NBME Form 7 Practice Test

A 14-month-old child is not yet walking but can stand alone, can empty raisins from a cup, and tries to eat with a spoon. The child is at the 25th percentile in length and 30th percentile in weight. What is the most appropriate next step?

Referral to physical therapy

Reassurance

Developmental milestones vary widely, especially in gross motor skills. By about 12 months many children start walking, but some walk later while other skills progress on schedule. This child can stand alone and is showing emerging self-help skills (emptying a cup, using a spoon), with normal growth percentiles. Those signs indicate overall healthy development with motor growth that is plausible to continue to progress over the next few months.

Because there are no red flags and other milestones are appropriate for age, the best step is reassurance and routine developmental surveillance, with follow-up at the next well-child visit or in a few months to ensure progression toward walking. Imaging or therapy isn’t indicated yet unless walking hasn’t begun by around 15–18 months or other milestones become concerning.

Echocardiogram

CT scan of brain