Current developmental surveillance: is it time for change?

Developmental screening tools are an integral part of child health surveillance, but only few valid and reliable tests are currently in use in the community. Early detection and referral of children with developmental delay is critical for long term outcomes. Developmental screening, using standardised tests, is increasingly important. The public health nurses in the Midlands currently use a modified version of Denver Development Screening Tool (DDST) for screening infants at 9 months of age. The DDST however fails to identify a high proportion of children developmentally at risk, because of its poor sensitivity, an outcome of which is a high proportion of under-referrals. The low sensitivity of the test is a source of potentially misleading information and may be responsible for many at-risk children remaining undetected. Sensitive and specific screening questionnaires need to be introduced in community child health screening surveillance to minimise the risk of missing children with developmental delay.