来自于美国疾病预防控制中心的儿科医生和顾问的报告《切莫忽略儿童的发育筛查》

\ 大家好！我是Zubler博士，是美国疾病预防控制中心的儿科医生和顾问。美国疾病控制与预防中心最近的一份报告显示,儿童发育筛查率很低——在 2007年，筛查率仅有20%，自那以后，筛查率有所改善，上升至30%- -50%左右,这个数字取决于你是否像孩子的父母或儿科医生询问过相关情况。然而,这意味着大约一半的孩子没有根据美国儿科学会建议的日期进行发育筛查。（美国儿科学会推荐在儿童的在9月龄、18月龄、24或30月龄时进行发育筛查。）

发育障碍和延迟是很常见的,6个孩子就有1个存在这种情况。这样的数字很可能说明每个儿童诊所或儿保科门诊中都会碰到发育障碍的儿童。

儿保科医生在提供发育筛查方面起着至关重要的作用。筛查可以识别早期的发育迟缓,帮助儿童接受进一步的帮助不仅,可以教他们新的生活技能,而且可以帮助他们充分激发他们的潜力。与父母独自进行发育监测相比，正式的筛查效果要好得多。如果发育迟缓能够在早期被识别，那么干预措施也就可以相应的早期启动,对发育迟缓的儿童来说预后也会更好。

我们需要改善现有的发育筛查率。大多数儿保科医生都认同这一点,然而,大多数儿保科门诊却不执行常规发育筛查。是什么造成这种情况呢？

门诊人流量太大，人均就诊时间太短被认为为目前开展常规发育筛查的最大障碍。临床医生发现父母是非常欢迎实施发育筛查的，在施行时均给予了积极的反应。大多数发育筛查工具只需要几分钟就能完成,而且，由家长完成的筛查工具并不会增加儿保科医生对单个病人就诊时间的延长。实践发现,实施常规筛查比想象的要容易,而且接受了筛查的儿童父母普遍对实施筛查的儿保科满意度提高不少。

然而,如何有效地将常规发育筛查融入到繁忙的工作中对我们来说可能是一个挑战。有一些方法可以儿保科医生减轻负担,提高我们识别这六分之一发育障碍儿童的能力。以下是一些小建议：

首先,教育孩子的父母为什么要做发育筛查以及何时应该带孩子去进行发育筛查，使家长更易接受常规发育筛查。这类教育宣教可以通过网络进行，在父母的工作时间许可的范围内，可以在办公室网络进行访问,并设置自动提醒功能。

第二,请家长在进行就诊前自行完成筛查问卷，比如事先在家完成或在候诊的时间内完成。

第三,培训儿保医师使之了解发育筛查的重要性，在父母进入诊室的时候给他们分发纸张或电子形式的筛查问卷。此外，需培训儿保医师对筛选问卷进行评分的能力，或者也可以电子化处理问卷最终结果。然后，儿保科医生就可以根据问卷结果与父母讨论发育的情况，并给予相应的指导。

早期识别发育问题是儿童保健中很关键的一部分。许多医疗机构已经成功实现常规发育筛查，相信你也可以做到。

注：以上内容翻译自美国疾病预防控制中心的Jen Zubler博士的采访录像
附：采访原稿：

Hello. I am Dr Jen Zubler, a practicing pediatrician and a consultant for the Centers for Disease Control and Prevention.A recent CDC report shows that the rate of childhood developmental screening is low—about 20% in 2007. Screening rates have improved since then, to about30%-50%, depending on whether you ask parents or pediatricians. However, this means that about half of children are not receiving the American Academy of Pediatrics recommended developmental screening at 9, 18, and 24 or 30 months of age.

Developmental disabilities and delays are surprisingly common, affecting 1 in 6 children. With numbers like this, it's very likely that children with unidentified developmental disabilities are seen in every pediatric practice.

Pediatric providers play an important role in conducting developmental screening. Screening can identify developmental delays early, helping children receive services that can teach them new skills and help them reach their full potential. And formal screening does a better job of this than does developmental surveillance alone. The earlier atypical development is recognized, the earlier interventions can be started, and the better the outcome for children with developmental delays.

We need to improve our rates of developmental screening. Most pediatric providers agree with this, yet most offices do not perform universal developmental screening. Why this discrepancy?

Lack of time is often cited as the biggest barrier to routine developmental screening. However, physicians have reported positive responses from parents when screening was implemented. Most developmental screening tools take only a few minutes to complete, and the use of a parent-completed screener did not increase the average office visit time.Providers in one busy urban practice found that implementing routine screening was easier than expected, and parents of children who were screened reported greater satisfaction with their child's medical care.

Nevertheless, efficiently integrating routine developmental screening into a busy practice can be challenging. There are some ways to ease the burden on pediatric providers to screen all children,improving our ability to identify the 1 in 6 with developmental disabilities.Here are a few tips to make this easier:

First, make developmental screening a routine expectation by educating parents about why and when developmental screening will be done. Education can be done on practice websites, on in-office displays, when parents schedule well-child visits, and through automated appointment reminders. Second, ask parents to complete the screener at home before the appointment, in the waiting room or in the exam room while they are waiting for the provider. And third, train staff on the importance of developmental screening and train them to distribute screeners in paper or electronic form when parents check in. Staff can also be trained to score the screening tool, or scoring can be done electronically. Pediatric providers can then discuss the results with parents as part of their typical discussions about developmental milestones and anticipatory guidance.

For resources on developmental screening,visit Birth to 5: Watch Me Thrive!. You can also find free tools, such as"Learn the Signs. Act Early." milestone checklists in English and Spanish, to help you and families you serve track children development. Visit our website for more information.

Identifying developmental concerns early is a critical part of optimal care for children. Many practices have successfully implemented universal developmental screening; yours can too.