Question

Difficulty: HardNormal Growth and Development

A 24-month-old boy is brought to the clinic for a routine well-child visit. His parents have no specific concerns. On developmental assessment, the boy is able to run well, kick a ball, and walk up and down the stairs placing both feet on each step. He can build a tower of six cubes, turn the pages of a book one at a time, and remove his shoes. He has a vocabulary of approximately 50 words, uses two-word phrases, and his speech is understood by strangers about half of the time. When in the waiting room, he plays with his own toys alongside other children but does not directly interact with them. Physical examination is unremarkable. The pediatrician provides anticipatory guidance to the parents regarding the developmental milestones expected over the upcoming year. Which of the following skills is this patient most likely to acquire by his next annual visit at 36 months of age?

  1. A
    Walking down stairs with alternating feet
  2. B
    Copying a cross on a piece of paper
  3. C
    Speaking in sentences that are fully intelligible to strangers
  4. D
    Engaging in cooperative play with other children
  5. Pedaling a tricycleAnswer

Answer

Pedaling a tricycle
At 3 years (36 months) of age, a child is expected to achieve several key developmental milestones. In the gross motor domain, a 3-year-old can pedal a tricycle, jump in place, and walk up stairs with alternating feet. In the fine motor domain, they can copy a circle and use utensils without spilling. Language skills at 3 years include 3-word sentences and being 75% intelligible to strangers. Socially, they begin engaging in associative play and know their own age and gender. The patient currently demonstrates perfectly appropriate 2-year milestones and should be expected to develop the ability to pedal a tricycle over the next year.

Step-by-Step Solution

1
Analyze the patient's current developmental stage based on the clinical vignette.
The patient exhibits normal 24-month (2-year) milestones: kicks a ball, walks stairs (2 feet/step), 6-cube tower, 50 words, 2-word phrases, 50% intelligibility, and parallel play.
Establishing the current baseline ensures there are no developmental delays that would alter anticipatory guidance.
2
Identify the timeframe specified in the question.
The question asks what the patient will achieve by his next annual visit at 36 months (3 years) of age.
Anticipatory guidance requires knowing the precise age for expected future milestones.
3
Evaluate each option to determine the exact age at which the milestone is typically achieved.
Walking down stairs alternating feet (4 years), Copying a cross (4 years), 100% speech intelligibility (4 years), Cooperative play (4 years), Pedaling a tricycle (3 years).
Only one option corresponds to a 3-year milestone, while the others represent 4-year milestones.
4
Select the milestone that correctly matches the 3-year age mark.
Pedaling a tricycle is the correct 3-year milestone.
This directly answers the prompt regarding expected acquisition by 36 months.

Key Concept

Normal developmental milestones at 3 years of age.
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