A 6-month-old girl is brought to the office for a routine well-child visit. The patient has been breastfeeding well and has recently started eating pureed solid foods. She babbles but does not say "mama" or "dada." Her 2-year-old brother has a speech delay requiring therapy twice a week. The patient is at the 40th percentile for length, 50th percentile for weight, and 60th percentile for head circumference. She cries when the physician picks her up but is easily consoled by her mother. The patient transfers a toy from her left hand to her right and sits unsupported, but she falls forward after a few seconds. When her father calls her name, she turns to him and smiles. She is unable to pull to a stand and does not crawl. Moro and grasp reflexes are absent. Firm stroking of the soles of her feet causes the big toes to turn up. Which of the following is the most appropriate assessment of this child's development?

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11ec25c8_d5fc_e3f3_bc81_ff4fe9e333b3_MD0003_00 Every well-child examination should include an assessment of developmental milestones, as prompt recognition allows for early intervention with therapies to optimize both skill acquisition and overall long-term health. This infant demonstrates appropriate motor and cognitive developmental skills for a 6-month-old. By 6 months, a child should be able to sit momentarily on propped hands and begin to sit unsupported, as seen in this child. Transferring objects from one hand to another is also a 6-month motor milestone; however, crawling and pulling to a stand is not expected for another few months. This child recognizes her parents and responds appropriately to her name, yet she cries when picked up by the physician. Stranger anxiety is a normal phase of cognitive and social development that can begin as early as age 6 months and last until age 18-24 months. By age 6 months, primitive reflexes (eg, Moro, grasp) have typically already disappeared as the infant initiates purposeful movement of the extremities. The tongue protrusion reflex also disappears by age 4-6 months, allowing for coordination to ingest solid foods at this age. The Babinski reflex is the only primitive reflex that may persist in healthy children up to age 2 years but can disappear as early as age 12 months. Babinski reflex Educational objective: A healthy 6-month-old infant should be able to sit momentarily on propped hands, transfer objects between hands, and respond to name. Stranger anxiety also develops around this age. Primitive Moro and grasp reflexes disappear before 6 months, but Babinski is typically still present. References: Developmental milestones. (http://www.ncbi.nlm.nih.gov/pubmed/26729779)

A 6-Month-Old Girl Is Brought to the Office for a Routine