# Review the toddler's developmental surveillance timeline and determine the appropriate screening and referral response. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=en > language: en > subject: Developmental Stages and Transitions > category: HPM ## Question Review the toddler's developmental surveillance timeline and determine the appropriate screening and referral response. | Time | Data | | --- | --- | | 12-month visit | The child waves, points to request a toy, says 'mama' and 'dada,' and pulls to stand. Growth follows the expected curve. | | 15-month visit | The caregiver reports no new words and less frequent pointing. A milestone checklist is reviewed, and close follow-up is planned. | | 18-month visit | The child uses no words beyond 'mama' and 'dada,' does not point to show interesting objects, and no longer waves. The caregiver asks whether to keep waiting. | Q1. How should the nurse interpret the developmental trend? Normal variation because physical growth is on curve A confirmed autism diagnosis based on caregiver report Missed and lost milestones that require prompt standardized screening and evaluation Q2. Which next step is most appropriate? Reassure the caregiver and repeat surveillance at age 3 years Communicate the concern, complete validated developmental and autism screening, and facilitate early-intervention referral Use the milestone checklist as the final diagnostic test Q3. Which response best supports the caregiver? Children all develop differently, so concern is unnecessary Do not discuss this until a specialist makes a diagnosis Focus only on height and weight because those findings are objective Your observations across visits are important; we will act on them now and explain each follow-up step ## Explanation Developmental monitoring follows how a child plays, learns, communicates, acts, and moves over time. By 18 months, most children point to show something interesting and try at least three words besides 'mama' or 'dada.' A loss of a previously acquired skill is especially concerning. A milestone checklist supports surveillance but does not diagnose a disorder or replace a validated screening tool. The nurse should acknowledge the caregiver's observations, communicate them to the clinician, obtain recommended developmental and autism screening, and facilitate referral for further evaluation and early intervention rather than recommending a passive wait-and-see approach. ## In-depth explanation Trend to recognize Communication and social milestones are not advancing, and a previously used gesture has been lost. The longitudinal change matters more than a single office impression. Next health-promotion step Validate the caregiver's concern, use standardized developmental and autism screening at the appropriate visit, and initiate evaluation and early-intervention referral when concerns persist. Scope rule A milestone checklist is surveillance, not a diagnosis. The nurse should not label the child with autism from these observations alone. Why the alternatives fail Waiting several months can postpone services during a key developmental period. Reassurance based only on normal height and weight does not address communication or social development. Sources 1CDC Milestones by 18 Months 2CDC Developmental Monitoring and Screening 32026 NCLEX-RN Test Plan ## Clinical scenario Well-child care The nurse compares caregiver observations across visits for an 18-month-old child. The caregiver is increasingly concerned about communication and social interaction. ## Related questions - [A nurse is conducting an annual well-adolescent visit for a 15-year-old client per AAP Bri…](https://mymerci.kr/pages/nclex_q.php?qn_id=366228&lang=en) - [A client has repeated injuries and the partner answers all questions. Which nursing action…](https://mymerci.kr/pages/nclex_q.php?qn_id=397290&lang=en) - [A 57-year-old client asks about shingles vaccination. Which teaching should the nurse prov…](https://mymerci.kr/pages/nclex_q.php?qn_id=397346&lang=en) - [Review the infant's developmental timeline and determine the most appropriate nursing resp…](https://mymerci.kr/pages/nclex_q.php?qn_id=547004&lang=en) - [At a 4-year-old well-child visit, the nurse notes the child's immunization record shows va…](https://mymerci.kr/pages/nclex_q.php?qn_id=558427&lang=en) - [A nurse is planning therapeutic play activities for three hospitalized children. Match eac…](https://mymerci.kr/pages/nclex_q.php?qn_id=568379&lang=en) - [A pediatric nurse must select the highest indicated next action for each independent visit…](https://mymerci.kr/pages/nclex_q.php?qn_id=569392&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=395206&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._