At an 18-month well-child visit, which finding would raise concern for developmental delay?

• A. Rarely speaks.
• B. Holds own bottle.
• C. Walks independently.
• D. Uses two-word phrases.

Answer: (A)

Language development at around 18 months is a key signal of developmental progress. By this age, children typically have a growing vocabulary and may start putting two words together. A child who rarely speaks raises concern for a potential language delay and prompts evaluation for possible speech-language issues, and sometimes hearing problems, since hearing is essential for language acquisition. This would lead to a plan that may include a hearing screen and referral to a speech-language pathologist if needed.

The other findings fit within normal variation for this age. Walking independently is expected by around 18 months. Holding a bottle is common as children are transitioning to self-feeding and cup use. Using two-word phrases may be developing for some children around this time, so while it’s a positive sign of growth, its absence doesn’t by itself indicate delay as strongly as very limited speech does.