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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.
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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
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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
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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
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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.
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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 ...