KIDS' STUFF
CHANGING A CHILD’S FUTURE THROUGH SCREENING
AUTHOR Megan Krease, DO
P
arents observe their children grow-
ing and changing daily, but often
question if their child is meeting
developmental milestones. Through
apps on their phones such as Wonder
Weeks, YouTube and Google, parents
are trying to decipher if their child is
“normal.” As a pediatrician, development is a
major topic of discussion during office visits, and more structured
guidelines are being incorporated.
Early diagnosis of developmental delays is an integral component
of well child care and essential for early intervention. Delays or
disordered development may indicate risk for other behavioral or
medical complications, thus identification is an important responsi-
bility of health care professionals. Currently, the American Academy
of Pediatrics (AAP) recommends developmental surveillance with
every well child check and standardized screening at nine, 18, and
24 or 30 months. It is vital to highlight the importance of continual
developmental surveillance and screening, as repeated screenings
are more likely to identify a delay.
Developmental surveillance is the process of identifying children
who may be at risk for developmental delays. Delays are observed
when a child is not achieving a skill within an expected time frame.
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LOUISVILLE MEDICINE
At every well child check, surveillance is conducted by the health care
professional by eliciting any parental concerns about development
or behaviors they have observed. Parents often do not differentiate
between development and behavior, thus developmental delays often
manifest through behavioral concerns. Health care professionals
should also elicit any risk factors in the child’s life that may impact
his or her development, ask about changes since the last well visit
and identify any regression of skills. Loss of a developmental skill
can signal a serious underlying medical problem.
During the physical exam, health care professionals continue
surveillance through developmental physical evaluation. This may
include observing the child opening and turning pages of a book,
pointing to specific animals or colors, or interacting with his or her
caregiver. Documentation of parental and/or physician concerns are
important for incorporating appropriate interventions and therapies.
Identification of children at risk for developmental and/or behav-
ioral problems is less sensitive through clinical impressions rather
than formal screening. Thus, the use of standardized tools has been
included in the current recommendations. Per AAP recommen-
dations, screenings should be conducted if there are appropriate
parental concerns or physician concerns, and at age-appropriate well
care visits. Examples of developmental screens include, but are not
limited to, the Ages and Stages Questionnaires, Parents’ Evaluation