This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Summary

Developmental surveillance should be a component of every preventive care visit. Standardized developmental screening tools should be used when such surveillance identifies concerns about a child's development and for children who appear to be at low risk of a developmental disorder at the 9-, 18-, and 30-month* visits.

When a child has a positive screening result for a developmental problem, developmental and medical evaluations to identify the specific developmental disorders and related medical problems are warranted. In addition, children who have positive screening results for developmental problems should be referred to early developmental intervention and early childhood services and scheduled for earlier return visits to increase developmental surveillance.

Children diagnosed with developmental disorders should be identified as children with special health care needs; chronic-condition management for these children should be initiated.

Recommendations

For the Medical Home

1. Perform developmental surveillance at every preventive visit throughout childhood, and ensure that such surveillance includes eliciting and attending to parents' concerns, obtaining a developmental history, making accurate and informed observations of the child, identifying the presence of risk and protective factors, and documenting the process and findings.
2. Administer a standardized developmental screening tool for children who appear to be at low risk of a developmental disorder at the 9-, 18-, and or 30-month* visits and for those whose surveillance yields concerns about delayed or disordered development.
3. Schedule early return visits for children whose surveillance raises concerns that are not confirmed by a developmental screening tool.
4. Refer children about whom developmental concerns are raised to early intervention and early-childhood programs.
5. Coordinate developmental and medical evaluations for children who have positive screening results for developmental disorders.
6. Initiate a program of chronic-condition management for any child identified with a developmental disorder.
7. Document all surveillance, screening, evaluation, and referral activities in the child's health chart.
8. Establish working relationships with state and local programs, services, and resources.
9. Use a quality-improvement model to integrate surveillance and screening into office procedures and to monitor their effectiveness and outcomes.

For Policy and Advocacy

10. Provide appropriate payment for developmental surveillance, screening, and evaluation.
11. Teach child health professionals, through training and continuing education programs, to conduct developmental surveillance and screening as an integral responsibility of the medical home.

*Note: Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.

A clinical algorithm titled "Developmental surveillance and screening algorithm within a pediatric preventive care visit" is provided in the original guideline document.

The type of evidence supporting each recommendation is not specifically stated.

Not applicable: The guideline was not adapted from another source.

2006 Jul

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Council on Children With Disabilities
Section on Developmental Behavioral Pediatrics
Bright Futures Steering Committee
Medical Home Initiatives for Children With Special Needs Project Advisory Committee

Council on Children With Disabilities: John C. Duby, MD;  Paul H. Lipkin, MD, PRC, Chairperson

Section on Developmental and Behavioral Pediatrics: Michelle M. Macias, MD; Lynn M. Wegner, MD

Bright Futures Steering Committee: Paula Duncan, MD;  Joseph F. Hagan, Jr, MD

Medical Home Initiatives for Children With Special Needs Project Advisory Committee: W. Carl Cooley, MD; Nancy Swigonski, MD, MPH

Liaisons: Paul G. Biondich, MD, MS, Partnership for Policy Implementation (PPI); Donald Lollar, EdD, Centers for Disease Control and Prevention

Staff: Jill Ackermann; Amy Brin, MA; Mary Crane, PhD, LSW; Amy Gibson, MS, RN; Stephanie Mucha Skipper, MPH, Principal Staff; Darcy Steinberg-Hastings, MPH

Consultant: Melissa Capers, MA, MFA

Not stated

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

None available

This NGC summary was completed by ECRI on August 18, 2006. The information was verified by the guideline developer on September 1, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.