Dosman Cara F, Andrews Debbi, Goulden Keith J
Division of Developmental Pediatrics, Department of Pediatrics, University of Alberta, Edmonton, Alberta.
Paediatr Child Health. 2012 Dec;17(10):561-8. doi: 10.1093/pch/17.10.561.
Developmental surveillance is the process of monitoring child development over time to promote healthy development and to identify possible problems. Standardized developmental screeners have greater sensitivity than milestone-based history taking. Unfortunately, Canadian screening guidelines, to date, are sparse, logistical barriers to implementation have slowed uptake of screening tests and physicians continue to rely on milestones. When using clinical impression as a framework for surveillance, clinicians may not know when to consider a milestone delayed because developmental attainments exist within an age range and there is an absence of referenced percentiles on available published tables, which are particularly problematic for the cognitive and social-emotional sectors, which are less familiar to physicians. A novel, five-sector milestone framework with upper limits, referenced to the best available level of evidence, is presented. This framework may be used in teaching and may help physicians to better recognize failed milestones to facilitate early identification of children at risk for developmental disorders.
发育监测是一个随着时间推移监测儿童发育情况以促进健康发育并识别可能问题的过程。标准化发育筛查工具比基于发育里程碑的病史采集具有更高的敏感性。不幸的是，迄今为止加拿大的筛查指南较为稀少，实施过程中的后勤障碍减缓了筛查测试的采用，而且医生仍继续依赖发育里程碑。当以临床印象作为监测框架时，临床医生可能不知道何时应认为某个发育里程碑延迟，因为发育成就存在于一个年龄范围内，并且现有的已发表表格中没有参考百分位数，这对于认知和社会情感领域尤其成问题，因为医生对这些领域不太熟悉。本文提出了一个新颖的、有上限的五领域发育里程碑框架，该框架参考了现有最佳证据水平。这个框架可用于教学，可能有助于医生更好地识别未达标的发育里程碑，以便于早期识别有发育障碍风险的儿童。
