BACKGROUND AND OBJECTIVES: Pediatric surveillance of young children depends on providers' assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment. METHODS:We analyzed responses to the developmental screening form of the Survey of Wellbeing of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC). RESULTS:A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P , .01), social determinants of health (P , .01), Medicaid (P , .01), male sex (P , .01), and child race (P , .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that "most children pass" and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should "act early." An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided. CONCLUSIONS: Detailed normative data on individual developmental milestones can help clinicians guide caregivers' expectations for milestone attainment, thereby offering greater specificity to CDC guidelines. WHAT'S KNOWN ON THIS SUBJECT: Developmental milestones are commonly assessed to support pediatric surveillance and as part of developmental screening. However, normative data for individual milestones are sparse, and existing guidelines lack specificity. WHAT THIS STUDY ADDS: Early development varies across a range of child factors. A high proportion of children pass milestones by the ages at which Centers for Disease Control and Prevention guidelines indicate that parents should "act early." Normative data can help clinicians set realistic expectations for milestone attainment.
Pediatric settings are increasingly called upon to implement early childhood developmental and behavioral health screening as an early identification and health promotion strategy. Understanding the dynamic barriers and facilitators of implementation at various stages will help implementers plan for and address these factors in support of high quality implementation. Our research supported this goal by analyzing longitudinal, qualitative data. There were 128 semistructured interviews conducted with pediatric clinic and implementation providers across four years. Interviews were transcribed, coded, and synthesized using rigorous qualitative methods. Results were produced using an iterative process to summarize, analyze, and consolidate themes about screening implementation over time. Barriers and facilitators of implementation included characteristics of screening implementation as well as contextual characteristics of the pediatric primary care setting. Some implementation themes were stable over time whereas others demonstrated shifts. Results are discussed in terms of lessons learned for successfully integrating this critical preventive practice within pediatric clinics.
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