Paeds SAQs · growth-development-and-behaviour
Normal language, communication and social development — formative SAQs
Formative SAQs on normal language and social-communication milestones, red flags and bedside plans.
On this page & tools
Target exams
SAQ 1 (10 marks)
Parents of a 15-month-old ask what “normal talking” should look like. [1] [4]
- Distinguish receptive language, expressive language and social communication. (3) [4]
- List expected skills around 12–18 months using evidence-informed milestones. (4) [1]
- Name two red flags that would stop pure reassurance today. (3) [1] [2]
Model answer
Receptive language is understanding. Expressive language is words and meaning. Social communication is how skills are used with people — joint attention, gesture, name response and reciprocity. [4] By 12–18 months most children have first meaningful words, emerging pointing/gesture and comprehension of familiar phrases; babble and name response should already be established earlier. [1] Red flags include no words by about 16 months, absent pointing/joint attention, no babble by 12 months, or any regression. [1] [2]
SAQ 2 (10 marks)
A bilingual 22-month-old has few English words. The caregiver is worried. [2] [8]
- How do you assess language without pathologising bilingualism? (3) [8]
- Outline bedside observation priorities. (4) [1] [4]
- Immediate actions if red flags are present. (3) [2] [6] [13]
Model answer
Assess total language exposure across languages; do not count English alone. Use a professional interpreter for history and counselling. [8] Observe name response, joint attention, pointing, comprehension, babble/words and play. Document domains. [1] [4] If red flags exist: arrange hearing assessment, early speech-language therapy referral, social-communication pathway as indicated, written safety-net and timed follow-up — not open wait-and-see. [2] [6] [13]
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