An 18-month-old boy is brought to the office for a well-child visit. He was born full term and had no perinatal complications. He has had 2 episodes of otitis media that required treatment with antibiotics. The patient has a 12-15-word vocabulary, but strangers can understand only about 4 words. According to his parents, he babbles gibberish most of the time. He uses single words to indicate what he wants but does not combine them into 2-word phrases. He pulls to stand and can walk only while holding on to furniture or a parent's hand. Growth has been consistent along the 40th percentile for height, weight, and head circumference. During the visit, the patient pretends to feed a baby doll and sits on the floor scribbling with a crayon. He offers his mother the crayon but cries when the physician tries to play with him. Which of the following is the most likely diagnosis in this patient?

Question

An 18-month-old boy is brought to the office for a well-child visit.  He was born full term and had no perinatal complications.  He has had 2 episodes of otitis media that required treatment with antibiotics.  The patient has a 12-15-word vocabulary, but strangers can understand only about 4 words.  According to his parents, he babbles gibberish most of the time.  He uses single words to indicate what he wants but does not combine them into 2-word phrases.  He pulls to stand and can walk only while holding on to furniture or a parent's hand.  Growth has been consistent along the 40th percentile for height, weight, and head circumference.  During the visit, the patient pretends to feed a baby doll and sits on the floor scribbling with a crayon.  He offers his mother the crayon but cries when the physician tries to play with him.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec25c8_d6eb_897c_bc81_1b36410add23_MD0003_00 Well-child visits are an opportunity to assess growth and developmental milestones. The majority of children learn to take their first step independently at around age 12 months, and by 18 months most are learning to run and kick a ball. Scribbling is a normal fine motor skill at age 18 months, and typical language milestones include a vocabulary of around 10-25 words, still with frequent jargon (ie, unintelligible gibberish). This patient's language development and articulation are appropriate, as the majority of language is understood only by family members at this age, and 2-word phrases are not expected until age 24 months (Choices A and E). However, he does have signs of gross motor delay as he is still unable to walk without support. Once a developmental delay is recognized, infants and toddlers (age <3) should be referred for early intervention services for in-depth developmental evaluation. Early initiation of therapy for identified delays results in improved acquisition of skills and long-term positive outcomes. (Choice B) Impaired social interaction, a red flag for autism spectrum disorder, is not evident in this patient. This child demonstrates normal social interaction with his mother and appropriate stranger anxiety with the physician, which typically is present between age 6 months and 2 years. (Choice C) This child engages in pretend play (eg, feeding a doll) consistent with normal cognitive development at age 18 months. (Choice F) This child is not achieving normal 18-month gross motor milestones, such as walking and running independently. Educational objective: Normal development of an 18-month-old child includes a 10-25-word vocabulary, running, kicking, scribbling, and pretend play. The inability to walk or run independently by this age is a sign of gross motor delay. References: Efficacy of gross motor skill interventions in young children: an updated systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/27900154) Developmental milestones. (http://www.ncbi.nlm.nih.gov/pubmed/26729779)

An 18-Month-Old Boy Is Brought to the Office for a Well-Child