Infant health supervision 6–12 months — branching viva

Branch 1 — Routine 6-month visit

Examiner: How do you open this visit? [1]

Strong answer: Doorway look for wellness, then caregiver agenda, measurements, and structured domains — growth, development, feeding and iron, sleep, injury, oral health, vaccine status, and family psychosocial context — finishing with a shared plan and safety-net. [1] [7]

Examiner: Complementary foods have not started. What do you say? [2]

Strong answer: Around 6 months start iron-rich complementary foods while continuing breastmilk or formula; give practical first-food examples; avoid honey under 12 months; do not switch to unmodified cow’s milk as the main drink; check family supports that make feeding change realistic. [2] [3]

Branch 2 — 9-month iron and development

Examiner: The infant is pale, on cow’s milk bottles, not babbling. Caregiver is unworried. Proceed. [3]

Strong answer: State a problem representation that names iron-risk feeding, communication concern and growth trajectory; examine fully; do not accept non-worry as clearance; start iron pathway per local guidance; arrange audiology and developmental follow-up; book early review; address social determinants. [3] [4]

Examiner: Why not wait for 18-month autism screening? [4]

Strong answer: Developmental surveillance is every visit. Formal autism-specific tools such as M-CHAT-R/F are typically toddler-timed, but absent babble, poor response to sound or social engagement, or regression needs action now rather than calendar delay. [4] [8]

Branch 3 — Converted acute visit

Examiner: At 12 months the infant is mottled and lethargic at vaccine check-in. [1]

Strong answer: Convert to ABCDE and emergency care; call for help; check glucose if consciousness is altered; follow local sepsis pathway as indicated; defer vaccines; document that a preventive booking became acute care; plan catch-up when stable. [1]

Branch 4 — Communication and family

Examiner: Mother screens high for perinatal depression. [7]

Strong answer: Assess infant and caregiver safety today; use empathic non-judgemental language; arrange timely mental-health and social supports; book earlier review; document the shared plan. [7]

Scoring anchors

Threat-first when unwell; iron and complementary-feeding specifics; surveillance is not the same as waiting for a later autism tool; safe sleep and car-seat counselling continue after early infancy; family psychosocial care is part of the visit; leave a concrete safety-net and follow-up. [1] [3] [5] [6] [7]