Developmental and Behavioral Surveillance and Screening

In healthy development, a child will acquire new skills beginning prenatally and extending into at least young adulthood. The roots of this acquisition of skills lie in the development of the nervous system, with additional influences from the health status of other organ systems and the physical and social environment in which the development occurs. Development and its milestones are divided into the “streams” of gross motor, fine motor, verbal language (expressive and receptive), social language, and self-help. Behavior can be categorized into observable, spontaneous, and responsive behaviors in the settings of home, school, and community.

Although typical development is associated with a wide variability of skill acquisition in each of these streams, specific developmental and behavioral disorders are seen in approximately 1 of every 6 children and may affect the health, function, and well-being of the child and family for a lifetime. These disorders include rare conditions that often cause severe impairments, such as cerebral palsy and autism, and relatively common conditions such as attention-deficit/hyperactivity disorder, speech language disorders, and behavioral and emotional disorders that affect as many as 1 in 4 children. The more common conditions are generally perceived as “less severe,” but these too can have major short-term and long-term impact on the child's health and daily functioning in the home, school, and community and can affect lifelong well-being. Because of their high prevalence in children; their impact on health, social, and economic status; and their effect on the child, the home, and the community, these disorders require the attention of the pediatrician throughout childhood. In addition, both the child and the family benefit from the early identification and treatment of many of these conditions, including the most severe. It is therefore incumbent on the pediatric clinician to conduct regular developmental surveillance and periodic developmental screening at primary care health supervision visits aimed at early identification and treatment.

Among the many types of developmental or behavioral conditions, the most common include language problems, affecting at least 1 in 10 children (see Chapter 52 ); behavior or emotional disorders, affecting up to 25% of children, with 6% considered serious; attention-deficit/hyperactivity disorder, affecting 1 in 10 children ( Chapter 49 ); and learning disabilities, affecting up to 10% ( Chapters 50 and 51 ). Less common and more disabling are the intellectual disabilities (1–2%; Chapter 53 ); autism spectrum disorders (1 in 59 children; Chapter 54 ); cerebral palsy and related motor impairments (0.3%, or 1 in 345 children; Chapter 616 ); hearing impairment, also referred to as deafness, hard-of-hearing, or hearing loss (0.12%; Chapter 655 ); and nonrefractive vision impairment (0.8%; Chapter 639 ).