Welcome to American Academy of Pediatrics (AAP) Developmental Surveillance and Screening Initiatives pages. Watch our brief video to learn more about the AAP's recommendations and guidance on developmental disabilites.
Developmental Surveillance and Screening Patient Care Overview
Given the prevalence of developmental delays and disabilities, all pediatric primary care clinicians should be prepared to screen, identify, and care for children and youth with developmental delays and disabilities and their families.
Activities to promote developmental surveillance and screening are implemented across numerous Academy initiatives, including Bright Futures, the Council on Children with Disabilities, Council on Early Childhood, Section on Developmental and Behavioral Pediatrics, and the Screening Technical Assistance and Resource (STAR) Center.
Below you will find information about developmental surveillance and screening tools and resources for pediatricians. Resources for parents, families, and caregivers are available on the AAP parenting website, HealthyChildren.org.
AAP Policies and Clinical Reports
- 1 in 6 children aged 3-17 years have developmental disabilities- conditions that affect how children play, learn, speak, act, or move.
- Many children with a developmental disability are not identified until after starting school.
- Nationally, only 17% of children younger than 5 years of age with developmental delays received services for those delays.
- Studies of children who are younger than 3 show that large numbers of presumably eligible children are not enrolled in early intervention. Despite high rates of developmental delays among children who receive Early Head Start, <5% of these children were also enrolled in early intervention.
- The percentage of children aged 3–17 years diagnosed with a developmental disorder increased–from 16.2% in 2009–2011 to 17.8% in 2015–2017.
- Specifically, diagnoses increased for attention-deficit/hyperactivity disorder (ADHD) (8.5% to 9.5%), autism spectrum disorder (ASD) (1.1% to 2.5%), and intellectual disabilities (ID) (0.9% to 1.2%).
What is the Difference Between Developmental Surveillance and Developmental Screening?
It is important to understand how developmental surveillance is different from developmental screening.
Developmental Surveillance is an important way for clinicians to identify children at risk for developmental delay and should occur during every health supervision visit. During these visits, clinicians should address developmental progress, concerns, and promotion. AAP recommends conducting developmental surveillance at every health supervision visit, with special attention at the 4- to 5-year visit as the child prepares to enter elementary school. Developmental surveillance resources can be integrated into office procedures.
Six components of developmental surveillance
- Eliciting parent’s concerns
- Obtaining a developmental history
- Observing the child
- Identifying risks, strengths, and protective factors
- Maintaining a record
- Sharing opinions and findings
Developmental screening supplements and strengthens ongoing developmental surveillance to identify subtle risks for developmental delays that parents and pediatricians may not recognize during routine interactions. General developmental screening tests should be conducted at the 9-, 18-, and 30-month health supervision visit. Autism spectrum disorder screening tests should be conducted at the 18- and 24- month health supervision visits. Screening tests should also be administered when a clinician, parents, or early childhood professionals have concerns during surveillance or at any other time concerns arise. Screening involves the use of validated, standardized screening tests used universally at specific ages, as well as when developmental surveillance reveals a concern.
It’s very important to remember that surveillance is NOT screening and should not be thought to take the place of a validated screening tool. Think of surveillance as working together with those specific screening tools!
Developmental Surveillance and Screening Resources for Pediatricians
Here you will find essential resources and helpful tools that you can use for developmental surveillance and screening in your practice.
Resources for Pediatricians to Share with Families
Family Friendly Referral Guide
The AAP offers a free fillable Family Friendly Referral Guide focused on supporting families and caregivers whose child has a developmental concern. Pediatric practices can customize this guide with information about local referral resources, and then use the guide to support families/caregivers in understanding what to do if a developmental concern has been identified. The guide also illustrates the importance of following through with developmental referrals.
Learn the Signs. Act Early.
The Centers for Disease Control and Prevention Learn the Signs. Act Early program provides parents, childcare professionals, and pediatric clinicians free resources, in English and Spanish, for monitoring a child's development. The program offers parent-friendly, research-based milestone checklists for children as young as 2 months of age. The Milestone Tracker mobile app can help parents track their child's development and share the information with their pediatricians.
American Academy of Pediatrics: Universal Screening Urged for Developmental Delays
“Through comprehensive screenings, we hope to identify problem areas and missed milestones before a child turns 3,” said Paul H. Lipkin, MD, FAAP, lead author of the clinical report. “With continued surveillance, early learning and attention problems often become more apparent by age 4 or 5. The earlier we can address these problems, the better.”
HealthyChildren.org Articles for Families
The Academy’s parent facing Web site, HealthyChildren.org, offers numerous articles in English and Spanish related to developmental surveillance and screening. Two articles of particular relevance include Assessing Developmental Delays and How Pediatricians Screen for Autism.
American Academy of Pediatrics