Toddler language concern — normal communication OSCE · Paeds Cases

Prompt

16-month-old with caregiver concern about talking and social engagement.

Objectives

Elicit language and social-communication concerns. [2]
Observe age-adapted communication skills. [1] [4]
Separate domains and identify red flags. [1]
Counsel with a clear plan including hearing and safety-net. [6] [13]

Candidate brief

12-minute station. Caregiver and 16-month-old present. [1]

Expected actions

Open with caregiver concern about talking and connecting. [2]
Observe eye contact, name response, gesture/pointing, babble or words, comprehension and play. [1] [4]
Explain speech versus language versus social communication in plain language. [4]
State red-flag thresholds and why pure wait-and-see is unsafe if present. [1] [2]
Arrange hearing assessment; consider developmental/autism-pathway tools if social concern high. [3] [6]
Give interim talk-read-play strategies and timed follow-up with teach-back. [2] [13]

Marking

Pass: domain-based assessment, correct red flags, hearing plan, early referral when indicated, clear counselling. [1] [2] [6]
Fail: word-count-only assessment; ignore hearing; pure wait-and-see despite red flags; child used as interpreter. [2] [6] [8]

References

[1]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
[2]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
[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]McQuiston S Speech and language development: monitoring process and problems. Pediatrics in review, 2011.PMID 21632874
[5]Feldman HM Evaluation and management of language and speech disorders in preschool children. Pediatrics in review, 2005.PMID 15805236
[6]Moeller MP Early intervention and language development in children who are deaf and hard of hearing. Pediatrics, 2000.PMID 10969127
[7]Garner AS Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 2012.PMID 22201148
[8]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
[9]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
[10]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
[11]Committee on Practice and Ambulatory Medicine 2023 Recommendations for Preventive Pediatric Health Care. Pediatrics, 2023.PMID 36938620
[12]Schonhaut L Validity of the ages and stages questionnaires in term and preterm infants. Pediatrics, 2013.PMID 23629619
[13]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
[14]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731

Expected actions

Open with caregiver concern about talking and connecting. [2]

Observe eye contact, name response, gesture/pointing, babble or words, comprehension and play. [1] [4]

Explain speech versus language versus social communication in plain language. [4]

State red-flag thresholds and why pure wait-and-see is unsafe if present. [1] [2]

Arrange hearing assessment; consider developmental/autism-pathway tools if social concern high. [3] [6]

Give interim talk-read-play strategies and timed follow-up with teach-back. [2] [13]

Marking

References

[1]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
[2]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
[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]McQuiston S Speech and language development: monitoring process and problems. Pediatrics in review, 2011.PMID 21632874
[5]Feldman HM Evaluation and management of language and speech disorders in preschool children. Pediatrics in review, 2005.PMID 15805236
[6]Moeller MP Early intervention and language development in children who are deaf and hard of hearing. Pediatrics, 2000.PMID 10969127
[7]Garner AS Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 2012.PMID 22201148
[8]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
[9]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
[10]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
[11]Committee on Practice and Ambulatory Medicine 2023 Recommendations for Preventive Pediatric Health Care. Pediatrics, 2023.PMID 36938620
[12]Schonhaut L Validity of the ages and stages questionnaires in term and preterm infants. Pediatrics, 2013.PMID 23629619
[13]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
[14]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731