Pediatric Nursing for NCLEX: Milestones, Immunizations & Priority Care

Preparing for NCLEX pediatrics can feel intense. The good news: you don’t need to memorize everything. Focus on growth and development, vaccines, safety, high-yield illnesses, and family-centered care. Use simple rules and priority thinking.

What You’ll Master

• Age-based milestones and safety tips

• Immunization schedule and key contraindications

• Common pediatric illnesses and “what to do first”

• Weight-based dosing and medication safety

• Family-centered communication that earns points on NCLEX

Growth & Development (by age)

Infants (0–12 months)

• 0–3 mo: lifts head prone, follows objects, social smile.

• 3–6 mo: rolls, reaches, sits with support, babbles.

• 6–12 mo: sits without support, crawls, pulls to stand, first words.

• Weight: doubles by 6 months, triples by 12 months.
  Safety: Back to sleep, no pillows or loose blankets, secure on changing tables, avoid small objects. Expect stranger anxiety around 8–9 months.

Toddlers (1–3 years)

• Walks by 12–15 mo; runs and climbs by 2 yrs; toilet readiness near 3 yrs.

• Short phrases, strong need for control (“no”).
  Care tips: Lock cabinets, supervise near water, use simple choices, allow comfort objects during care.

Preschoolers (3–5 years)

• Rides tricycle, hops, skips.

• “Magical thinking,” fears are common.
  Teach: Helmet use, fire safety (stop–drop–roll), practice through play.

School-Age (6–12 years)

• Grows ~2 inches and gains 4–7 lb per year.

• Industry vs. inferiority; likes rules and tasks.
  Care tips: Involve in simple decisions, answer honestly, support privacy, build study habits.

Adolescents (13–18 years)

• Puberty, rapid growth, identity forming.
  Care tips: Ensure privacy, screen for risk behaviors, encourage healthy body image and coping.

Immunizations (high-yield)

• Birth–2 mo: Hep B (birth, 1–2 mo).

• 2 mo: DTaP, IPV, Hib, PCV13, Rotavirus.

• 4 mo: repeat 2-month series.

• 6 mo: repeat series + influenza (≥6 mo).

• 12–15 mo: MMR, Varicella, Hib final, PCV13 final.

• 15–18 mo: DTaP (4th).

• 4–6 yr: DTaP, IPV, MMR, Varicella.

• 11–12 yr: Tdap, HPV, MenACWY.

Avoid live vaccines (MMR, Varicella) if immunocompromised or pregnant. Always verify allergies and keep epinephrine available.

Common Pediatric Conditions (NCLEX priorities)

Croup (laryngotracheobronchitis)

• Barking cough, inspiratory stridor, worse at night.

• Do: cool mist, corticosteroids; racemic epinephrine if needed.

• Priority: ease work of breathing; avoid agitation.

Epiglottitis (emergency)

• High fever, drooling, tripod posture, muffled voice.

• Do NOT inspect throat. Prepare airway/intubation; start IV antibiotics.

• Priority: airway first.

Bronchiolitis (RSV)

• Wheezing, tachypnea, poor feeding, congestion.

• Do: oxygen as needed, hydration, frequent suctioning.

• Precautions: contact and standard; cohort if needed.

Pyloric stenosis

• Projectile, non-bilious vomiting; “olive” mass RUQ.

• Do: NPO, IV fluids, correct electrolytes, post-op feed per protocol.

Intussusception

• Colicky pain, knees to chest, currant-jelly stools, sausage-shaped mass.

• Do: NPO, IV fluids, prepare for air/contrast enema.

Medication Safety & Dosing

• Always use weight-based dosing (mg/kg).

• Double-check high-alert meds (insulin, opioids).

• Use the right syringes for small volumes.

• Watch total daily acetaminophen and ibuprofen across combination products.

• Recheck calculations with another nurse when required.

Family-Centered Care

• Parents and caregivers are partners.

• Use teach-back: “Can you show me how you’ll draw up the medication?”

• Provide short, clear instructions with visuals or handouts.

• Respect culture, language, and literacy levels. Offer an interpreter when needed.

Fast Test-Taking Tips

• Look for cues: priority, initial, best.

• Safety first: Airway and breathing before teaching.

• Remove answers that are unsafe, developmentally inappropriate, or outside nursing scope.

• For growth questions, tie tasks to age (e.g., 9-mo olds should sit unsupported; 18-mo olds walk up steps with help).

Quick Checklist (day before exam)

• Review vaccine schedule and live-vaccine rules.

• Scan milestones and safety per age group.

• Practice 25–50 pediatric NCLEX-style questions with rationales.

• Sleep, hydrate, and plan your timing.

Suggested Internal Reads 

• Therapeutic Communication for NCLEX

• NCLEX Fundamentals Guide

• NCLEX Pharmacology Exam Guide

• Pediatric Dosage Calculations Quick Sheet