# The nurse reviews an 18-month-old child’s developmental history. Which findings require follow-up? Highlight the findings that warrant developmental screening or early evaluation.

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> category: HPM

## Question

The nurse reviews an 18-month-old child’s developmental history. Which findings require follow-up? Highlight the findings that warrant developmental screening or early evaluation.

| Developmental area | Caregiver report |
| --- | --- |
| Movement | Child cannot walk independently without holding support |
| Language | Child uses only “mama” and “dada” without other words |
| Self-help | Child picks up small foods and feeds themself with fingers during meals |
| Social communication | Child points toward an airplane to share interest with the nearby caregiver |
| Regression | Child previously waved goodbye but no longer does so |
| Understanding | Child follows a familiar one-step direction without any caregiver gesture |
| Fine motor | Child makes several spontaneous scribbles after receiving a crayon at the visit |
| Play | Child pushes a toy car back and forth during simple independent play |

## Explanation

Not walking independently, using only parent names, and losing a previously acquired gesture require follow-up. Missed milestones or skill loss should prompt timely screening and referral.

## In-depth explanation

Quick answer
Highlight not walking independently, saying only “mama” and “dada,” and losing the ability to wave. These are absent or lost skills expected in developmental surveillance at 18 months.

Why this is correct
CDC milestones describe skills that most children can do by a given age, including independent walking and trying at least 3 words beyond parent names. A missed milestone or regression should lead to prompt discussion, validated screening, and early-intervention referral when indicated.[2]

Easy analogy or mental picture
Think of milestones as dashboard lights, not a final diagnosis. One light that has not appeared or a light that turns off calls for a closer check; the picture supports early action but cannot replace standardized developmental screening.

Memory hook
Missing, lost, or concerning: screen and act early.

NCLEX decision rule
For pediatric development, distinguish normal variation from a missed age-based milestone or any regression; do not reassure away lost skills, and use validated screening plus referral rather than diagnosing from a checklist alone.

Why the other choices are wrong
Finger feeding, pointing to share interest, following a one-step direction without gestures, scribbling, and simple toy play are expected 18-month skills. Their presence supports development but does not erase concern about another missing or lost domain.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]CDC: Milestones by 18 MonthsCenters for Disease Control and Prevention

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