British and American recommendations for developmental monitoring: the role of surveillance

Major British and American pediatric organizations have recently issued recommendations for developmental monitoring during preventive child health care. After initial inspection, similarities between the British and American recommendations are not apparent. For example, the Committee on Practice and Ambulatory Medicine of the American Academy of Pediatrics emphasizes the importance of assessing development during all child health supervision visits, whereas the British Joint Working Party on Child Health Surveillance discourages routine, repeated developmental examinations. Further analysis reveals, however, that such recommendations are compatible. Neither committee recommends the routine administration of developmental screening tests. Such recommendations are consistent with the lack of evidence to justify routine screening of all children for developmental problems. Instead, both committees suggest that developmental monitoring be performed by the process of surveillance. With developmental surveillance, the importance of eliciting parents' opinions and concerns, obtaining a relevant developmental history, and performing skilled, longitudinal observations of children is emphasized. The success of surveillance depends on the extent to which its implementation is enhanced through clinical practice, professional training, and research.