Missed opportunities in surveillance and screening systems to detect developmental delay: A developing country perspective

The future of human societies depends on children being able to achieve their optimal physical and psychological development. Developmental delay is failure to acquire age-appropriate functionality. It may involve one or more streams of development. Responsive parenting has potential to promote better development. Primary health physicians are in the best arrangement to provide this assistance as they can monitor child's development longitudinally and understand the child's developmental trajectory better. Current strategy employed by majority of primary-care providers to monitor the trajectory is termed 'developmental surveillance'. It is "a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care". Age-appropriate developmental checklists are also used to record milestones as part of surveillance. Both, the American Academy of Pediatrics and the British Joint Working Party on Child Health Services, recommend developmental surveillance by physicians as a method of identification of developmental delays. Developmental screening, however, improves the accuracy of identifying children with delay, compared with surveillance. Primary health physicians should consider using developmental screening tools that are standardized, reliable, valid and practical in the office setting, be familiar with screening techniques which should be incorporated into ongoing care, and keep abreast of current literature. Pakistan, as a developing country, needs specific strategies to ensure that we seize all the chances to detect this delay at an earlier age and introduce intervention, in order to lessen the burden of the disability on child, family and society.