A 6-month-old infant does not visually track a face, has no social smile, and does not coo. The parents report normal birth history. Which evaluation is MOST important to perform first?

• A Visual acuity assessment and ophthalmologic evaluation ✓
• B Auditory brainstem response testing (ABR) for hearing
• C MRI brain
• D Chromosomal microarray

Explanation

Failure to fix and follow (track a face) and absent social smile by 6 weeks–3 months should prompt ophthalmic evaluation; by 6 months, absent visual tracking indicates significant visual impairment until proven otherwise. Social smiling begins around 6 weeks (definitely by 3 months); absent vocalization (cooing) by 4 months is also a red flag for hearing or global developmental delay. Since the most prominent finding here is absent visual tracking, ophthalmology referral (excluding cortical visual impairment, cataract, retinal disease) is the most immediate priority. Hearing assessment (ABR) is equally critical for the language delay component but the absent visual tracking dominates.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.