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Current evidence-based recommendations on investigating children with global developmental delay
  1. Renuka Mithyantha1,
  2. Rachel Kneen2,3,
  3. Emma McCann4,
  4. Melissa Gladstone1,5
  1. 1 Department of Developmental Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  2. 2 Department of Paediatric Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  3. 3 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  4. 4 Department of Clinical Genetics, Liverpool Women’s Hospital, Liverpool, UK
  5. 5 Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Melissa Gladstone, Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children’s NHS Foundation Trust, Liverpool, L14 5AB, UK; M.J.Gladstone{at}


Introduction Global developmental delay (GDD) affects 1%–3% of the population of children under 5 years of age, making it one of the most common conditions presenting in paediatric clinics; causes are exogenous, genetic (non-metabolic) or genetic (metabolic). Recent advances in biotechnology and genetic testing mean that the investigations available to perform for children under 5 years are increasing and are more sensitive than previously. This change in availability and type of testing necessitates an update in the recommendations for investigating GDD.

Methods We conducted a review of the literature from 2006 to 2016 to identify articles with evidence relating to the investigation of developmental delay in children under the age of 5 years. We collated the evidence into first-line and second-line investigations and, where available, on their yield and cost implications.

Results We have provided up-to-date guidance for first-line and second-line investigations for children with GDD under the age of 5 years. Recent evidence demonstrates that genetic testing for all children with unexplained GDD should be first line, if an exogenous cause is not already established. Our review of the literature demonstrates that all patients, irrespective of severity of GDD, should have investigations for treatable conditions. Evidence demonstrates that the yield for treatable conditions is higher than previously thought and that investigations for these metabolic conditions should be considered as first line. Additional second-line investigations can be led by history, examination and developmental trajectories.

Discussion We may need to update present recommendations in the UK for investigation of developmental delay. This would include microarray testing as first line and a more thorough approach to investigations for metabolic disorders that can be treated. Clinical assessment remains vital for guiding investigations.

  • neurodevelopment
  • genetics
  • neurodisability

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  • Contributors RM, RK, EM and MG contributed to the initial idea for the paper, wrote and reviewed sections of the paper and approved the final version. RM conducted the literature review with the support of MG and wrote the first draft of the paper.

  • Funding None declared.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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