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Difficulty: MediumNormal Growth and Development

A 15-month-old boy is brought to the office by his parents for a routine well-child visit. His parents are anxious because they noticed other children his age at daycare are running and putting words together. They report that their son currently walks well independently but frequently falls when he tries to move more quickly. He says "mama," "dada," "baba," and "up." He consistently points to objects he wants and brings books to his parents to read. He can drink from a cup, scribble on paper with a crayon, and build a tower of two blocks. He responds to his name and easily follows simple commands, such as "bring me the ball," when his mother points to the object. His physical examination, including muscle tone and deep tendon reflexes, is within normal limits. Which of the following is the most appropriate next step in the management of this patient?

  1. Continue with age-appropriate health maintenanceAnswer
  2. B
    Recommend a formal evaluation by a speech-language pathologist
  3. C
    Initiate an assessment for targeted physical therapy services
  4. D
    Administer a formal autism spectrum screening instrument
  5. E
    Order formal testing of auditory evoked potentials

Answer

Continue with age-appropriate health maintenance
The correct answer is to continue with age-appropriate health maintenance. This patient is meeting all typical milestones for a 15-month-old child. At 15 months, a child is expected to walk independently, have a vocabulary of 3 to 5 words, point to objects of interest (joint attention), follow 1-step commands with gestures, and demonstrate fine motor skills like scribbling and building a tower of 2 blocks. The parents' concerns regarding the child's inability to run or combine words are premature; running is typically mastered around 18 months, and combining words into simple two-word phrases is expected at 24 months. Because the child's development is entirely on track, reassurance and routine follow-up are the most appropriate steps.

Step-by-Step Solution

1
Evaluate the patient's gross motor and fine motor milestones.
The patient walks independently, drinks from a cup, scribbles, and builds a 2-block tower.
These perfectly align with the expected milestones for a 15-month-old child.
2
Evaluate the patient's speech, language, and social milestones.
The patient has a 4-word vocabulary, points to objects, and follows 1-step commands with a gesture.
These align with expected 15-month milestones. Two-word phrases are not expected until 24 months.
3
Determine the next best step based on the milestone analysis.
Since all milestones are age-appropriate, no specialty referrals or early diagnostic testing are indicated.
Misinterpreting normal developmental progression as delayed leads to unnecessary and costly interventions.

Key Concept

Normal pediatric developmental milestones at 15 months of age include independent walking, a 3-5 word vocabulary, following a 1-step command with a gesture, and pointing to objects of interest.
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Topics

Normal Growth and Development

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