Developmental Milestones

Introduction
A critical part of childhood development is recognition of developmental milestones not being met which allows for children to receive early intervention (EI) sooner if necessary. With developmental disorders being more prevalent than they were 15 years ago (Chakrabarti & Fombonne, 2005), it is important to identify the disorders so children and families can be directed to appropriate interventions as early as possible. Due to the use of informal milestone checklists, only one-third of the children out of the 16% who have developmental disabilities are detected by their health professionals (Brothers, Glascoe, & Robertshaw, 2008; Guevara et al., 2013; Mackrides & Ryherd, 2011; Morelli et al., 2014 & Sheldrick et al., 2016). Along

with health professionals, parents can play a critical role in the screening process for early recognition of missed developmental milestones. Programs about developmental milestones must be created for parents in order to efficiently screen and administer children into early intervention (EI) prior to kindergarten.
Physician’s Role
Pediatricians and primary health careae providers are responsible for detecting if any milestones are being missed during well-child checkups.

Professionals use age-appropriate developmental checklists to record milestones during well-care checkups (American Academy of Pediatrics, 2001). Individuals with Disabilities Education Improvement Act (IDEA) mandates that child health care professionals identify and find interventions for children with developmental disabilities through community based systems (American Academy of Pediatrics, 2006 & American Academy of Pediatrics, 2001). Due to IDEA the emphasis of screening is focused on infants and children from birth to 2 years of age. IDEA act requests that children who are suspected to have developmental problems be referred to an appropriate EI system (American Academy of Pediatrics, 2001). Although screening is emphasized there are inconsistencies in how health care professionals apply

screening.
Screening
Screening by pediatricians and primary health care providers is a vital part of the journey for children to receive EI if they are missing any of their milestone marks. Guevara et al. (2013) indicated that children who were a part of developmental screening were referred to EI sooner than children who weren’t. This supports policies being in place for developmental screening. Although valid and standardized tool are available for screening, it is not conducted routinely in primary care settings. Less than 50% of pediatricians report screening routinely with these tools (Guevara et al., 2013 & Sand et al., 2005). To address this issue a national health care promotion initiative known as Bright Futures has recommended that health care professionals implement surveillance at all well-child visits and conduct screenings at 9,18,30 months of age (Guevara et al., 2013).
Screening is the first step in addressing any concerns in a child’s development. Healthcare professionals and parents should continue surveillance and screening through childhood; screening tools should be used whenever a concern rises about a child’s developmental (Lee, Lu, Allan, Yeh, & Chang, 2015). American Academy of Pediatrics (AAP) has suggested evidence-based screening tools to improve early detection, causing use of screening tools to increase (Sheldrick et al., 2016). According to a survey by American Academy of Pediatrics (AAP) there have not been improvements in developmental screening in primary care setting; pediatricians are not using effective screening methods for their patients (American Academy of Pediatrics, 2006). Thomas, Spragins, Mazloum, Cronkhite, & Maru (2016) conducted a study that suggested that health care professionals (1) override evidence-based screening results with their informal judgement; and/or (2) they need assistance with making referrals and understanding tests. Based on literature, screening policies need to be mandated and standard for each child, for the best results.
Parents Role
Parents’ play an informal role in detection of any developmental milestones being missed. Their role is critical for professionals because their observations and reports are considered at checkups. Parental report of skills has shown to be helpful in predicting developmental problems, despite barriers that exist (American Academy of Pediatrics, 2001). Barriers can be overcome through education to parents about how to use instruments that can help with evaluation of children (American Academy of Pediatrics, 2001 & Mackrides & Ryherd, 2011). Winter, Morawska, & Sanders (2012) conducted a study where parents were assessed for knowledge of child development and milestones; their results indicated that increasing knowledge about child development processes and milestones is important. Involving parents in their child’s development process can lead to earlier recognition of any developmental milestones being missed.
Parent’s desire and enthusiasm is crucial for health care professionals and it provides an opportunity to educate parents on development and developmental milestones (Eaton, Bodnarchuk, & McKeen, 2014). Eaton, Bodnarchuk, & McKeen (2014) found that parents want to be active part of their child’s milestone progresses. Glascoe & Dworkin (1995) reviewed 78 research articles and tests that depended on information from parents. They found that there are several mechanisms of obtaining parental information and that making use of this information is an effective way of early identification of any developmental problems Parents are in a position where they can play a vital role in indicating any discrepancies in their child’s development if they are educated on development.
Parents versus Physicians
Parents and physicians both feel that discussing a child’s development during checkup is important but parents feel that their health care professionals undervalue parent’s knowledge and concerns about child development (Morelli et al., 2014). Physicians state that parents lacked knowledge about development but they still used parental reports for their assessment (Morelli et al., 2014). Parents felt that clinicians did not spend enough time assessing their’ children’s development (Morelli et al., 2014). Parents are in a position to be an active part of report their child’s behaviors and indicate if they have any concerns to their physician. Combining the reports of parents with consistent screening from physicians can lead to better outcomes and increase the rate of recognition of developmental delays.
Early Intervention
In the United States, EI services are readily available for children with developmental delays from birth to 3 years of age and early childhood education services for children 3 to 5 years of age (American Academy of Pediatrics, 2001). EI programs are important for children who are not meeting their developmental milestones; these programs provide a variety of services to children immediately regardless of the outcome of evaluations. A diagnosis is not necessary for a referral to EI (American Academy of Pediatrics, 2006).
The Role of Occupational Therapy
Occupational therapists are in a great position to take on the role of teaching parents about developmental milestones and screening/reports.

Muir (2012) discusses occupational therapy in the primary care field in her article. She states that someday OTs should be the first professional some patients and are assessed by. She indicates that OTs are qualified for well-baby checkups and would assess for infant developmental milestones and other patterns. An OT is in a good position to be able to take parent’s focused interventions if any delay is noticed, they would be in a position where the link to EI for children who need it (Muir, 2012). Future research can also look into making policies of screening strict, eliminating physicians bias on whether to screen or

not.