Considers the evidence for the effectiveness of health care services aimed at promoting optimal development in children from birth to 3 years of age. A review of the literature documents the efficacy of various screening, surveillance, educational, and intervention activities, including assessments of developmental problems, psychosocial risk factors, and child behavior, but no wide-scale, multi-site effectiveness studies of these delivery approaches have been conducted. Future studies should: (1) examine cost- and time-efficient approaches to developmental assessment in the first 3 years of life; (2) identify the best clinical strategies for developmental, psychosocial, and behavioral assessments; (3) examine the effectiveness of physician teaching activities, with emphasis on those promoting positive social experiences between parent and child that are harmonious in the emotional sense and stimulating in the cognitive sense; (4) define and evaluate criteria for referrals to behavioral sub-specialists; (5) elaborate strategies for care coordination and monitoring of services for children with developmental and behavioral concerns; and (6) suggest ways to improve physician understanding of the concepts of developmental surveillance, screening, and early intervention and their application in routine pediatric care. In this way, promising approaches to promoting optimal child development in health care settings can be expanded.
