Toddler speech concern — developmental surveillance OSCE · Paeds Cases

Prompt

18-month-old with caregiver speech and social concern.

Objectives

Elicit developmental concerns. [1]
Perform age-adapted observation. [2]
Choose screening/referral appropriately. [3]
Counsel with teach-back and safety-net. [10]

Candidate brief

12-minute station. Caregiver and toddler present. [1]

Expected actions

Open concern-focused history. [1]
Observe joint attention, gesture, words, gait. [2]
Explain surveillance vs screening in plain language. [1]
Plan validated screen / autism-specific tool if indicated with limits of interpretation. [3]
Refer early; safety-net wait time. [10]

Marking

Pass: structured surveillance, correct tool limits, early referral, clear counselling. [1] [3]
Fail: pure wait-and-see despite red flags; screen treated as diagnosis; child used as interpreter. [1] [3] [6]

References

[1]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
[2]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
[3]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
[4]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[5]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
[6]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
[7]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[8]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
[9]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
[10]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428

Marking

References

[1]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
[2]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
[3]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
[4]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[5]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
[6]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
[7]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
[8]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
[9]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
[10]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428