Growth, Development & Safeguarding — MCQs
On this page
A 13-year-old girl attends the sexual health clinic requesting emergency contraception following unprotected sexual intercourse 36 hours ago. She appears nervous and is reluctant to provide details. She eventually discloses that her mother's boyfriend, aged 34, is the partner involved. She begs you not to tell anyone as she will 'get in trouble'. What is the most appropriate immediate management regarding confidentiality and safeguarding?
A 3-year-old girl is brought to the emergency department by her father with a scald injury to her buttocks and perineum. He reports she climbed into the bath before he could check the water temperature. The burn has clear demarcation lines with no splash marks. The child appears frightened and clings to the nursing staff rather than her father. There is no past medical history of note. What feature of this presentation is most suggestive of non-accidental injury?
A 5-year-old boy is referred to the community paediatrician because his height has fallen from the 50th centile at age 2 years to the 9th centile currently. His weight remains on the 50th centile. He was born at term with normal birth parameters. His parents are of average height. He has no significant past medical history. On examination, he has mild facial puffiness and dry skin. What is the most likely diagnosis?
A health visitor is assessing developmental milestones in infants. At what age would a typically developing child be expected to demonstrate stranger anxiety and separation anxiety as normal developmental phenomena?
A 6-year-old girl is brought to the emergency department by her mother with a 2-day history of dysuria and offensive-smelling urine. On examination, you notice multiple bruises on her inner thighs in various stages of healing. The mother explains the child is 'very clumsy' and bruises easily. The child appears withdrawn and makes poor eye contact. Urinalysis confirms urinary tract infection. What is the most appropriate immediate action?
A 17-month-old boy is reviewed in the community paediatric clinic. He can walk independently and stoop to pick up toys. He can say 'mama', 'dada', and 3 other words. He can drink from a cup with two hands and helps with dressing by holding out arms. He has a mature pincer grip and can build a tower of 3 cubes. What is the most accurate assessment of this child's development?
A paediatric registrar is reviewing safeguarding procedures for children presenting with fractures. Which clinical scenario most strongly indicates the need for immediate safeguarding investigation?
A 28-month-old girl is brought to the GP by her mother who is concerned about her language development. The child can say approximately 15 single words but does not combine words into phrases. She follows simple one-step commands, points to objects in books when named, and engages in pretend play. Her hearing was tested at 6 months and was normal. She walked independently at 13 months. What is the most appropriate next step?
A 4-year-old boy attends nursery where staff report he is unable to hop on one foot, struggles with pedalling a tricycle, and cannot copy a circle when drawing. He speaks in short 2-3 word phrases and is not toilet trained. His parents report he was born at term with no complications. On examination, he appears well nourished and interactive. What is the most appropriate initial management?
A practice nurse reviews the developmental progress notes for several children in preparation for health surveillance clinics. For a 36-month-old child, which of the following would be most concerning as a potential indicator of developmental delay requiring referral?
Growth, Development & Safeguarding UK Medical PG Practice Questions and MCQs
Question 61: A 13-year-old girl attends the sexual health clinic requesting emergency contraception following unprotected sexual intercourse 36 hours ago. She appears nervous and is reluctant to provide details. She eventually discloses that her mother's boyfriend, aged 34, is the partner involved. She begs you not to tell anyone as she will 'get in trouble'. What is the most appropriate immediate management regarding confidentiality and safeguarding?
- A. Maintain confidentiality as requested and provide emergency contraception without disclosure
- B. Inform the girl you must breach confidentiality and make a safeguarding referral immediately (Correct Answer)
- C. Provide emergency contraception and encourage her to tell her mother herself
- D. Arrange a follow-up appointment to explore the situation further before deciding on disclosure
- E. Contact the police immediately without informing the girl
Explanation: ***Inform the girl you must breach confidentiality and make a safeguarding referral immediately*** - Sexual activity involving a child under the age of 16 with a much older adult (34 years old) in a **position of trust** constitutes **child sexual abuse** and a serious safeguarding concern. - While **Fraser guidelines** support confidentiality for under-16s, it must be breached if there is a risk of **significant harm** or a criminal offense has occurred, necessitating a **multi-agency safeguarding referral**. *Maintain confidentiality as requested and provide emergency contraception without disclosure* - Maintaining absolute confidentiality in this scenario would fail the practitioner's **legal and ethical duty of care** to protect a child from ongoing abuse. - Safeguarding protocols mandate that information must be shared when a child is at risk of **exploitation** or physical/emotional harm. *Provide emergency contraception and encourage her to tell her mother herself* - Placing the burden of disclosure on the child is inappropriate and dangerous, especially when the perpetrator is the **mother's partner** and likely present in the home. - This approach is insufficient as it does not fulfill the **mandatory reporting requirements** for suspected sexual abuse. *Arrange a follow-up appointment to explore the situation further before deciding on disclosure* - Delaying action leaves the child at continued risk of **re-victimization** and further harm within the domestic environment. - Immediate action is required in safeguarding cases involving **sexual contact** between a minor and an adult to ensure the child's safety is prioritized. *Contact the police immediately without informing the girl* - While the police may need to be involved, the practitioner should ideally **inform the patient** before breaching confidentiality to maintain a degree of trust and transparency. - The correct pathway is a **safeguarding referral** to social services or the local safeguarding lead, who then coordinate with the police as part of a multi-agency response.
Question 62: A 3-year-old girl is brought to the emergency department by her father with a scald injury to her buttocks and perineum. He reports she climbed into the bath before he could check the water temperature. The burn has clear demarcation lines with no splash marks. The child appears frightened and clings to the nursing staff rather than her father. There is no past medical history of note. What feature of this presentation is most suggestive of non-accidental injury?
- A. The child's age of 3 years
- B. The anatomical distribution with clear demarcation lines (Correct Answer)
- C. The absence of previous medical attendances
- D. The father bringing the child rather than the mother
- E. The child showing fear and clinging to nursing staff
Explanation: ***The anatomical distribution with clear demarcation lines*** - Burns to the **buttocks and perineum** with **clear demarcation lines** and an absence of **splash marks** strongly suggest **forced immersion**, which is a classic sign of **non-accidental injury (NAI)**. - Accidental scalds usually result in **irregular margins** and splash patterns as the child reflexively moves away from the heat, making the sharp borders incompatible with the provided history. *The child's age of 3 years* - While **toddlers and preschoolers** are at high risk for both accidental and non-accidental injuries, age alone does not differentiate the mechanism of the burn. - A **3-year-old** is developmentally capable of climbing into a bath, so the age is semi-consistent with the story but does not prove NAI. *The absence of previous medical attendances* - A **lack of previous hospital visits** or a clean medical history does not rule out abuse; many children presenting with severe NAI have no prior documented safeguarding concerns. - This is a neutral finding and is less suggestive of **child maltreatment** than objective physical evidence of a forced injury. *The father bringing the child rather than the mother* - The identity of the presenting parent is not a diagnostic indicator of NAI, as it is appropriate for **either caregiver** to seek emergency medical attention. - While the history provided by the caregiver may be inconsistent with clinical findings, the **act of bringing the child** itself is not the most suggestive feature. *The child showing fear and clinging to nursing staff* - While **abnormal attachment behavior** or fear of a caregiver can be a red flag for **emotional or physical abuse**, it is more subjective and less diagnostic than physical burn patterns. - Behavioral responses in a 3-year-old can be influenced by the **trauma of the injury** itself and the unfamiliar environment of the emergency department.
Question 63: A 5-year-old boy is referred to the community paediatrician because his height has fallen from the 50th centile at age 2 years to the 9th centile currently. His weight remains on the 50th centile. He was born at term with normal birth parameters. His parents are of average height. He has no significant past medical history. On examination, he has mild facial puffiness and dry skin. What is the most likely diagnosis?
- A. Constitutional delay of growth and puberty
- B. Growth hormone deficiency
- C. Coeliac disease
- D. Hypothyroidism (Correct Answer)
- E. Familial short stature
Explanation: ***Hypothyroidism*** - Acquired hypothyroidism in children typically presents with **linear growth deceleration** (falling from 50th to 9th centile) while **weight is maintained** (remaining on the 50th centile), leading to a high weight-for-height ratio. - The clinical findings of **mild facial puffiness** and **dry skin** are classic signs of decreased thyroid hormone levels affecting metabolism and skin integrity (myxedema). *Constitutional delay of growth and puberty* - This condition usually presents with a **delayed bone age** and often a family history of delayed growth, but generally involves both height and weight being proportionally low. - It does not typically include **systemic features** like facial puffiness or dry skin, and children are otherwise healthy. *Growth hormone deficiency* - While it causes **growth failure** and a fall in height centiles, it often presents with a **normal or increased weight-for-height ratio** and a "cherubic" appearance. - It does not typically cause **facial puffiness** or **dry skin** as seen in hypothyroidism. *Coeliac disease* - This typically presents as **malabsorption**, where **weight centiles fall first** and are often more severely affected than height centiles. - Children with coeliac disease often appear **thin or wasted** and may have gastrointestinal symptoms, which are not described here. *Familial short stature* - In this condition, the child's height tracks consistently along a specific lower centile, proportional to **parental heights**, without crossing centiles significantly. - These children are clinically well with **normal physical examination findings**, lacking the specific signs like facial puffiness and dry skin.
Question 64: A health visitor is assessing developmental milestones in infants. At what age would a typically developing child be expected to demonstrate stranger anxiety and separation anxiety as normal developmental phenomena?
- A. 12-15 months
- B. 18-24 months
- C. 3-4 months
- D. 5-6 months
- E. 8-9 months (Correct Answer)
Explanation: ***8-9 months***- **Stranger anxiety** and **separation anxiety** typically emerge at this age as infants develop **object permanence** and form specific attachments.- This milestone indicates that the child can distinguish between primary caregivers and unfamiliar individuals, often peaking around **12-18 months**.*12-15 months*- While anxiety remains present, it is already well-established by this stage and is no longer the initial point of **emergence**.- Developmental focus at this age shifts more toward **independent walking** and the beginning of **expressive language**.*18-24 months*- At this stage, separation anxiety typically begins to **gradually diminish** as the child gains a sense of security and independence.- Behavior at this age is often characterized by the "**terrible twos**" and the development of **self-identity**.*3-4 months*- Infants at this age are generally in the stage of **indiscriminate sociability** and will smile at most human faces.- They have not yet developed the **cognitive maturity** or **object permanence** required to experience specific stranger distress.*5-6 months*- Infants can recognize **familiar faces** and their primary caregivers but usually remain friendly with strangers.- True **stranger anxiety** requires a deeper level of cognitive discrimination that typically consolidates a few months later.
Question 65: A 6-year-old girl is brought to the emergency department by her mother with a 2-day history of dysuria and offensive-smelling urine. On examination, you notice multiple bruises on her inner thighs in various stages of healing. The mother explains the child is 'very clumsy' and bruises easily. The child appears withdrawn and makes poor eye contact. Urinalysis confirms urinary tract infection. What is the most appropriate immediate action?
- A. Refer to paediatric haematology for assessment of easy bruising
- B. Treat the urinary tract infection and arrange routine outpatient follow-up
- C. Document concerns, treat the infection, and discuss with the safeguarding lead before discharge (Correct Answer)
- D. Request coagulation studies to investigate possible bleeding disorder
- E. Provide written safety advice about falls prevention and discharge
Explanation: ***Document concerns, treat the infection, and discuss with the safeguarding lead before discharge***- The presence of **inner thigh bruising** (a protected soft-tissue area), **multiple stages of healing**, and a **withdrawn demeanor** are red flags for **non-accidental injury (NAI)** or **potential sexual abuse**.- Healthcare professionals have a duty to **document suspicious findings** and consult with a **safeguarding lead** before the child leaves the clinical setting to ensure their safety.*Treat the urinary tract infection and arrange routine outpatient follow-up*- Routine follow-up is insufficient when there is a risk of **ongoing child abuse**, as it leaves the child in a potentially dangerous environment.- Missing the **safeguarding concerns** highlighted by suspicious bruising locations and behavioral changes is a clinical failure in child protection.*Request coagulation studies to investigate possible bleeding disorder*- While investigating **bleeding disorders** can be a part of the workup for bruising, the **anatomical distribution** (inner thighs) strongly favors child abuse over a medical condition.- Delaying the **safeguarding referral** while waiting for blood results can put the child at further risk of harm.*Refer to paediatric haematology for assessment of easy bruising*- A hematology referral ignores the **behavioral red flags** and the highly suspicious **location of the bruises** that do not match the "clumsiness" narrative.- **Safeguarding assessment** is the clinical priority to manage the immediate risk of physical or sexual trauma.*Provide written safety advice about falls prevention and discharge*- Discharging the child with fall prevention advice accepts the mother's **implausible explanation** for injuries on non-bony prominences.- This action constitutes a serious oversight in **clinical judgment** regarding the protection of a vulnerable child from potential abuse.
Question 66: A 17-month-old boy is reviewed in the community paediatric clinic. He can walk independently and stoop to pick up toys. He can say 'mama', 'dada', and 3 other words. He can drink from a cup with two hands and helps with dressing by holding out arms. He has a mature pincer grip and can build a tower of 3 cubes. What is the most accurate assessment of this child's development?
- A. Global developmental delay requiring urgent neurodevelopmental assessment
- B. Isolated expressive language delay requiring speech therapy referral
- C. Normal development for corrected age if born at 32 weeks gestation
- D. Development appropriate for chronological age (Correct Answer)
- E. Gross motor delay requiring physiotherapy assessment
Explanation: ***Development appropriate for chronological age*** - This child exhibits key developmental milestones within the expected range for **17 months**, including **independent walking** (typically by 15-18 months) and a **mature pincer grip** for building a 3-cube tower (expected by 15-18 months). - His expressive language (5 words including 'mama' and 'dada') and social-adaptive skills (drinking from a cup, helping with dressing) are also consistent with **normal development** for his age. *Global developmental delay requiring urgent neurodevelopmental assessment* - **Global developmental delay** implies significant delay in two or more developmental domains; this child meets milestones across all assessed areas. - Urgent assessment for GDD is indicated for more profound delays, especially if there is **milestone regression** or a severe lack of age-appropriate skills. *Isolated expressive language delay requiring speech therapy referral* - The child's vocabulary of **5 words** is within the normal range for a 17-month-old; typically, 3-5 words are expected by **18 months**. - A referral for **speech therapy** is usually considered if a child has no single words by 18 months or significantly fewer than expected. *Normal development for corrected age if born at 32 weeks gestation* - While his development would be normal for a **corrected age** of 15 months, it is already normal for his **chronological age** of 17 months. - **Correction for prematurity** is applied when development is delayed for chronological age but normal for corrected age; here, the child is developing normally for his actual age. *Gross motor delay requiring physiotherapy assessment* - The child's ability to **walk independently** at 17 months is well within the normal range of 12-18 months for this **gross motor milestone**. - The demonstration of **stooping to pick up toys** further indicates good balance and coordination, negating the need for a **physiotherapy** assessment.
Question 67: A paediatric registrar is reviewing safeguarding procedures for children presenting with fractures. Which clinical scenario most strongly indicates the need for immediate safeguarding investigation?
- A. A 7-year-old boy with a greenstick fracture of the radius sustained falling from monkey bars at school with witnessed account
- B. A 4-month-old infant with a spiral fracture of the humerus whose parents report the baby fell from the sofa (Correct Answer)
- C. A 10-year-old girl with a fractured clavicle sustained during a football match
- D. A 3-year-old boy with a fractured tibia sustained jumping on a trampoline with siblings present
- E. A 14-year-old boy with a fractured wrist from skateboarding with friends
Explanation: ***A 4-month-old infant with a spiral fracture of the humerus whose parents report the baby fell from the sofa*** - A **pre-mobile infant** (under 6 months) lacks the developmental capability to roll or crawl off a surface, making a fall from a sofa a highly **inconsistent mechanism** for a fracture. - **Spiral fractures** result from **torsional (twisting) forces** and are highly suspicious for **non-accidental injury (NAI)** when found in children who are not yet walking. *A 7-year-old boy with a greenstick fracture of the radius sustained falling from monkey bars at school with witnessed account* - **Greenstick fractures** are common pediatric injuries due to the flexibility of young bones and are consistent with a fall onto an **outstretched hand**. - The injury is explained by a **witnessed account** and occurs during an age-appropriate, high-risk activity (monkey bars). *A 10-year-old girl with a fractured clavicle sustained during a football match* - **Clavicle fractures** are frequent injuries in **contact sports** due to direct impact or falls onto the shoulder. - The scenario describes an **age-appropriate activity** where the force involved matches the clinical presentation. *A 3-year-old boy with a fractured tibia sustained jumping on a trampoline with siblings present* - Jumping on **trampolines** is a well-recognized cause of **tibial fractures** (often referred to as 'trampoline fractures') in toddlers. - While trampolines are a safety hazard, the presence of **witnesses (siblings)** and the typical mechanism make this less suspicious for abuse. *A 14-year-old boy with a fractured wrist from skateboarding with friends* - Falling while **skateboarding** is a high-velocity mechanism that frequently results in **distal radius or wrist fractures** in adolescents. - The developmental stage and social context (skateboarding with friends) align with a standard **accidental injury** profile.
Question 68: A 28-month-old girl is brought to the GP by her mother who is concerned about her language development. The child can say approximately 15 single words but does not combine words into phrases. She follows simple one-step commands, points to objects in books when named, and engages in pretend play. Her hearing was tested at 6 months and was normal. She walked independently at 13 months. What is the most appropriate next step?
- A. Reassure that this is within normal limits and review at 3 years
- B. Arrange urgent audiology assessment for hearing test
- C. Refer to speech and language therapy (Correct Answer)
- D. Screen for autism spectrum disorder
- E. Assess for oral motor dysfunction
Explanation: ***Refer to speech and language therapy***- By **24 months**, a child should typically have a vocabulary of **50+ single words** and be able to combine two words into **simple phrases**; this child is 28 months old with only 15 words.- Since her **receptive language** (following commands) and **social skills** (pretend play) are intact, a targeted referral to **speech and language therapy** is the most appropriate intervention to address her expressive delay.*Reassure that this is within normal limits and review at 3 years*- Reassurance is incorrect because the child has failed a major **developmental milestone** for her age, and early intervention is crucial for better outcomes.- Waiting until 3 years would lead to a significant **delay in treatment** for a child who is already well behind the expected expressive language curve.*Arrange urgent audiology assessment for hearing test*- While hearing should be assessed in any child with speech delay, there is no indication for an **urgent** referral as her **receptive language** (pointing to named objects) suggests she can hear.- Her hearing was previously noted as **normal at 6 months**, making a primary deafness diagnosis less likely than a specific expressive language impairment.*Screen for autism spectrum disorder*- Clinical features such as **engaging in pretend play** and **pointing to objects** in books (joint attention) are strong indicators against a diagnosis of **Autism Spectrum Disorder (ASD)**.- This child demonstrates **normal social development** and normal motor milestones, suggesting the issue is isolated to expressive language rather than a pervasive developmental disorder.*Assess for oral motor dysfunction*- Oral motor dysfunction usually presents with difficulties in **feeding, swallowing, or drooling**, none of which are mentioned in this clinical history.- The primary issue here is a lack of **word acquisition and syntax** rather than a mechanical difficulty in articulating or producing sounds (dysarthria).
Question 69: A 4-year-old boy attends nursery where staff report he is unable to hop on one foot, struggles with pedalling a tricycle, and cannot copy a circle when drawing. He speaks in short 2-3 word phrases and is not toilet trained. His parents report he was born at term with no complications. On examination, he appears well nourished and interactive. What is the most appropriate initial management?
- A. Reassure parents this is normal variation and review in 6 months
- B. Refer urgently to paediatrics for assessment of global developmental delay (Correct Answer)
- C. Arrange hearing assessment as priority
- D. Refer to educational psychologist for autism assessment
- E. Commence occupational therapy for fine motor skills
Explanation: ***Refer urgently to paediatrics for assessment of global developmental delay***- This child exhibits significant delays across **multiple domains** including gross motor (cannot hop, struggles pedalling), fine motor (cannot copy circle), language (2-3 word phrases), and adaptive (not toilet trained), which collectively defines **global developmental delay (GDD)**.- At 4 years, children are expected to have mastered these milestones; such pervasive delays warrant an urgent **multidisciplinary paediatric assessment** to determine underlying causes and initiate appropriate interventions.*Reassure parents this is normal variation and review in 6 months*- Significant delays across **multiple developmental domains** in a 4-year-old are not considered normal variation and require prompt investigation, as early intervention is critical.- Delaying assessment risks missing potential underlying **genetic, metabolic, or neurological disorders** that may require urgent diagnosis and management.*Arrange hearing assessment as priority*- While a **hearing assessment** is crucial for evaluating language delay, it does not explain the concurrent **gross motor, fine motor, and adaptive deficits** observed in this child.- An isolated hearing check as a priority would be appropriate for **isolated language delay**, but this child's presentation suggests a more widespread developmental issue.*Refer to educational psychologist for autism assessment*- Although some language and social/adaptive delays can be present in **Autism Spectrum Disorder (ASD)**, the significant **gross and fine motor delays** are not primary diagnostic indicators of ASD.- A comprehensive **paediatric assessment for GDD** is essential first to rule out other neurological, genetic, or metabolic conditions before focusing on a specific neurodevelopmental diagnosis like ASD.*Commence occupational therapy for fine motor skills*- **Occupational therapy** primarily addresses fine motor skills, sensory processing, and activities of daily living, which only targets one component of this child's extensive developmental delays.- Given the delays across **multiple domains**, a holistic and coordinated **multidisciplinary team (MDT)** approach led by a paediatrician is necessary, rather than an isolated therapy referral.
Question 70: A practice nurse reviews the developmental progress notes for several children in preparation for health surveillance clinics. For a 36-month-old child, which of the following would be most concerning as a potential indicator of developmental delay requiring referral?
- A. Unable to pedal a tricycle
- B. Cannot copy a circle when shown how
- C. Uses only two-word phrases with no three-word sentences (Correct Answer)
- D. Cannot give their full name when asked
- E. Unable to walk upstairs alternating feet
Explanation: ***Uses only two-word phrases with no three-word sentences*** - By **36 months (3 years)**, a child is expected to speak in **sentences of 3-4 words**; restricted use of two-word phrases indicates a significant **language delay**. - This is a critical indicator for potential underlying issues like **hearing impairment**, **autism spectrum disorder**, or **global developmental delay**, necessitating immediate referral. *Unable to pedal a tricycle* - While many children learn to **pedal a tricycle** by age 3, it is not considered a critical "red flag" if they master it closer to **3.5 or 4 years**. - This is a **gross motor skill** that can be influenced by lack of exposure or practice rather than a primary developmental pathology. *Cannot copy a circle when shown how* - **Copying a circle** is a fine motor milestone typically achieved between **3 and 4 years** of age. - Failure to perform this exactly at 36 months is considered **borderline** and does not carry the same clinical weight as severe speech delay. *Cannot give their full name when asked* - Most 3-year-olds can provide their **first name**, but consistently knowing and verbalizing a **full name (first and last)** is a skill that often stabilizes closer to **3.5 years**. - This is a component of **social and cognitive development** that can show high individual variability depending on the child's environment. *Unable to walk upstairs alternating feet* - **Alternating feet** while climbing stairs without a railing is a milestone usually perfected between **3.5 and 4 years**. - At 36 months, many children still use a **mark-time gait** (two feet on each step), which is developmentally appropriate for this age.
Practice by Chapter
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free