Intended for healthcare professionals

Clinical Review

Developmental assessment of children

BMJ 2013; 346 doi: (Published 15 January 2013) Cite this as: BMJ 2013;346:e8687
  1. Martin Bellman, consultant paediatrician1,
  2. Orlaith Byrne, consultant community paediatrician2,
  3. Robert Sege, professor of pediatrics3
  1. 1Department of Paediatrics, Royal Free Hospital, London NW3 2QG, UK
  2. 2Department of Child Health, Birmingham Community Healthcare NHS Trust, Birmingham, UK
  3. 3Department of Pediatrics, Boston University, Boston, MA, USA
  1. Correspondence to: M Bellman m.bellman{at}

Summary points

  • Every consultation is an opportunity to ask flexible questions about a child’s development as part of comprehensive medical care

  • Parents who voice concerns about their child’s development are usually right

  • Loss of previously acquired skills (regression) is a red flag and should prompt rapid referral for detailed assessment and investigation

  • Parents and carers are usually more aware of norms for gross motor milestones, such as walking independently, than for milestones and patterns of normal speech, language acquisition, and play skills; consider targeted questioning

  • Consider use of developmental screening questionnaires and measurement tools to supplement clinical judgment

Developmental assessment is the process of mapping a child’s performance compared with children of similar age. The comparison group is obtained from a representative sample of the population that the child comes from. Several factors contribute to performance varying greatly between different population groups.1 In a multicultural society it can be challenging to find appropriate benchmarks for these standards.

This article reviews the literature on the assessment of child development. It aims to highlight what normal developmental parameters are, when and how to assess a child, and when to refer for specialist assessment.

Sources and selection criteria

We searched PubMed, the Cochrane Database of Systematic Reviews, and reference lists of relevant publications using the subject headings and key words “development”, “developmental assessment”, “developmental delay”, “disability”, “mental retardation”, “developmental screening tools”, “screening”, and “diagnosis”. We also reviewed guidelines from the American Academy of Pediatrics2 and the UK Healthy Child Programme.3

We have extensive clinical experience in developmental paediatrics in the United Kingdom and United States, which we drew on to comment on the extensive and potentially confusing technology currently used for developmental assessment.

What is child development?

Development is the process by which each child evolves from helpless infancy to independent adulthood.

Growth and development …

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