During a well-child visit, a 12-month-old who was born 6 weeks premature is noted to use a raking grasp. What is the correct initial step when screening suggests potential delay?

During a well-child visit, a 12-month-old who was born 6 weeks premature is noted to use a raking grasp. What is the correct initial step when screening suggests potential delay?

• A. Refer the infant to a developmental specialist.
• B. Suggest activities to improve fine motor skills.
• C. Perform an in-depth developmental assessment.
• D. Reassure the parent that this is normal for a premature infant.

Answer: (C)

A thorough developmental assessment is the appropriate next step when screening suggests potential delay. Screening tools flag potential concerns, but they don’t diagnose or define the specifics of a delay, so a comprehensive evaluation is needed to understand which domains are affected, the severity, and how it might relate to the child’s prematurity. In this case, the child is 12 months chronological age but 6 weeks premature, so you interpret milestones using corrected age (about 10.5 months). A raking grasp at this stage can be within the expected range for adjusted age, but a single observation isn’t enough to confirm normal development. The in-depth assessment gathers history, parental concerns, and conducts formal testing across multiple domains—gross motor, fine motor, language, and social skills—to determine whether a true delay exists and to guide management. This approach is more informative than simply suggesting activities or reassuring, and it helps decide if early intervention services or referral to a developmental specialist are warranted after the evaluation.

A thorough developmental assessment is the appropriate next step when screening suggests potential delay. Screening tools flag potential concerns, but they don’t diagnose or define the specifics of a delay, so a comprehensive evaluation is needed to understand which domains are affected, the severity, and how it might relate to the child’s prematurity.

In this case, the child is 12 months chronological age but 6 weeks premature, so you interpret milestones using corrected age (about 10.5 months). A raking grasp at this stage can be within the expected range for adjusted age, but a single observation isn’t enough to confirm normal development. The in-depth assessment gathers history, parental concerns, and conducts formal testing across multiple domains—gross motor, fine motor, language, and social skills—to determine whether a true delay exists and to guide management.

This approach is more informative than simply suggesting activities or reassuring, and it helps decide if early intervention services or referral to a developmental specialist are warranted after the evaluation.