Certified Pediatric Nurse (CPN)

For a 4-month-old being evaluated for development, which finding would be the most concerning?

1. He doesn't hold objects in his hands

2. He doesn't rake objects with his hands

3. He doesn't transfer objects from hand to hand

4. He doesn't clap his hands

The correct answer is: He doesn't hold objects in his hands

At 4 months of age, developmental milestones include certain expectations for fine motor skills. By this age, infants typically start showing some ability to grasp and hold objects. The lack of this ability—specifically not holding objects in hand—indicates potential delays in motor development. In contrast, while raking objects (which refers to using a sweeping motion to bring an object closer) and transferring objects from hand to hand are skills that emerge shortly after 4 months, they are generally considered less critical than the ability to hold objects. Clapping hands is a milestone that occurs later in development (around 9 months), so not demonstrating this skill at 4 months is not as concerning. Therefore, the inability to hold objects signifies a more significant potential concern regarding the child's developmental progress, indicating a need for further assessment or intervention.