From Medscape Public Health > Perspectives in Prevention From the American College of Preventive Medicine
Jacqueline Sedgwick, MD, MPH
Increased Risks for Developmental Delay During Early Childhood
The early years provide the foundation for a child’s future development in most aspects of life, including health, academics, and social and emotional well-being. Epidemiologic studies demonstrate that adverse early childhood experiences, premature birth, and inadequate physical and social support contribute to inequality between and within populations, and that interventions with the child and family can help mitigate the effects of adversity.[1-3] In the United States, poverty, nutritional problems, and chronic physical or mental health issues are prevalent; these modifiable factors contribute to inequality in health, development, and lifespan.[4,5]
A recent study by the Centers for Disease Control and Prevention found that in 2008, 15% of children in the United States were diagnosed with a developmental disability, including attention deficit disorder, intellectual disability, cerebral palsy, or autism, and the proportion of affected children was higher in low-income families. According to US Census statistics from 2010, 17.9% of children live in families with incomes at or below the poverty level. Poverty is often accompanied by limited food options, exposure to environmental hazards, chronic physical and mental health problems, and restricted learning opportunities. Only 47.6% of children 3 and 4 years of age attend preschool, and attendance is lower among children living in low-income families.
Another factor affecting child development is caretaker mental health, and 9% of mothers in the United States experience major depression during the year after giving birth.
The Role of Screening for Child Developmental Delay
Screening is a public health service intended to detect specific medical conditions, even in people who believe they are well or who do not perceive that they are at risk for or are affected by a condition. For screening to be effective, appropriate screening tests and preventive care or treatments must be available and acceptable to clinicians and families. Screening tools can be integrated into well-child checks to identify patients and families at risk for nutritional, physical, mental, developmental, and social support problems.
To efficiently screen patients in busy clinics, clinicians can select age-appropriate screening tests for issues that are prevalent in their patient populations and train staff to implement these tests routinely during periodic well-child visits (Appendix, Table 1). Staff should be trained to:
- Provide age-appropriate screening questionnaires to parents;
- Conduct age-appropriate, routine developmental screenings;
- Offer standardized age-appropriate health education;
- Assist clinicians and parents to help arrange referrals;
- Coordinate care between the practice and outside services; and
- Follow-up with community agencies.
The Maternal and Child Health Bureau and the American Academy of Pediatrics partnered to develop Bright Futures, a health promotion and disease prevention initiative that addresses children’s health needs in the context of family and community. Bright Futures offers excellent screening and health education practice aides.
Having staff complete routine screenings and health education during periodic well-child visits frees clinicians to confirm and review the results with parents, identify parental concerns, and focus on treatment plans while supporting a healthy child/parent relationship. The clinician can begin this portion of the patient visit by asking the parents, "Do you have any concerns or questions that you would like to discuss today?" Addressing parents’ concerns and supporting their decisions helps to develop a relationship that ultimately will benefit the child.
Next, confirm and review the screening test results with parents. The clinician can then provide treatment or refer patients to appropriate community resources for patients and families with similar problems. Training staff to use a practice-specific referral form that includes your practice information and the names and contact information of your referral partners will facilitate this process (Appendix, Table 2).
The staff member who completes your practice’s referral form should give a copy to the child’s parents, fax it with the required information to outside referral agencies, and inform the parents on how best to contact your practice and the referral agency in case they have questions or need to reschedule their appointment. Your practice may want to develop a tracking system to monitor high-risk families. Having staff coordinate referrals, obtain results and recommendations from the outside agencies, and ensure that the patient has a follow-up visit with the clinician will help the clinician to support and monitor the patient’s care and create a medical home.[9,10]
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