Developmental delay (2016)
Developmental Delay Screening in Children Aged 1-4 Years (2016)
This recommendation applies only to children aged 1 to 4 years who are not at high risk of developmental delay, do not show any signs suggestive of developmental delay, and whose development is not a concern to parents or clinicians. This recommendation therefore applies to children whose ability to reach developmental milestones on time, in the areas of fine and gross motor skills, social/emotional skills, language, and cognition, is not a source of concern. The age at which a milestone is reached should be based on the oldest age at which the skill should have been achieved.
This recommendation does not apply to children for whom signs and symptoms or parental concern may indicate developmental delay, or whose development is closely monitored due to risk factors such as premature birth or low birth weight.
Recommendation
We recommend not screening1 for developmental delay using standardized tools in children aged 1 to 4 years with no apparent signs of developmental delay and whose development is not a concern to parents and clinicians.
(Strong recommendation; low quality evidence)
Implementation Considerations
Screening for developmental delay using standardized tools is not recommended, but clinicians should continue to apply standard clinical practice for children, including surveilling development, identifying risk factors, encouraging parents to express concerns, and discussing development with parents. If a child has significant risk factors for developmental delay, if development is a concern to parents or clinicians, or if a child's developmental trajectory reveals abnormalities, clinicians should consider the possibility of developmental delay and conduct further assessment (or refer for specialist evaluation) appropriate to the clinical picture. Clinicians should stay informed about factors that increase the risk of developmental delay, such as low birth weight, premature birth, or family history, and try to identify potential social, economic, or environmental factors (e.g., low maternal education, mental illness, neglect or abuse, poverty, English/French as a second language) that could reduce the likelihood of parents raising concerns about their child's development.
1Screening refers to population-based screening. It involves the use of standardized tools to identify developmental delay in children who show no apparent signs of such delay, are not considered at high risk of developmental delay, and whose development is not a concern to parents or clinicians.
Screening differs from developmental surveillance, i.e., the ongoing process of monitoring development, identifying risk factors, and encouraging parents to express their concerns. Although the term is commonly used in developmental pediatrics, developmental surveillance is usually considered by the Task Force to be a component of standard clinical practice for children.
Screening differs from case-finding, which involves identifying developmental delay in populations at increased risk and generally does not involve the use of a specific tool. It is often mistakenly believed that screening refers to testing children when developmental delay is suspected or the risk is high.
Both screening and case-finding aim to detect signs or symptoms suggestive of developmental delay, and, where indicated, should be followed by a diagnosis to determine the presence or absence of a specific disorder.