Developmental Delay and Parental Concerns

Summary:

This case focuses on a mother concerned about her child's developmental milestones, particularly verbal skills and walking. At 14 months, the child shows signs of typical development, but the parent is anxious about potential delays.

Key Points:

Developmental Milestones

Verbal Development: Typically expected milestones for 14 months include responding to names and simple commands.
Motor Skills: Includes walking and other physical skills, like the ability to sit independently and stand with support.
Fine Motor Skills: Consider observing pincer grasp (ability to pick up small objects), which is a key fine motor milestone at this age.

Clinical History Taking

Family History: Check for family history of developmental delays or genetic conditions that may affect development.
Pregnancy and Birth History: Important to identify potential risk factors, such as birth complications that might lead to conditions like cerebral palsy.
Hip Dysplasia: Screening should include the "Gower's Sign" – difficulty rising without using hands for support, indicating possible muscle weakness or dysplasia.

Parental Concerns and Social History

Parental Observations: Parents are often attuned to subtle behaviors in their child; asking about the child's sleeping, eating, and unique ways of standing or walking can reveal additional concerns.
Social and Environmental Factors: Determine the primary caregiver and family support; this provides context for the child's social interactions and may impact observed behavior.

Important Considerations:

Normal Variability: Reassure parents that children develop at different rates. Highlight that milestones like independent walking are typically achieved by 18 months.
Follow-Up Strategy: Propose a two-month follow-up to monitor progress, addressing any changes in behavior or new concerns as they arise.

Diagnostic Approach:

Developmental History: Evaluate the child’s social, verbal, and motor skills through specific questions on observed behaviors.
Physical Examination: Check fine motor skills (e.g., pincer grasp), overall muscle tone, and signs of hip dysplasia.
Family and Birth History: Inquire about any familial patterns or birth complications that could contribute to developmental challenges.
Screening for Red Flags: Identify any indicators of severe issues, such as persistent fever, difficulty breathing, or signs of non-accidental injury, even if the primary concern is developmental delay.

Management:

Observation and Monitoring: Recommend reassessing developmental progress at a follow-up in two months rather than immediate intervention, as the child’s age allows room for further growth.
Safety Netting: Educate the parent on red flags like dehydration, breathing issues, or high fever and advise immediate medical consultation if observed.
Reassurance and Education: Educate the parent on typical developmental timelines and encourage a supportive, observant approach rather than constant monitoring, which may increase parental anxiety.

Communication Skills:

Empathetic Reassurance: Validate parental concerns while reassuring them that slight delays are often within the normal range.
Clear Explanations: Use lay language to explain developmental expectations for 14 months, emphasizing individualized growth trajectories.
Structured Follow-Up Offer: Suggest a follow-up meeting in two months to give the parent confidence in the ongoing support for their child’s development.

Ethical Considerations:

Non-accidental Injury Caution: Although unlikely in this case, be alert to any signs of abuse in pediatric cases. However, the focus here is on addressing a parent’s anxiety about normal development.
Parental Anxiety: Recognize and address the parent's heightened concern without reinforcing undue worry. Maintain an objective, reassuring approach.

Additional Resources:

Good Medical Practice (GMC): Guidance on empathetic communication and safe clinical care as outlined in the GMC guidelines.
PLAB 2 Examiner Tips: Be genuine in communication, avoid using "stock phrases" excessively, and focus on structured, clear information delivery.

This structured approach will guide candidates in handling parental concerns about developmental delays effectively, balancing reassurance with proactive follow-up to support the parent and child.