Effectiveness of enhanced developmental screening at 18 months to identify developmental delays

Objective — We sought to measure whether receipt of an enhanced 18-month well-baby visit with use of a developmental screening tool versus a routine 18-month well-baby visit (which typically involves developmental surveillance without screening) is associated with time to identification of developmental delays.

Method — We conducted a cohort study of children (17–22 months) in Ontario who received an 18-month well-baby visit (March 2020‒March 2022), followed to September 2022 using linked health administrative datasets. Visits were categorized as enhanced (n = 83,554) or routine (n = 15,723). The outcome was the identification of a developmental delay within 6 months (early) and more than 6 months after (late) the 18-month visit. Piecewise Cox proportional hazards models estimated hazard ratios (aHR) adjusted for child, maternal, and physician factors, comparing developmental delay diagnosis by visit type.

Results — Children who received an enhanced visit were slightly older, had a lower representation in the most deprived group, and a higher percentage of patients with pediatricians as their usual provider of care. After adjustment, children with enhanced compared with routine visits were more likely to have developmental delays detected in the early period (aHR 1.19 95% CI 1.11‒1.28) but not in the late period following the well-baby visit.

Conclusion — Enhanced visits are associated with earlier identification of developmental delays compared with routine visits in the 6 months following the 18-month well-baby visit. Enhanced developmental monitoring using screening tools may facilitate earlier recognition of developmental concerns.