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Each pediatric encounter is an opportunity to monitor a child’s development at a single point in time. Making focused observations about developmental progress and behavioral patterns should be an integral part of each pediatric encounter—in the office or clinic, during acute visits and those for chronic conditions, in the emergency department or an inpatient setting, and during telephone calls. Careful observations and active inquiries about developmental milestones and behaviors provides clinicians with clinical insights into the child and the family.1 Children can be our guides.


Children will do their own developmental assessment if you just give them a chance. Children always practice the leading edge of their developmental competency, work at an emerging or newly acquired skill, and delight in a toy or activity that is just a little new and challenging. The clinician should set the agenda, set the stage, and then let the drama begin. This process depends on the clinician knowing what to look for, what to ask, and what simple maneuvers can be done quickly with a child and family.2


The ongoing process of developmental and behavioral monitoring is the core of developmental surveillance. It is a flexible and longitudinal process that occurs over time in the context of continuity of care in a primary care pediatric setting. Developmental surveillance simultaneously supports healthy development, provides parent education, and identifies children at risk for developmental delays and behavioral conditions. The major components of surveillance are eliciting parent concerns with direct questions, maintaining a developmental history, making informed observations of the child (and child-parent interactions), identifying risk and protective factors, and documenting findings in the medical record.3


One of the most effective ways to feel confident that developmental and behavioral surveillance is a part of each encounter is to ask the parent directly, “Do you have any concerns about your child’s development or behavior?” This open-ended question with an emphasis on the word concern has been shown in many different languages to yield accurate information. The success of this strategy is dependent on allowing the parent enough time to respond without quickly going off to the next question. It requires sufficient time for the parent to tell her story. A parent’s concern often provides the elements of an initial impression that may lead to other questions or a formal screening test.4


Surveillance requires attention to interpersonal process of a clinical interview in order to obtain accurate information. Characteristics of an effective interview include the enhancement of trust, empathy, limiting anxieties that restrict information exchange, and active participation of the parent as discussed in Chapters 3 and 4.


Surveillance can be enhanced by the use of “developmental themes” as a way to focus well-child visits. With the recognition that children progress along several dimensions at any one time, there is usually a specific theme that captures major changes at each age. The use of a ...

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