Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So if you're ready, let's jump right in.
Leonardo is a healthy four-month-old who was born at 40 weeks gestation. He is in the office for a well-child visit. His parents voice no concerns and state, “He's a very happy baby who loves to eat and is a good sleeper.” Which of the following is an anticipated normative developmental finding on an infant of this age?
I do want to bring a couple of things to your attention. With the stem of the question or the story of the question, before we go along. We are told this baby was born at term. Term is 37 to 42 weeks of gestation. And so he was a term infant. We do not need to correct for prematurity. We're also told that the parents have no concerns over him. So what we should anticipate is there is not going to be any major concern in this. We’re truly looking for something normal, and we're advised normative developmental finding for an infant of this age.
Would it be:
A. Sits without support? This is not correct. While infants between the ages of 4 to 6 months can often sit briefly with support, and a lot of times the family will report, Oh yeah, we prop Leonardo up with a couple of pillows. He can sit not being in a chair, but then he kind of like droops over and he can't support himself for very long, even with some supportive pillows or something like that. They typically do not sit solo without support until they're about 6 to 8 months of age. And if you're thinking, oh, well, how would I remember that? Remember when kids start to sit solo, they look a little bit like the number six because they have that rounded back. And you can remember then they start sitting without support around the time that they're six months old. And as it is with every other developmental milestone, there's a range at 6 to 8 months.
B. Minimal to no Moro reflex noted. That's actually the correct answer. And you might say, well, why would the absence of Moro, be a normative finding? Well, let's take a look at this. The Moro reflex, sometimes called the startle reflex tonic neck reflex, and palmer grasp reflexes are often called collectively the primitive reflexes and are in an infant who is four months of age should be absent or minimally present because that neurological system has developed so rapidly over such a short period of time, there is hardly any resemblance between a brand new day one newborn and a four month old. They're entirely different creatures. Trust me, on that one. And they do lose these more primitive reflexes. Or there might be just like a little touch of them left. That is a normative finding. Persistence of these primitive reflexes is considered to be a developmental concern of a child of this age. Now, let's say that you can elicit one or two of them, but very, very mild in this little one. Again, you’re going to see this baby back at six months for the next well-child visit can just say, all right, I'm going to make note to myself. I'm going to double check at six months and make sure that these are gone. Okay.
C. Rolling from tummy to back. Now, while rolling back to tummy is often noted in infants between the ages of 4 to 6 months, rolling tummy to back takes more strength in developmental maturity and is not achieved until the baby is about 6 to 8 months old. One way to kind of trigger your memory on this is the baby can usually not roll back to tummy until about 6 to 8 months old. And the developmental maturity to do this comes on at about the time the little one can sit solo. Okay.
D. Smiles when smiled to. So that's sometimes known as a responsive smile in developmental terms where the baby in a responsive smile is often even defined more as the baby smiling only when a person smiles at the baby. This occurs between 1 to 3 months, so we would expect that the baby would have a responsive smile at age four months. But this baby will also have spontaneous smile, which occurs at 3 to 4 months of age. That's smiling at somebody, but without a trigger. Well, a four-month-old, of course, will smile when smiled too. This is a developmental milestone that should have been achieved in a healthy infant, which is what Leonardo looks like he is as early as age 1 to 3 months. So therefore, it is not a new milestone. And when choosing the correct answer on a developmental question, what you want to do is choose the most recently achieved milestone, not one that's been present for a while.
Key takeaway One of the most important parts of providing well-child care is performing a developmental assessment, sharing this information with parents and caregivers is a key part of the visit. If a developmental concern is present, early identification provides the opportunity for further monitoring and possibly intervention.
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