Question
A 9-month-old child is brought to OPD with developmental concerns. The child cannot sit with support but can roll over, says “dada” and “mama”, and has stranger anxiety. What is the appropriate management?
| A. |
Order an immediate MRI
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| B. |
Reassure the parents that it’s normal development
|
| C. |
Refer to neurologist for developmental assessment
|
| D. |
Advise parents to start exercises
|
Show Answer
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Correct Answer » C
Explanation
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|
A 9-month-old infant is expected to achieve several developmental milestones:
- Sits without support by 8–9 months
- Rolls over by 5–6 months
- Babbles using “mama” and “dada” nonspecifically by 8–9 months
- Stranger anxiety develops around 6–9 months
In this child:
- Rolling over is appropriate.
- Stranger anxiety is appropriate.
- Saying “mama” and “dada” is appropriate.
- Failure to sit even with support at 9 months is abnormal and represents a gross motor developmental delay.
This warrants a formal developmental assessment to identify the underlying cause and initiate early intervention.
Explanation of the Correct Answer
Option C. Refer the child to a neurologist/developmental pediatrician for developmental assessment
- Correct.
- Failure to achieve an expected gross motor milestone at 9 months is a developmental red flag.
- The child requires detailed neurological examination, developmental assessment, and further investigations if indicated.
- Early diagnosis allows timely intervention and improves long-term outcomes.
Why the Other Options are Incorrect
Option A. Order an immediate MRI
- Incorrect.
- MRI is not the first step in every child with isolated developmental delay.
- A detailed developmental and neurological assessment should precede neuroimaging.
- MRI is indicated if there are focal neurological deficits, abnormal head size, seizures, regression, or suspicion of structural brain abnormalities.
Option B. Reassure the parents that this is normal development
- Incorrect.
- A 9-month-old should be able to sit without support.
- Failure to sit even with support is abnormal and should not be considered normal variation.
Option D. Advise the parents to start exercises
- Incorrect.
- Although physiotherapy may eventually be required, the child should first undergo a comprehensive developmental evaluation to determine the cause of the delay and guide management.
