A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development?

Choice A reason: By 4 months, infants should be able to support their head steadily. Persistent head lag or inability to hold the head upright may indicate neuromuscular delay or hypotonia. This warrants further evaluation to rule out developmental concerns. Choice B reason: Sitting without assistance is not expected at 4 months. Most infants still require support and are developing trunk control. This behavior is within normal limits and does not require referral. Choice C reason: Rolling from prone to supine is an appropriate milestone for 4-month-olds. It reflects developing gross motor skills and is a positive sign of neuromuscular development. Choice D reason: Reaching for nearby objects is a normal fine motor milestone at 4 months. It demonstrates visual-motor coordination and curiosity. This behavior is expected and does not indicate concern.