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 concerns as early as possible.  The American Academy of Pediatrics (AAP) recommends that healthcare providers do the following:

• Monitor the child’s development during regular well-child visits.
• Screen all children with validated tools at recommended ages 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 delays. 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.
• Share information with early childhood professionals.

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

Developmental screening is more in-depth than monitoring and may identify children with a developmental risk that was not identified during developmental monitoring.

The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening for all children during regular well-child visits at these ages:

• 9 months
• 18 months
• 30 months

In addition, AAP recommends that all children be screened specifically for autism spectrum disorder (ASD) during regular well-child visits at:

• 18 months
• 24 months

Developmental screening with a validated test is recommended for all children at these ages 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.

Evidence-based screening tools that include reports from parents and early childhood professionals 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, 3rd edition, Parents’ Evaluation of Developmental Status with Developmental Milestones, 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. More information is available from the AAP’s Screening Technical Assistance and Resource Center (STAR Center). 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 developmental evaluation 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.

Early care and education 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

The following are resources to integrate screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care:

• The CDC’s Learn the Signs. Act Early program has FREE resources and recommendations for integrating developmental surveillance into health supervision visits.
• The AAP’s Screening Technical Assistance and Resource Center (STAR Center)has resources for implementing surveillance, screening, referral, follow-up and continuing education.
• The AAP’s Developmental Surveillance and Screening webpage has resources for pediatric clinicians, providers, and families including free courses provided by the AAP.
• Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents

References

1. Lipkin PH, Macias MM, Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), e20193449.