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Developmental Surveillance and Screening

Asking about and addressing parents' concerns is one of the most important and valuable aspects of well-child care. The American Academy of Pediatrics (AAP) recommends that pediatricians ask all parents if they have concerns about their child's learning, development, or behaviors. In addition, the AAP and Bright Futures guidelines call for routine screening by pediatric health care providers for developmental and behavioral problems and delays using standardized developmental screening tools.1

Parents were asked a series of questions to assess whether children received basic developmental surveillance and to measure whether a parent completed a developmental and behavioral screening tool. Specifically, parents were asked: (1) whether the child's doctors or other health care providers asked the parent if he or she had concerns about the child's learning, development or behavior; and (2) whether parents filled out a questionnaire about specific concerns and observations they had about their child's development, communication or social behavior. These items were based on the Promoting Healthy Development Survey.2

Parents of about half of children aged 0-5 years were asked by their children's doctors whether they had concerns about their child's development or behavior, and fewer than 20 percent of children received a standardized developmental screen. The likelihood of being asked about concerns or receiving a standardized screen varied by family income, but did not vary by the child's level of risk for developmental or behavioral delays (data not shown).

Parents with higher household incomes were more likely to report having been asked about their concerns, while parents with lower household incomes were more likely to report having received a standardized developmental screen. Parents of 55.2 percent of children with household incomes of 400 percent or more of the Federal poverty level (FPL) were asked about their concerns, compared to parents of 39.6 percent of children with household incomes below the poverty level. In contrast, parents of 21.7 percent of children with household incomes below poverty reported receiving developmental screening, compared to parents of 17.1 percent of children with household incomes of 400 percent or more of FPL.

1 Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Third edition. Elk Grove Village, IL: American Academy of Pediatrics, 2008.

2Bethell C, Reuland C, Schor E. Assessing health system provision of well-child care: The Promoting Healthy Development Survey. Pediatrics 2001; 107(5): 1084-94.


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