An 11-year-old boy is brought to his pediatrician by his parents for the routine Tdap immunization booster dose that is given during adolescence. Upon reviewing the patient’s medical records, the pediatrician notes that he was immunized according to CDC recommendations, with the exception that he received a catch-up Tdap immunization at the age of 8 years. When the pediatrician asks the boy’s parents about this delay, they inform the doctor that they immigrated to this country 3 years ago from Southeast Asia, where the child had not been immunized against diphtheria, tetanus, and pertussis. Therefore, he received a catch-up series at 8 years of age, which included the first dose of the Tdap vaccine. Which of the following options should the pediatrician choose to continue the boy’s immunization schedule?

A single dose of Tdap vaccine at 13 years of age

A single dose of Td vaccine at 18 years of age

A single dose of Td vaccine now

A single dose of Tdap vaccine now

A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 lbs, 9 oz), and his height is 30 inches (birth length 18 inches). Are there any aspects of this child's development that are delayed?

There are no developmental concerns

A 6-month-old girl presents to an outpatient office for a routine physical. She can sit momentarily propped on her hands, babbles with consonants, and transfers objects hand to hand. The pediatrician assures the parents that their daughter has reached appropriate developmental milestones. Which additional milestone would be expected at this stage in development?

Showing an object to her parents to share her interest in that object

A 4-month-old boy is brought to the physician for a well-child examination. He was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. He weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, he appears well. His pulse is 146/min, the respirations are 39/min, and the blood pressure is 78/44 mm Hg. He weighs 7.5 kg (16 lb 9 oz) and measures 65 cm (25.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?

Grasps small objects between thumb and finger

Transfers objects from hand to hand

Bounces actively when held in standing position

A 2-month-old is brought to the physician for a well-child examination. She was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. She weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, she appears well. Her pulse is 136/min, the respirations are 41/min, and the blood pressure is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?

Absence of asymmetric tonic neck reflex

A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is 90/min, respirations are 23/min, and oxygen saturation is 99% on room air. The child is in the corner stacking blocks. He does not look the physician in the eye nor answer your questions. He continually tries to return to the blocks and becomes very upset when you move the blocks back to their storage space. The parents state that the child has not begun to speak and often exhibits similar behaviors with toy blocks he has at home. On occasion, they have observed him biting his elbows. Which of the following is the best next step in management?

Educating the parents about autism spectrum disorder

Restructuring of the home environment

A 4-year-old boy is brought to a pediatrician by his parents for a consultation after his teacher complained about his inability to focus or make friends at school. They mention that the boy does not interact well with others at home, school, or daycare. On physical examination, his vital signs are stable with normal weight, height, and head circumference for his age and sex. His general examination and neurologic examination are completely normal. A recent audiological evaluation shows normal hearing, and intellectual disability has been ruled out by a clinical psychologist. Which of the following investigations is indicated as part of his diagnostic evaluation at present?

Autism spectrum disorder screening and developmental assessment

Magnetic resonance imaging (MRI) of brain

Positron Emission Tomography (PET) scanning of head

Developmental surveillance for USMLE Step 2 CK: High-Yield Pediatrics Lessons

Developmental Surveillance - The First Look

Developmental surveillance is a flexible, continuous process of skilled observations during every health visit. It contrasts with screening, which uses formal, standardized tools at specific ages, and assessment, a detailed evaluation to establish a diagnosis.

⭐ Parental concern about their child's development is a significant predictor and has high specificity. Always take parental concerns seriously.

Gross Motor Milestones - The Big Moves

Follows a cephalocaudal (head-to-toe) progression.

3 mo: Head control achieved.
5 mo: Rolls over (tummy to back first).
6 mo: Sits with support (tripod).
8 mo: Sits without support.
9 mo: Pulls to stand; crawls.
12 mo: Stands independently; walks holding one hand.
15 mo: Walks alone.
18 mo: Runs.
2 yr: Jumps; up/down stairs 2 feet/step.
3 yr: Rides a tricycle; alternates feet on stairs.

Gross Motor Milestones: Birth to 6 Years

⭐ Red Flag: Failure to walk independently by 18 months warrants further evaluation.

Fine Motor & Language - Clever Hands, Clever Words

Infant Grasp Development: Palmar to Superior Pincer

Age	Fine Motor (Hand Control)	Language (Vocalization)
2 mo	Hands predominantly open	Cooing, social smile
4 mo	Bimanual reach for objects	Laughs, orients to voice
6 mo	Unimanual reach, transfers objects	Monosyllabic babble
9 mo	Immature pincer grasp (rakes)	Polysyllabic babble (non-specific)
12 mo	Neat pincer grasp	1-2 words with meaning
2 yr	Tower of 6 blocks, turns pages	2-3 word sentences, 50+ words

📌 Language Ladder: Coo at 2, Laugh at 4, Babble at 6, Mama-Dada (non-specific) at 9, Words (specific) at 12.

Key Social Milestones:
- 2 mo: Social Smile (recognizes mother)
- 6-7 mo: Stranger Anxiety starts
- 9-10 mo: Object Permanence (searches for dropped objects)
- 18-24 mo: Symbolic Play (e.g., using a block as a phone)

Indian Screening Tools:
- Trivandrum Developmental Screening Chart (TDSC)
- Baroda Screening Test

⭐ The Trivandrum Developmental Screening Chart (TDSC) is validated for children up to 2 years and includes items for both performance testing and maternal report.

High‑Yield Points - ⚡ Biggest Takeaways

Developmental surveillance is a continuous, flexible process, while screening is formal and periodic.

Universal screening is recommended at 9, 18, and 30 months; autism-specific screening (M-CHAT-R) at 18 and 24 months.

The DDST is a screening tool, not a diagnostic or IQ test; it assesses four domains.

A failed screening test warrants a comprehensive developmental evaluation, not immediate therapy.

Parental concern about delays is a significant red flag and should always trigger a formal evaluation.

Continue reading on Oncourse

CONTINUE READING — FREE

or get the app

App Store|Google Play