Developmental surveillance — branching viva · Paeds Vivas

Prompt

Well-child clinic with speech and social communication concerns in a toddler.

Stem

You are in clinic with a toddler and caregiver. [1]

Examiner: Define developmental surveillance. [1]

Strong answer: Continuous process each visit: concerns, observation, documentation, action on red flags. [1]

Examiner: How do revised milestone lists help? [2]

Strong answer: Evidence-informed milestones achieved by most children at that age reduce false reassurance. [2]

Examiner: Positive M-CHAT-R pathway — meaning? [3]

Strong answer: Elevated autism risk needing follow-up interview and likely referral; not a diagnosis alone. [3]

Examiner: Mother does not speak English fluently. [6]

Strong answer: Professional interpreter for screening and counselling; not child interpreters. [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

Stem

You are in clinic with a toddler and caregiver. [1]

Examiner: Define developmental surveillance. [1]

Strong answer: Continuous process each visit: concerns, observation, documentation, action on red flags. [1]

Examiner: How do revised milestone lists help? [2]

Strong answer: Evidence-informed milestones achieved by most children at that age reduce false reassurance. [2]

Examiner: Positive M-CHAT-R pathway — meaning? [3]

Strong answer: Elevated autism risk needing follow-up interview and likely referral; not a diagnosis alone. [3]

Examiner: Mother does not speak English fluently. [6]

Strong answer: Professional interpreter for screening and counselling; not child interpreters. [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