Other jurisdictions provide targeted or opportunistic 18-month screening, often without use of formal screening tools. There is variation in where the screening takes place, which health professionals do it, and the instruments used. Six provinces and territories – Ontario, Prince Edward Island, Newfoundland & Labrador, Nunavut, the Yukon and the Northwest Territories incorporate formal developmental surveillance or screening as part of an 18-month well-baby visit during routine visits, or around immunization schedules. They recommend that an evidence-based supervision guide be used to monitor health, such as the Rourke Baby Record (RBR) and that a developmental screening tool (the most widely used are the Nipissing District Developmental Screen, ASQ, and PEDS/PEDS:DM) be used to stimulate discussion with parents about their child’s development. The Canadian Paediatric Society (CPS) has advocated for a universal visit using structured developmental assessment tools for all children at the 18-month well-baby visit. The American Academy of Pediatrics and the Canadian Paediatric Society have recommended routine developmental surveillance by primary care providers at all visits and the AAP guidelines recommend routine developmental screening tests be done at 9, 18 and 30-month visits. The best approach to developmental surveillance and screening is not clear cut.
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