*Developmental surveillance is defined as the process for recognizing children who might be at risk for developmental delays.
**Developmental screening is the use of a standardized validated tool to identify and refine the recognized risk
Why is developmental surveillance necessary? Why the first 3 years of life?
Apart from their genetic potential (or their own “nature”), their environmental stimulation (or their “nurture”) plays important role on their development. If they receive appropriate care, both physically and mentally, they could achieve their full developmental potential. On the other hand, a child with high potential who is neglected or exposed to inappropriate nurturing could have underachieved development.
Early identification of any possible risks or negative factors to a child’s development is crucial, because the sooner we can correct those problems, the better developmental outcome the child can achieve.
How developmental surveillance should be done?
According to the recommendation from the American Academy of Pediatrics and The Royal College of Pediatricians of Thailand, developmental surveillance should be done in every baby visit in every primary care setting using the following steps:
Whenever concern has been raised, either from the child’s caregiver or doctor, proper developmental evaluation should be carried out immediately. However, if there is no concern, every child’s development should still be assessed using proper developmental screening tool on 9, 18 and 24–30 months.
Why should they be assessed at 9, 18 and 24–30 months?
At this age, we can accurately detect problems of crucial developmental milestones, including hearing, vision, and motor development. Also at this time, we may be able to detect delay or deviate social and communication skills, such as the ability to make eye contact, form attachment with the caregiver, indicate their needs, and share their interest to their family member. The delay or deficit social interaction may be an early sign of a particular developmental disorder.
If a child cannot be assessed at 9 months, at least he/she should be assessed before 1 year old.
One and a half year old is an important stage for language development. At this age, a child should be able to say at least one single word, not including words to call out to family members such as papa, mama or dada. If any child is unable to use meaningful words at this age, he/she should be assessed for his/her receptive language (or ability to understand what other people say). A child should be able to follow some simple commands such as “bring a ball to mama”, or “put this in the bin”. If a child isn’t using any meaningful words, and is unable to understand or seems uninterested in other people, he/she should be assessed for possible developmental disorders, such as Autism or developmental language disorder, by developmental specialist.
Crucial problems on motor development should be assessed at this age. If a child has not achieved proper motor milestones such as walking, or shows regression of previous motor development, these findings could be red flags sign for serious neurological disorder.
Children with autism usually show social interaction deficit, delayed communication skills, and may show unusual or limited interest or repetitive behaviors. Well established research evidences confirm that early identification is the key to success for Autism treatment. The earlier the diagnosis is made, the sooner treatment is started, the better outcome of the child achieves.
At this age, any significant developmental problems related to motor, language and social development should have been identified and treatment should have been started already. However, for subtle problems or milder form of developmental disorder, they might just be recognized around this age. Therefore, it is worth to do a final full developmental assessment to pick up any concerns or late problems at this age.
Moreover, this age is the time to prepare for school readiness. In many countries, such as in Thailand, a child starts school at the age of 3, in kindergarten level. Therefore, at two years old, parents should have the opportunity to get advice, discuss about school plans with pediatrician, includes school readiness evaluation and any other concerns on a child’s behavior, especially on attention skill, self-help skill, and social skill.
Who should be responsible for developmental surveillance and screening?
Pediatricians or any medical professionals who see your child regularly could be the perfect person to help monitor your child’s development. If the caregiver or pediatrician raises any concerns, it is worth to proceed with further assessments promptly. They can help parents to arrange proper assessments with the specialist by reliable standardized developmental screening tools.
After developmental screening, what is the next step?
If the assessment result confirms any risk for developmental disorders, the pediatricians in charge will refer the child to a specialist for definite diagnosis and proper treatment or intervention. The specialists they refer to could be a developmental and behavioral pediatrician, neurodevelopmental pediatrician, or child psychiatrist.
Once specialists have confirmed the diagnosis, the child should receive “early intervention” which is tailored for his/her developmental concern. Early intervention includes holistic care from the multidisciplinary team (usually includes developmental and behavioral pediatrician, physical therapists, occupational therapists, speech therapists, and behavioral therapists). The child should receive regular assessment to monitor his/her progression.
If the assessment result shows no developmental abnormality, parents should keep monitoring their child’s developmental progression continuously. Whenever they have any concern at any time, they should inform a medical personal once again for reassessment. If not, the child should receive proper developmental screening as recommended above (9months, 18 months, and 24-30 months).
M.D., Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 1998.