Late walker and non-crawler counselling — development OSCE

Objectives

1. Explain WHO walking and crawling windows in plain language. [1]
2. Distinguish healthy bottom-shuffling variation from red-flag motor patterns. [1] [5]
3. Perform or describe a focused motor observation and exam. [2] [3]
4. Leave a dated plan with opportunity supports and safety-net. [3] [10]

Candidate brief

12-minute station. Caregivers present with a lively 14-month-old who bottom-shuffles, sits well, uses both hands, and is not yet walking alone. They fear “missing cerebral palsy” and also fear being “over-medicalised.” No regression reported. [1] [5]

Expected actions

• Elicit exact ages of sitting, locomotion style, pull-to-stand, cruise, hand use and any skill loss. [2] [3]
• Observe spontaneous movement, transitions, symmetry and quality before handling. [2]
• Examine tone, power, reflexes, posture and fine motor; note corrected age only if relevant. [3] [5]
• Explain that walking alone has a wide WHO window (about 8.2–17.6 months) and that some healthy children never hands-and-knees crawl (~4.3%). [1]
• Avoid pure “everything is fine forever” if observation is limited; also avoid MRI-first for normal quality variation. [1] [5]
• Promote floor play and reduce prolonged restrictive devices; book a timed recheck; safety-net regression, asymmetry, stiff/floppy tone, feeding collapse or stalled progress. [3] [10]
• Use a professional interpreter if language discordance is present. [8]

Marking

Pass: correct window framing, quality/symmetry check, variation vs red-flag distinction, dated recheck or appropriate escalation, clear safety-net. [1] [3] [5]
Fail: reassures with “should walk by twelve months” folklore; ignores early hand preference/fisting; orders shotgun imaging for normal exam; pure open-ended wait-and-see with no return plan. [1] [5] [10]