A nurse is assessing a 4-year old preschooler. Which of the following findings should indicate to the nurse a need to refer the child for a possible developmental delay? (Select all that apply.)

The child occasionally reverses letters when writing.

The child is unable to follow simple two-step instructions.

The child occasionally stutters when excited or nervous.

The child has a vocabulary of fewer than 50 words

The child has difficulty sharing toys with peers