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.

COPYRIGHT 2003 American Academy of Family PhysiciansCOPYRIGHT 2003 Gale Group

 
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