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Difficulty: MediumDevelopmental Stages and Transitions

A nurse in a community health clinic is evaluating a 24-month-old child whose parents have brought them in for a general assessment. After observing the child's interactions and motor skills, the nurse reviews the findings. Which assessment finding should the nurse identify as a developmental delay requiring further evaluation?

  1. The child has a spoken vocabulary of six words and relies primarily on pointing to communicate.Answer
  2. B
    The child is unable to independently pedal a tricycle or balance on one foot.
  3. C
    The child shouts 'No!' and becomes upset when the parent attempts to assist with putting on a jacket.
  4. D
    The child plays with a set of toy blocks beside another toddler without attempting to interact or share.

Answer

The child having a spoken vocabulary of only six words and relying on pointing indicates a language development delay.
By 24 months (2 years) of age, a child is expected to have a vocabulary of 50 or more words and begin putting two words together to form simple phrases (e.g., 'more milk'). A vocabulary restricted to only six words with a reliance on pointing is a significant language delay and requires immediate referral for a hearing evaluation and speech-language therapy.

Step-by-Step Solution

1
Identify the client's current age and the core concept being assessed.
The client is 24 months (2 years) old, and the nurse must evaluate if the observed behaviors meet expected developmental milestones.
Accurate age identification is necessary to apply the correct cognitive, motor, and psychosocial parameters.
2
Evaluate the language milestone presented in the options.
A 24-month-old should speak at least 50 words and use two-word phrases. A vocabulary of six words falls far below this expectation.
Identifying missing critical milestones highlights areas needing early intervention.
3
Analyze the remaining options to ensure they describe normal behavior for a 24-month-old.
Parallel play, negativism ('No!'), and the inability to pedal a tricycle are all completely normal and expected for a 2-year-old.
Distinguishing normal developmental behaviors from actual delays prevents unnecessary referrals and guides appropriate parental reassurance.

Key Concept

Toddler Developmental Milestones (24 Months)
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Topics

Developmental Stages and Transitions

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