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Difficulty: EasyNormal Growth and Development

A 15-month-old girl is brought to the pediatric clinic for a routine well-child visit. Her parents express concern that she is not yet speaking in two-word phrases, such as "more juice" or "go bye-bye." They report that she currently has a vocabulary of five words, including "mama" and "dada." She walks independently, scribbles spontaneously with a crayon, and drinks from a cup. She consistently points to objects she wants and makes good eye contact. Her physical examination is unremarkable. Which of the following is the most appropriate next step in management?

  1. A
    Referral for comprehensive audiologic evaluation
  2. B
    Referral to a speech-language pathologist
  3. C
    Administration of a standardized autism spectrum disorder screening tool
  4. Reassurance and routine follow-upAnswer
  5. E
    Recommendation for a developmental early intervention program

Answer

Reassurance and routine follow-up
The correct answer is reassurance and routine follow-up because the patient is demonstrating normal development for her age. At 15 months, a child is expected to walk independently, scribble, drink from a cup, and have a vocabulary of 3 to 5 words. The parents' concern about a lack of two-word phrases is premature, as combining words into short sentences is a developmental milestone typically achieved at 24 months of age. Because the child has met all appropriate gross motor, fine motor, language, and social milestones, no further diagnostic testing or referral is warranted at this time.

Step-by-Step Solution

1
Evaluate the child's current language milestones.
The child uses five distinct words, which fully meets the expected 15-month milestone of 3 to 5 words.
To determine if there is an objective language delay compared to age-matched norms.
2
Assess the parents' specific developmental concern.
The parents expect two-word phrases, which is an expected milestone for a 24-month-old, not a 15-month-old.
To identify whether the parental concern stems from a true delay or a misunderstanding of normal timelines.
3
Determine the appropriate clinical intervention.
Because the child's development is completely normal across all domains, reassurance is indicated.
Unnecessary specialist referrals or testing should be avoided when a child is developing typically.

Key Concept

Normal developmental milestones at 15 months include walking independently, using 3 to 5 words, and scribbling. The use of two-word phrases is not expected until 24 months of age.
Estimated Time:1m 0s
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Topics

Normal Growth and Development

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