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Gross motor variation — DCH MCQ

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ModerateDevelopmentGross motor variationDCH

A term-born 14-month-old girl is not yet walking independently. She pulls to stand and cruises around furniture. She uses a pincer grip, says two meaningful words and has age-appropriate social development. There has been no regression, and neurological examination is normal. What is the most appropriate management?

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Correct answer: C — Review at 15 months; refer if still not walking or sooner if regression develops

The correct answer is C. She is progressing through the expected gross motor sequence by pulling to stand and cruising, with normal development in other domains and a normal neurological examination. NICE recommends referral to a child development service if a girl is not walking independently by 15 months, corrected for gestational age. She should therefore be reviewed at that threshold and referred if she remains unable to walk. Earlier assessment is required if regression or other neurological abnormalities develop. Cerebral palsy should not be presumed without abnormal tone, posture, movement or asymmetry. Global developmental delay requires significant delay across at least two developmental domains. EEG and urgent MRI are not indicated without seizures, regression, focal neurological findings or other features suggesting intracranial pathology.

Reference: NICE. Suspected neurological conditions: recognition and referral (NG127), section 1.25.2, Motor development delay. Updated 2023. https://www.nice.org.uk/guidance/ng127/chapter/recommendations-for-children-aged-under-16