A nurse is posted in the paediatric immunisation clinic. She notices a child who is very active. He is climbing stairs in the playroom, walking forward and turning pages in a book. Based on these observations, what may be the approximate age of the child?

1. A

   18-24 months

2. B

   8-10 months

3. C

   10-12 months

4. D

   6-9 months

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• The combination of multiple advanced motor skills is the key to identifying the correct age range.
• Confident, forward walking is typically well-established by 18 months.
• Climbing stairs, even with assistance or by crawling up, is a milestone that begins around 15 months and is refined during the 18-24 month period.
• Turning pages in a book, while a fine motor skill, complements the gross motor observations, pointing towards an age where toddlers are actively exploring their environment.
• The simultaneous presence of these skills makes the 18-24 month range the most plausible answer, as earlier stages involve mastering the prerequisites for these actions (e.g., crawling, standing).

Why Other Options Were Wrong

• Option B: At 8-10 months, a child is typically crawling and may be 'cruising' (walking while holding furniture). They do not have the balance or strength for independent walking or climbing stairs.
• Option C: At 10-12 months, a child might be taking their first independent steps but walking is unsteady. They are not yet capable of climbing stairs upright or running.
• Option D: At 6-9 months, major milestones include sitting without support and starting to crawl. The skills of walking and climbing stairs are far too advanced for this age.

Related Visual

• Visual 1: Chart - A developmental milestone chart showing key gross and fine motor skills from 6 months to 3 years. This would visually map skills like sitting, crawling, walking, and climbing to their respective age ranges, making the differences clear.
• Visual 2: Infographic - An infographic illustrating the progression of walking, from cruising (10 months) to independent steps (12-15 months) to running (18 months), to help differentiate the stages.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pediatric Developmental Milestones (Gross and Fine Motor Skills) to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a crucial role in developmental screening during every pediatric visit. Using standardized tools (like the Denver Developmental Screening Test) helps in the early identification of developmental delays.
• Observing a child's play is an effective and informal way to assess their developmental stage. It provides valuable information about their motor, cognitive, and social skills.
• Early detection of developmental delays is critical because it allows for timely referral to specialists (e.g., physical therapists, occupational therapists) and the initiation of early intervention services, which can significantly improve a child's long-term outcomes.

How to Approach the Question

• First, identify the key actions described in the question: climbing stairs, walking forward, and turning pages.
• Categorize these actions into developmental domains (primarily gross motor, with one fine motor skill).
• Recall the typical age ranges for when these specific milestones are achieved. For example, when does walking start vs. when does it become stable? When does stair climbing begin?
• Evaluate each option by comparing the expected milestones for that age against the observed skills.
• Eliminate the age ranges where the observed skills would be too advanced (e.g., a 9-month-old cannot walk and climb stairs).
• Select the age range that best encompasses all the observed activities. The child's ability to perform multiple complex tasks simultaneously points to a more advanced stage of toddlerhood.

Concept Tested & Keywords

• Concept Tested: Pediatric Developmental Milestones (Gross and Fine Motor Skills)
• Stem keywords: paediatric, climbing stairs, walking forward, turning pages, developmental milestones
• Lead-in keywords: approximate age
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

Q0hf35DaONha7AaA9CZV5l

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