A clinic nurse is assessing infants and toddlers for fine and gross motor development. Which child should the nurse refer to a healthcare provider (HCP) for further evaluation?

Rationale: A. 3-year-old preferring to walk on the tip toes: Occasional toe-walking can be normal in toddlers and preschoolers, particularly if it is intermittent and the child has normal muscle tone and coordination. Persistent tip-toe walking may warrant monitoring. B. 5-month-old with use of whole hand grasp: Using a palmar (whole hand) grasp at 5 months is within normal fine motor development milestones. Infants typically progress from a palmar grasp to a raking grasp around 6–7 months, so this finding does not require referral. C. 1½-year-old attempting to scribble on paper: Attempting to scribble at 18 months is an appropriate fine motor milestone. At this age, children are developing the coordination to hold crayons and make random marks, so no referral is necessary. D. 3-month-old with diminished Moro reflex: A diminished or absent Moro reflex at 3 months is abnormal because the reflex should be present until about 4–6 months. This may indicate neurological impairment or developmental delay, making referral essential.