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 I have had many families whose pediatricians did not have significant experience supporting children with social delays and referred them to a developmental pediatrician rather than their primary care doctor. Given the inconsistencies in doctors pushing/explaining/reporting delays, do you think rather than looking to educate families it might be more beneficial to focus attention on pediatricians?

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 I have had many families whose pediatricians did not have significant experience supporting children with social delays and referred them to a developmental pediatrician rather than their primary care doctor. Given the inconsistencies in doctors pushing/explaining/reporting delays, do you think rather than looking to educate families it might be more beneficial to focus attention on pediatricians?

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Understanding from The American Academy of Pediatrics (AAP) where recommends conducting developmental surveillance at every health supervision visit and conducting developmental screening using formal, validated tools at 9, 18, and 30 months or whenever surveillance reveals a concern. However, there is still a substantial portion of developmental delays in young children going undetected due to many factors.
Do you think it is possible to expand caregivers’ knowledge of screenings and empower them with tools in tracking their child's progress? For example, a recording system that allows them to record their child's screening results and share them across provider settings.

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Singapore provides health booklets for a newborn that their families can record and update information regarding health and development. This booklet is taken to medical appointments during childhood and assessed between the professionals and family. How can parents/ families be better informed early on about their child's development? How can families gain knowledge what is developmentally age appropriate and assess their child's development objectively and therefore collaborate with professionals?

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According to Elensary and Silverstein (2020), in the U.S. it the responsibility of the doctors to perform developmental screenings and then if needed they refer patients to early interventionists. However, doctors still do not perform screenings on all of their patients and parents are not as involved in the process. In Singapore, parents are given a health booklet that helps them keep track of their child's developmental progress (Koh et al., 2016). How can we (as educators) help parents to advocate for additional screenings/services for their children?

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Many families are not able to afford medical insurance and receive care that may not be equitable to families from higher socioeconomic backgrounds but all families have to present an updated vaccination record for children to attend school. To improve developmental screening processes, I wonder if embedding the ASQ or similar screenings into child wellness doctor visits each time children have to get scheduled vaccines would help ensure they are completed at each stage of the child's early life as opposed to handing a checklist off to a family member to complete. Working in preschool and kindergarten I have seen many times when children were not allowed to come back to school until their vaccination record was updated. Parents want children to attend school, so they always made this a priority when notified. This would ensure questions were answered accurately and fully and most importantly by a professional and timely. I think this would also ensure collaboration between families, health services, and school systems. Families may not trust school officials and their recommendations but are more likely to have confidence in the advice of a licensed medical professional.

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In the article, The Utility of Developmental Checklists in Parent-held Health Records, parents were asked how and if they used the developmental checklist handbook. Most parents stated that they were aware of the developmental checklist and felt that the checklists were helpful in identifying strengths and needs in their child's development.
It was discovered that most parents could complete the checklist on their own but about 11% of parents needed support from the nurse or pediatrician to understand the questions.  This development indicated that improvements could be made to support the families to complete the checklist independently.
In the United States, the Center for Disease Control and Prevention (CDC) has a developmental checklist to print or complete online. The CDC website has videos to model what some of the skills look like, activities to support the child to make progress on the skills, what to do if their child is not meeting the developmental milestones, and an app to download onto their phone or computer for activities to support their child's development.
Since this article was written in 2015, my question is if improvements have been made to support families in administering the checklists more independently and if there is now an online version of the checklist.

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It has been validated that early detection of developmental delays is found during developmental assessments.  The Health Booklet in Singapore and the Ages and Stages assessment in the United States are used by doctors during the well-visits of young children.  Many parents are not aware of the importance of these assessments. How can a parent be educated on the importance of developmental screening? Can the developmental screening be part of government-funded home visits by trained paraprofessionals?

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The DDST, Singapore, is the local version of the well-known Denver Developmental Screening Test (DDST), that was developed and normed over 3 decades ago. Would the developmental checklists in the Health Booklet still be considered reliable and valid in our current population? With most parents working full-time in Singapore, and children spending a large portion of their time in school, could the checklists be adapted as an assessment tool for teachers to complete instead?

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The health booklets seem like they can be very informative when used properly. The only draw back for me personally and others who are similar to myself, would be keeping up with the health booklet. I wonder if there is a way in which the health booklet could be made digital for individuals who prefer to use it that way? If this were possible, could doctors and other specialists have access to each booklet and have conversations with families in between visits? This way if any questions arise they can be shared in the moment instead of having to call or wait for the next appointment.

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It the article “Understanding gaps in developmental screening and referral”, it was stated that a full one-third of pediatricians still report not using formal screening instruments to detect

children with developmental delays, and a greater proportion report not referring those with a positive screen result to early intervention. How can we assure that all children and families from different social-economic and cultural backgrounds receive equity services for referrals and interventions? What can we put in place so that families will complete their child's developmental milestones screenings to learn how to identify a concern or delay?

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In the USA, a lot of the validated screeners have often been tested on populations that do not represent the very diverse communities across the nation. A suggested improvement for the screening process is creating a screener that can be adapted to fit the needs of the community it is being used for. How do you think this adjustment could be implemented? One thought I had was using an over arching questions to cover a miliestone . . . (i.e. Are they communicating with facial expressions?) but then having follow up questions that would take in account factors that communities face when reaching each milestone.

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According to American Academy of Paediatrics (AAP),  9 months, 18 months, and 2.5 years old are seen as important periods for screening in ensuring timely identification of children with developmental issues. However, monitoring of children's development might be easily overlooked once childhood immunization is completed at 18 months of age (Koh et al., 2016). Do you think it could be possible to have a reminder set in place for mandatory screening at 2.5 years old where parents are required to bring their child back to their healthcare providers for timely screening? Do you see this to be a feasible solution in the long run?

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Elensary and Silverstein used the example of pediatrician's treatment of febrile infants to highlight the importance of clinical judgement in determining next steps, including making referrals to EI agencies. How do you see the interplay of screening and clinical judgement? When looking at mandatory practices, where does clinical judgement fit in, if at all?

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Health booklet that was introduced in Singapore since 1984 is a useful and easily accessible tool for parents to use. With the advancement of technology and moving more to a digitalised world, would it be better for health booklet to be made into a mobile application? Mobile application would serve a purpose of reminding families to bring their child for developmental screening as well as for Health Promotion Board (agency in-charge of health booklet), to update relevant information (ie child's height and weight, immunisation record etc). This would in turn involve parents to be responsible and highlight the importance of developmental screening.

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A suggestion from Koh et. al. was to provide families with no developmental concerns a virtual option for their child’s developmental scheduled visit (2016). A virtual option would be convenient for families from middle to high socioeconomic families, what could be an alternative option for families that may not have access as easily? Would a reminder letter to a home or email to an email address be a sufficient reminder for families?

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As per Koh et al (2016), it could be seen that only 1 in 4 parents brought their child to the 24-36 month developmental visits. It would also be great if there could be a pre developmental test where parents can be involved to complete checklists prior to bringing their child to the developmental screening. This way, other concerns that may not have been indicated in the health booklet could also be discussed with the professionals.  Trainings on how to carry out developmental screenings can also be provided to parents and even pregnant mothers. It is also crucial that educators should have a say in the child's developmental screenings as most children in Singapore start attending full day preschools at a very young age of 2 months. In terms of cultural relevance, I am also wondering if the health booklet in SG is available in all 4 national languages to make it more accessible to all.

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As per Koh et al (2016), it could be seen that only 1 in 4 parents brought their child to the 24-36 month developmental visits. It would also be great if there could be a pre developmental test where parents can be involved to complete checklists prior to bringing their child to the developmental screening. This way, other concerns that may not have been indicated in the health booklet could also be discussed with the professionals.  Trainings on how to carry out developmental screenings can also be provided to parents and even pregnant mothers. It is also crucial that educators should have a say in the child's developmental screenings as most children in Singapore start attending full day preschools at a very young age of 2 months. In terms of cultural relevance, I am also wondering if the health booklet in SG is available in all 4 national languages to make it more accessible to all.

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I believe a major improvement needed for developmental screenings in both Singapore and the United States is having more normed developmental screeners for the current population. According to Koh et al (2016) article the Denver Developmental Screening Test is the only normed developmental screening in Singapore and it was normed in 1989....over 30 years ago. In the United States many of our developmental screeners no longer represent the ever changing populations in the United States. As educators, how can we help to encourage more accurately normed screeners to be used?

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For families that do not have high quality health care insurance, what could be a suggestion to help support them in getting the same quality EI services, as other demographic groups that have hands on resources and better health care (supportive doctors, coverage for services, etc)? This has been an issue that can lead to children getting diagnosed much later and missing out on services.

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Could there be a system in place, possibly technology-based that would notify parents, caregivers, healthcare professionals and ECE educators that specific-aged children are due for their developmental screening? With that, possible training for everyone(caregiver, healthcare professionals and educators) to use a standardized tool to track children’s growth and development would be helpful to identify possible developmental delays. I am hoping for this to be possible in both US and Singapore.

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Grace L
It was reported that the issue of formalized developmental screening has gained substantial interest in Singapore.  It was mentioned, then, that it is important to develop strategies to have a more widespread developmental screening, including understanding the root causes of significant minority of pediatricians who do not practice formalized screenings. Do you perceive this hesitance from the minority pediatricians as having some cultural basis? In your practice, how do you think such barrier could be overcome?

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As a foster parent in the United States, we have often relied on the electronic records of children's health and development when children move into our home.  Often these children may have been in more than one home before coming to us and I can see how it would be challenging to maintain a record in a Health Booklet as a child moves, or if you are raising a child who you may have very limited information about.  This could easily make it more difficult to identify children who may have developmental delays.  Similarly, it seems to be a concern in Singapore that children who have less accurate or less complete health records may be at-risk for unidentified delays. If an online system were created, who all in Singapore (specific agencies, health care professionals, families, educational professionals, etc.) would need access to the data in order to make sure the children with delays or concerns are being offered services?

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One suggested improvement to the screening process in Singapore is to offer an electronic application for parents to use when conducting and documenting developmental screenings (Koh et al., 2016). In the US, there would be concerns about families in rural or under-resourced areas accessing technology for this purpose. Given the size and largely urban landscape of Singapore, would this be a concern there as well? Do citizens have easy and equal access to the technology required for this type of system?

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The Elsenary article (2020) suggests that developing a greater understanding of why gaps in developmental screening and referral exist, as well as other “viable clinical practices” that can also support better developmental outcomes for young children, is just as important as strategizing widespread screening processes. What are some examples from your professional experience of other culturally-responsive practices that could be used in conjunction with developmental screenings to support early identification and referral for all children?

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Making developmental monitoring tools easily and conveniently accessible (e.g. online website, developing an app etc) to parents may increase the usage and educational awareness. However, do you think that making EI follow-ups mandatory would be a viable option in your culture to improve the effectiveness of the screening process?