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Question

Difficulty: HardDevelopmental Stages and Transitions

During a local family wellness event, a practical nurse observes multiple young children interacting with their caregivers. Which observed behavior is a significant deviation from expected developmental transitions and requires escalation to the registered nurse for further assessment?

  1. A
    An 8-month-old infant who uses a raking motion to pick up cereal and cries loudly when an unfamiliar adult approaches
  2. B
    A 15-month-old child who repeatedly spills food while attempting to self-feed with a spoon and clings tightly to their parent's leg
  3. A 24-month-old toddler who communicates solely through pointing and grunting, and is unable to kick a ball forwardAnswer
  4. D
    A 3-year-old child who plays next to peers without sharing toys and talks to a stuffed animal as if it were alive

Answer

The 24-month-old toddler who communicates solely through pointing and grunting, and is unable to kick a ball forward.
By 24 months of age, toddlers are expected to have a vocabulary of at least 50 words, use two-word phrases, and demonstrate gross motor skills such as kicking a ball and walking up stairs. Communicating solely through pointing and grunting at this age is a significant language delay, and the inability to kick a ball indicates a gross motor delay. These findings fall outside normal developmental transitions and require immediate reporting to the registered nurse for comprehensive evaluation.

Step-by-Step Solution

1
Evaluate the 8-month-old infant's presentation.
The raking grasp and stranger anxiety are developmentally appropriate for 8 months of age.
Eliminates normal infant developmental milestones.
2
Evaluate the 15-month-old child's presentation.
Attempting to self-feed (with spilling) and separation anxiety are appropriate for early toddlerhood.
Eliminates normal early toddler developmental transitions.
3
Evaluate the 3-year-old child's presentation.
Parallel play and animism (believing inanimate objects are alive) are expected behaviors for a 3-year-old.
Eliminates normal early preschooler cognitive and social milestones.
4
Evaluate the 24-month-old toddler's presentation.
Failure to use words (pointing/grunting only) and inability to perform basic gross motor tasks like kicking a ball represent a clear delay.
Identifies the deviation from expected milestones that requires clinical escalation.

Key Concept

Age-Specific Developmental Milestones and Transitions
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Topics

Developmental Stages and Transitions

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