Abstract
Objective:
Clinicians and caregivers rely on milestone checklists as tools for tracking a child’s development. In addition, medical students and residents use milestone checklists to learn about normal child development. However, there are multiple published milestone checklists that vary qualitatively in structure and content, hindering their effective use in developmental surveillance and medical education. This project systematically evaluated the consistency and variability between commonly used milestone checklists.
Methods:
A team of child psychologists and developmental pediatricians reviewed a total of 1,094 milestones derived from four published checklists (two developed for providers, two developed for caregivers) in order to create a comprehensive set of 728 discrete developmental observations, with each observation mapped to corresponding milestones. This observation-milestone relational database was then used to determine the degree of content overlap and milestone age-range concordance across milestone checklists.
Results:
Of the 728 discrete developmental observations, 40 (5.5%) mapped to milestones in all four milestone checklists, and an additional 90 (12.4%) mapped to three checklists. Among these 40 “universal” observations, most (42.5%) were in the motor domain. Of those 130 observations mapped to milestones in at least 3 of the 4 checklists, 26.9% (35/130) mapped to milestones that were discordant in their associated age range.
Conclusions:
Four commonly used developmental milestone checklists were found to have limited overlap in content and those that overlapped were inconsistent in their associated age-ranges. The resulting observation-milestone relational database could be used to further validate age-estimates of milestones and facilitate milestone surveillance through the electronic health record.
Keywords: Growth/Developmental Milestones, Developmental Surveillance, Developmental/Behavioral Issues, Community Pediatrics
INTRODUCTION
Identification of developmental delays in young children is the first step in referral to early intervention and improving developmental and behavioral outcomes. As such, the American Academy of Pediatrics (AAP) recommends ongoing developmental surveillance at all health supervision visits, and developmental screening using evidence-based tools at 9-, 18-, and 24- or 30-month visits.1 However, adoption of developmental screening in the primary care setting has been challenging due to a variety of issues including administration time and cost2,3, lack of a gold-standard screening tool, and concern over the effectiveness of available tools. Despite AAP recommendations for screening, fewer than half of primary care physicians surveyed 3 years after this recommendation use a validated screening tool.4 More recently, an analysis from the 2016 National Survey of Children’s Health found fewer than 40% of parents with children between 9 and 35 months reported being asked about their child’s learning, development, or behavior by their health care provider with large differences between states.5 Interestingly, integration of developmental surveillance and screening into the electronic health record (EHR) through computerized clinical decision support systems have shown promise in improving rates of screening6, however integration of such tools is not widespread across EHR platforms.
Developmental surveillance is defined as a “flexible, longitudinal, continuous, and cumulative process where by health care professionals identify children who may have developmental delays”.1 It is informed by several factors including (1) eliciting and attending to parents’ concerns about their child’s development, (2) documenting and maintaining a developmental history, (3) observing a child’s abilities, (4) identifying risk and protective factors, and (5) maintaining a record of the above findings.1 Developmental milestone checklists are commonly used by health professional as tools for tracking and documenting development as part of developmental surveillance.2 In addition, in order to improve parents’ knowledge of typical development, both the AAP7 and the Centers for Disease Control and Prevention (CDC)8 have developed milestone checklists and mobile apps, aimed at caregivers, encouraging parents to act early if they have concerns about their child’s development. Finally, milestone checklists are also used in medical and resident education to teach typical development, and memorization of milestones is tested on Board examinations. However, several limitations have also been raised regarding the quality and utility of milestone checklists4,9:
Variability:
There are multiple sources for developmental milestones available to both providers and caregivers, however they vary considerably in their specificity, structure, and timelines. For example, the majority of sources present milestones associated with their mean age of acquisition (50th percentile)9–11, while others report the 75th or 90th percentile, and others no information at all.12 In addition, milestone checklists are often organized into different age groups. For example, Bright Futures10, a checklist developed for providers, presents milestones associated with timing of well child visits, while HealthyChildren.org7, a website for parents from the AAP, reports milestones for longer age ranges—grouping together all milestones between 1–2 years of age. Such variability can lead to confusion for both providers and parents on when to have concerns and in turn, when to refer.
Unclear validity:
Many of the original sources for developmental milestone checklists are from studies of either small sample sizes or of limited diversity9,13,14. Studies investigating the longitudinal development of milestones across cultures, socioeconomic status, and geography are lacking. Indeed, evidence suggests that surveillance alone, compared to screening, leads to delayed identification of and referral for developmental delay15. Despite this, the validity of screening tools have also been questioned, as both the US Preventative Service Task Force and Canadian Task Force on Preventative Health Care have found insufficient evidence to support developmental screening in children16–18, although surveillance using developmental milestones is still recommended.
Given the apparent disconnect between promotion, adoption, and consistency amongst milestone checklists, this study aimed to systematically evaluate the consistency and variability between four common developmental milestones checklists, used either by physicians (Bright Futures, 3rd edition10 and those recurrently published in Pediatrics in Review11,19–21), or caregivers (CDC: Learn the Signs. Act Early8 and Healthy Children: Ages and Stages7). In order to overcome variability in the language and organization of the milestone checklists, a comprehensive list of developmental observations were developed and individual milestones were mapped to these observations. We examined how consistent these checklists were with respect to the milestones covered, as well as the expected age for milestones present across checklists.
METHODS
Relational Database Development
Given the broad audience for milestone checklists, two checklists aimed at caregivers and two checklists aimed at providers were chosen from respected organizations. A team of expert developmental specialists came to group consensus on the checklists chosen based on the following criteria: wide-spread use, age range covered at least 0–5 years, overlapping primary sources (in order to increase likelihood of consensus), and inclusion of milestones in at least four domains (motor, language, cognitive, and social-emotional). Table 1 describes characteristics for each of these milestone checklists, including their primary sources.
Table 1:
Characteristic of Analyzed Milestone Checklists
| Characteristic | CDC: Learn the Signs. Act Early. | Healthy Children: Ages and Stages | Bright Futures 3rd Edition | Pediatrics in Review Article (Scharf et. al) |
|---|---|---|---|---|
| Aimed Audience | Caregiver | Caregiver | Physician | Physician |
| Total # of milestones | 214 | 183 | 171 | 525 |
| Target ages for milestones | 2, 4, 6, 9, 12, 18, 24, 36, 48, 60 | 1, 3, 7, 12, 24, 48, 60 | <1, 1, 2, 4, 6, 9, 12, 15, 18, 24, 30, 36, 48, 72 | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 18, 20, 22, 24, 28, 30, 33, 36, 48, 60, 72 |
| Categories | Language/Communication Cognitive Movement/Physical Development Social/Emotional |
Movement Visual and Hearing Smell and Touch Social and Emotional Language Cognitive |
Social-Emotional Communicative Cognitive Physical |
Gross Motor Fine Motor Self-Help Problem-solving Social/Emotional Receptive Language Expressive Language |
| Sources cited by system | Caring for your baby and young child: Birth to Age 5, 5th Edition12 Bright Futures, 3rd Edition9 |
Caring for your baby and young child: Birth to Age 5, 5th Edition12 | Early Language Milestone Scale. 2nd Edition23 DENVER II Training Manual24 |
Johnson, C. AAP Council on Children with Disabilities. Contributions from Glascoe, FP, Robertshaw, N, and Trimm, F. CDC: Learn the Signs. Act Early8 National Institute for Literacy/Reach Out and Read Brigance Diagnostic Inventory of Early Development25 |
The team was composed of child psychologists and developmental-behavioral pediatricians – three faculty members (1 MD, 2 PhD) in Developmental-Behavioral-Pediatrics at Boston Children’s Hospital with an average of 16.7 years of experience, and two MD fellows in Developmental-Behavioral-Pediatrics. Observations were created or rewritten from existing milestones in order to be 1) unambiguous, 2) discrete, and 3) objectively observable behaviors or skills that could be mapped to one or more milestones. Given that the milestone table presented in the 2016 Pediatrics in Review paper19 had the most extensive list of milestones, and a large majority of these were already in the form of a discrete observation, these were first used to create the master list of observations. Working in pairs, team members then reviewed milestones from the three remaining checklists and either matched them with the appropriate existing observation(s) or created new observations when appropriate. Discrepancies warranting further discussion were tagged. Each observation and its corresponding milestones were then reviewed in-person by the full team. During these meetings, observation-milestone associations, and the wording of observations were finalized using expert group consensus (See Table 2 for examples). This resulted in the creation of an observation-milestone relational database which was further analyzed. A list of all the observations with links to their corresponding milestones is available at www.idob.info.
Table 2:
Examples of common discrepancies between milestone checklists. Target age is provided next to each milestone.
| Observation | CDC | Healthy Children | Bright Futures | Peds in Review |
|---|---|---|---|---|
| Examples of numeric milestone discrepancies | ||||
| Draws a 2-part person | Draws person with two to four body parts (48) | Draws person with two to four body parts (48) | Draws a person with 2 body parts (head and one other part) (36) | Draws a two-to-three-part person (36) |
| Draws a 3-part person | Draws person with two to four body parts (48) | Draws person with two to four body parts (48) | Draws a person with 3 parts (48) | Draws a two-to-three-part person (36) |
| Draws a 4-part person | Draws person with two to four body parts (48) | Draws person with two to four body parts (48) | Draws a four-to-six-part person (48) | |
| Examples of inconsistent description of skills | ||||
| Uses simple gestures | Uses simple gestures, like shaking head “no” or waving “bye-bye” (12) Says and shakes head “no” (18) |
Uses simple gestures, such as shaking head for “no” (12) | Waves “bye-bye” (12) | Shakes head for “no”. (8) Wave “bye-bye” (10) |
| Engages in pretend play with other people (eg. tea party, birthday party) | Plays simple make believe games (24) | Begins make-believe play (24) | Play is starting to include other children to an increasing degree, such as play tea parties or chase games (30) | Engages in pretend play with other people (eg, tea party, birthday party) (18) |
Common Discrepancies
During the above process, several common conflicts between milestone sources were observed. Below we describe each of these conflicts and how they were aligned.
Numeric milestones:
Many of the milestone sources used different ranges of numbers to describe a skill. For example: “Draws a two-to-three-part person” versus “Draws person with 2 to 4 body parts.” For these cases the milestone was matched to multiple observations, each specific to the discrete observable number (Table 2).
Inconsistent description of skills:
Different milestone sources often describe the same skill in different ways. In some cases milestones describe a very specific observation that is likely meant to represent a larger skill set. These differences were discussed as a team and a single observation was created using wording that was both specific and comprehensive. For example, milestones “Shakes head “no” and “Waves “bye-bye”” were associated with the single observations – “Uses simple gestures”. In other cases, milestones are quite broad, especially when compared to similar, but more detailed milestones – “throws ball overhand” vs “throws ball overhand 10 feet”. In these cases multiple specific observations were created with broad milestones matching to multiple observations.
Conglomerates:
Milestones were often composed of two related but discrete skills. For example: “Says and shakes head ‘no’” or “May walk up steps and run”. These milestones may be confusing if a child has mastered only one of the two skills listed. From these milestones, two observations were created with the same milestone associated with each. In some cases, it was difficult to discern whether booleans like “and” and “or” were to be taken strictly. For these purposes, we considered all conjunctions to be a non-exclusive “or.”
Target age differences:
Milestones matched to the same observation were often noted to have different target ages. For example, “Throws ball overhand” has a target age of 24-months in the CDC: Learn the Signs, Act Early checklist and 48-months in the Healthy Children: Ages and Stages checklist. Given this, an analysis of age concordance (described below) was performed.
Analysis of observation-milestone relational database
A total of 728 unique observations were created, mapping to 1094 milestones from across all four milestone checklists. As shown in Table 1, each checklist varied in the age range of milestones covered, as well as the number of milestones included. Given the variability in age ranges covered, analyses were limited to milestones targeted at 72 months or younger. Additionally, the analysis excluded inverse-type milestones used by some checklists, where a negative observation (“Can’t hold head steady”) is listed at a certain age as cause for concern.
Age concordance analysis:
Since each of the four milestone checklists use different target ages, the following analysis was developed to determine whether milestones associated with a common observation also shared a similar target age (Figure 1). Target ages across checklists were defined as concordant if they either (1) matched exactly or (2) the target age from one checklist (eg. 18 months, CDC) was adjacent to the target age from another checklist (eg. 12 and 24 months from Healthy Children; 15 and 24 months from Bright Futures; 16 and 20 months from Pediatrics in Review). Using this method, a 5-month milestone in Pediatrics in Review, would be age-concordant with CDC and Bright Futures milestones at 4 and 6 months, Healthy Children’s milestones at 3 and 7 months, but not milestones in those checklists at 9 or 12 months. Using this analysis, age concordance for an observation was defined as the maximum number of age-concordant associated milestones (Figure 1 for examples).
Figure 1:
1A – An example visualization of analysis determining age concordance among all four systems for a single observation. Solid lines represent paths finding successful agreement between milestones, while dashed lines show attempted but failed paths. Colored blocks show the target age at which the observation is represented by a milestone in the correspondingly- colored system. In an effort to be permissive, the analysis determines the final level of agreement based on the highest number of concordant systems. Figure 1B – An example visualization of analysis showing age concordance among three systems for a single observation.
RESULTS
Variability between Milestone Checklists
In order to assess the variability in types of milestones included the checklists analyzed, we determined the number of milestones within each checklist that referenced developmental observations shared by other milestone checklists. Surprisingly, there was low overlap between milestone checklists. While all milestones checklists had at least 170 individual milestones, on average only 40 milestones within a checklist were shared with the other three checklists (Table 3).
Table 3:
Content overlap between Milestone Checklists
| Milestone Checklist | Total | No overlap | 1 other checklist | 2 other checklists | 3 other checklists |
|---|---|---|---|---|---|
| CDC | 214 | 22 (10.3%) | 68 (31.8%) | 80 (37.4%) | 44 (20.6%) |
| Healthy Children | 183 | 33 (18.0%) | 57 (31.1%) | 57 (31.1%) | 36 (19.7%) |
| Bright Futures | 171 | 40 (23.4%) | 60 (35.1%) | 33 (19.3%) | 38 (22.2%) |
| Peds in Review | 525 | 303 (57.7%) | 91 (17.3%) | 87 (16.6%) | 45 (8.6%) |
As shown in Table 3, the Pediatrics in Review checklist had over twice as many milestones, and therefore had many milestones that did not overlap with other systems. Many of these milestones covered progressive abilities at developmental timepoints not covered by other systems (eg. “Transfers objects hand-mouth-hand at 5-months), or covered academic and social milestones at the older age ranges that were not included in other checklists (eg. Reads 25 words; Apologizes for mistakes; Responds to “why” questions”).
Universal Observations
We next set out to determine which developmental observations mapped onto all four milestone checklists. 40 of the 728 observations (5.5%) were associated with milestones from all four checklists. Table 4 shows a list of these 40 “universal” observations. Among the 40 universal observations, over 40% (17 of 40) were in the motor domain. In addition, of the 160 milestones associated with these 40 universal observations, 130 (81.3%) represented skills that occurred at 36 months or younger (Figure 2A).
Table 4:
Universal observations, referenced by all four analyzed checklists
Motor/Physical Development
|
Language/Communication
|
Social/Emotional
|
Cognitive
|
Figure 2: Histograms of age distribution for milestones.
A: A total of 160 milestones were associated with the 40 universal observations found in all 4 systems. 130 of those milestones represent skills between 0 and 36 months of age. B: A total of 418 milestones were associated with the 130 observations found in at least 3 of the 4 systems. 322 of those milestones represent skills between 0 and 36 months of age.
Given the small number of universal observations, we next determined which observations were associated with milestones across three of four checklists. 90 (12.4%) additional observations were identified. We then used these set of observations to analyze the degree of content consensus across checklists. Of these 90 observations, each checklist contributed to varying degrees, with Bright Futures contributing to the fewest observations: CDC 83/90 (92%); Pediatrics in Review 81/90 (90%); Healthy Children 64/90 (71%), Bright Futures 38/90 (42%).
Age Concordance
Variability in milestones sources has been previously observed, but not specifically analyzed in a data driven manner. During the development of the observation-milestone relational database (see methods) we frequently noted that the target age for milestones differed between checklists.
Using the finalized observation-milestone relational database, we were able to formally assess the degree of these age discrepancies (see methods for description of analysis, Figure 1).
Of those 130 observations mapped to milestones in at least 3 of the 4 checklists, 26.9% (35/130) mapped to milestones that were discordant in their associated age range. Within the 40 universal observations, just over half (22) had age concordance between all four checklists, while the majority (36) had age concordance between milestones from three checklists. For the 130 observations covered by at least three milestone checklists, 73.1% (95/130) had age concordance between at least 3 checklists, while 98.5% (128/130) had age concordance between at least two checklists. Table 5 shows the list of 22 milestones that were both present in all four milestone checklists and had consistent expected ages in all four checklists.
Table 5:
Universally-agreed observations and their expected ages
| Observation | CDC | Healthy Children | Bright Futures | Peds in Review |
|---|---|---|---|---|
| Supports upper body with arms when lying on stomach | 4 | 3 | 2 | 3 |
| Makes sounds to show joy and displeasure | 6 | 7 | 4 | 5 |
| Begins to respond to name | 6 | 7 | 6 | 5 |
| Sits without support steadily | 6, 9 | 7 | 6 | 7 |
| Moves easily on hands and knees | 9 | 12 | 9 | 10 |
| Pulls to stand | 9 | 12 | 9 | 9 |
| Copies gestures (like waving bye bye) | 9, 12 | 12 | 12, 15 | 10 |
| Immature jargoning: inflection without real words | 12 | 12 | 12 | 13 |
| Uses simple gestures | 12, 18 | 12 | 12 | 8, 10 |
| Puts objects into container | 12 | 12 | 15 | 15 |
| Follows one-step command with gesture | 12 | 12 | 12, 15 | 12 |
| Walks up stairs with support, putting both feet on each step | 18 | 24 | 18, 24 | 18, 22 |
| Walks down stairs with support, putting both feet on each step | 24 | 24 | 24 | 20, 24 |
| Kicks ball with demonstration | 24 | 24 | 24 | 22 |
| Two-word sentence (noun + verb) | 24 | 24 | 24 | 24 |
| Follows two-step instruction | 24, 36 | 24 | 24 | 24 |
| Walks up stairs without support, alternating feet | 36 | 48 | 36 | 36 |
| Is understandable to others 75% of the time by unfamiliar listeners | 36 | 48 | 36 | 36 |
| Skips | 60 | 60 | 72 | 60 |
| Copies triangle | 60 | 60 | 72 | 60 |
| Balances on one foot for 10 seconds | 60 | 60 | 72 | 60 |
| Hops on one foot 15 times | 60 | 60 | 72 | 60 |
DISCUSSION
Developmental surveillance is an ongoing process in which providers both elicit caregiver concerns about their child’s development and systematically track their developmental progress in order to identify risk of delays. Combined ongoing surveillance and periodic screening is recommended by the AAP, and improves identification of developmental delays than either strategy used alone22. Here we report that the milestone checklists clinicians and caregivers often rely on as part of developmental surveillance can be vague, surprisingly inconsistent in content, and are often biased toward skills occurring between 0–36 months, as well as gross motor skills. The results from this study also highlight inconsistencies in information provided about expected ages for milestone achievement. It should be noted that while the milestone checklists analyzed were aimed at different audiences (providers vs. caregivers), the cited sources for these checklists have considerable overlap. Despite this, there was surprisingly low overlap in content, and only 40 developmental observations were present in all four checklists. Of the 90 developmental observations associated with milestones from at least three checklists, three systems had strong concordance, while Bright Futures did not, contributing to less than half of the 90 observations.
Content of milestones was also skewed toward specific developmental domains. Over 40% of these 40 universal milestones fell in the motor domain, while only 10% fell in the social-emotional domain, perhaps reflecting the dearth of research in typical social-emotional development. This also highlights the need for more comprehensive and validated social-emotional milestones that may improve earlier identification of related disorders such autism spectrum disorders or mood disorders, such as anxiety.
Furthermore expected age concordance between milestones from different checklists was low. Of the 130 observations mapped to milestones in at least 3 of the 4 checklists, over 25% were associated with milestones with discordant target ages. Some of this discordance is likely explained by variability in whether milestone checklists report expected ages that correspond to the 50th percentile. Of the four checklists analyzed in this study, the Pediatrics in Review article and Bright Futures specifically state they report the 50th percentile, while CDC: Learn the Signs. Act Early and Healthy Children: Ages and Stages do not provide details. Knowing that this variability would be present, we developed an age-concordance analysis which accepted liberal differences between checklists. Despite this, many milestones greatly disagreed in their expected ages. Another likely reason for poor age-concordance is the vaguely defined nature of many of the milestones. For example, the CDC milestone “Dresses and undresses self” versus the Healthy Children’s milestone “Dresses and undresses without assistance” seem similar in description, however the CDC target age is 36 months and the Healthy Children’s target age is 60 months. Dressing independently requires increasing ability depending on the type of clothing (eg. buttons, zippers), and therefore could be accomplished at a variety of ages. To improve consistency amongst milestones and their target ages, milestones need to be written to both reduce ambiguity, but also acknowledge that the targeted skill may be demonstrated in multiple ways.
The results from this study raise questions around the effectiveness of using milestones checklists as part of ongoing developmental surveillance, and emphasize the importance of using validated screening tools with defined age-norms in order to identify children with delays. This study also demonstrates the need for significantly more research and review of developmental milestones to improve consistency, and in turn usability by clinicians, caregivers, and researchers.
Limitations
There are many milestone checklists available to providers and caregivers. This analysis only considered four of these checklists. Therefore, it is possible that other checklists could be more closely matched. However, we attempted to reduce variability between checklists by using checklists with common references. Notably, three of the four checklists included in this analysis are published by the American Association of Pediatrics, and the 4th checklist, the CDC: Learn the Signs. Act Early, uses overlapping references based on Bright Futures 3rd Edition and Healthy Children.
Future Directions
The results of this study highlight the need for objectively defined and accurately normed milestones. This will require large scale monitoring of milestones across a geographically, racially, and socioeconomically diverse population. The electronic health record (EHR) is an ideal platform for such large scale data collection and has the potential to provide rich data sets that would allow for further analysis of what milestones predict later neurodevelopmental diagnoses. EHRs have also been identified as a vehicle to improve rates of developmental surveillance and screening6,23. However there has been slow implementation of developmental milestones into EHR platforms. Variability in the format, terminology, and public domain availability of developmental surveillance and screening tools make integration of developmental milestones into EHR systems challenging.9,23. With strong support from the AAP, Health Level Seven International, an international standards organization that produces standards for transfer of clinical and administrative data between software systems, recently published standards for how developmental screening should be incorporated into EHRs.24 However, while these standards would require EHRs to prompt providers to complete developmental surveillance and screening, they fall short of requiring full integration of developmental milestone checklists or selected developmental screeners.
Virtually every aspect of the pediatric health record has a standardized coding system. There are systems for diagnoses (Systematized Nomenclature of Medicine Clinical Terms- SNOMED CT25, International Classification of Disease, 10th Revision - ICD1026), as well as for medications (RxNorm27), procedures (Current Procedural Terminology - CPT28), and labs (Logical Observation Identifiers Names and Codes - LOINC29,30). While many of these systems are used for billing purposes, they also provide a universal language across electronic health records (EHRs) allowing for robust large-scale biomedical research. Creation of a standardized coding system for developmental milestones is the first step in integrating milestone documentation and potentially integrating milestone-based validated developmental screeners into the EHR. Improved and more efficient tracking of milestones may allow providers to focus their time on other aspects of developmental surveillance, including eliciting parental concerns and assessing for other risk factors that may affect development. Finally, successful integration of developmental milestones into an EHR would facilitate much needed population-based research allowing for more accurate estimates of when developmental skills are accomplished in both the general population but also in within specific neurodevelopmental disorders.
To aid in the development of a standardized coding system, we are sharing the ontology of developmental observations and associated milestones we created as part of this project. Called the Index of Developmental Observations (IDOB – idob.info), it is freely available as a resource for researchers, EHR vendors, and the producers of milestones and developmental screeners to standardize the production or analysis of developmental data.
CONCLUSION
Systematic development and evaluation of a developmental observation-milestone relational database uncovered variability and inconsistency across four commonly used milestone checklists. Reducing inconsistency and creating a standardized system for tracking developmental milestones are crucial steps toward increasing the rate of developmental surveillance and screening in the primary care setting.
Funding Sources:
CLW was supported by The National Institutes of Health (1T32MH112510)
Abbreviations:
- AAP
American Academy of Pediatrics
- BF
Bright Futures
- CDC
Center for Disease Control
- CPT
Current Procedural Terminology
- EHR
Electronic Health Record
- HC
Healthy Children
- ICD10
International Statistical Classification of Diseases and Related Health Problems
- IDOB
Index of Developmental Observations
- LOINC
Logical Observation Identifiers Names and Codes
- PIR
Pediatrics in Review
- SNOMED CT
Systematized Nomenclature of Medicine Clinical Terms
Footnotes
Financial Disclosure: All authors have indicated they have no financial relationships relevant to this article to disclose.
Conflict of Interest: The authors have indicated they have no potential conflicts of interest to disclose.
REFERENCES
- 1.Infants Identifying and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics. 2006;118(1):405–420. doi: 10.1542/peds.2006-1231 [DOI] [PubMed] [Google Scholar]
- 2.Sices L, Feundtner C, McLaughlin J, et al. How do primary care physicians identify young children with developmental delays? A national survey. J Dev Behav Pediatr. 2003;24(6):409–417. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=psyc4&NEWS=N&AN=2003-10988-002. Accessed March 16, 2018. [DOI] [PubMed] [Google Scholar]
- 3.Sand N, Silverstein M, Glascoe FP, et al. Pediatricians’ reported practices regarding developmental screening: do guidelines work? Do they help? Pediatrics. 2005;116(1):174–179. doi: 10.1542/peds.2004-1809 [DOI] [PubMed] [Google Scholar]
- 4.Radecki L, Sand-Loud N, O’Connor KG, et al. Trends in the Use of Standardized Tools for Developmental Screening in Early Childhood: 2002–2009. Pediatrics. 2011;128(1):14–19. doi: 10.1542/peds.2010-2180 [DOI] [PubMed] [Google Scholar]
- 5.Hirai AH, Kogan MD, Kandasamy V, et al. Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. JAMA Pediatr July 2018. doi: 10.1001/jamapediatrics.2018.1524 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Carroll AE, Bauer NS, Dugan TM, et al. Use of a Computerized Decision Aid for Developmental Surveillance and Screening. JAMA Pediatr. 2014;168(9):815. doi: 10.1001/jamapediatrics.2014.464 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.American Academy of Pediatrics. Healthy Children Ages and Stages. https://www.healthychildren.org/english/ages-stages/pages/default.aspx. Published 2009.
- 8.CDC: Learn the Signs. Act Early. https://www.cdc.gov/ncbddd/actearly/milestones/index.html.
- 9.Sices L Use of Developmental Milestones in Pediatric Residency Training and Practice : Time to Rethink the Meaning of the Mean. J Dev Behav Pediatr. 2007;28(1):47–52. https://insights-ovid-com.ezp-prod1.hul.harvard.edu/pubmed?pmid=17353732. Accessed March 16, 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Hagan J, Shaw J, Duncan P. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 3rd edition Elk Groove Village, IL American Academy of Pediatrics; 2008. [Google Scholar]
- 11.Wilks T, Gerber RJ, Erdie-Lalena C. Developmental milestones: cognitive development. Pediatr Rev. 2010;31(9):364–367. doi: 10.1542/pir.31-9-364 [DOI] [PubMed] [Google Scholar]
- 12.American Academy Of Pediatrics. Caring for Your Baby and Young Child, Revised Edition. 5th Editio. (Shelov SP, Altmann TR, eds.). American Academy of Pediatrics; 2009. [Google Scholar]
- 13.Gesell A, Amatruda CS. Developmental Diagnosis; Normal and Abnormal Child Development, Clinical Methods and Pediatric Applications. New York: Paul B. Hoeber; 1947. [Google Scholar]
- 14.Ireton H Child Development Inventories (CDI).; 1990. [Google Scholar]
- 15.Guevara JP, Gerdes M, Localio R, et al. Effectiveness of developmental screening in an urban setting. Pediatrics. 2013;131(1):30–37. doi: 10.1542/peds.2012-0765 [DOI] [PubMed] [Google Scholar]
- 16.Siu AL. Screening for Speech and Language Delay and Disorders in Children Aged 5 Years or Younger: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2015;136(2):e474–e481. doi: 10.1542/peds.2015-1711 [DOI] [PubMed] [Google Scholar]
- 17.Siu AL. Screening for autism spectrum disorder in young children US preventive services task force recommendation statement. JAMA - J Am Med Assoc. 2016;315(7):691–696. doi: 10.1001/jama.2016.0018 [DOI] [PubMed] [Google Scholar]
- 18.Canadian Task Force on Preventive Health Care. Recommendations on screening for developmental delay. CMAJ. 2016;188(8):p 579–587. doi: 10.1503/cmaj [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Scharf RJ, Scharp G, Stroustrup A. Developmental Milestones. Pediatr Rev. 2016;37(1):0–1. http://pedsinreview.aappublications.org/. Accessed July 4, 2018. [DOI] [PubMed] [Google Scholar]
- 20.Wilks T, Gerber RJ, Erdie-Lalena C. Developmental milestones: cognitive development. Pediatr Rev. 2010;31(9):364–367. doi: 10.1542/pir.31-9-364 [DOI] [PubMed] [Google Scholar]
- 21.Gerber RJ, Wilks T, Erdie-Lalena C. Developmental milestones 3: social-emotional development. Pediatr Rev. 2011;32(12):533–536. doi: 10.1542/pir.32-12-533 [DOI] [PubMed] [Google Scholar]
- 22.Barger B, Rice C, Wolf R, et al. Better together: Developmental screening and monitoring best identify children who need early intervention. Disabil Health J. 2018;11(3):420–426. doi: 10.1016/j.dhjo.2018.01.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Jensen RE, Chan KS, Weiner JP, et al. Implementing Electronic Health Record-Based Quality Measures for Developmental Screening. Pediatrics. 2009;124(4):e648–e654. doi: 10.1542/peds.2008-3091 [DOI] [PubMed] [Google Scholar]
- 24.Child Health Functional Profile for Developmental Screening Release 1 - US Realm. Health Level Seven International. http://www.hl7.org/implement/standards/product_brief.cfm?product_id=468. Published 2017. Accessed August 6, 2018.
- 25.SNOMED CT. https://www.nlm.nih.gov/healthit/snomedct/.
- 26.International Classification of Diseases and Related Health Problems 10th Revision. https://icd.who.int/browse10/2016/en.
- 27.RxNorm. https://www.nlm.nih.gov/research/umls/rxnorm/.
- 28.Current Procedural Terminology. https://www.ama-assn.org/amaone/cpt-current-procedural-terminology.
- 29.Huff SM, Rocha RA, McDonald CJ, et al. Development of the Logical Observation Identifier Names and Codes (LOINC) vocabulary. J Am Med Inform Assoc. 1998;5(3):276–292. http://www.ncbi.nlm.nih.gov/pubmed/9609498. Accessed April 16, 2019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Baorto DM, Cimino JJ, Parvin CA, et al. Combining laboratory data sets from multiple institutions using the logical observation identifier names and codes (LOINC). Int J Med Inform. 1998;51(1):29–37. http://www.ncbi.nlm.nih.gov/pubmed/9749897. Accessed April 16, 2019. [DOI] [PubMed] [Google Scholar]