Pediatric Nurse Practitioner
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Case Scenario 4: Mr. Zee presents to the clinic with his son Eric for a 14-month well-child visit. He expresses concern that Eric is not walking yet. The APRN reviews Eric’s past medical and birth history in the electronic medical record. Max was born at 34.5 weeks’ gestation via emergency C-section and was discharged 2 weeks later.
• What fine motor and gross motor skills should the APRN expect a 15-month-old toddler to perform? Should Eric be able to perform those skills as well? Why or why not?
• What type of screening test(s) should the APRN utilize to assess Eric’s current motor skills?
• What type of anticipatory guidance and support should the APRN provide to monitor and encourage Eric’s continued physical development?
Sample Solution
“Fine motor” refers to the movements we make with the small muscles of the hands. Children start to use their hands right at birth to explore their own bodies and the world around them. Their fine motor skills develop as their whole body starts to move and become more stable. They also learn to do more things with their hands as their cognitive and social/emotional skills improve. Between the ages of 12-18 months, your child will: point to pictures in the books; build a tower using 2 blocks; se their hands together to hold a toy at the middle of their body; scribble with a crayon. Red flags: Your child is not able to use a pincer grasp (thumb and pointer finger) to pick up small objects; Your child’s movements seem shaky or stiff.
