Global developmental delay in children - Clinical Briefs - Brief Article

Author: Carrie Morantz, Brian Torrey
Date: Sept 1, 2003

The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society have released a practice parameter on global developmental delay. "Evaluation of the Child with Global Developmental Delay" appears in the February 2003 issue of Neurology.

Global developmental delay is common and affects 1 to 3 percent of children. Included in the practice parameter are the following key points:

* Routine metabolic screening is not indicated in the initial evaluation of a child with global developmental delay.

* Even in the absence of dysmorphic features or features suggestive of a specific syndrome, routine cytogenetic studies and molecular testing for the fragile X mutation are recommended.

* The diagnosis of Rett syndrome should be considered in girls with unexplained moderate to severe developmental delay.

* Additional genetic studies (e.g., subtelomeric chromosomal rearrangements) also may be considered in selected children.

* Evaluation of serum lead levels should be restricted to those children with identifiable risk factors for excessive lead exposure.

* Thyroid studies need not be undertaken (unless clinically indicated) if the child underwent newborn screening.

* An electroencephalogram is not recommended as part of the initial evaluation unless there are historical features suggestive of epilepsy or a specific epileptic syndrome. Routine neuroimaging, with magnetic resonance imaging preferred to computed tomography, is recommended, particularly if abnormalities are found on physical examination.

* Because of the increased incidence of visual and auditory impairments, children with global developmental delay may undergo appropriate visual and audiometric assessment at the time of diagnosis.

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