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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 13  |  Issue : 1  |  Page : 5-8

Pragati Pustak – A parent-oriented screening tool for identification of developmental delay in children till 2 years of age


1 Department of Neurosciences PT, DVVPF's College of Physiotherapy, Ahmednagar, Maharashtra, India
2 Department of Community Physiotherapy, DVVPF's College of Physiotherapy, Ahmednagar, Maharashtra, India

Date of Submission17-Aug-2018
Date of Acceptance10-Apr-2019
Date of Web Publication29-Jun-2019

Correspondence Address:
Dr. Suvarna Ganvir
Department of Neurosciences PT, DVVPF's College of Physiotherapy, Ahmednagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_29_18

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  Abstract 

INTRODUCTION: To empower the parents to detect developmental delay in the early stage of a child's life, a community-oriented tool was developed. This tool primarily aimed at helping parents of children till 2 years of age to monitor the development of their child and if there is any red flag signs which indicated that the child needs health care. Early identification of this delay is important in reducing the complications and its related morbidity and disability.
METHOD: Twelve villages around the institute were covered wherein the parents of children till 2 years of age were contacted by a team of physiotherapy and were provided with this Pragati Pustak. It is a card on which information about normal developmental milestones is provided along with the red flag signs in the pictorial format. Information about the use of this tool was provided.
RESULT: Parents found it easy to use this card and were comfortable in using the card. Physiotherapy team identified 49 children with developmental delay during their visit to these villages. These children were then treated in the institute for their developmental delay.
CONCLUSION: Pragati Pustak is an effective tool which can be used by parents effectively to monitor developmental milestones of their child.

Keywords: Developmental delay, parents, screening


How to cite this article:
Ganvir S, Kunde C, Harishchandre M, Ganvir S. Pragati Pustak – A parent-oriented screening tool for identification of developmental delay in children till 2 years of age. Physiother - J Indian Assoc Physiother 2019;13:5-8

How to cite this URL:
Ganvir S, Kunde C, Harishchandre M, Ganvir S. Pragati Pustak – A parent-oriented screening tool for identification of developmental delay in children till 2 years of age. Physiother - J Indian Assoc Physiother [serial online] 2019 [cited 2019 Sep 17];13:5-8. Available from: http://www.pjiap.org/text.asp?2019/13/1/5/261817


  Background Top


In India, there is a prevalence of 1.5%–2.5% of developmental delay in children under 2 years of age.[1],[2] These impairments impact not only the child and family but also the society in general in terms of cost incurred for providing health-care facility, educational support, and impaired quality of life. Evidence suggests that early identification of impairment or disability being helpful to reduce the after effects of poor health-care facility at the correct time of early intervention. The studies from the United States of America have reported that only about one-third of children were identified before their school-going age; this may be a hindrance for providing early care when the disability is minimum.[3] Early identification in a timely manner may prove to be the key factor for reducing the cost of health-care services to the disable population. Hence, significant emphasis needs to be placed on developmental surveillance and screening.

Developmental surveillance is defined as a flexible longitudinal continuous process through which potential risk factor for developmental and behavioral disorders can be identified.[4] The first landmark for this longitudinal process can be in the form of parents who are the primary source of accurate information much needed for the documentation which is accurate enough.

Learn the Signs. Act Early campaign is an evidence-based approach to educating parents about child development.[5] Furthermore, it is found that extent of impact of disabilities was much greater among children with multiple disabilities or with either cerebral palsy, epilepsy, or seizures, delays in growth and development, or emotional or behavioral problems.[6] In concordance, previous studies confirm that asking parents about their view regarding their child's development learning or behavior can be a source of quality information which is helpful for assessing child's development.[7],[8],[9] The ideal screening method should use a standardized and validated tool with well-established psychometric qualities and should be easy to perform and interpret and should be inexpensive to administer.[6],[10],[11]

It is necessary to identify at-risk children at much early stage so as to reduce the likelihood of complications at a later stage. Who can be the better person to help in identification than the parents who are the most reliable and trustworthy information provider?.

With this aim in mind, community-oriented parent-friendly screening tool was developed in the form of Pragati Pustak. This screening tool is in a native language along with pictorial presentation (considering the illiterate population in the rural areas) which will provide adequate information about normal developmental milestones till 2 years of age along with certain red flag signs. The primary aim behind developing this Pragati Pustak was to increase knowledge about developmental milestones and providing an aid to keep track of child's development. Second, the aim was to provide key communication between parents and health-care providers about developmental milestones, to encourage parents to seek early medical help in case of any delay, and also to motivate other parents for the same by forming a local help group.


  Methodology Top


A focused group discussion was held among the health-care workers such as pediatrician, physiotherapist, social workers, and the parents of children with developmental delay. With the inputs from all the components to be included under the screening tool were finalized and a rough draft of the tool was prepared. It was then circulated among the stack holders. This rough draft consisted of four pages of information about developmental milestones after every 3 months of age. The information was primarily in the form of detailed description in the text format. It required minimum 7–8 min to completely fill up the information. It was then discussed in the second meeting of stakeholders. Majority were of the opinion that it was a bit lengthy document and also illiterate parents may not be able to read the complete description. Hence, it was suggested to incorporate a pictorial format with minimum description in the text form, and furthermore, to reduce the number of pages, it was suggested that only the major developmental landmarks be included in the tool.

As per the suggestion from the group, the card was modified with minimum two pages, and pictures of developmental milestones 2 years of age were included. After the approval from all members of the focus group, a minimum 20 copies were prepared. It was named Pragati Pustak which means progress card similar to the progress card of school-going children which has detailed information about the student and whether he/she passes in the said examination.

Prevalidation

Before the card was being used in the actual study, prevalidation was done with the help of local parents who resembled actual village parents who were the target population. Local parents were those who were visiting the Physiotherapy Department for some other reasons but having a similar background as that of target population. Parents were given the card and explained about its use, and information was sought from them. Since they themselves were getting benefitted by the information related to their children, parents gave their valuable feedback about the card. Of 20 parents, 18 expressed their full satisfaction about the card and its utility. Two parents expressed that it will be difficult to keep the card safe for 2 years and may not be helpful in a long run. This concern for safety of the card was recorded, and it was decided that it will be resolved in the due process.

Procedure – after preparation of card and prevalidation, the various regions were chosen for making a visit. Selection of the villages on the basis of fix criteria is within 40 km from the periphery of our institute. With the help of a social worker, the head of the village was contacted at least 1 week before the actual visit. The head of village was informed about the purpose of the visit possible benefits and the required population, i.e., parents of the children till 5 years of age. This upper limit of 5 years was decided through our clinical experience and the poor level of awareness among parents about the ideal age of achievements of developmental milestones. A team of physiotherapy consisted of a qualified physiotherapist and a teacher, postgraduate students and undergraduate students posted in the Department of Neurophysiotherapy, and community-based rehabilitation. On the day of visit the physiotherapy team met the head in the village at a predecided place where the concerned population was also invited. A brief presentation was given about the card its practical utility and the possible advantages for the parents. The presentation also consisted of information about health-care workers who can be contacted in case of any developmental delay. Details of physiotherapy intervention in the various stages of growth were also given; after the presentation, individual counseling session was held between the parent and members of physiotherapy team. A card was given to the parents and was explained about the procedure for using it. The queries raised by the parents were sorted out.

Follow-up was kept through the phone call for communication with parents about the effective use of card. Parents were called once in 2 months for knowing the progress of their child.


  Results Top


Phase 1

Till now, 12 villages have been covered and a population of 594 parents of children till 2 years of age have been contacted. A total of 49 children with developmental delay were identified [Table 1]. The parents of these children were advised to report to physiotherapy department for further management. Of 49 children, 33 reported for further management. Of these 33 children, 25 were cerebral palsy, 2 were spina bifida, 3 were hydrocephalus, and 3 were meningomyelocele]. On probing for grading the utilityof this pragati pustak, 80% parents opined that it was very useful [Figure 1].
Table 1: Details about the beneficiaries of Pragati Pustak in different villages

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Figure 1: Pie diagram showing the perception of parents about the utility of Pragati Pustak

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  Discussion Top


This is the first of its kind utility card prepared for parents of children from 0 to 24 months of age. Furthermore, the project initiated by our institute is unique with respect to the population being covered, i.e., before the school-going age. Utility of Pragati Pustak by parents and its outcome was investigated in detail in this study. High percentage (80%) of parents showed adherence to the monitoring of developmental milestones of their child/children with the help of this tool. This was more than hypothesized percentage. This is probably due to pictorial, easy-to-understand features, appropriate length of content, and hassle-free checklist in the tool.

Parents are the first stakeholders who raise concern about the child's development.[11],[12] Education, income, and socioeconomic status do have a role in parenting knowledge of child development.[13],[14],[15] Comparison between rural and urban population parents about their parenting knowledge is not studied. However, in the present study, parents from rural background were included who showed high percentage of knowledge and adherence.

On an average, there were 4–5 children with some developmental delay in each village. These children were the beneficiaries of this tool. It was possible to identify these children with the help of this tool. Majority of the children were in the moderate category of developmental delay. They could be benefitted by conservative management. Thus, this tool helped to differentiate between the various categories of delay and thus plan management for the same.

With the help of this card, it was possible to identify children with developmental delay at the maximum possible earliest time frame. This will allow the parents to take corrective action in the early stages of their child's life. The parents were advised to consult the health-care worker in the form of either the pediatrician or a physiotherapist so that early intervention can be initiated. Members of the physiotherapy team evaluated the child at the same time and discussed the possible plan of care with the parents and advised them accordingly.

It is aimed further to expand this project to further more 10 villages in the next 1 year in the vicinity of institute so that care can be provided to these children. Distance between the village and institute and transport facility is also a major variable in the follow-up treatment of these children. Although the children admitted at free of cost in the institute for physiotherapy management, staying away from home for longer periods of time is difficult for parents at certain point of time.

Thus, this screening tool has been found to be effective in identifying children at risk of delayed development by appropriately educating the parents at their doorstep.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Radecki L, Sand-Loud N, O'Connor KG, Sharp S, Olson LM. Trends in the use of standardized tools for developmental screening in early childhood: 2002-2009. Pediatrics 2011;128:14-9.  Back to cited text no. 1
    
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Bailey DB Jr., Hebbeler K, Scarborough A, Spiker D, Mallik S. First experiences with early intervention: A national perspective. Pediatrics 2004;113:887-96.  Back to cited text no. 2
    
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Sices L, Egbert L, Mercer MB. Sugar-coaters and straight talkers: Communicating about developmental delays in primary care. Pediatrics 2009;124:e705-13.  Back to cited text no. 3
    
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Schonwald A, Huntington N, Chan E, Risko W, Bridgemohan C. Routine developmental screening implemented in urban primary care settings: More evidence of feasibility and effectiveness. Pediatrics 2009;123:660-8.  Back to cited text no. 4
    
5.
Daniel KL, Prue C, Taylor MK, Thomas J, Scales M. 'Learn the signs. Act early': A campaign to help every child reach his or her full potential. Public Health 2009;123 Suppl 1:e11-6.  Back to cited text no. 5
    
6.
Boyle CA, Decouflé P, Yeargin-Allsopp M. Prevalence and health impact of developmental disabilities in US children. Pediatrics 1994;93:399-403.  Back to cited text no. 6
    
7.
Pinto-Martin JA, Dunkle M, Earls M, Fliedner D, Landes C. Developmental stages of developmental screening: Steps to implementation of a successful program. Am J Public Health 2005;95:1928-32.  Back to cited text no. 7
    
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Benasich AA, Brooks-Gunn J. Maternal attitudes and knowledge of child-rearing: Associations with family and child outcomes. Child Dev 1996;67:1186-205.  Back to cited text no. 8
    
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Engle WA. Morbidity and mortality in late preterm and early term newborns: A continuum. Clin Perinatol 2011;38:493-516.  Back to cited text no. 9
    
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Kerstjens JM, de Winter AF, Bocca-Tjeertes IF, ten Vergert EM, Reijneveld SA, Bos AF, et al. Developmental delay in moderately preterm-born children at school entry. J Pediatr 2011;159:92-8.  Back to cited text no. 10
    
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Palfrey JS, Singer JD, Walker DK, Butler JA. Early identification of children's special needs: A study in five metropolitan communities. J Pediatr 1987;111:651-9.  Back to cited text no. 11
    
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Norlin C, Crawford MA, Bell CT, Sheng X, Stein MT. Delivery of well-child care: A look inside the door. Acad Pediatr 2011;11:18-26.  Back to cited text no. 12
    
13.
Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioral problems. Pediatrics 1995;95:829-36.  Back to cited text no. 13
    
14.
Glascoe FP. Parents' evaluation of developmental status: How well do parents' concerns identify children with behavioral and emotional problems? Clin Pediatr (Phila) 2003;42:133-8.  Back to cited text no. 14
    
15.
Regalado M, Halfon N. Primary care services promoting optimal child development from birth to age 3 years: Review of the literature. Arch Pediatr Adolesc Med 2001;155:1311-22.  Back to cited text no. 15
    


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    Tables

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