MCQs on Growth and Development

Written by Dr. Emily Chang (MBBS, FRACP) – Paediatrician

Question 1

Maya, a 9-month-old girl, is brought in by her mother for a routine check-up. The mother is concerned that Maya is not yet walking. On examination, Maya can sit without support, crawl, transfer objects from one hand to another, and babble “mama” and “dada” non-specifically. She smiles socially and has a strong attachment to her mother.

Which of the following is the most appropriate response?

A) Reassure the mother that development is normal for age
B) Refer urgently to a paediatric neurologist
C) Schedule physiotherapy for suspected gross motor delay
D) Order brain imaging to rule out cerebral palsy
E) Arrange audiology assessment

Correct Answer: A) Reassure the mother that development is normal for age

At 9 months, normal developmental milestones include:

Gross motor: Sitting without support, crawling (walking is expected closer to 12–15 months)
Fine motor: Transferring objects between hands, raking grasp
Language: Babbling, non-specific “mama” and “dada”
Social: Social smiling, stranger anxiety, strong attachment

Maya’s development in all domains is appropriate for her age. Not walking at 9 months is not a concern, as this typically develops between 12 to 15 months. Therefore, the appropriate action is reassurance.

Question 2

Liam, a 10-month-old boy, is brought to the GP by his father due to concerns about poor weight gain. Liam was born at term with a birth weight of 3.4 kg. His current weight is 6.8 kg, length is 69 cm, and head circumference is 44 cm. All three parameters have dropped from the 50th to below the 3rd percentile over the last 4 months. The father reports that Liam has frequent loose stools and spits up after feeds. On examination, Liam appears alert, with no dysmorphic features or hepatosplenomegaly. Developmentally, he is sitting unsupported and can say “mama” and “dada” nonspecifically.

Which of the following is the most likely underlying cause?

A) Pyloric stenosis
B) Coeliac disease
C) Inadequate caloric intake
D) Congenital hypothyroidism
E) Autism spectrum disorder

Correct Answer: C) Inadequate caloric intake

Failure to thrive (FTT) is defined as inadequate physical growth, typically identified by crossing two or more major percentile lines downward on a growth chart. The most common cause is non-organic, particularly due to inadequate caloric intake, such as feeding difficulties, incorrect formula preparation, or neglect.

In Liam’s case, all growth parameters (weight, length, and head circumference) are affected, but weight is usually affected first in nutritional causes. His development appears appropriate for age, and no dysmorphic or systemic signs point to an organic cause.

Pyloric stenosis usually presents earlier with projectile vomiting and poor weight gain, not chronic FTT. Coeliac disease typically presents after introduction of gluten with symptoms like steatorrhea and irritability, and is rare before 12 months. Congenital hypothyroidism often presents with hypotonia and developmental delay. Autism spectrum disorder may affect social and language development but is not a primary cause of FTT.

Question 3

Jackson, a 3-year-old boy, is brought in by his parents due to concerns about his speech and social interaction. He speaks only a few single words and does not combine words into phrases. He rarely responds to his name and avoids eye contact. He becomes distressed when routines are changed and spends a lot of time spinning the wheels of his toy car. On examination, there are no physical abnormalities, and his hearing screen at 18 months was normal.

Which of the following is the most appropriate next step in management?

A) Reassure the parents that language delay is common at this age
B) Refer for a speech and language therapy assessment only
C) Order an urgent brain MRI
D) Refer for multidisciplinary developmental assessment
E) Initiate risperidone therapy

Correct Answer: D) Refer for multidisciplinary developmental assessment

Jackson presents with several red flags for autism spectrum disorder (ASD): delayed speech, poor eye contact, lack of response to name, resistance to change, and repetitive behaviors (e.g., spinning wheels). These social and behavioral features are consistent with ASD, which typically presents before age 3.

Early diagnosis and intervention are crucial for optimal outcomes in ASD. The gold standard approach involves a multidisciplinary developmental assessment, which includes developmental paediatricians, psychologists, and speech/language pathologists.

While speech therapy will likely be part of the intervention, referral to speech therapy alone is not sufficient for diagnosis. Reassurance without further evaluation is inappropriate given multiple concerning features. Brain imaging is not routinely indicated in ASD unless there are neurological signs. Risperidone is reserved for severe behavioral issues and is not a first-line diagnostic or early intervention strategy.

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15. Paediatrics Module

15.1 Neonatology

15.2 Growth and Development

15.3 Paediatric Neurology

15.4 Paediatric Cardiology

15.5 Paediatric Respiratory

15.6 Paediatric Gastroenterology

15.7 Paediatric Nephrology

15.8 Paediatric Infections

15.9 Other Paediatric Disorders