A 4-year-old boy cannot use utensils properly, walks on his toes, and frequently falls. He cannot jump on one foot or climb stairs alternating feet. His speech is limited to 3-word sentences and he does not use pronouns. He can copy a circle but not a cross, and names 4 colours. Which developmental domain shows the MOST significant delay?

• A Language (expressive)
• B Gross motor ✓
• C Fine motor
• D Social-adaptive

Explanation

By 4 years, a child should hop on one foot, climb stairs with alternating feet, and run steadily. This child cannot perform any of these, indicating a significant gross motor delay. In terms of language, 3-word sentences at 4 years is behind (expected: 4–5 word sentences, use of pronouns by 3 years), but gross motor delay is more striking. Fine motor (copying circle but not cross) is slightly delayed (cross copying expected at 4 years), but gross motor deficit is the most severe. This pattern should prompt evaluation for cerebral palsy or neuromuscular disorder.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.