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Pediatrics: Growth, Vital Signs and Immunizations
Milestones, Erikson and play, vital signs, vaccines, safety, pain scales and dehydration for NCLEX
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Growth and milestones
- Birth weight doubles by 5 to 6 mo, triples by 12 mo
- Fontanels: posterior closes by 2 mo, anterior at 7 to 19 mo (exams: 12 to 18). Sunken: dehydration; bulging: raised ICP
| Age | Motor | Language | Social |
|---|---|---|---|
| 2 mo | Lifts head on tummy | Sounds besides crying | Social smile |
| 6 mo | Rolls tummy to back | Squeals, raspberries | Laughs; knows familiar people |
| 9 mo | Sits alone; toy hand to hand | Babbles (mamama) | Stranger anxiety |
| 12 mo | Cruises; pincer grasp | Mama or dada; waves | Pat-a-cake |
| 18 mo | Walks alone; scribbles | 3 or more words | Moves away, checks back |
| 2 yr | Runs; kicks a ball | 2-word phrases | Notices others upset |
| 5 yr | Hops on one foot | Tells a short story | Follows game rules |
Erikson, play and communication
| Age | Erikson | Communicating |
|---|---|---|
| Infant (0 to 1) | Trust vs mistrust | Parent close; comfort items |
| Toddler (1 to 3) | Autonomy vs shame/doubt | Simple words; medical play kit |
| Preschool (3 to 5) | Initiative vs guilt | Use play; not their fault |
| School-age (6 to 12) | Industry vs inferiority | Honest; explain why |
| Teen (12 to 18) | Identity vs role confusion | Privacy; share decisions |
Play: solitary (infant), parallel (toddler), associative (preschool), cooperative, with rules (school-age).
Normal vital signs
| Age | HR | RR | SBP |
|---|---|---|---|
| Newborn | 100–160 | 30–60 | 65–85 |
| Infant (1–12 mo) | 100–160 | 30–53 | 70–100 |
| Toddler (1–3 yr) | 80–130 | 20–30 | 72–110 |
| Preschool (3–5 yr) | 80–120 | 20–26 | 78–112 |
| School-age (6–12 yr) | 70–110 | 16–24 | 82–126 |
| Teen (13+ yr) | 60–100 | 12–20 | 100–120 |
Fever: 38.0 °C (100.4 °F) or higher; rectal is most accurate in infants. At 3 mo or younger, notify the provider at once.
Routine immunizations
| Age | Vaccines |
|---|---|
| Birth | HepB within 24 hr; mother HBsAg-positive: HepB and HBIG within 12 hr |
| 2, 4, 6 mo | DTaP, Hib, PCV, IPV, oral rotavirus (start before 15 wk, last dose by 8 mo); more HepB |
| RSV season | RSV antibody under 8 mo unless mother vaccinated 14+ days before birth |
| 6 mo and up | Flu yearly; 2 doses 4+ wk apart if under 9 yr with fewer than 2 prior doses |
| 12 to 18 mo | MMR, varicella, HepA, Hib and PCV boosters, DTaP |
| 4 to 6 yr | DTaP, IPV, MMR, varicella |
| 11 to 12 yr | Tdap, HPV, MenACWY (booster at 16) |
Exams test this CDC/AAP routine schedule. As of October 18, 2026, a March 2026 court order still blocks a January 2026 CDC revision that moved several of these off routine use; a related appeal, argued October 6, awaits a ruling. Check the current schedule: cdc.gov/vaccines/hcp/imz-schedules
Safety: car seats, poisoning, lead
- Rear-facing to the seat's limit, then a forward-facing harness to its limit
- Booster until the belt fits (about 4 ft 9 in, age 8 to 12); back seat until 13
- Never a rear-facing seat in front of an active airbag
- Poison Help 1-800-222-1222 (911 if unresponsive, not breathing or seizing); do not induce vomiting
- Lock up medicines and chemicals in their original containers
- Lead: Medicaid requires blood tests at 12 and 24 mo; 3.5 µg/dL or higher (CDC reference value) needs follow-up
Pain scales and dehydration
- FLACC: nurse scores face, legs, activity, cry and consolability, 0 to 2 each (total 0 to 10), when a child cannot self-report
- Wong-Baker FACES: self-report, age 3 and up
| Finding | Mild to moderate | Severe |
|---|---|---|
| Behavior | Normal to irritable | Lethargic or unresponsive |
| Eyes, tears, mouth | Slightly sunken, fewer tears, dry | Deeply sunken, no tears, parched |
| Skin fold, refill | Recoils under 2 s; refill prolonged | Recoils over 2 s; refill prolonged or minimal |
| Limbs, urine | Cool; less urine | Cold, mottled; minimal urine |
- Mild to moderate: oral rehydration solution 50 to 100 mL/kg over 2 to 4 hr; keep breastfeeding; no soda or juice
- If vomiting: 5 mL every 5 min by spoon or syringe, increasing slowly
- Severe: IV isotonic fluid, 20 mL/kg boluses
- Typical doses for exam study; follow your institution's protocols
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Calculators for this topic
Sources
- Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule by Age (schedule posted with addendum updated July 2, 2025). Link
- Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule Notes (Recommendations for Ages 18 Years or Younger, United States, 2025). Link
- American Academy of Pediatrics. Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger, United States, 2026 (updated September 2, 2026). Link
- HealthyChildren.org (AAP). AAP Releases Recommended Childhood and Adolescent Immunization Schedule for 2026. January 26, 2026. Link
- Congressional Research Service. The 2026 Childhood Immunization Schedule. Report R48982, June 11, 2026. Link
- Georgetown University Center for Children and Families. Court Order Presses Pause on New ACIP Committee and Changes to Childhood Vaccination Schedule. March 31, 2026. Link
- Georgetown University Law Center. Health Care Litigation Tracker: American Academy of Pediatrics et al. v. Kennedy et al. (last updated October 7, 2026). Link
- Vega E. Judge Pauses Pediatricians' Lawsuit Over Kennedy's Vaccine Changes as Families Await October 6 Appeals Court Argument. Medical Daily, September 15, 2026. Link
- Brief for Plaintiffs-Appellees, American Academy of Pediatrics v. Kennedy, No. 26-1503 (1st Cir. filed July 21, 2026) (the government appeals only the stay of the ACIP appointments). Link
- Centers for Disease Control and Prevention. General Best Practice Guidelines for Immunization: Contraindications and Precautions (last reviewed July 25, 2024). Link
- Centers for Disease Control and Prevention. Flu Vaccines and People with Egg Allergies (September 17, 2024). Link
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