What is the most appropriate management for an 8-month-old infant, born at 28 weeks’ gestation, who is unable to sit without support and has a corrected age of 5 months?

Management of an 8-Month-Old Infant (Born at 28 Weeks) Unable to Sit Without Support

Reassure the parents because the infant's corrected age is 5 months, and sitting without support is not expected until 6-7 months of corrected age. 1, 2

Corrected Age Calculation and Application

For infants born preterm (before 36 weeks' gestation), developmental milestones must be assessed using corrected age rather than chronological age for at least the first 24 months of life. 1, 2 This infant was born at 28 weeks (12 weeks early), making their corrected age 5 months when they are 8 months chronologically. 2

Expected Developmental Milestones at 5 Months Corrected Age

At 5 months corrected age, infants are expected to demonstrate:

• Rolling from prone to supine 1
• Supporting themselves on elbows and wrists in prone position 1
• Keeping hands unfisted most of the time 1
• Grasping and reaching for objects 1

Sitting without support is NOT expected until 6-7 months of corrected age, making this infant's inability to sit independently entirely appropriate for their developmental stage. 1

Surveillance Plan Without Immediate Referral

The American Academy of Pediatrics recommends continuous developmental surveillance with scheduled follow-up rather than immediate extensive evaluation when milestones fall within expected ranges. 1, 3 For this infant:

• Schedule close follow-up at the 9-month chronological age visit (6 months corrected) to reassess motor milestones 1, 3
• Document the infant's current motor abilities including rolling, prone positioning, and hand function 1
• Elicit and address any parental concerns about development 1
• Observe the infant's spontaneous motor function without stressful performance demands 1

Red Flags That Would Require Immediate Referral

Instruct parents to return immediately if any of the following develop:

• Regression or loss of previously acquired motor skills (major red flag for progressive neuromuscular disorders) 1, 4
• Asymmetry in movement patterns or persistent one-handed activities (suggests unilateral cerebral palsy) 1
• Feeding, swallowing, or respiratory concerns 1
• Development of hypotonia (floppiness) or abnormal muscle tone 4

When Referral Would Be Indicated

Referral for developmental evaluation would be appropriate if at the 9-month chronological visit (6 months corrected age), the infant demonstrates:

• Inability to roll over from prone to supine 1
• Inability to support weight on elbows/wrists in prone position 1
• Persistent fisted hands 1
• Failure to grasp or reach for objects 1
• Any regression of previously acquired skills 1, 4

Special Considerations for Extremely Preterm Infants

Infants born at 28 weeks' gestation are at elevated risk for neurodevelopmental disabilities, with risk inversely correlated with gestational age at birth. 2 However, this elevated risk does not change the approach to milestone assessment—corrected age must still be used, and surveillance should continue at regular intervals. 2 The American Academy of Pediatrics emphasizes that ongoing developmental monitoring with early return visits facilitates prompt referrals when indicated, even when specific neuromotor diagnoses have not been identified. 1

Documentation and Parental Education

• Explain to parents the concept of corrected age and why their infant's development should be compared to a 5-month-old, not an 8-month-old 2
• Reassure parents that their infant's current motor abilities are appropriate for corrected age 1
• Provide anticipatory guidance about expected milestones at 6 months corrected age (rolling, sitting with support progressing to independent sitting) 1
• Emphasize that parent concern is valid and they should not hesitate to return if new concerns arise 1