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Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians
  1. Nadia Coscini1,2,
  2. Priya Heyes3,
  3. Helen Bedford4,
  4. Eyal Cohen5,6,
  5. Anita D’Aprano1,7,
  6. Sharon Goldfeld1,8,
  7. Dougal Hargreaves9,
  8. Sarah Loveday10,
  9. Sahar Nejat11,
  10. Gehan Roberts1,8,
  11. Anna Sarkadi12,
  12. Natasha Ruth Saunders5,6,
  13. Susan Woolfenden13,14,
  14. Kate Milner15,16
  1. 1Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2Health Services Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  3. 3Department of Child Development Service, Government of Western Australia Child and Adolescent Health Service, Perth, Western Australia, Australia
  4. 4Population, Policy and Practice Department, University College London Institute of Child Health, London, UK
  5. 5Department of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
  6. 6Department of Paediatrics, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
  7. 7Department of Paediatrics, The University of Melbourne Melbourne Medical School, Melbourne, Victoria, Australia
  8. 8Population Health Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  9. 9Department of Primary Care and Public Health, Imperial College London, London, UK
  10. 10Health Services Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  11. 11Department of Public Health and Caring Sciences, Uppsala Universitet Institutionen for euroasiatiska studier, Uppsala, Sweden
  12. 12Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
  13. 13School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
  14. 14Department of Community Child Health, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
  15. 15Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  16. 16Neurodisability and Rehabilitation Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr Nadia Coscini, Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; nadia.coscini{at}


Background Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups.

Methods Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0–5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points.

Results Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking.

Conclusion Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.

  • Child Development
  • Infant Development
  • Child Health Services
  • Health services research

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  • Contributors NC contributed to the background literature review, completed data collection, synthesis and first and subsequent manuscript drafts. PH completed the background literature review, contributed to data collection and synthesis and manuscript drafting. HB, EC, AD, SG DH, SL, SN, GR, AS, NRS and SW provided country-based data and contributed to manuscript drafting and review. KM contributed to scope and structure of the paper, review of data collection and synthesis, drafting and review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NRS and DH are on the Editorial Board of the Archives of Diseases in Childhood.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.