NCLEX Review Guide: Growth & Development and Immunizations

Key Principles

• Growth refers to physical changes in size, weight, and height, while development encompasses cognitive, emotional, and social maturation processes.
• Development follows predictable patterns: cephalocaudal (head to toe) and proximodistal (center to periphery).
• Each child develops at their own pace, but milestones provide important benchmarks for assessment.

Infancy (0-12 months)

• Trust vs. Mistrust (Erikson): Consistent caregiving builds foundation for future relationships.
• Motor milestones: sits without support (6 months), walks independently (12-15 months).
• Language: first words by 12 months, understands simple commands.

Toddlerhood (1-3 years)

• Autonomy vs. Shame/Doubt: Independence-seeking behavior, toilet training readiness.
• Parallel play predominates; tantrums are normal developmental behavior.
• Language explosion: 2-word phrases by 2 years, 3-word sentences by 3 years.

Preschool (3-6 years)

• Initiative vs. Guilt: Develops sense of purpose through play and social interaction.
• Magical thinking and animism are characteristic cognitive patterns.
• Cooperative play emerges; follows 2-3 step instructions consistently.

Birth to 6 Months

1. Birth: Hepatitis B (first dose within 24 hours)
2. 2 months: DTaP, IPV, Hib, PCV13, RV (first doses)
3. 4 months: DTaP, IPV, Hib, PCV13, RV (second doses)
4. 6 months: DTaP, PCV13, RV (third doses), Hepatitis B (second dose), annual influenza begins

6 Months to 2 Years

• 12-15 months: MMR, Varicella, Hib, PCV13 (critical timing for measles protection)
• 12-23 months: Hepatitis A series (2 doses, 6 months apart)
• Annual influenza vaccine continues throughout childhood.

Frequently Confused Concepts

• Growth vs. Development: Growth is quantitative (measurable), development is qualitative (behavioral/cognitive changes).
• Cephalocaudal vs. Proximodistal: Remember "head to tail" vs. "inside out" progression patterns.
• Live vaccines require immunocompetent status; inactivated vaccines are safer for compromised immunity.

Quick Check ✓

• □ Can I differentiate growth from development?
• □ Do I know the major developmental milestones by age?
• □ Can I identify which vaccines are live vs. inactivated?
• □ Do I understand immunization contraindications?