A 13-month-old boy walks independently and climbs onto furniture but has never crawled on hands and knees. He pulls to stand, cruises, babbles with meaning, and has good eye contact. His parents are worried he skipped a milestone. What is the most appropriate advice?
- A Reassure, because crawling is not an obligatory milestone and its absence with normal walking is a benign variant ✓
- B Order MRI of the brain to exclude cerebral palsy
- C Refer for physiotherapy to teach reciprocal crawling
- D Perform nerve conduction studies to exclude peripheral neuropathy
Correct answer: A. Reassure, because crawling is not an obligatory milestone and its absence with normal walking is a benign variant
Explanation
Some children bottom-shuffle or roll and proceed directly to walking without ever crawling; crawling is not a universal or obligatory milestone, and skipping it carries no prognostic significance when walking and other domains are normal. Investigating or treating a child whose gross motor, fine motor, social, and language milestones are all age appropriate is unnecessary. Red flags would be regression, asymmetry, persistent primitive reflexes, or failure to walk by 18 months.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.