A 9-month-old infant cannot sit without support, has no pincer grasp, and does not babble. She shows no stranger anxiety and does not respond to her name. The mother reports decreased fetal movements during pregnancy. Which developmental domain is MOST delayed, and what is the key clinical flag?

• A Language delay only; normal gross motor
• B Global developmental delay involving gross motor, fine motor, and social domains — absence of stranger anxiety at 9 months is a key red flag ✓
• C Isolated social delay suggesting autism spectrum disorder
• D Motor delay only; language and social milestones are age-appropriate

Explanation

At 9 months, a normal infant can sit without support, demonstrates finger-thumb apposition approaching pincer grasp, babbles with consonant sounds, and exhibits stranger anxiety with differential social engagement (a critical socio-emotional milestone). Absence of stranger anxiety at 9 months, combined with delays across multiple domains (gross motor, fine motor, language, social), indicates global developmental delay requiring comprehensive evaluation including hearing assessment, ophthalmological review, metabolic workup, and neuroimaging. Isolated absence of stranger anxiety could raise an autism flag but only if other social-communication skills are also absent.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.