Neurodevelopmental Research Center, Mental Health Institute, Beer Sheva, Israel.
KI Research Institute, Kfar Malal, Israel.
Pediatrics. 2024 Apr 1;153(4). doi: 10.1542/peds.2023-062483.
Developmental surveillance, conducted routinely worldwide, is fundamental for early detection of children at risk for developmental delay. We aimed to explore sex-related difference in attainment rates of developmental milestones and to evaluate the clinical need for separate sex-specific scales.
This is a cross-sectional, natiowide retrospective study, utilizing data from a national child surveillance program of ∼1000 maternal child health clinics. The main cohort, used for constructing sex-specific developmental scales, included all children born between January 2014 to September 2020, who visited maternal child health clinics from birth to 6 years of age (n = 839 574). Children with abnormal developmental potential were excluded (n = 195 616). A validation cohort included all visits between 2020 and 2021 (n = 309 181). The sex-differences in normative attainment age of 59 developmental milestones from 4 domains were evaluated. The milestones with a significant gap between males and females were identified, and the projected error rates when conducting unified versus sex-specific surveillance were calculated.
A new sex-specific developmental scale was constructed. In total, females preceded males in most milestones of all developmental domains, mainly at older ages. Conducting routine developmental surveillance using a unified scale, compared with sex-specific scales, resulted in potential missing of females at risk for developmental delay (19.3% of failed assessments) and over-diagnosis of males not requiring further evaluation (5.9% of failed assessments).
There are sex-related differences in the normative attainment rates of developmental milestones, indicating possible distortion of the currently used unified scales. These findings suggest that using sex-specific scales may improve the accuracy of early childhood developmental surveillance.
发育监测在全球范围内常规进行，是早期发现发育迟缓高危儿童的基础。我们旨在探讨性别的发育里程碑达成率是否存在差异，并评估单独使用性别特异性量表的临床需求。
这是一项全国性的横断面回顾性研究，利用全国儿童监测计划中约 1000 家母婴健康诊所的数据。主要队列用于构建性别特异性发育量表，包括 2014 年 1 月至 2020 年 9 月期间出生、在出生至 6 岁期间访问母婴健康诊所的所有儿童（n=839574）。排除有发育异常潜在风险的儿童（n=195616）。验证队列包括 2020 年至 2021 年期间的所有就诊（n=309181）。评估了 4 个领域的 59 个发育里程碑的正常达成年龄的性别差异。确定了男性和女性之间存在显著差异的里程碑，并计算了使用统一监测与性别特异性监测时的预测错误率。
构建了新的性别特异性发育量表。总体而言，女性在所有发育领域的大多数里程碑中都领先于男性，主要是在较晚的年龄。使用统一量表进行常规发育监测，与性别特异性量表相比，可能会导致发育迟缓风险女性的漏诊（19.3%的评估失败），以及需要进一步评估的男性的过度诊断（5.9%的评估失败）。
发育里程碑的正常达成率存在性别差异，表明当前使用的统一量表可能存在失真。这些发现表明，使用性别特异性量表可能会提高儿童早期发育监测的准确性。
