| Course | DNRS 6800 Advanced Pediatric Development and Behavior |
|---|---|
| Week | Week 3 |
| Paper type | Milestone analysis paper |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for DNRS 6800 Week 3
Milestone Analysis: A 24-Month-Old Whose Family Hears Many Words and Whose Visit Showed Few
Student Name
College of Nursing, Walden University
DNRS 6800: Advanced Pediatric Development and Behavior
Instructor Name
Month Day, Year
Milestone Analysis: A 24-Month-Old Whose Family Hears Many Words and Whose Visit Showed Few
The Pattern Across Domains
Mateo is a composite 24-month-old boy seen for a well-child visit. His family speaks mostly Spanish at home; he attends an English-speaking child care program 3 days a week. Table 1 sets what was seen in the visit beside what his mother reports and the reference milestone from the revised CDC and AAP checklists, which list skills most children, at least 75%, show by 24 months (Zubler et al., 2022).
Table 1
Mateo at 24 Months: Observed, Reported, and Reference Milestone
| Domain | Seen in the visit | Family reports | Reference milestone by 24 months |
|---|---|---|---|
| Gross motor | Runs across the room; kicks a ball forward | "He runs everywhere and climbs the stairs at his grandmother's." | Kicks a ball; runs |
| Fine motor and cognitive | Holds a toy car in one hand while opening a box with the other | "He opens every cupboard." | Holds something in one hand while using the other |
| Receptive language | Points to his nose and eyes when asked in Spanish; points to a dog in a book when asked in English | "He understands everything we say." | Points to at least two body parts when asked |
| Expressive language | Four single words heard, all in English: "car," "no," "ball," "mama"; no two-word combinations | "He says lots of words. He talks all day." | Says at least two words together |
| Social-emotional | Looks at his mother's face when the nurse enters; brings her a toy | "He's very loving with his cousins." | Looks at your face to see how to react in a new situation |
Domain by Domain
Gross motor, fine motor, receptive language, and social-emotional development line up: what was seen, what the family reports, and the reference milestones agree. His receptive language is particularly reassuring, because he followed requests in both languages.
Expressive language does not line up, and this paragraph carries the problem. In the visit, he said four single English words and did not combine words. His mother says, "He says lots of words. He talks all day." Both accounts can be true. The clinic heard him in English, in an unfamiliar room, for 20 minutes; his mother hears him in Spanish, at home, all day. The reference milestone of two-word combinations was not seen, but the setting was the one least likely to show it. The mismatch is real, and it is not yet a finding about Mateo; it is a finding about what the two sources of information could each observe.
Two Ordinary Explanations
The first is that he is developing two languages and was sampled in the weaker one. In a study of children from about 22 to 30 months of age, bilingually developing children scored below monolingual peers on vocabulary and grammar when each language was measured alone, but were comparable on total vocabulary across both languages, and their skill in each language tracked the amount of input in that language (Hoff et al., 2012). A child with mostly Spanish input would be expected to show more words and combinations in Spanish.
The second is that his expressive language is delayed in both languages and his mother's report reflects warmth and familiarity more than a count of words. Parents often understand a toddler's approximations that others would not recognize as words.
A third explanation, a hearing problem, was considered and set aside for now: he turns to his name from across the room, follows spoken requests without visual cues in both languages, and passed his newborn hearing screen. If the two-language count shows a delay, a hearing test would be part of the evaluation rather than assumed normal. The order matters. Checking the ordinary explanations first avoids labeling a typically developing bilingual child as delayed, a mistake that can lead families to drop the home language in the belief that it is the cause.
Closing Judgment
The first explanation is more likely, given his strong understanding in both languages, his social engagement, and the input pattern. The judgment would change on one piece of evidence: a count of his words and word combinations in Spanish. His mother will be asked to complete a two-language vocabulary checklist before the next visit and to write down any two-word phrases she hears over a week. If his combined vocabulary is below what is expected at his age, or he has no word combinations in either language, the concern moves from explaining a mismatch to acting on a delay, and a speech-language evaluation in both languages is requested, consistent with the surveillance approach that treats a concern as grounds for screening rather than waiting (Lipkin et al., 2020).
References
Hoff, E., Core, C., Place, S., Rumiche, R., Señor, M., & Parra, M. (2012). Dual language exposure and early bilingual development. Journal of Child Language, 39(1), 1-27. https://doi.org/10.1017/S0305000910000759
Lipkin, P. H., Macias, M. M., Council on Children With Disabilities, & Section on Developmental and Behavioral Pediatrics. (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), Article e20193449. https://doi.org/10.1542/peds.2019-3449
Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics, 149(3), Article e2021052138. https://doi.org/10.1542/peds.2021-052138
DNRS 6800 Week 3 instructions, in plain terms
The third week commonly asks for a milestone analysis of a child at a given age, comparing observed and reported skills against developmental norms across domains. You assess gross motor, fine motor, language, cognitive and social or emotional development, identify any concerns, and recommend next steps. DNRS 6800 prompts often add a factor that complicates interpretation, such as prematurity or bilingual exposure. DNRS 6800 milestone papers are structured, three to five APA pages, and usually carry a table. Cite current milestone references and research specific to the complicating factor. The conclusion should state whether the pattern warrants referral, rescreening or routine follow-up. Each domain needs coverage, even those that look fine. Report the child's age in months on the day of the visit. Where a parent report and the visit disagree, the prompt usually wants both recorded and the gap explained.
How the DNRS 6800 Week 3 example is put together
A compact table opens the paper: domain down the left, what the child was seen doing, what the family reports, and a reference band from a published surveillance schedule. Gross motor and receptive language line up. Expressive language does not, and the mismatch is left visible in the table instead of averaged away in prose. The paragraphs beneath work one domain at a time, and the expressive language paragraph is longest because it carries the problem. The family account is quoted rather than paraphrased, which keeps the parent's certainty and the writer's uncertainty distinguishable. A short paragraph names two ordinary explanations for the gap, including a bilingual home, before the closing judgment picks one and says what would change it.
DNRS 6800 Week 3 rubric: what earns full marks
Graders on a milestone paper look first for whether every required domain was addressed, and thin coverage of the domains that looked fine is a quiet way to lose a row that was easy to keep. The second row rewards a named, cited reference standard, because a milestone claim without one is an opinion about a child. The example cites its schedule at first use and never floats an age expectation unattributed. Points bleed away when a paper resolves the parent's account and the observed pattern by simply preferring one, with no sentence acknowledging that a family sees a child in settings a clinic never will. Papers also lose marks for a conclusion that arrives softened into meaninglessness, where three hedges cancel each other and no reader can say what the writer decided.
Common DNRS 6800 Week 3 mistakes, and how to avoid them
The quiet loss on milestone papers is thin coverage of the domains that looked typical; write a sentence or two of evidence for each one. Another common error is reading low English vocabulary in a bilingual toddler as delay without counting both languages. Writers also let the parent report and the visit observation sit side by side without explaining the difference. Name the likely reasons, such as a child who is quiet in a clinic. Avoid diagnostic labels at a single visit. Make sure the age used for comparison matches the child's exact age. Close with a clear next step and when it should happen. Writers also skip the screening tool result when one was used, though it anchors the comparison. And remember that a child who attends English child care three days a week is still building both languages, so the reference point must match.
Get a DNRS 6800 Week 3 example written to your instructions
Send the Week 3 prompt with the rubric your section posted and, if you have one, the domain list it requires. The desk returns a milestone analysis built to that structure, first one free, back in 24-48 hours, with its table and its reference standard laid out so you can see how the comparison is carried.
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DNRS 6800 Week 3 questions, answered
Does the example use a specific screening tool?
It names a published surveillance schedule and cites it properly, because a milestone claim needs an attributable standard behind it. Which instrument your section expects is set by your prompt, and tools differ in age bands and in the populations they were built on. The example is written so that swapping the reference changes citations and numbers without disturbing the argument.
Is Week 3 the milestone assignment in every section?
Not necessarily. There is no public Walden schedule to point at, so the shelf describes a typical arc: early weeks establish how development gets documented, and a milestone comparison commonly lands in this stretch. Some sections run it a week either side, and some fold it into a longer case. The classroom is the authority.
What if the family account and the observation contradict each other?
That is usually the paper. The example treats the contradiction as its finding rather than a nuisance, quotes both sources fairly, and states which one carries more weight for this particular question and why. Graders reward writing that can hold two accounts at once far more than writing that quietly discards the inconvenient one.
Where can I find a free DNRS 6800 Week 3 sample paper?
Mateo's milestone analysis is printed here with the comparison table, the domain by domain reading, the two ordinary explanations and the closing judgment.
How are bilingual toddlers assessed for language in DNRS 6800 Week 3?
The example counts words across both languages and compares that total with expectations, so a small English vocabulary is not mistaken for delay.