All the following milestones are present in a five-month-old child, EXCEPT:

Appeared in: AIIMS Delhi NO-2016

Explanation

Sitting up straight without support is a gross motor skill that develops after the age of five months.
The average age for an infant to sit independently without support is around 6 to 8 months.
At five months, an infant has developing trunk control and can typically sit only with support, often with a rounded back.

Option A: The social smile is one of the earliest social milestones, typically appearing around 2 months of age. It is well-established by five months.
Option B: Cooing, which involves making musical vowel sounds, begins around 2-3 months of age. It is an expected vocalization for a five-month-old.
Option D: Good head support and control (no head lag) is a key milestone achieved by 4 months. A five-month-old has steady head control.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Developmental Milestones in Infancy as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in assessing developmental milestones during well-child visits to identify any potential delays early.
Understanding the normal sequence of development allows nurses to provide appropriate anticipatory guidance to parents about what to expect next and how to create a safe environment (e.g., fall risks once rolling and sitting begin).
What if? If a 9-month-old child was still unable to sit without support, this would be considered a significant developmental delay (a 'red flag'), warranting a referral for a more detailed neurodevelopmental evaluation.

How to Approach the Question

First, identify the keywords in the question: 'five-month-old child' and the negative lead-in 'EXCEPT'.
This means you need to find the one option that is NOT a typical milestone for a 5-month-old.
Mentally review the developmental timeline for each option.
Evaluate each milestone: Is a social smile present at 5 months? Yes. Is cooing present? Yes. Is head support present? Yes.
Evaluate the final milestone: Is sitting up straight (independently) present at 5 months? No, this usually happens later.
Therefore, 'Sitting up straight' is the correct answer because it is the exception.

Concept Tested & Keywords

Concept Tested: Developmental Milestones in Infancy
Stem keywords: milestones, five-month-old, child
Lead-in keywords: EXCEPT
Clinical cues: Age: 5 months - This specific age is the key to evaluating which milestones should be present or absent.
Negative lead-in flag: The question asks for the milestone that is NOT present (EXCEPT).

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

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 33-35

Practise the full AIIMS Delhi NO-2016

Attempt every question from this paper in a timed mock, then review the full solution for each one.