A 12-month-old boy is brought to the office by his parents for a routine well-child visit. He was born at 39 weeks gestation. Birth weight was 3.4 kg (7 lb 8 oz) and length was 50.8 cm (20 in) . He was primarily breastfed until last week, when he was transitioned to cow's milk. The patient can feed himself small pieces of table food with his thumb and first finger and drinks from a sippy cup. His only words are "mama," "dada," and "doggy." His parents are concerned about his growth because some children at his day care center seem taller. The patient weighs 12 kg (26.5 lb) and is 76.2 cm (30 in) tall. On examination, he can pull himself up to stand and stand unassisted but requires holding onto objects for support while walking. He comes to his parents when called by name but does not speak during the examination. Which of the following is the most appropriate assessment of this patient's development?

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11ec25c8_d5fc_95d1_bc81_5db06cc64d23_MD0003_00 Routine well-child visits are an opportunity to assess growth and development, as delays can signify a serious medical condition. Infants grow rapidly during the first 6 months of life, gaining approximately 1 oz (30 g) a day for the first 3 months and doubling their birth weight by age 4 months. By age 12 months, an infant's weight triples and height increases by 50%, as seen in this patient. At age 12 months, an infant should stand unassisted and walk while holding objects for support. Although infants may begin to take independent steps at age 12 months, it is considered developmentally normal to not walk independently until age 15 months. A 12-month-old infant typically uses a 2-finger pincer grasp (ie, thumb and first finger) to pick up objects and eat table foods, as seen in this patient. Saying at least 1 word other than "mama" and "dada" is typical language development at this age, and an infant should also be able to follow a 1-step command (eg, come when called) accompanied by a gesture. Although this patient may not demonstrate full language abilities at the physician's office due to shyness in an unfamiliar environment, his reported language development is age-appropriate. This patient also exhibits normal motor milestones and will likely begin walking independently within the next few months. The parents should be reassured that their son is growing and developing normally. Educational objective: By age 12 months, an infant's weight triples and height increases by 50%. Developmental milestones include standing unassisted and learning to walk independently, using a 2-finger pincer grasp, saying 1 word other than "mama" and "dada," and following a 1-step command with a gesture. References: Developmental milestones. (http://www.ncbi.nlm.nih.gov/pubmed/26729779) Growth of breastfed infants. (http://www.ncbi.nlm.nih.gov/pubmed/19827923)

A 12-Month-Old Boy Is Brought to the Office by His