Children typically manifest anxiety toward strangers at what age?
Correct Answer B:
At 3 - 4 months of age, a normal term baby will smile at almost anyone. By 9 months of age, there is a developmentally normal anxiety over separation from the mother (Or primary care giver), as well as anxiety at the sight of an unfamiliar face (at ~ 6 months). Coincident with the increased mobility gained by walking (usually at 12-15 months of age), these anxieties normally abate.
A mother brings her 12-month-old son to your clinic, concerned that he is repeatedly banging his head against the floor, wall, or crib. She reports that this behavior began 2 months ago. It now occurs several times per week, and at times is incited when the child is frustrated with a toy or when he does not get what he wants from his parents. The mother notes that she is sometimes awakened at night by the sound of her son rhythmically banging his head against the rail of his crib.
Physical examination reveals a normal child with some soft-tissue swelling of the forehead, but no broken skin, ecchymosis, or signs of bony damage. Developmental milestones and growth have been normal, and the child is not on any medications.
Children with this presentation are most likely to have which one of the following?
Correct Answer D:
Head banging has been estimated to be present in 3%-15% of normal children and usually begins between the ages of 5 and 11 months. The vast majority of these children will engage in this activity for only a few months, and most will stop by age 3. Rarely does this behavior cause lacerations or skull fractures, and the presence of either should prompt the physician to consider the possibility of another cause such as abuse. The incidence of head banging is higher in children with developmental disorders such as Lesch-Nyhan syndrome Down syndrome, or autism. However, this child has no sign of any such disorder and has normal developmental milestones.
Neurological, intellectual, and physical development in infants and children occur in an orderly and sequential manner. All of the following are integers of developmental milestones, except:
Correct Answer C: Bone age is not a developmental milestone, but rather a physiologic standard of growth based on radiographs.
All of the remaining choices are recognized developmental milestones.
You are conducting a well-child visit. The mother is concerned because a neighbor commented to her that she could only understand about half of what the 2-year-old boy was saying. The mother is wondering whether this is appropriate or whether she should be offended. You advise her:
Correct Answer A: Two-year-old children usually produce 2-3 word phrases, may follow 2-step commands, and be understood by a stranger about 50% of the time.
B. See explanation for A.
C. Speech therapy is not necessary and should not be offered as an option.
D. Speech therapy is not necessary.
E. ENT clinic is unnecessary.
During a routine well-child visit, a patient’s mother tells you she is concerned about her daughter’s development. On further questioning you discover that the child knows six words, including “mama”, walks alone, and recently started walking backwards. After you demonstrate, she is able to build a tower of two blocks and scribble with a pen, but cannot form a circle or a cross.
You reassure the mother that her child is showing normal development for a child of:
Correct Answer C: The milestones above are appropriate for a child of 15 months. At this age a child should be able to walk backwards, creep up stairs, scribble, build a tower of two blocks, and use 4-6 words.
A. At 9 months, the average child can neither walk nor talk.
B. An average 1-year-old knows 1-3 words and cannot walk backwards.
D. At 2 years, a child should know about 100 words and be able to walk up and down stairs.
E. At 3 years, a child should be able to use 3-word sentences, dress himself, and draw a circle.
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