A Standardized Infant Physical Exam to Incorporate Developmental Screening
Principal Investigator: Laura McGuinn, M.D.
In Collaboration with: The Johns Hopkins University School of Medicine, Department of Pediatrics
Although early treatment of developmental delay yields positive results, evidence suggests that only a minority of pediatric practices use developmental screening tests. The primary goal of this study was to validate a standardized physical exam that served as a developmental screener without increasing the time required of the clinician for the required physical exam.
Preliminary data from 144 encounters suggests that observations during standardized physical exams of 2, 4, and 6 month olds hold promise for being an efficient, accurate screening test for delayed development. Infants underwent standardized physical exams at 2, 4, or 6 months of age; standard developmental testing (Bayley Scales of Infant Development; Bayley, 1969) was completed between 6 and 8 months. Item scores were compared within and across the three age groups (2, 4, and 6 months). Clinical indices of sensitivity and specificity were estimated considering younger infants as a surrogate for those with delayed developmental level.
These pilot data yielded impressive results, suggesting that the chosen indices have the capacity to reliably distinguish infants at differing developmental levels. This structured approach to opportunistic observation appears to be promising for the detection of developmental delays using a process that is simultaneous with required physical examinations. The implication is that pediatricians may be considered reliable professionals to help accomplish the national mandate of early detection. A shift of professional focus toward infant developmental functioning may help broaden the agenda of child health supervision.
