# Situation: A nurse at a Rural Health Unit (RHU) runs a well-child clinic for children aged 3 to 6 years before they enter school. The nurse screens the speech of four children. Which child should the nurse refer to a speech specialist?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629638  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse at a Rural Health Unit (RHU) runs a well-child clinic for children aged 3 to 6 years before they enter school.

The nurse screens the speech of four children. Which child should the nurse refer to a speech specialist?

## 보기

1. A 3-year-old who tells long stories about an imaginary friend
2. A 4-year-old who has repeated sounds and words for 8 months, without visible strain **✔ 정답**
3. A 3-year-old who has repeated whole words, as in "I-I-I want," for 3 months, without strain
4. A 4-year-old whose speech strangers understand most of the time

**정답: 2**

## 해설

Normal dysfluency, such as repeating words or phrases, is common between about 2 and 4 years and usually resolves. Referral is needed when stuttering involves visible struggle, tension, or avoidance, lasts more than about 6 months, or begins after age 5. The first child has no strain, but the dysfluency has lasted 8 months, which alone meets a referral criterion.

## 심화 해설

The child who needs referral
Repeating sounds, syllables, or words is common in young children and is often called normal dysfluency. It occurs most often between about 2 and 4 years, while language is developing rapidly, and usually resolves on its own. Referral to a speech specialist is needed when dysfluency shows warning features: visible struggle, tension, or avoidance, persistence for more than about 6 months, or onset after age 5. The 4-year-old who has repeated sounds and words for 8 months meets a referral criterion because of the duration alone, even without visible strain.

Why duration matters
Most normal dysfluency is brief and comes and goes. When it persists beyond about 6 months, the chance that it will resolve on its own decreases, and early assessment and therapy are more effective than waiting. Absence of strain is reassuring in a child with a short history, but it does not cancel the significance of a long duration. Watch out! Do not let the phrase without visible strain lead you to choose no referral; the 8-month duration is enough.

Comparing the four children

| Child | Finding | Interpretation |
| --- | --- | --- |
| 3-year-old | Long stories about an imaginary friend | Normal preschool imagination |
| 4-year-old | Repetitions of sounds and words for 8 months, no strain | Refer: duration more than about 6 months |
| 3-year-old | Whole-word repetitions such as I-I-I want for 3 months, no strain | Normal dysfluency |
| 4-year-old | Strangers understand most of the speech | Expected intelligibility at 4 years |

Counseling the parents
For the children with normal dysfluency, the nurse advises parents to speak slowly and calmly, give the child time to finish, listen patiently, and avoid telling the child to slow down, start over, or think before speaking, which can increase anxiety. They should not label the child as a stutterer. If the dysfluency continues, increases, or begins to cause struggle or avoidance, they should return for referral.

Exam takeaway
Refer a child whose dysfluency shows struggle or avoidance, lasts more than about 6 months, or begins after age 5. Key point! Any one warning feature is enough for referral; the child does not need all of them.

## 임상 시나리오

Speech Dysfluency ScreeningPreschool well-child clinic
Normal dysfluency, such as repeating words or phrases, is common between about 2 and 4 years and usually resolves.

Refer when there is visible struggle, tension, or avoidance, duration of more than about 6 months, or onset after age 5.

Advise parents to listen patiently, give the child time, and avoid telling the child to slow down or start over.

CautionLack of strain does not cancel a long duration. Dysfluency lasting 8 months needs referral.

## 핵심 개념

- **Normal dysfluency** — Brief, effortless repetition of words or phrases common in children about 2 to 4 years old.
- **Stuttering** — A speech disorder with repetitions, prolongations, or blocks that disrupt the flow of speech.
- **Speech intelligibility** — How much of a child's speech can be understood by listeners, especially strangers.
- **Imaginary companion** — A pretend friend common in preschoolers as part of normal imaginative play.

## 같은 주제 문제

- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629426)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629427)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629428)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629429)
- [Situation: A nurse from the Rural Health Unit (RHU) makes postnatal home visits to healthy…](https://mymerci.kr/pages/nclex_q.php?qn_id=629430)
- [Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=629431)
- [Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=629432)
- [Situation: The nurse holds a weekly well-baby clinic at a Barangay Health Station (BHS) fo…](https://mymerci.kr/pages/nclex_q.php?qn_id=629433)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._