Milestones

Question 1

Which of the following are positive clues to developmental delay?

1. No head control by 2 months
2. Fisting beyond 3-4 months
3. Primitive reflexes persisting past 3 months
4. No 3 word phrases by 2 years
5. Echolalia beyond 30 months

Answer 1

1. NO: head control is expected by 3 monhts, so at 2 months this is ok.
2. YES: Fisting shoudl go away by 3-4 months.
3. NO: Primitive reflexes may persist up to 6 months normally.
4. NO: By age 2, you should expect at least 50 words and 2 word phrases (not 3 word).
5. YES: Echolalia should not persist beyond 2.5 years (30 months).

Question 2

An infant is seen for 6 month well child check and is observed to still have fisting. Should this infant be referred for further developmental screening?

Answer 2

Yes. The hands should be opened up by 3-4 months.

Question 3

A 2 year old’s mother reports he has 40-50 words and speaks in 1-2 word phrases. Should he be referred for developmental delay?

Answer 3

No. By age two, they should have 50 words and speak in 2 word phrases.

Question 4

A 3-year old’s father states his daughter often just repeats back things he says to her instead of engaging in conversation. Should this child be referred?

Answer 4

Yes: Echolalia should resolve by 30 months of age.

Question 5

A newborn’s mother is worried about when she can stop worring about her daughter’s head control. When should her infant be expected to have good head control?

Answer 5

By 3 months of age.

Question 6

What is the formula for mid-parental height?

Answer 6

(MOM + DAD ± 13) ÷ 2

The average of mom and dad’s height shifted by 13 cm up or down based on gender.

Question 7

When should height compared to birth length be expected to:

1. Be at least 1.5x
2. Double
3. Triple

What is the expected growth velocity before puberty?

Answer 7

1. 12 months
2. 4 years
3. 13 years

2 cm/year until puberty.

Question 8

At what ages should weight in relation to birth weight be expected to:

1. Double
2. Triple
3. Quadruple

What is the expected velocity of weight gain thereafter until puberty?

Answer 8

1. 4 months
2. 12 months
3. 24 months

2.5 kg per year until puberty.

Question 9

You are seeing a 12 month old for his 1 year well-child check and you note her weight is double her birth weight. Is this of concern?

Answer 9

YES: By 12 months, weight should have TRIPLED. Doubling is expected at 4 months.

Question 10

1. Head circumference is expected to change at what rate(s) in the first 12 months?
2. When should brain weight double?
3. Triple?

Answer 10

1. Rapid growth 0.5 cm/week for the first 2 months. 1 cm/mo for the next 12 months.
2. 6 months
3. 12 months

Question 11

By 4 months, an infant should have no head lag when pulled to sitting. By what age would you expect an infant to anticipate being lifted?

Answer 11

6 months

Question 12

By what age should an infant be able to roll front-to-back?

Answer 12

4-5 months

Question 13

By what age should an infant be able to roll back-to-front?

Answer 13

5-6 months

Question 14

A normally developing infant can now roll back-to-front. What is his most likely age?

Answer 14

6 months (assuming you’re seeing him at his well-child check.)

Question 15

By what age should an infant be able to sit:

• With support
• Without support

Answer 15

• 6 mo
• 7 mo

Question 16

An infant is being seen at his 12 month checkup and he still has trouble sitting without support. Should he be referred?

Answer 16

YES: Infants should sit without support by 7 monhts.

Question 17

What is the expected height for a girl who’s father is 182 cm and mother is 152 cm?

Answer 17

(182 + 152 - 13) / 2 = 160.5 cm

Question 18

In constitutional growth delay, is normal adult height achieved?

Answer 18

Usually there is a rapid catch-up growth period and the person achieves predicted height.

Question 19

Failure to thrive can be defined by growth curve percentiles. What are the concerning findings for:

• Single growth curve points
• Series of growth curve points

Answer 19

• SINGLE
  
  • Weight < 3rd percentile
  • Weight for height < 5th percentile
  • Weight 20% or more below ideal weight for height
• SERIES
  
  • Weight gain < 20 g/day from 0-3 months
  • Weight gain < 15 g/day from 3-6 months
  • Downward crossing of >= 2 percentiles

Question 20

At what ages should the following reflexes be extinguished?

1. Moro
2. Palmar

Answer 20

1. Absent by 3-4 months.
2. Absent by 203 months.

Question 21

An infant is examined for a well-child check. The child is developing normally. The parachute reflex is present. What is the minimum age of this infant most likely to be?

Answer 21

6 months

The parachute reflex is present by 6-9 months.

Question 22

When does separation anxiety usually develop and when does it usually resolve?

Answer 22

• 6 months
• After 12 months

Question 23

A peds intern is assisting in the routine exam of a newborn baby and says, “Oh look, he already has a social smile.” What should you tell the intern?

Answer 23

Social smile doesn’t develop until 1-2 months. It depends on further vision development.

Question 24

At what age do you expect use of cup and spoon well?

Answer 24

15 months

Question 25

1. A normally developing child can make a stack of 4 blocks. What do you expect his age to be? 2. Her cousing is also developing normally and can do just 2 cubes. What is his expected age?

Answer 25

1. 18 months 2. 13 months

Question 26

Normal or abnormal? A 3 year old runs in clinic but is uncoordinated.

Answer 26

Possibly abnormal. Running well should be present by age 2.

Question 27

By what age should a child be able to take stairs one foot per stair at a time?

Answer 27

4 years

Question 28

Normal or abnormal? A two year old can jump up with both feet leaving the ground but cannot skip or hop on one foot.

Answer 28

Normal * Skipping doesn't appear until age 5. * Hopping on foot appears at age 4.

Question 29

A normally developing male shows off his new trick of balancing on one foot. What is his minimum likely age?

Answer 29

3 years If he can balance 6-10 seconds, likely 4 years old.

Question 30

Normal or Abnormal? A mother is concerned her child doesn't wave "bye-bye." The child is 7 months old.

Answer 30

Normal. This doesn't usually develop until 10 months.

Question 31

A four year girl old cannot tell fantasy from reality, cannot speak in four word sentences, cannot tie shoe laces, and can get dressed but can't do buttons very well. For which if these issues should the child be referred?

Answer 31

* For speach problems. By this age she should speak 4 word sentences. * Age 1.5-2 years: 2 word sentences * Age 2-3 years: 3 word sentences * Age 3-4 years: 4 word sentences * Fantasy from reality develops at age 5. * Tieing shoes develops at age 5. * Getting dressed, but not being able to do buttons in back is normal in her case, and children should be able to dress themselves for the most part by age 3.