# Review the infant's developmental timeline and determine the most appropriate nursing response.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=547004&lang=en  
> language: en  
> subject: Developmental Stages and Transitions  
> category: HPM

## Question

Review the infant's developmental timeline and determine the most appropriate nursing response.

| Time | Data |
| --- | --- |
| 9-month visit | Sits without support, transfers objects, babbles repeated sounds, and responds to name. |
| 12-month visit | Pulls to stand, waves, uses two consistent words, and points to request an object. |
| 15-month visit | Caregiver reports the infant no longer uses the two words, rarely waves or points, and stopped pulling to stand over the past 6 weeks. |

Q1. How should the nurse interpret the pattern?

Normal variation limited to expressive vocabulary
Developmental regression across communication, social gesture, and motor domains
A normal response to a passed newborn hearing screen
A temporary sleep-related change

Q2. What is the priority response?

Wait until the 18-month visit before reassessing
Provide reassurance because all children develop at different rates
Arrange prompt standardized screening, medical-developmental evaluation, and early-intervention referral
Diagnose a specific disorder from the timeline alone

Q3. Which principle should guide caregiver teaching?

Only failure to gain a skill is clinically relevant
A passed newborn screen rules out later developmental concern
Screening produces a definitive diagnosis
Loss of previously acquired skills warrants action rather than watchful waiting

## Explanation

Developmental surveillance must address both failure to gain skills and loss of previously acquired skills. Regression across communication, social gesture, and motor domains is a red flag regardless of a normal newborn hearing screen. The nurse should validate the caregiver's concern, arrange prompt standardized developmental screening and medical-developmental evaluation, and initiate early-intervention referral as appropriate without adopting a wait-and-see approach. Screening supports assessment but does not itself establish a diagnosis.

## In-depth explanation

Correct Answer
The pattern is developmental regression requiring prompt evaluation and referral.

Why It Fits
The infant first acquired skills and later lost words, gestures, and standing ability across more than one domain.

Clinical Picture
A prior normal screening result does not negate new developmental loss reported by a caregiver.

Memory Link
Missing a milestone matters; losing a milestone escalates.

NCLEX Rule
Developmental concerns arising during surveillance should trigger standardized screening and timely referral rather than waiting for the next routine interval.

Why the Alternatives Fail
Reassurance alone, a delayed recheck, or assigning a diagnosis from screening evidence can delay needed assessment and services.

Sources
1AAP Developmental Surveillance and Screening Clinical Report
2NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Pediatric primary care
The nurse compares milestone surveillance recorded at prior visits with the caregiver's current observations. Hearing screening at birth was documented as passed, and the infant has had no acute illness.

## Key concepts

- **Developmental regression** — Loss of a skill that a child had previously acquired.
- **Developmental surveillance** — An ongoing process of eliciting concerns, observing the child, reviewing history, and tracking development at health visits.
- **Standardized developmental screening** — Use of a validated tool to identify children who need more detailed developmental evaluation.

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