Saturday, July 2, 2011

Many pediatricians don't do developmental screening

NEW YORK (Reuters Health) - Only about half of U.S. pediatricians regularly perform the recommended tests to look for developmental delays in infants and young children, a new study suggests.

The study, reported in the journal Pediatrics, found that the number of pediatricians who routinely did the screening tests had doubled between 2002 and 2009.

But that still meant that by 2009, only 48 percent were doing these tests regularly.

The American Academy of Pediatrics (AAP) and some other medical groups recommend that doctors use standardized tests for spotting possible developmental delays in babies and young children.

Those tests check the child's language and speech, and movement skills like crawling and walking, for delays or other problems that may be signs of specific disorders like autism. Screening tests do not definitively diagnose a problem but can help spot children who need to be evaluated further.

Only recently have pediatricians had detailed guidelines on how and when to do developmental screening. In 2006, the AAP advised doctors to use certain standardized tests during routine "well child" visits at the ages of 9 months, 18 months and between 2 and 3 years.

The new findings, researchers say, suggest the recommendations have had an impact.

Out of about 1,600 U.S. pediatricians surveyed in 2009, 48 percent said they always or almost always used at least one of the recommended screening tools for children younger than 3. That was up from 23 percent in 2002.

"The numbers have increased a lot, which is encouraging," said Dr. Nina Sand-Loud, a pediatrician at Dartmouth-Hitchcock Medical Center who worked on the study.

"But we still have about half of pediatricians who are not using these screening tools," she told Reuters Health.

The study did not look at doctors' reasons for screening or not screening. But Sand-Loud said past research has suggested that their biggest barrier is time.

Pediatricians have to do a lot during routine well-child visits, she noted, so many may find it tough to fit in developmental screening. And it's also possible that some pediatricians are still unaware that routine screening is recommended.

Like with any health screening, there are downsides to screening for developmental delays. The tests can create false alarms if they suggest a problem where none exists.

According to Sand-Loud, the recommended developmental screening tools will pick up at least 75 percent of cases of true developmental delay. On the other hand, up to 25 percent of children who screen "positive" will later be found to have no significant delays.

It's not clear whether that issue is affecting pediatricians' use of screening tools, according to Sand-Loud. "But," she said, "some pediatricians might be concerned about worrying parents needlessly."

The AAP recommends routine, early screening because earlier intervention, such as therapy for language or behavioral difficulties, is thought to be more effective.

"More and more research is suggesting that the earlier the intervention, the better kids will do in the future," Sand-Loud said.

Estimating the cost-effectiveness of routine developmental screening can be tricky, according to Sand-Loud, because some potential benefits -- like doing better in school or getting a better job after school -- may be hard to measure.

But the screening itself "isn't very costly," she said, and there is evidence that it could save money in the long run. She noted that interventions for developmental delays in early childhood, for instance, would generally cost less than school-based programs for kids whose difficulties are caught later.

The bottom line for parents, Sand-Loud said, is that they should be aware that developmental screening is recommended. And if their child has not been screened, she said, parents should ask their health provider about it.

SOURCE: http://bit.ly/m56Y1d Pediatrics, online June 27, 2011.

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