Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood | Child Development | JAMA Pediatrics | JAMA Network
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Original Investigation
September 2018

Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood

Author Affiliations
  • 1Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
  • 2Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
  • 3Department of Pediatrics, Oregon Health and Sciences University, Portland
  • 4Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Pediatr. 2018;172(9):857-866. doi:10.1001/jamapediatrics.2018.1524
Key Points

Question  What are the latest national estimates of standardized developmental screening and surveillance, as well as individual and state variation, that may identify opportunities for improvement?

Findings  In this cross-sectional analysis of the 2016 National Survey of Children’s Health, an estimated 30.4% of children 9 through 35 months of age received a parent-completed developmental screening and 37.1% received developmental surveillance from a health care professional in the past year. State-level differences far exceeded those by child and family characteristics, spanning 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon).

Meaning  Overall rates of developmental screening and surveillance remain low; however, substantial state-level variation underscores the importance and potential of quality improvement efforts.


Importance  Since 2001, the American Academy of Pediatrics has recommended universal developmental screening and surveillance to promote early diagnosis and intervention and to improve the outcomes of children with developmental delays and disabilities.

Objective  To examine the current prevalence and variation of developmental screening and surveillance of children by various sociodemographic, enabling, and health characteristics.

Design, Setting, and Participants  This cross-sectional analysis of the Health Resources and Services Administration’s 2016 National Survey of Children’s Health—a nationally representative survey of US children completed between June 2016 and February 2017—examined 5668 randomly selected children 9 through 35 months of age whose parent or caregiver responded to the address-based survey by mail or via a website. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population counts of all noninstitutionalized US children residing in housing units.

Main Outcomes and Measures  Developmental screening was measured through a validated set of 3 items indicating receipt in the past year of parent-completed screening from a health care professional with age-appropriate content regarding language development and social behavior. Surveillance was determined by an item capturing verbal elicitation of developmental concerns by a health care professional.

Results  Of the estimated 9.0 million children aged 9 through 35 months, an estimated 30.4% (95% CI, 28.0%-33.0%) were reported by their parent or guardian to have received a parent-completed developmental screening and 37.1% (95% CI, 34.4%-39.8%) were reported to have received developmental surveillance from a health care professional in the past year. Characteristics associated with screening and/or surveillance that remained significant after adjustment included primary household language, family structure, household education, income, medical home, past-year preventive visit, child health status, and special health care needs. Having health care that meets medical home criteria was significantly associated with both developmental screening (adjusted rate ratio, 1.34; 95% CI, 1.13-1.57) and surveillance (adjusted rate ratio, 1.24; 95% CI, 1.08-1.42), representing an 8 to 9 absolute percentage point increase. State-level differences spanned 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon), with approximately 90% of variation not explained by child and family characteristics.

Conclusions and Relevance  Despite more than a decade of initiatives, rates of developmental screening and surveillance remain low. However, state-level variation indicates continued potential for improvement. Systems-level quality improvement efforts, building on the medical home, will be necessary to achieve recommended screening and surveillance goals.