseases             

Late Adulthood

(65 years old until death)

Erikson Developmental Stage

Integrity versus Despair

A healthy ego is a result of the accumulated assurance of its capacity for order and meaning. Despair is the result of the fear of one's own death as well as the loss of self-sufficiency and of loved partners and friends.

Normal Development

The significant persons are the spouse, children and friends. There is a decrease in mental performance and speed with a decrease in the short-term memory and recall. The skin and cardiovascular tissue decrease in elasticity. The ability to respond to stress declines. Changes in the skeletal system results in a lower center of gravity that leads to a wider stance and slower gait. There are adjustments related to aging. The person in late adulthood needs to confront their own mortality and the death of their spouse and friends.

Physical

There is a decreased tolerance to heat & cold. There is decreased peripheral  circulation.

Cardiac and renal function is declining. There is decreased respiratory capacity.

May be losing teeth. The bones are more porous & muscle weight declines. Height decreases. Continuing loss of visual acuity. Hearing loss is present as well as decreased memory and slowing of mental function.

Motor & Sensory

Most metal skills and abilities depend on the cognitive capabilities that were developed earlier in life, the person's general health and their involvement in society.

The muscles and joints respond more slowly and physical skills are declining.

In the absence of disease, reasoning, creative imagination and judgment skills continue to develop throughout the life span.

Psychosocial

Shares wisdom with others. Develops supportive relationships with others. Have become established as grandparents.

Usually have retired. They are facing changes in their role in society. They are coming to terms with their accomplishments and may pursue a second career, explore new hobbies, become involved in new/additional community and leisure activities.

They reflect inwardly and perform a life review.

They are concerned about their health.

Patient Care

Procedures should be explained logically using the correct terminology. Use visual aids and be concrete and specific.

Explore the impact of the hospitalization on the patient and their significant other. Determine the individuals' support system and look at the related existing conditions. Continually assess and manage pain. Provide information on pain control methods.

Provide adequate nutrition. Assist with aspects of care the patient cannot perform. Frequently assess skin integrity and apply lotion immediately after bathing.

Safety

*Seat belt for travel              

*Major life changes such as the death of a spouse, retirement, body changes can create stress

*High risk for heart disease, diabetes, cancer, respiratory diseases and arthritis

* May smoke, use alcohol or illegal drugs or may use prescription medications in a manner inconsistent with labeling

*Changes in bone composition and gait predisposes to falls and fractures