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Difficulty: MediumNormal Growth and Development

An infant boy aged 9 months is evaluated during a routine health maintenance visit. His parents are anxious about his development after comparing him to other children in their playgroup. The parents report that he can sit without support and pull himself to a standing position using the furniture, but he has not begun to take independent steps. While eating, he grasps small cereal pieces using his thumb and two fingers rather than utilizing a mature grip with just his thumb and index finger. In addition, the infant babbles frequently and says "mama" and "dada," but he uses these sounds indiscriminately without referring specifically to either parent. Over the past month, he has also started crying inconsolably whenever his parents leave him with a familiar babysitter. The physical examination shows a well-appearing, interactive infant with normal muscle tone and reflexes. Which of the following is the most appropriate next step in management?

  1. A
    Administration of an autism spectrum disorder screening tool
  2. B
    Referral for early intervention physical therapy
  3. C
    Referral for formal speech-language evaluation
  4. D
    Referral for occupational therapy
  5. Reassurance and routine careAnswer

Answer

Reassurance and routine care
The correct action is to provide reassurance and routine care because this patient is exhibiting completely normal developmental milestones for a 9-month-old infant. At 9 months, expected milestones include pulling to stand and cruising (gross motor), using an immature or three-finger pincer grasp (fine motor), saying "mama" and "dada" non-specifically (language), and exhibiting separation anxiety or stranger anxiety (social). The parents are expecting 12-month milestones, which include taking independent steps, using a mature two-finger pincer grasp, and saying "mama/dada" specifically.

Step-by-Step Solution

1
Evaluate the infant's gross motor development.
The infant pulls to a stand, which is normal for 9 months. Independent walking is not expected until 12 months.
To determine if there is a gross motor delay warranting physical therapy.
2
Evaluate the infant's fine motor development.
The infant uses an immature, three-finger pincer grasp, which is the expected milestone at 9 months. A mature two-finger grasp develops at 12 months.
To rule out fine motor deficits that would require occupational therapy.
3
Evaluate the infant's language and social development.
Saying "mama/dada" non-specifically is normal at 9 months (specific use is at 12 months). Separation anxiety typically begins between 9 and 12 months as the infant develops object permanence.
To assess for speech delay or abnormal social development (e.g., autism spectrum disorder).
4
Synthesize the milestone assessment into a management plan.
All domains demonstrate normal 9-month milestones. Therefore, the parents should be reassured.
Interventions or specialized screenings are contraindicated for age-appropriate behavior.

Key Concept

Normal developmental milestones at 9 months of age
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Topics

Normal Growth and Development

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