A nurse observes a child who cannot wave bye-bye, sits with support (tripod sitting), transfers objects between hands, and has an immature pincer grasp. What is the approximate age of the child?

1. A

   14 months

2. B

   12 months

3. C

   7 months

4. D

   4 months

Appeared in: RML MAINS 2025

Explanation

• The combination of sitting with support (tripod), transferring objects hand-to-hand, and not yet waving bye-bye strongly points to the 6-8 month age range.
• Tripod sitting is a classic gross motor skill for a 6-7 month old who is learning to balance.
• Transferring objects is a key fine motor milestone that develops around 5.5-7 months.
• The inability to wave 'bye-bye' is expected, as this skill typically emerges later, around 9-10 months.
• An 'immature pincer grasp' at this age refers to a raking motion with the fingers, which precedes the true pincer grasp that develops closer to 10-12 months.

Why Other Options Were Wrong

• Option A: A 14-month-old has much more advanced motor skills. They can typically walk independently, build a tower of 2-3 blocks, and use a mature pincer grasp.
• Option B: A 12-month-old should be able to wave bye-bye, stand alone or walk with support, and would have a mature (not immature) pincer grasp.
• Option D: A 4-month-old infant lacks the trunk control to sit, even with support. They can bring hands to the midline but cannot yet purposefully transfer objects from one hand to the other.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Infant Developmental Milestones to guide bedside assessment, documentation, and the next nursing action.
• Nurses use developmental milestone assessments to screen for potential developmental delays. Early identification is crucial for initiating timely interventions.
• Understanding normal developmental progression allows the nurse to provide appropriate anticipatory guidance to parents about safety, nutrition, and stimulating activities for their child's age.
• What if the 7-month-old child could not lift their head or bring hands to the midline? This would be a significant 'red flag' for developmental delay, as these are skills mastered by 4 months, and would warrant an immediate referral for a comprehensive developmental evaluation.

How to Approach the Question

• First, identify the key skills and behaviors mentioned in the question: cannot wave, tripod sitting, transfers objects, immature pincer grasp.
• For each skill, recall the typical age range for its development. Create a mental checklist.
• Analyze the combination of skills. Note both the presence and absence of certain milestones (e.g., 'can do X' but 'cannot do Y').
• Evaluate each option against the cluster of observed milestones. The correct answer will be the age that best matches the overall developmental picture.
• Eliminate options that are clearly too young or too old. A 4-month-old cannot sit up, and a 12-month-old has more advanced skills.
• Select the age that provides the most consistent fit for all the described behaviors.

Concept Tested & Keywords

• Concept Tested: Infant Developmental Milestones
• Stem keywords: child, wave bye-bye, tripod sitting, transfers objects, immature pincer grasp
• Lead-in keywords: approximate age
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

Qbbsl23zTWm3WuHYRdWWV2

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 24-26

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 197-199