Bright Futures, the health maintenance recommendations developed in partnership with the American Academy of Pediatrics (AAP), stresses the AAP’s long-standing recommendation to screen children for developmental concerns as a part of well-child care and to refer high-risk children with potential delay for further evaluation and early intervention services. How have we been doing over the years? Lipkin et al (10.1542/peds.2019-0851) turned to AAP Periodic Survey data from 2002, 2009, and 2016 to report on results involving close to 500 pediatricians in each survey with a response rate that hovered around 50% in each of the three years. The good news is that over the 15-year period, pediatricians have increased their use of developmental screening tools from 21% to 63% (p<.001) and increased their referrals to early intervention services from 41% to 59% (p<.001). The bad news is that about a third of pediatricians are not using these tools or are not referring patients as often as they perhaps should be to early intervention—and the surveys suggest that barriers to screening and treatment continue to persist in office settings.
Why is this? We asked Dr. Mei Elansary and Michael Silverstein from Boston Medical Center to weigh in with an accompanying commentary (10.1542/peds.2020-0164). They raise issues such as the changing epidemiology of behavioral and mental health issues in children (e.g. the increased prevalence of autism, long-term developmental issues of very preterm infants, and the role of adverse childhood experiences on developmental advancement), as well as time and adequate reimbursement being barriers to screening, leaving clinical judgment as the lone tool used by many pediatricians. And yet Drs. Elansary and Silverstein note that clinical judgment may be better than not monitoring for developmental progress or delay at all, and some willingness to screen, even if only with clinical judgment is better than no willingness to screen. Perhaps we can learn from the practice of referrals from those who do not use formal screening tools. Check out this study and commentary, and then decide what changes in development screening might develop as a result in your own practice.