Developmental Monitoring and Screening for Health Professionals

If a child has a developmental delay, it is important to identify it early so that the child and family can receive needed intervention services and support. Healthcare providers play a critical role in monitoring children’s growth and development and identifying problems as early as possible.  The American Academy of Pediatrics (AAP) recommends that healthcare providers do the following:

• Monitor the child’s development at each visit.
• Periodically screen children with validated tools to identify any areas of concern that may require a further examination or evaluation.
• Ensure that more comprehensive developmental evaluations are completed if risks are identified.

Developmental monitoring and screening can be done by a number of professionals in healthcare, community, and school settings in collaboration with parents and caregivers. Pediatric primary care providers are in a unique position to promote children’s healthy development because they have regular contact with children before they reach school age, and their families. The AAP encourages pediatric care providers to provide family-centered, comprehensive, and coordinated care.

Developmental Monitoring

Developmental monitoring, also called developmental surveillance, is the process of recognizing children who might be at risk for developmental delays¹. The AAP recommends that developmental monitoring should be a part of every well-child preventive care visit. Monitoring can include using a brief checklist of milestones, but is less formal than developmental screening. Developmental monitoring should include the following:

• Asking about parents’ concerns.
• Obtaining a developmental history.
• Observing the child.
• Identifying risk and protective factors.
• Documenting the findings.

If concerns are identified through developmental monitoring, they should be addressed promptly with validated screening tools to identify and refine any risk or concern that has been noticed.

Developmental Screening

All children should be screened using a validated test during well-child visits at 9, 18, 24, and 30 months even if there are no concerns. Healthcare providers may screen a child more frequently if there are additional risk factors, such as preterm birth, low birthweight, and lead exposure, among others. Developmental screening is more in-depth than monitoring and may identify children with a developmental risk that was not identified during developmental monitoring.

Evidence-based screening tools that include parent reports can help parents and healthcare professionals talk about the child’s development in a systematic way. A number of good screening tools designed for a variety of settings, ages, and purposes are available (e.g., Ages and Stages Questionnaire, the Parents’ Evaluation of Developmental Status, and Child Development Inventory). Screening tools can be specific to a disorder (for example, autism), an area (for example, cognitive development, language, or gross motor skills), or they can be about development in general, addressing multiple areas of concern. A list of examples of validated screening tools is available from the American Academy of Pediatrics.

If the screening test identifies a potential developmental problem, further developmental and medical evaluation is needed. Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed by a thorough assessment done by a trained provider. A more detailed evaluation will show whether the child needs treatment and early developmental intervention services. Medical examinations can identify whether the problems are related to underlying medical conditions that need to be treated.

Children aged 0-3 years can be referred to early intervention programs and children aged 3 years and older can be referred to special education services for assessment and services. Learn more about early intervention and special education. Children with behavior problems can also benefit from parent behavior therapy and may need a referral to a mental health provider.

Teaching Parents and Caregivers to Recognize Developmental Milestones

Parents can monitor a child’s development as well. Research studies have confirmed that parents are reliable sources of information about their child’s development. Parents who are aware of developmental milestones can observe their child and inform their healthcare provider about any concerns they may have about their child’s development. Pediatric healthcare providers can provide parents with milestone checklists to track their child’s milestones at home. CDC’s “Learn the Signs. Act Early.” campaign was designed to give parents and professionals the tools they need to track healthy child development and move toward evaluation and intervention if concerns are noted.

Childcare providers can also be a valuable source of information on how the child is developing.

• Learn the Signs. Act Early. Developmental Milestone checklists
• Birth to 5: Watch Me Thrive – Families
• Motor Delay Tool

Ensuring All Children Have a Medical Home

Quality of care is best when children receive coordinated care and services. Having a medical home means having consistent access to health care that is comprehensive, well-coordinated, and of high quality, and that provides an ongoing relationship with personal providers who treat the whole child. The AAP describes a family-centered medical home as an approach in which the pediatric care team works in partnership with a child and a child’s family to assure that all of the medical and non-medical needs of the patient are met.

In a medical home approach, developmental monitoring and screening includes the following:

• Identifying children with diagnosed developmental disorders as children with special healthcare needs and managing their care as a chronic condition.¹
• Coordinating with specialists about additional evaluation that the child may need.
• Integrating feedback from early childhood providers who can monitor and screen the children in the early childhood setting.

Integrating Developmental Screening into Pediatric Primary Care

Integrating routine developmental screening into the primary care setting can seem daunting but has benefits. The following are resources to help practices integrate screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care:

• AAP’s Practice Resources to Implement Developmental Screening
• Flowchart to Plan Pediatric Developmental Screening
• Freely Available Developmental and Behavioral Screening and Assessment Tools
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents
• Bright Futures: Children with Special Health Care Needs
• CDC’s “Learn the Signs. Act Early.” campaign

References

1. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee and Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics 2006;118(1):405-420.
2. Regalado M, Halfon N. Primary care services promoting optimal child development from birth to age 3 years. Archives of Pediatrics & Adolescent Medicine 2001;155:1311-1322.
3. Skellern C, Rogers Y, O’Calaghan M. A parent-completed developmental questionnaire: Follow up of ex-premature infants. Journal of Paediatrics and Child Health 2001;37(2):125-129.
4. Glascoe FP. Parents’ evaluation of developmental status: how well do parents’ concerns identify children with behavioral and emotional problems? Clinical Pediatrics 2003;42(2):133-138.
5. Glascoe FP. Developmental, Mental Health/Behavioral and Academic Screens, 2010. Updated from Glascoe FP. Collaborating with Parents and Glascoe FP, Robertshaw NS, PEDS: Developmental Milestones, Professionals’ Manual. 2010. Nashville, Tennessee: PEDSTest.com, LLC.