Prioritization & Delegation Cheat Sheet: Decision‑...

I. Introduction: Why Pediatric Milestones Matter on the NCLEX

Growth and development questions pop up in both health‑promotion and psychosocial‑integrity categories. Whether you’re assessing a six‑month‑old’s gross‑motor skills or teaching parents about adolescent psychosocial changes, knowing age‑appropriate milestones helps you identify red flags and provide safe, developmentally appropriate care. This cheat sheet condenses the most tested milestones and includes mnemonics, red‑flag warnings and tips for answering NCLEX questions.

🎯 Free pediatric quiz!
Check your milestone mastery before test day.

Take the Pediatric Practice Questions →

Pro Tip for the NCLEX: When a question asks, “Which finding requires follow‑up?” choose the milestone that falls outside the normal age range or indicates regression (e.g., a toddler who suddenly loses speech).

II. Growth & Development Overview (Birth–18 Years)

Age Range	Gross‑Motor	Fine‑Motor	Language	Social/Cognitive
0–2 mo	Lifts head briefly when prone	Hands fisted	Turns to sounds	Regards faces
3–4 mo	Rolls front→back	Grasps rattle	Laughs, coos	Smiles socially
6 mo	Sits with support, rolls both ways	Transfers objects hand‑to‑hand	Babbling with consonants	Stranger anxiety
9 mo	Pulls to stand, crawls	Pincer grasp starts	“Mama/Dada” nonspecific	Peek‑a‑boo, object permanence
12 mo	Cruises, may walk	Mature pincer	1–2 words + gestures	Separation anxiety
18 mo	Walks well, climbs stairs with help	Scribbles	10–25 words	Temper tantrums, parallel play
2 yrs	Runs, kicks ball	Tower of 6 blocks	2‑word phrases	Begins toilet training
3 yrs	Tricycle, climbs stairs alternating feet	Draws circle	3‑word sentences, 75 % intelligible	Imaginative play
4 yrs	Hops on one foot	Draws cross, square	Tells stories, 100 % intelligible	Cooperative play
5 yrs	Skips, swings independently	Draws triangle	Counts to 10, knows colors	Follows rules/games
6–12 yrs	Rides bike, organized sports	Cursive begins	Reading, jokes	Same‑gender friendships
13–18 yrs	Growth spurts, puberty	Fine‑motor fully developed	Abstract thinking	Identity & peer influence

(A printable PDF of this table will be added to the full guide: Pediatric Milestones Complete Chart.)

III. Infancy (Birth–12 Months)

Key Milestones

Gross‑Motor:
- 2 mo: lifts chest/head when prone
- 4 mo: rolls front to back
- 6 mo: sits with support then independently
- 9 mo: crawls, pulls to stand
- 12 mo: cruises along furniture, first steps
Fine‑Motor:
- 2 mo: hands mostly open
- 4 mo: grasps rattle
- 6 mo: transfers objects hand‑to‑hand
- 9 mo: crude pincer grasp
- 12 mo: mature pincer grasp (thumb + forefinger)
Language:
- 2 mo: coos
- 6 mo: babbles consonants
- 9 mo: “Mama/Dada” non‑specific
- 12 mo: first true words
Social:
- 6 mo: develops stranger anxiety
- 9 mo: object permanence
- 12 mo: waves bye‑bye, plays pat‑a‑cake

Red Flags

No head control by 4 months
No sitting by 9 months
No babbling by 6 months

Mnemonic: “1–2–3, 6–9–12”
1–2 mo lift head → 3 mo push up on arms → 6 mo sit → 9 mo crawl/stand → 12 mo walk.

IV. Toddler (1–3 Years)

Milestones

Gross‑Motor: Walks well by 15 mo, runs at 2 yrs, climbs stairs at 2½ yrs.
Fine‑Motor: Tower of 2 blocks at 15 mo, 6 blocks at 2 yrs.
Language: 50 words and 2‑word phrases by 2 yrs; speech 50 % understandable.
Toilet Training: Around 2 yrs—start when child is dry for 2 hr periods and can follow instructions.

Red Flags

No walking by 18 months
No single words by 16 months
Loss of language or social skills at any age (think autism, regression)

Mnemonic: “BLOCK 6 at 2”—Tower of 6 blocks at age 2.

V. Preschool (3–5 Years)

Milestones

3 yrs: Rides tricycle, draws a circle.
4 yrs: Hops, draws a cross or square, names colors.
5 yrs: Skips, draws triangle, prints letters, ties shoes.

🥇Voted #1 Nursing Study Tool.
Personalized AI Tutor + Instant Answers to All Your Questions. 100% Money Back Guarantee!

Get Started

Language & Social

3 yrs: 3‑word sentences, 75 % intelligible.
4 yrs: Tells stories; 100 % intelligible.
5 yrs: Counts to 10, knows address/phone.
Imaginative play, begins to share and take turns.

Red Flags

Unintelligible speech at 4 yrs
Inability to play cooperatively by 5 yrs

Mnemonic: “Trike‑Circle‑Three” → age 3.
“Hop‑Square‑Four” → age 4.
“Skip‑Triangle‑Five” → age 5.

VI. School‑Age (6–12 Years)

Development Highlights

Growth slows; 2–3 kg per year.
Concrete operational thinking: can classify, sort, reverse operations.
Social: same‑gender friendships, team sports, peer approval important.
Red Flag: Persistent bed‑wetting (enuresis) after 7 years may need evaluation.

Nursing Tips

Let the child participate in care decisions when possible.
Use diagrams and age‑appropriate explanations for procedures.
Emphasize safety gear for sports and bicycles.

VII. Adolescence (13–18 Years)

Physical Changes

Gender	Puberty Onset	Key Changes
Females	8–13 yrs	Breast buds → pubic hair → growth spurt → menarche
Males	9–14 yrs	Testicular enlargement → pubic hair → growth spurt → voice deepens

Psychosocial

Erikson Stage: Identity vs Role Confusion.
Risk‑taking behavior common—substance use, sexual activity.
Nursing role: provide confidential counseling, promote healthy choices.

Red Flags

Delayed puberty: No breast buds by 13 yrs or no testicular enlargement by 14 yrs.
Depression/self‑harm signs: Withdrawal, poor school performance, substance abuse.

VIII. NCLEX Tips: Answering Growth & Development Questions

Pick the milestone that’s off‑sequence: If a 3‑month‑old can roll over, that’s atypical—but the NCLEX often asks for delayed milestones (e.g., a 9‑month‑old who can’t sit).
Regression under stress is normal: A toddler hospitalized for surgery may revert to thumb‑sucking or bed‑wetting. Recognize regression as a normal coping mechanism.
Prioritize safety: Choose anticipatory guidance focused on injury prevention—e.g., toddlers need gates at stairways.
When in doubt, sequential order: Motor development proceeds cephalo‑caudal (head to toe) and proximo‑distal (core to extremities).

IX. Quick Mnemonic Round‑Up

“One is RUN” (walks at 1, runs at 2).
“Two is SHOE” (kicks a ball, climbs stairs).
“Three is TREE” (tricycle, climbs well, draws a circle).
“Four is DOOR” (hops, draws cross).
“Five is DRIVE” (skips, draws triangle, prints letters).

Growth and development questions reward students who can quickly match age ranges with milestones. Keep this cheat sheet handy, review it daily and test yourself using practice questions.

Explore these additional GoodNurse articles for a well‑rounded NCLEX study plan:

Prioritization & Delegation Cheat Sheet: Decision‑Making Frameworks for NCLEX Success

I. Introduction: Why Pediatric Milestones Matter on the NCLEX

II. Growth & Development Overview (Birth–18 Years)