Developmental monitoring: the value of noticing early, and the school's limit

One of the most delicate subjects in early childhood is noticing developmental differences early. It is delicate because the risk runs both ways: noticing late delays support, while interpreting hastily produces unnecessary anxiety and labelling. Roles therefore need to be clear.

What the data say

Kim's review of national developmental screening programmes reports that the prevalence of developmental disabilities is given in the literature as roughly 8–15% and is rising worldwide. The same review notes that the critical period for intervention is before a child reaches three years of age, and that primary care providers are advised to conduct developmental surveillance and screening at scheduled visits.

There is, however, a clear gap between recommendation and practice. In Porter and colleagues' study of paediatric primary care providers, about two thirds of respondents reported using a formal screening tool, with notable variation in which visits and which instruments were used.

The critical gap: access

Edwards and colleagues' Australian study describes a starker picture: only a small share of developmentally vulnerable children reach early intervention services in the preschool years. The same study reports that children from homes where another language is spoken and from socioeconomically disadvantaged families carry higher risk of developmental vulnerability, while accessing traditional clinic-based services less. The system misses most those who need it most.

That finding explains why early childhood institutions matter: the school is the one structure that sees the child every day and is in regular contact with the family. Solís-Cordero and colleagues' analysis of Brazil's public policies reaches a similar conclusion: structures capable of reaching more children with developmental monitoring need to be built.

Where the school's role ends

The line must be clear. An early childhood institution's role is to observe, record and, where warranted, refer. Screening, diagnosing and clinical assessment belong to health and related professions. A teacher's sentence — “this child might have…” — however well meant, leaves a lasting mark on a family and lies outside professional authority.

• The school's job: systematic observation, dated records, sharing with the family, referral where needed.
• Not the school's job: administering screening tools, diagnosing, offering clinical interpretation.
• The value of records: a family who consults a specialist arrives holding concrete, dated observations.
• Language: convey the observation, never the verdict.

The value of noticing early is not in question. But the way to protect that value is not to turn every school into a screening centre: it is to help schools observe well, direct families to the right specialist at the right time, and ensure concrete records travel with them.

References

• Kim, S. (2022). Worldwide national intervention of developmental screening programs in infant and early childhood. Clinical and Experimental Pediatrics.
• Porter, S., Qureshi, R. & Caldwell, B. A. (2016). Developmental surveillance and screening practices by pediatric primary care providers. Infants & Young Children.
• Edwards, K., Fernandez, R. & Rimes, T. (2020). Happy, Healthy, Ready — working with early childhood non-government organisations for developmental surveillance for vulnerable children. Australian Journal of Advanced Nursing.
• Solís-Cordero, K., Palombo, C. N. T. & Oliveira, C. V. R. (2021). Developmental surveillance, screening and evaluation: An analysis of Brazil's public policies for child care. Enfermería Actual en Costa Rica.