Growth and Development (Milestones, Developmental Disorders) MCQs

Pediatrics · 56 free questions with answers & explanations.

1. A 15-month-old child can walk independently, say 3-4 meaningful words, use a cup, and point to objects of interest. At what age should a child NORMALLY develop a pincer grasp (thumb-forefinger apposition)?
2. A 3-year-old child has no meaningful speech, avoids eye contact, does not respond to his name, engages in repetitive hand-flapping, and plays with toys in an unusual, repetitive manner. Which of the following BEST characterizes this child's condition?
3. A 30-month-old child does not speak single words, does not make eye contact, engages in repetitive spinning of objects, and does not point. Parents report the child had said 'mama' and 'dada' until 18 months and then stopped. Which feature of this history is MOST significant for classifying this as a 'red flag' for autism spectrum disorder?
4. A 4-year-old child can draw a circle and square but not a triangle, knows first and last name, plays cooperatively with peers, can hop on one foot, and uses 5–6 word sentences. Which developmental domain is MOST behind expected norms for age?
5. A 15-month-old child cannot walk independently, has no single meaningful words, does not point to objects, and does not wave bye-bye. These developmental domains — motor, language, and social-communication — are all delayed. Which developmental assessment tool is widely used in India to screen for developmental delays in children aged 0-6 years?
6. A 2-year-old child has no meaningful language, does not follow two-step commands, engages in repetitive hand-flapping, makes no eye contact, and does not respond to his name. Parents report normal development until 18 months followed by loss of previously acquired words. Which of the following best identifies the 'regression' pattern in this case and its significance?
7. A mother brings her 9-month-old for routine check-up. The child can sit without support for a few seconds, transfers objects hand to hand, babbles with 'mama/dada' non-specifically, and shows stranger anxiety. Which single developmental milestone would be MOST concerning if absent at 9 months?
8. A 20-month-old child uses no words (single words expected by 12 months), does not point, makes no eye contact, and does not respond to his name being called. He lines up toys repetitively. The most important first investigation is:
9. A 10-year-old boy is referred for short stature. His mid-parental height is 172 cm. Current height is at 3rd centile (128 cm). Bone age is 8 years. He has no dysmorphic features, normal pubertal stage (Tanner 1), and a positive family history of short stature with late puberty. The most likely diagnosis is:
10. At what age should a child achieve the gross motor milestone of running well and kicking a ball? This milestone tests coordination beyond simple walking.
11. A 5-year-old boy is noted to have difficulty paying attention in school, excessive fidgeting, frequently interrupting others, and impulsive behaviour across both home and school settings for over 6 months. Cognitive testing is normal. The most appropriate first-line management in a 5-year-old is:
12. Catch-up growth in a severely malnourished child is assessed by which parameter that best reflects lean body mass gain during rehabilitation?
13. A 3-year-old boy has no words, does not respond to his name, avoids eye contact, engages in repetitive hand flapping, and has restricted interests in spinning objects. He passed all motor milestones. What developmental screening tool is the MOST appropriate FIRST step?
14. A 9-month-old infant can sit without support, pincer grasp is not yet present, and she says 'mama' non-specifically. She transfers objects hand-to-hand and waves bye-bye inconsistently. Which skill is EXPECTED to develop NEXT (around 9–10 months)?
15. A 5-year-old is assessed for school readiness. He can hop on one foot, draw a person with 6 parts, copies a square, names 4 colors, and can define words. According to developmental norms, what ADDITIONAL skill would be expected to be present at this age?
16. An 18-month-old boy cannot walk independently, does not wave bye-bye, says only 'mama/dada' non-specifically, and cannot build a 2-cube tower. At what age should ALL these skills have normally been achieved?
17. A 30-month-old child (2.5 years) is brought by parents concerned about lack of speech. The child uses only 5 words, does not point to objects, does not follow 2-step commands, and has limited eye contact. He lines up toys repetitively and has meltdowns when routines change. Which developmental surveillance finding at what earlier age should have triggered formal evaluation for autism spectrum disorder?
18. A 10-year-old boy is 128 cm tall. His father is 172 cm, mother is 158 cm. Target height (mid-parental height) calculation indicates a prediction of 172 cm. The child's current height z-score is -2.5 SD. Bone age is 8 years. GH stimulation test peaks at 4.2 ng/mL. Which statement about GH deficiency criteria and treatment is MOST accurate?
19. A mother brings her 9-month-old infant for developmental assessment. The infant can sit without support, transfers objects hand-to-hand, has a good pincer grasp, babbles 'mama/dada' non-specifically, and waves bye-bye. The health worker notes the infant does not have a social smile or respond to their own name. Which aspect of development is MOST concerning and what is the MOST likely explanation?
20. Weight gain monitoring in a breastfed neonate: A baby weighing 3200 g at birth has lost 6.5% of birth weight by day 3. By day 7 the weight is still 100 g below birth weight. The mother reports difficulty latching. What is the maximum acceptable weight loss for a breastfed neonate, and when should birth weight be fully regained?
21. A 24-month-old child uses only 5–6 single words, does not combine two words, does not point to pictures, but maintains good eye contact, plays symbolically (feeds a doll), and follows 2-step commands. Hearing test is normal. This pattern suggests delay in which domain of development?
22. A 3-year-old boy is referred for stiff, toe-walking gait since he started walking at 18 months. He cannot run well and has difficulty climbing stairs. On examination, he has calf pseudohypertrophy, Gowers' sign, and proximal muscle weakness. CK is 25,000 IU/L. His maternal uncle had a similar condition and died at age 19. Which genetic mechanism explains why maternal uncle is affected?
23. A 10-year-old boy has a head circumference of 47 cm (expected >52 cm for age). He has mild intellectual disability, marked obesity with predominantly truncal fat, hypogonadism (small testes, undescended), and a history of neonatal hypotonia and poor feeding. Which genetic mechanism is implicated?
24. A 5-year-old girl who was developing normally until 18 months began to lose purposeful hand use, develop stereotyped hand-wringing movements, irregular breathing, and progressive intellectual regression. She has normal head circumference at birth but has developed acquired microcephaly. Seizures began at age 3. This presentation is pathognomonic of:
25. A developmental paediatrician applies the Revised Denver Developmental Screening Test (DDST-II) to screen a 12-month-old. Which of the following is a RED FLAG developmental concern at 12 months that mandates urgent referral?
26. A 9-month-old infant cannot sit without support, has no pincer grasp, and does not babble. She shows no stranger anxiety and does not respond to her name. The mother reports decreased fetal movements during pregnancy. Which developmental domain is MOST delayed, and what is the key clinical flag?
27. A 2-year-old boy has no words, no pointing, poor eye contact, and repetitive hand-flapping. His hearing is normal. He had normal development up to 12 months, then seemed to plateau. Which screening tool is specifically designed and validated for early detection of autism spectrum disorder (ASD) in toddlers aged 16–30 months?
28. A full-term neonate is born with microcephaly, sensorineural hearing loss, blueberry muffin rash, and hepatosplenomegaly. Ophthalmologic examination reveals chorioretinitis. The mother had a flu-like illness with rash at 10 weeks gestation and was found to have elevated IgG avidity to cytomegalovirus. Which additional investigation would BEST confirm congenital CMV infection in the neonate?
29. A 15-year-old boy has been on recombinant human growth hormone (rhGH) for GH deficiency since age 7. His bone age is now 14 years, and his current height velocity is 2 cm/year. The pediatric endocrinologist is considering stopping GH therapy. Which criterion indicates that growth is essentially complete and rhGH therapy for GH deficiency in childhood can be discontinued for reassessment?
30. A 14-month-old child can walk independently, says 3 meaningful words, uses a pincer grasp, and stacks 2 blocks. He waves bye-bye and points to a desired object. He does not yet respond to his name consistently when called. Which developmental assessment is most important at this visit?
31. The normal weight at birth for a term neonate is approximately 3.2 kg (±0.4 kg). What is the expected weight of a healthy Indian child at 1 year of age, and the formula used to estimate weight (in kg) for children 1–6 years?
32. A 30-month-old child is brought for evaluation of speech delay. The child can say approximately 20 single words but does not combine two words. She follows two-step commands and can identify body parts. She makes eye contact and engages in parallel play. The EXPECTED developmental milestone for expressive language at 24 months is:
33. A 4-year-old boy is referred for evaluation. He has been in daycare since age 2. His teacher reports he is unable to sit still, frequently disrupts class, runs around excessively, and cannot wait for his turn. His parents describe him as 'always on the go' since infancy. IQ is in the normal range (85–95). The minimum duration of symptoms required to diagnose ADHD according to DSM-5 is:
34. During a routine developmental assessment, a 12-month-old infant is observed to walk independently for the first time. At this age, which developmental milestone would be MOST EXPECTED concurrently in the language domain?
35. A 3-year-old child does not respond to his name consistently, avoids eye contact, has no pretend play, and makes repetitive hand-flapping movements. He speaks only 5 words and has lost 3 words he previously used at age 2. Parents note he lines up toys in rows obsessively. Which of the following is the BEST first-line intervention for this child's core social communication deficits?
36. A 6-year-old boy has difficulty sustaining attention in class, is easily distracted, frequently loses belongings, and cannot wait for his turn in games. His teacher reports he frequently interrupts others and blurts out answers. He performs normally on individual academic testing in a quiet room. His IQ is 95. Which of the following regarding the diagnosis of ADHD is MOST ACCURATE per DSM-5 criteria?
37. A 9-month-old infant is brought for routine check-up. The mother is concerned that the infant is not walking yet. Which of the following gross motor achievements is EXPECTED and NORMAL for a 9-month-old infant?
38. A neonate is born at term. At 2 minutes of life, the following are noted: heart rate 108 bpm, irregular gasping respirations, body pink but extremities blue, weak cry with grimace on stimulation, and good muscle tone. What is the Apgar score?
39. A child can walk independently, run, build a tower of 6 cubes, scribble spontaneously, use 2-3 word phrases, follow two-step commands, and shows parallel play. What is the approximate developmental age?
40. In a child with global developmental delay, the SINGLE most important first-line investigation to identify a potentially treatable cause is:
41. A 12-month-old does not yet walk independently but is cruising along furniture, stands briefly alone, and uses a pincer grasp to pick up small pellets. He says 'mama' and 'dada' with meaning and waves bye-bye. Based on developmental assessment, which domain is MOST delayed and warrants the most urgent evaluation?
42. A 6-month-old infant does not visually track a face, has no social smile, and does not coo. The parents report normal birth history. Which evaluation is MOST important to perform first?
43. A 9-month-old infant transfers objects from hand to hand, sits without support, bears weight when held standing, babbles with consonant sounds (da-da non-specific), and has a social smile. He does not have a pincer grasp yet. Which of these developmental milestones is MOST delayed, requiring further evaluation?
44. A 5-year-old child presents with impaired attention, memory deficits, borderline intellectual functioning, and dysmorphic features including smooth philtrum, thin upper lip, small palpebral fissures (short), and small head circumference. Maternal history reveals heavy alcohol consumption throughout pregnancy. Which feature is PATHOGNOMONIC for Fetal Alcohol Syndrome (FAS)?
45. A 4-year-old boy has normal gross motor development but shows difficulty with fine motor tasks, poor coordination, trouble with buttons, and has unclear speech with good comprehension. Neurological examination is normal. IQ testing is appropriate for age. Which is the MOST appropriate classification?
46. A 9-month-old infant cannot sit without support, does not transfer objects hand to hand, has no stranger anxiety, and does not babble consonant-vowel sounds (e.g., 'baba', 'dada'). He does fix and follow with his eyes. Which domain of development is most significantly delayed?
47. At what age should a normal child be able to draw a person with at least 6 body parts, copy a triangle, and engage in complex cooperative play with rules?
48. A 9-month-old infant cannot sit without support, has no pincer grasp, does not babble, and shows no stranger anxiety. Which of the following is the MOST concerning red flag?
49. 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:
50. A 9-month-old infant can sit without support, transfers objects from hand to hand, and babbles with consonant sounds like 'ba-ba'. He regards a pellet but does not pick it up. Which developmental milestone is he yet to achieve?
51. A 2-year-old child weighing 8 kg is brought with generalized pitting edema, sparse reddish hair, and a 'flaky paint' skin rash. She is miserable and anorexic. Serum albumin is 1.8 g/dL. What is the most likely diagnosis?
52. An 18-month-old child who was exclusively breastfed and never received complementary feeds presents with bowing of legs, craniotabes, and rachitic rosary. Serum calcium is 8.0 mg/dL, phosphorus is 2.5 mg/dL, alkaline phosphatase is markedly elevated. Which of the following is the single best initial intervention?
53. At what age does birth weight of a term infant typically double, triple, and quadruple (in that sequence)?
54. A 3-year-old child is brought for developmental assessment. He uses 3-word sentences, can name 4 colors, rides a tricycle, and can copy a circle but not a cross. He plays alongside other children without interacting. Which aspect of development is most delayed?
55. A 9-month-old infant is brought for a developmental check. He can sit without support, transfer objects hand-to-hand, and says 'da-da' non-specifically. He cannot yet pull to stand, wave bye-bye, or say 'mama' specifically. Which developmental domain shows a DELAY?
56. A child can walk upstairs using alternate feet, ride a tricycle, copy a circle (not a cross), name 3 colors, give full name, and feeds herself with a spoon. She has stranger anxiety but can separate from parents briefly. The most likely developmental age corresponding to these milestones is: