Developmental Surveillance and Screening
Asking about and addressing parents’ concerns is one of the most important aspects of well-child care. A key component of the American Academy of Pediatrics (AAP) recommendations for developmental surveillance is asking 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 The survey assessed whether children received basic developmental surveillance and 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 reported that their health care providers had asked them whether they had concerns about their child’s development or behavior. This percentage did not vary significantly by location, ranging from 47.6 percent in urban areas to 51.6 percent in large rural areas. In all locations, the parents of children with higher household incomes were more likely to report having been asked about their developmental concerns. Within each income group, however, the percentage of children whose parents were asked about their concerns did not vary by location. Overall, fewer than 20 percent of children between 10 months and 5 years of age receive a standardized developmental screen. This percentage did not vary by location, but did vary by household income; in all locations, children with lower household incomes were more likely to receive a standard screening.
1 American Academy of Pediatrics. Statement on Identifying Infants and Young Children with Developmental Disorders in the Medical Home. July 2006; Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 3rd edition. Elk Grove Village, IL: American Academy of Pediatrics, 2008.
2 Bethell C, Reuland C, Schor E. Assessing health system provision of well-child care: The Promoting Healthy Development Survey. Pediatrics 2001;107(5): 1084-94.