a. When the infant, held aloft in a parent’s arms, first crosses the threshold of the doctor’s office, she is likely to quickly glance at the clinician’s face, begin to whimper, and turn to the parent for reassurance. This is evidence of the infant’s growing capacity for social referencing—interpreting facial expressions. If the parent smiles encouragingly, the baby will begin to relax. If the parent looks wary, the baby will become more upset. The clinician can normalize stranger anxiety as a time when difficult behavior accompanies a new developmental step: the abilities to distinguish strangers and decipher facial expressions are consolidating. Parents may be embarrassed about the infant’s unsociable behavior. But clinicians can admire the fact that the baby knows whom she cannot yet trust and that she can turn to parents for reassurance and reliable information about people and situations she does not yet understand. This is also a subtle way of signaling to parents
that their nonverbal communication can reassure the infant about the clinical encounter.

b. Once the baby begins to relax, she may start to explore the new environment. Using her index finger, she will point at something, which she wants to find out about, a new accomplishment in both symbolic thinking and expressive communication that can be shared with parents. She may demonstrate new fine motor dexterity with her pincer grasp (apposition of thumb and index finger), reaching for the otoscope and other office equipment—another touchpoint in which a new developmental capacity brings new challenges. This provides a rapid assessment of infants’ fine motor development and parents’ ability to manage challenging behaviors. The clinician can comment positively on the new abilities, empathize with the new challenges for keeping the baby safe now, and join in problem solving to keep small objects out of reach that might choke her if she tries to swallow them.

c. After the infant has made herself at home with her fine motor mastery of the new setting, she is likely to start demonstrating new gross motor skills next— scooting, cruising, and crawling. This is another new developmental step that will disorganize the whole family. The infant’s behavior in the office provides an opportunity to observe her motor development as well as her parent’s reaction and ability to manage the challenges of new mobility. The onset of mobility requires a new round of baby-proofing at home and, in the office, is another opportunity for shared observation and discovery: “She gets into everything now! What strategies have you discovered to help keep her out of trouble?” Parents are much more responsive to such discussions when they are directly tied to the baby’s on-thespot behaviors and offered in the context of a partnership, rather than teaching.

d. Anticipatory guidance about the next touchpoint: expect the baby to be fussier and more easily frustrated until her drive to take her first step finally leads to success. Starting several weeks before, she is likely to start waking up at night every 3 to 4 hours. Parents may find her standing in her crib, gripping the rails, unable to get herself back down. She is so focused on motor development that she just cannot stop at night. Infants at this age spend more time in light sleep than at any other point in childhood. This temporary sleep cycle change may be necessary for motor learning and memory in preparation for walking. Parents may not be thrilled to learn this, but will be relieved that this regression is in the service of development, and should be temporary, provided that they limit their interactions with the infant when she awakens.