A 14-month-old toddler can walk independently but is not yet using any single words. He responds to his name, waves bye-bye, and shows joint attention by pointing. The MOST appropriate next step is:

• A Reassure parents; expressive language delay is normal until 18 months
• B Brain MRI to exclude structural pathology
• C Chromosomal microarray for suspected genetic syndrome
• D Hearing evaluation (audiometry) and speech therapy referral ✓

Explanation

Single words (other than mama/dada) are expected by 12 months; absence at 14 months warrants evaluation. The first step in any child with expressive language delay is formal hearing assessment (audiometry or ABR), since sensorineural or conductive hearing loss is the most common and treatable cause of speech-language delay. Simultaneous referral to speech-language therapy is appropriate. The preserved joint attention, response to name, and social gestures (waving) make ASD less likely but do not eliminate further evaluation.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.