Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Arch Dis Child. 2023 Mar;108(3):153-159. doi: 10.1136/archdischild-2021-322799. Epub 2022 Jun 28.
Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups.
Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points.
Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking.
Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
对患有神经发育障碍 (NDD) 的幼儿进行护理是儿科门诊实践的重要组成部分。然而，迄今为止，跨国实践审查的范围有限，并且现有数据表明，早期识别的机会被错过了，特别是在弱势群体亚组中。
对与发育监测、早期识别和儿童早期干预相关的国家儿科机构指导进行多国审查，同时审查 0-5 岁患有/有患 NDD 风险的儿童的发育评估的儿科医生门诊实践。审查包括五个具有类似国家化普遍儿童保健系统的国家（即澳大利亚、加拿大、新西兰、瑞典和英国）。使用已发表和灰色文献综述以及其他地方来源的补充资料，结合描述性综述相关数据点，收集数据。
各国在普遍的儿童健康监测的基础上，对患有 NDD 的幼儿进行早期识别的系统大致相似。然而，国家儿科指导、儿科发育培训和实践方面存在差异，包括儿科医生在初级保健一级发育监测中的角色不同。关于发育监测的覆盖范围、儿科发育评估实践的内容和质量的数据明显缺乏。
儿科医生在确保患有 NDD 的幼儿/有患 NDD 风险的幼儿获得公平的早期识别和干预机会方面发挥着重要作用。然而，要加强对患有 NDD 的儿童的儿科门诊护理，需要在不同背景下提供更明确的指导；培训应针对跨学科发育评估模式中不断变化的角色，并且需要改进数据，以提高患有 NDD 的儿童的发育评估的公平性和质量。
