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Question

Difficulty: MediumNormal Growth and Development

A 9-month-old boy is evaluated in the clinic for a routine well-child examination. His parents recently enrolled him in daycare and are concerned because the caregivers noted he is not yet pointing to toys he wants, unlike some of the older infants in his class. The mother also mentions that while he babbles constantly and says "mama" and "dada," he uses these terms for his daycare teachers as well as his parents. Physical examination reveals an alert, interactive infant who pulls himself to a stand at the exam table. He is able to transfer a block from one hand to the other and uses a three-finger grasp to pick up a small piece of cereal. When the physician hides the block under a small cloth, the infant immediately pulls the cloth away to find it. Which of the following is the most appropriate next step in management?

  1. A
    Referral for formal audiology evaluation
  2. B
    Administration of a standardized autism screening questionnaire
  3. Reassurance and routine pediatric careAnswer
  4. D
    Referral for early intervention speech therapy
  5. E
    Referral for pediatric developmental-behavioral evaluation

Answer

Reassurance and routine pediatric care
The correct answer is reassurance and routine pediatric care because this infant's developmental milestones are entirely appropriate for a 9-month-old. A 9-month-old child is expected to use a three-finger (immature) pincer grasp, pull to a standing position, exhibit object permanence (demonstrated by finding a hidden toy under a cloth), and say "mama" and "dada" nonspecifically. Pointing to share interest and using "mama" and "dada" specifically for the correct parents are milestones typically achieved later, around 12 months of age. Because the infant's development is completely on track, no further diagnostic testing or intervention is indicated at this time.

Step-by-Step Solution

1
Evaluate the patient's reported language and social milestones.
The infant says "mama/dada" nonspecifically and does not point to objects.
To determine if communication skills are appropriate for a 9-month-old. Nonspecific "mama/dada" is normal at 9 months; specific use and pointing to share interest emerge around 12 months.
2
Evaluate the patient's physical examination findings for motor and cognitive development.
The infant pulls to stand, uses a three-finger pincer grasp, and uncovers a hidden toy.
To assess gross motor (pulls to stand), fine motor (three-finger grasp), and cognitive (object permanence) domains, which are all perfectly normal for 9 months.
3
Synthesize the developmental findings to determine the next best step.
All milestones are age-appropriate.
Because the infant's development is entirely on track, no further diagnostic testing, screening, or intervention is indicated beyond routine care.

Key Concept

Normal pediatric developmental milestones at 9 months include pulling to stand, using an immature (three-finger) pincer grasp, exhibiting object permanence, and using nonspecific words like "mama" and "dada."
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Topics

Normal Growth and Development

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