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CHILD DEVELOPMENT: THE BASIC SCIENCE OF PEDIATRICS

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Dr. Julius Richmond (1916–2008), a pediatrician, the first national director of Head Start, and the 12th Surgeon General of the United States (from 1977 to 1981), recognized child development as the basic science of pediatrics. The longitudinal process of child development distinguishes pediatric medicine from all other medical specialties, and child development and behavior have an impact on every pediatric healthcare encounter. In addition, developmental and behavioral concerns are the most prevalent concerns in pediatric medicine. For example, while congenital heart disease affects about 1% of the pediatric population, chronic developmental-behavioral disorders (such as learning disabilities and other learning problems, attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder, intellectual disabilities, and cerebral palsy) affect approximately 20% to 25% of the pediatric population. These numbers indicate that to provide subspecialty level care to all of these patients, board-certified developmental-behavioral pediatricians should outnumber board-certified pediatric cardiologists by at least 20 to 1. In actuality, pediatric cardiologists outnumber developmental-behavioral pediatricians by 4 to 1, resulting in a severe shortage of developmental-behavioral pediatricians and extremely long waiting lists at tertiary care developmental pediatric centers nationally. Thus, the majority of the pediatric population with developmental-behavioral concerns needs to be identified, diagnosed, and longitudinally managed by their primary care pediatric medical providers, reaffirming child development as the basic science of primary care pediatric practice.

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DEVELOPMENTAL SURVEILLANCE, SCREENING, AND EVALUATION

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Because early intervention is critical in optimizing long-term developmental and behavioral outcomes, the American Academy of Pediatrics (AAP) has published policy statements to guide primary care pediatric medical providers in their identification and management of children with developmental delays. Current AAP policy describes three processes aimed at early identification of developmental delays: surveillance, screening, and evaluation. Developmental surveillance is a longitudinal clinical process that includes eliciting parental concerns, identifying medical and psychosocial risk and protective factors, documenting developmental histories provided by parents, and observing the developmental performance of the child. Developmental surveillance takes advantage of the clinical judgment and accumulated experience of pediatric medical providers, and it should be performed at every well-child encounter. Developmental screening involves the use of standardized questionnaires, which should be completed by parents at specified well-child visit ages (9 months, 18 months, 24 to 30 months, and prior to starting preschool or kindergarten). Developmental screening is designed to separate those who require further developmental evaluation from those who do not. If developmental concerns are identified through developmental surveillance or screening, children should be referred to their local early intervention (for children from birth to 3 years) or early childhood special education (for children from 3 to 5 years of age) programs. Developmental evaluation is a more complex process, including standardized developmental evaluation measures (rather than screens), and is aimed at making developmental diagnoses. AAP policy suggests that developmental evaluations can be performed by referral to pediatric subspecialists, such as developmental-behavioral pediatricians; however, given the prevalence of developmental-behavioral concerns in the general pediatric population, ...

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