Growth, Development & Safeguarding — MCQs
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A 10-year-old boy has had declining school attendance over 8 months, now attending only 40% of the time. His mother brings him to the GP reporting he complains of abdominal pain and headaches on school mornings but is well at weekends. There is no organic cause found on examination. The child appears anxious and mentions he 'doesn't like leaving mum alone'. The mother appears low in mood and mentions her partner left 6 months ago. What is the most likely diagnosis?
A paediatric registrar is asked to review a child protection medical report. A 8-year-old girl was examined following disclosure of sexual abuse by her mother's boyfriend. The examination findings are documented as 'normal anogenital examination with no physical findings'. What is the most appropriate interpretation of these findings?
A 26-month-old child attends for a routine developmental assessment. The health visitor notes the child can walk up stairs holding a rail, kick a ball, and scribble with a crayon. The child says approximately 8 single words but does not combine words. Which aspect of development requires further assessment or monitoring?
A 5-month-old infant is brought to the emergency department by her mother with a swollen left thigh. X-ray reveals a spiral femoral fracture. The mother reports the baby rolled off the sofa onto a carpeted floor. The infant is not yet rolling independently. Examination shows the injury is isolated with no other bruising. What feature of this presentation is most concerning for non-accidental injury?
A 7-year-old boy presents to his GP with his grandmother who has recently become his kinship carer. She reports that he frequently wets the bed, has nightmares, and becomes distressed when meeting new people. He was removed from his parents' care 3 months ago due to neglect. At school, teachers report he hoards food and struggles to form friendships. What is the most likely underlying explanation for this presentation?
A 33-month-old girl is reviewed in the developmental clinic. She can build a tower of 6 cubes, uses 2-3 word phrases, and can jump with both feet together. She is not yet toilet trained during the day. Her parents are concerned about the lack of toilet training. What is the most appropriate advice?
A 18-month-old child is brought to the emergency department by their mother with a scalding injury to the buttocks and perineum. The mother reports the child climbed into the bath while she briefly left the bathroom to answer the door. The child has circular bruises on both upper arms. What is the most appropriate initial management?
A GP reviews safeguarding procedures with a new foundation doctor. A 4-year-old child attends with their parent who refuses to allow the child to be examined despite concerning bruising visible on the arms. The parent becomes aggressive and states they will leave. What is the most appropriate immediate action?
A community paediatrician is assessing growth patterns in children. A 8-year-old boy's height has been tracking along the 75th centile since birth, but over the past year has dropped to the 50th centile while weight remains on the 75th centile. The child is otherwise well, with no symptoms. What is the most appropriate interpretation of this growth pattern?
A 11-month-old infant is brought to the GP for routine review. The parents report that the baby can sit unsupported, transfer objects between hands, and says 'dada' and 'mama' non-specifically. The child does not yet pull to stand. Which statement best describes this developmental profile?
Growth, Development & Safeguarding UK Medical PG Practice Questions and MCQs
Question 101: A 10-year-old boy has had declining school attendance over 8 months, now attending only 40% of the time. His mother brings him to the GP reporting he complains of abdominal pain and headaches on school mornings but is well at weekends. There is no organic cause found on examination. The child appears anxious and mentions he 'doesn't like leaving mum alone'. The mother appears low in mood and mentions her partner left 6 months ago. What is the most likely diagnosis?
- A. Separation anxiety disorder with emotionally based school avoidance (Correct Answer)
- B. Truancy with fabricated somatic symptoms to avoid consequences
- C. Bullying at school causing psychosomatic symptoms
- D. Adjustment disorder following parental separation
- E. Emerging school refusal secondary to social anxiety disorder
Explanation: ***Separation anxiety disorder with emotionally based school avoidance*** - The child's statement that he **'doesn't like leaving mum alone'** combined with somatic symptoms that only occur on school mornings indicates a primary **separation anxiety** pattern. - This is **emotionally based school avoidance**, where the child's absence is driven by fear and distress rather than conduct issues, often exacerbated by the mother's low mood after the parental separation. *Truancy with fabricated somatic symptoms to avoid consequences* - **Truancy** typically involves the child hiding their absence from parents and lacks the **anxiety** about the separation or school itself observed here. - In this case, the mother is fully aware of the absence, and the child displays clear **internalizing symptoms** rather than antisocial behavior or a desire to deceive. *Bullying at school causing psychosomatic symptoms* - While bullying can lead to **school refusal**, the child specifically identifies his mother's well-being as the source of his concern rather than a fear of peers or the school environment due to bullying. - Physical symptoms due to **bullying** would usually be accompanied by social withdrawal or distress related to specific interactions at school, which are not mentioned. *Adjustment disorder following parental separation* - While the parental split is a clear **stressor**, adjustment disorder is a broad diagnosis that doesn't specifically address the core symptom of **separation anxiety**. - The pattern of **somatic complaints** triggered specifically by separation is better captured by the more specific diagnosis of separation anxiety disorder. *Emerging school refusal secondary to social anxiety disorder* - **Social anxiety disorder** involves a pervasive fear of social evaluation, performance, or judgment by others in the school setting. - This child’s distress is rooted in the **attachment relationship** with his mother rather than a fear of social interaction or scrutiny at school.
Question 102: A paediatric registrar is asked to review a child protection medical report. A 8-year-old girl was examined following disclosure of sexual abuse by her mother's boyfriend. The examination findings are documented as 'normal anogenital examination with no physical findings'. What is the most appropriate interpretation of these findings?
- A. Normal examination findings effectively exclude the possibility of sexual abuse
- B. The absence of physical findings suggests the child's disclosure is unreliable
- C. Normal examination findings are common in child sexual abuse and do not refute the disclosure (Correct Answer)
- D. Further invasive examination under anaesthesia is required to identify subtle injuries
- E. The examination should be repeated in 2 weeks as injuries may become apparent with time
Explanation: ***Normal examination findings are common in child sexual abuse and do not refute the disclosure*** - In approximately **90-95% of child sexual abuse cases**, the physical examination is entirely normal because many forms of abuse leave no physical trace. - Tissues in the **prepubertal anogenital area** heal very rapidly, and a lack of findings never invalidates a child's **disclosure**. *Normal examination findings effectively exclude the possibility of sexual abuse* - Absence of evidence is not **evidence of absence**; many types of abuse (non-contact or non-penetrative) do not cause physical trauma. - Relying solely on physical findings would lead to a high rate of **false negatives** and fail to protect vulnerable children. *The absence of physical findings suggests the child's disclosure is unreliable* - A child's **history and disclosure** are the most critical components of a safeguarding assessment, regardless of physical signs. - Forensic studies show that most **confirmed cases** of sexual abuse have no physical evidence on examination. *Further invasive examination under anaesthesia is required to identify subtle injuries* - **Examination under anaesthesia (EUA)** is an invasive procedure that is rarely indicated unless there is a need for surgical repair of acute, severe trauma. - Performing an EUA in the absence of clinical indications would be **disproportionate** and potentially re-traumatise the child. *The examination should be repeated in 2 weeks as injuries may become apparent with time* - Physical findings such as **bruising or lacerations** usually resolve over time rather than appearing later. - **Repeat examinations** are not recommended unless there are new clinical symptoms, as they offer no forensic benefit and increase distress.
Question 103: A 26-month-old child attends for a routine developmental assessment. The health visitor notes the child can walk up stairs holding a rail, kick a ball, and scribble with a crayon. The child says approximately 8 single words but does not combine words. Which aspect of development requires further assessment or monitoring?
- A. Gross motor skills are delayed for age and require physiotherapy referral
- B. Fine motor development is significantly delayed requiring occupational therapy input
- C. Language development is below expected for age and warrants speech therapy referral (Correct Answer)
- D. Social development cannot be adequately assessed from this information
- E. All developmental domains are progressing within normal limits for age
Explanation: ***Language development is below expected for age and warrants speech therapy referral*** - By **24 months (2 years)**, a child is expected to have a vocabulary of at least **50 words** and be able to combine **two or more words** into simple phrases. - This child’s limited vocabulary of only **8 single words** and inability to combine words at 26 months constitutes a significant **expressive language delay**, necessitating further evaluation. *Gross motor skills are delayed for age and require physiotherapy referral* - The child's ability to **walk up stairs holding a rail** and **kick a ball** are appropriate gross motor milestones for a 24-month-old. - These skills indicate that **gross motor development** is progressing within normal limits for their age, so physiotherapy referral is not indicated. *Fine motor development is significantly delayed requiring occupational therapy input* - Being able to **scribble with a crayon** is an expected **fine motor milestone** typically achieved by approximately **18-24 months** of age. - This skill demonstrates that the child's **fine motor development** is age-appropriate, thus occupational therapy input is not required based on this information. *Social development cannot be adequately assessed from this information* - While the provided information focuses on motor and language skills and lacks specific details about social interactions, the **language delay** is a clear and immediate concern. - Regardless of a complete social assessment, the significant **language deficit** is a primary clinical priority for referral and intervention. *All developmental domains are progressing within normal limits for age* - This statement is incorrect because the child’s **expressive language** is significantly below the expected milestones for a 26-month-old, particularly regarding vocabulary size and word combination. - Failing to recognize and address a delay in the **speech and language** domain at this critical age can impede beneficial **early intervention** and impact overall development.
Question 104: A 5-month-old infant is brought to the emergency department by her mother with a swollen left thigh. X-ray reveals a spiral femoral fracture. The mother reports the baby rolled off the sofa onto a carpeted floor. The infant is not yet rolling independently. Examination shows the injury is isolated with no other bruising. What feature of this presentation is most concerning for non-accidental injury?
- A. The age of the child, as infants under 1 year commonly sustain fractures from low-height falls
- B. The mechanism described is inconsistent with the developmental capabilities of the child (Correct Answer)
- C. Spiral fractures are always diagnostic of non-accidental injury in children
- D. The absence of other injuries makes non-accidental injury unlikely
- E. Falls onto carpet typically cause more severe fractures than reported
Explanation: ***The mechanism described is inconsistent with the developmental capabilities of the child*** - A 5-month-old infant is typically not capable of **rolling independently** or generating sufficient force to cause a **spiral femoral fracture** from a low-height fall. - A **discrepancy** between the reported mechanism of injury and the child's **developmental stage** is a critical red flag for **non-accidental injury (NAI)**. *The age of the child, as infants under 1 year commonly sustain fractures from low-height falls* - **Fractures in non-ambulatory infants** (especially under 6 months) are rare from accidental low-height falls and warrant a high suspicion for **abuse**. - The statement that infants commonly sustain fractures from low-height falls is generally **incorrect** for significant fractures, particularly in pre-mobile infants. *Spiral fractures are always diagnostic of non-accidental injury in children* - While **spiral fractures** indicate torsional force and are highly suspicious for NAI, particularly in infants, they are **not pathognomonic** and can rarely occur accidentally in older, mobile children. - Other fracture types like **metaphyseal corner fractures** and **posterior rib fractures** have higher specificity for NAI. *The absence of other injuries makes non-accidental injury unlikely* - **Non-accidental injury** can frequently present as an **isolated injury**, so the absence of other bruising or fractures does not rule out abuse. - In cases of suspected NAI, a **full skeletal survey** and **ophthalmology examination** are crucial, regardless of initial clinical appearance. *Falls onto carpet typically cause more severe fractures than reported* - Falls onto **carpeted surfaces** tend to **absorb impact** and are less likely to cause severe fractures compared to hard surfaces. - Therefore, a significant injury like a **spiral femoral fracture** from a fall onto carpet is inconsistent with the typical outcome and increases suspicion for NAI.
Question 105: A 7-year-old boy presents to his GP with his grandmother who has recently become his kinship carer. She reports that he frequently wets the bed, has nightmares, and becomes distressed when meeting new people. He was removed from his parents' care 3 months ago due to neglect. At school, teachers report he hoards food and struggles to form friendships. What is the most likely underlying explanation for this presentation?
- A. Attention deficit hyperactivity disorder with comorbid enuresis
- B. Reactive attachment disorder secondary to early adversity and neglect (Correct Answer)
- C. Autism spectrum disorder with associated anxiety
- D. Normal adjustment reaction to change in primary caregiver
- E. Post-traumatic stress disorder following physical abuse
Explanation: ***Reactive attachment disorder secondary to early adversity and neglect***- The history of **severe neglect** and removal from parents, combined with difficulty forming friendships and distress with new people, strongly indicates **Reactive attachment disorder (RAD)**.- **Food hoarding**, frequent bedwetting (enuresis), and nightmares are common manifestations of developmental trauma and **insecure attachment** in children who have experienced early deprivation.*Attention deficit hyperactivity disorder with comorbid enuresis*- While enuresis is noted, the primary symptoms of **ADHD** (inattention, hyperactivity, impulsivity) are not the central features of this presentation.- The profound **social difficulties** and **food hoarding** are not typical primary symptoms of ADHD, differentiating it from this case.*Autism spectrum disorder with associated anxiety*- **Autism spectrum disorder (ASD)** involves primary deficits in social communication and repetitive behaviors, which are neurodevelopmental and not directly caused by neglect.- The child's distress with new people and struggles with friendships, in the context of neglect, are more indicative of **attachment-related difficulties** rather than a primary ASD diagnosis.*Normal adjustment reaction to change in primary caregiver*- An **adjustment reaction** is usually milder and time-limited, often resolving within six months, and typically does not include the severity of symptoms like **food hoarding** or severe social withdrawal.- The history of **prolonged neglect** suggests a more pervasive and deep-seated issue than a transient response to a change in caregiving arrangement.*Post-traumatic stress disorder following physical abuse*- The prompt specifies **neglect** as the reason for removal, not physical abuse, which is a key differentiator for **PTSD**'s typical etiology.- While nightmares can be a symptom, **PTSD** often includes intrusive memories, avoidance, and hyperarousal directly related to a specific traumatic event, and the full symptom constellation, especially **food hoarding**, points away from a primary PTSD diagnosis.
Question 106: A 33-month-old girl is reviewed in the developmental clinic. She can build a tower of 6 cubes, uses 2-3 word phrases, and can jump with both feet together. She is not yet toilet trained during the day. Her parents are concerned about the lack of toilet training. What is the most appropriate advice?
- A. This represents developmental delay in self-care skills requiring referral to occupational therapy
- B. Toilet training should be established by 30 months; arrange for continence nurse specialist assessment
- C. Her development in other domains is appropriate; reassure and advise on toilet training strategies (Correct Answer)
- D. This may indicate autism spectrum disorder; refer for multidisciplinary neurodevelopmental assessment
- E. Her language delay is affecting toilet training ability; refer to speech and language therapy first
Explanation: ***Her development in other domains is appropriate; reassure and advise on toilet training strategies*** - Daytime **toilet training** is highly variable, and many children are not fully continent until age 3 or older, making this child's status within **normal limits**. - The child's achievements, such as building a **tower of 6 cubes** and jumping with both feet, indicate that her fine motor, gross motor, and language skills are developmentally on track for her age. *This represents developmental delay in self-care skills requiring referral to occupational therapy* - **Toilet training** is not considered a clinical delay at 33 months if other developmental milestones are being met normally. - Referral to **occupational therapy** is unnecessary as there are no signs of dyspraxia or significant fine motor deficits, as evidenced by her ability to build a **6-cube tower**. *Toilet training should be established by 30 months; arrange for continence nurse specialist assessment* - There is no strict medical rule that training must be complete by **30 months**; readiness and acquisition of continence vary widely among healthy children. - A **continence nurse specialist** assessment is typically reserved for older children (e.g., 4-5 years) with primary or secondary enuresis or more significant bladder/bowel issues. *This may indicate autism spectrum disorder; refer for multidisciplinary neurodevelopmental assessment* - The child is achieving appropriate **social and language milestones**, such as using **2-3 word phrases**, and no other red flags for **autism spectrum disorder** like social communication deficits or restrictive behaviors are mentioned. - Isolated lack of toilet training at this age, without other **neurodevelopmental concerns**, is not an indicator for an autism spectrum disorder assessment. *Her language delay is affecting toilet training ability; refer to speech and language therapy first* - Using **2-3 word phrases** at 33 months is developmentally appropriate (typically expected around 2.5 years), and therefore does not represent a significant **language delay**. - While communication aids training, her current **expressive language skills** are sufficient for basic needs related to toilet training, and a **speech and language therapy referral** is not warranted.
Question 107: A 18-month-old child is brought to the emergency department by their mother with a scalding injury to the buttocks and perineum. The mother reports the child climbed into the bath while she briefly left the bathroom to answer the door. The child has circular bruises on both upper arms. What is the most appropriate initial management?
- A. Treat the burns, provide safeguarding advice to the mother, and arrange paediatric outpatient follow-up
- B. Admit the child for burn management and initiate a child protection medical assessment (Correct Answer)
- C. Treat the burns, document concerns, and make a routine referral to children's social care
- D. Discharge with burn care advice and arrange for the health visitor to conduct a home visit
- E. Refer to plastic surgery for burn management and ask them to assess safeguarding concerns
Explanation: ***Admit the child for burn management and initiate a child protection medical assessment*** - The combination of **buttock and perineal scalds**, which are highly suggestive of **forced immersion**, and **circular bruises** on the upper arms, indicative of **forceful gripping**, raises strong suspicion of Non-Accidental Injury (NAI). - **Admission** is crucial to ensure the child's immediate safety and allows for a comprehensive **child protection medical assessment**, including a **skeletal survey** and multidisciplinary team involvement, before the child returns home. *Treat the burns, provide safeguarding advice to the mother, and arrange paediatric outpatient follow-up* - This approach is inadequate given the high suspicion of **Non-Accidental Injury (NAI)**; simply providing advice does not address the immediate safety concerns or initiate a formal investigation. - **Outpatient follow-up** would return the child to a potentially harmful environment without proper assessment and intervention, posing a significant risk. *Treat the burns, document concerns, and make a routine referral to children's social care* - A **routine referral** to children's social care is insufficient when there are immediate and serious concerns about physical abuse; such cases demand an **urgent referral** and immediate protective action. - This option fails to ensure a **place of safety** for the child, which is paramount when the injuries (e.g., immersion burns, gripping bruises) strongly contradict the given history. *Discharge with burn care advice and arrange for the health visitor to conduct a home visit* - **Discharge** is contraindicated in situations with strong indicators of **child abuse**, as it places the child at continued risk in an unassessed home environment. - A **health visitor visit** is not an immediate protective measure and cannot replace the urgent need for a thorough medical and social assessment in a safe, controlled setting. *Refer to plastic surgery for burn management and ask them to assess safeguarding concerns* - While **plastic surgery** manages the burn wounds, the primary responsibility for comprehensive **safeguarding assessments** and coordinating the child protection response lies with the **pediatric team** and social services. - It is inappropriate to solely rely on a surgical specialty for the critical initial assessment and management of suspected **child abuse**, as it requires a broader, multidisciplinary approach.
Question 108: A GP reviews safeguarding procedures with a new foundation doctor. A 4-year-old child attends with their parent who refuses to allow the child to be examined despite concerning bruising visible on the arms. The parent becomes aggressive and states they will leave. What is the most appropriate immediate action?
- A. Allow the family to leave and make a routine referral to children's social care within 48 hours
- B. Attempt to negotiate with the parent and arrange a follow-up appointment within one week
- C. Contact children's social care immediately for advice and consider if it is safe to allow the child to leave (Correct Answer)
- D. Call hospital security to prevent the family leaving until a full assessment is completed
- E. Document the concerns clearly and ask the health visitor to conduct a home visit
Explanation: ***Contact children's social care immediately for advice and consider if it is safe to allow the child to leave*** - When a child has **concerning injuries** and a parent refuses examination or attempts to leave, this constitutes an **immediate safeguarding risk** requiring urgent intervention. - Contacting **social care** (or the police if immediate harm is likely) ensures that a multi-agency risk assessment is performed to protect the child from potential **physical abuse**. *Allow the family to leave and make a routine referral to children's social care within 48 hours* - A **routine referral** is inappropriate because the child is at **immediate risk** of harm, and delaying action for 48 hours may leave the child in a dangerous environment. - Healthcare professionals have a duty to act immediately if they believe a child's **safety is compromised**; simply allowing them to leave without a plan is a failure of care. *Attempt to negotiate with the parent and arrange a follow-up appointment within one week* - Delaying the assessment by **one week** is unsafe when there are signs of **non-accidental injury** and the parent is being obstructive. - Negotiation is unlikely to be effective in a high-risk, **aggressive encounter**, and the primary focus must remain on the **immediate safety** of the child. *Call hospital security to prevent the family leaving until a full assessment is completed* - Security personnel do not have the legal authority to **detain a family** against their will in a general practice or hospital setting; this typically requires **police intervention**. - While physical safety in the building is important, the response to the safeguarding concern itself must involve specialized **child protection services**. *Document the concerns clearly and ask the health visitor to conduct a home visit* - While **documentation** is essential for all safeguarding cases, it is an insufficient standalone action when an **acute risk** is identified. - A **health visitor** visit is not an urgent enough response to suspected physical abuse where a parent is actively avoiding medical assessment for a child.
Question 109: A community paediatrician is assessing growth patterns in children. A 8-year-old boy's height has been tracking along the 75th centile since birth, but over the past year has dropped to the 50th centile while weight remains on the 75th centile. The child is otherwise well, with no symptoms. What is the most appropriate interpretation of this growth pattern?
- A. This represents normal variation and requires routine monitoring only
- B. This pattern suggests possible growth hormone deficiency requiring investigation
- C. The child is likely experiencing constitutional delay of growth and puberty
- D. This pattern is concerning for chronic disease and warrants investigation (Correct Answer)
- E. This represents familial short stature with normal growth velocity
Explanation: ***This pattern is concerning for chronic disease and warrants investigation*** - A significant drop in height centile (from 75th to 50th) over a year indicates **faltering growth**, which is always a red flag requiring investigation in an 8-year-old. - **Height faltering with preserved weight** often points towards insidious **chronic diseases** such as coeliac disease, inflammatory bowel disease, or renal disease, even when the child is initially asymptomatic. *This represents normal variation and requires routine monitoring only* - **Centile crossing**, especially a downward trajectory of 25 centile points, is not considered normal variation and warrants a proactive workup, not just routine monitoring. - Normal variation typically involves consistent tracking along a centile curve once past infancy, without significant deviation. *This pattern suggests possible growth hormone deficiency requiring investigation* - While **growth hormone deficiency** can cause a drop in height centiles, it often presents with more pronounced **deceleration in growth velocity** and may be associated with increased adiposity or other features. - In an otherwise well child with isolated height faltering and maintained weight, chronic systemic illness is often a more common initial differential than primary growth hormone deficiency. *The child is likely experiencing constitutional delay of growth and puberty* - **Constitutional delay** is characterized by a child growing along a *lower* centile curve from early life, with normal growth velocity, followed by a delayed pubertal growth spurt. - This child was tracking on the 75th centile and then *dropped*, which indicates a change in growth velocity not consistent with a constitutional growth pattern. *This represents familial short stature with normal growth velocity* - **Familial short stature** describes a child who tracks consistently along a lower, but stable, centile curve parallel to the normal curves, reflecting genetic potential. - The described pattern involves a **drop in centile**, indicating a change in growth velocity rather than stable growth along a genetically predetermined lower centile.
Question 110: A 11-month-old infant is brought to the GP for routine review. The parents report that the baby can sit unsupported, transfer objects between hands, and says 'dada' and 'mama' non-specifically. The child does not yet pull to stand. Which statement best describes this developmental profile?
- A. Gross motor development is delayed; other domains are appropriate for age (Correct Answer)
- B. Language development is advanced; gross motor skills are delayed
- C. All developmental domains are appropriate for corrected age
- D. Fine motor and language skills are delayed for age
- E. This represents global developmental delay requiring urgent referral
Explanation: ***Gross motor development is delayed; other domains are appropriate for age*** - By **9 months**, most infants should be able to **pull to stand**; the inability to do so at 11 months indicates a delay in **gross motor** milestones. - **Fine motor** skills (transferring objects at 6–7 months) and **language** skills (non-specific 'mama/dada' at 7–9 months) are consistent with expected development for an 11-month-old. *Language development is advanced; gross motor skills are delayed* - Saying 'mama' and 'dada' **non-specifically** is a milestone typical for **9 months**, so it is age-appropriate rather than advanced. - While the gross motor delay is correctly identified, labeling the language domain as advanced is inaccurate based on standard **developmental charts**. *All developmental domains are appropriate for corrected age* - This statement is incorrect because **pulling to stand** is a significant gross motor milestone that is expected to be present by **9 to 10 months**. - Only the fine motor and language milestones mentioned are truly appropriate for the infant's chronological age of **11 months**. *Fine motor and language skills are delayed for age* - **Transferring objects** between hands is a fine motor skill typically achieved by **6 to 7 months**, making it well within the expected range for this child. - Non-specific vocalizations like 'dada' are expected by **9 months**, so these skills are actually progressing normally, not showing a delay. *This represents global developmental delay requiring urgent referral* - **Global developmental delay** is defined as significant delay in **two or more** developmental domains (e.g., motor, language, social). - Since the delay is isolated to **gross motor** skills, it does not meet the criteria for global delay, though it still requires monitoring and evaluation.
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