By Judi Yamamoto, M.D.

House Calls

Most parents take their child to see a pediatrician for physical checkups and to diagnose and treat illnesses. What many parents do not realize is that the pediatrician’s role also includes identifying developmental delays and behavioral problems in infants and young children.

According to the American Academy of Pediatrics, 12 percent to 16 percent of all children in the United States have developmental or behavioral disorders - including problems in the areas of fine or gross motor skills; cognitive development and problem solving; and, most commonly, speech delays.

Early detection is key. As the primary care providers for children, pediatricians are a gateway to early intervention programs and education services that could greatly improve a child’s life.

Screening tools for developmental delays include age-appropriate checklists to record a child’s developmental milestones at each checkup. Developmental milestones provide a systematic approach to observe the progress of the young child over time.

If the child shows any developmental delays or behavioral concerns, the pediatrician will more closely monitor the child’s development. If necessary, the pediatrician will then refer the child to a health-care specialist for further evaluation or treatment, or to a community agency for special services.

Detecting developmental delays can be challenging for parents and pediatricians. In many cases, the problem is brought to light because of a family history of developmental issues, other physical or medical conditions that would make such delays likely - such as prematurity or a chronic illness - or parental concerns.

When a child fails to meet the typical progression of developmental milestones, it is critical that action be taken immediately. If parents and caregivers wait until the child misses further milestones, such as talking or walking, it may be too late to get optimal results from treatment or therapy.

For example, if a child is not babbling by the time he or she is 6 months old, this may indicate a hearing problem that could be corrected or improved - preventing further developmental delays. If a child has developmental disabilities, such as cerebral palsy, physical therapy and other treatment must also begin early.

Because patterns of child development can vary greatly, it can be especially difficult to detect mild developmental delays and deviations. In addition, physicians and parents may have differing opinions about how and when to treat mild cases. Discussion of a child’s delays can also be a sensitive subject for pediatricians to broach with parents.

Developmental screening tests are widely used, but they have been criticized by some professionals for their limited ability to predict a young child’s future levels of functioning. These tools can also lack sensitivity, and for this reason they must be consistently reassessed. But, overall, they are fairly stringent and reliable, and they have been standardized for children from different ethnic, linguistic and economic backgrounds.

All infants and young children should be screened regularly in their pediatrician’s office for developmental delays. This screening should become a regular part of every infant and young child’s health care experience, so that if a problem exists, it can be promptly diagnosed.

Early detection of a developmental delay or disability facilitates early treatment or intervention. While this may initially be a stressful or difficult time for a family, addressing the problem quickly will ultimately benefit both the child and parents.

Yamamoto is a pediatrician at the Los Altos Center of the Palo Alto Medical Foundation. The foundation and column editor Arian Dasmalchi provide this monthly column.