Quality statement 4: Developmental assessment at 4 years

Quality statement

Children born before 28+0 weeks' gestation have a developmental assessment at 4 years.

Rationale

Children who are born before 28+0 weeks' gestation are at increased risk of a range of developmental problems and disorders that may have an impact on their health and well-being. Significant problems cannot always be reliably assessed at the 2-year assessment, or problems and disorders of a lesser severity may only become evident at this later age. A face-to-face developmental assessment at 4 years allows difficulties to be identified and gives an understanding of overall development. This allows appropriate support and intervention to be provided to improve a child's outcomes and school-based learning.

Quality measures

Structure

a) Evidence of local systems, such as BadgerNet, to record data on children born preterm and identify those born before 28+0 weeks' gestation.

Data source: Local data collection, for example, service specifications.

b) Evidence of local systems to arrange a developmental assessment at 4 years (uncorrected age) with children who are born before 28+0 weeks' gestation.

Data source: Local data collection, for example, service protocols.

Process

Proportion of children born before 28+0 weeks' gestation who have a face-to-face developmental assessment at 4 years (uncorrected age).

Numerator – the number in the denominator who have a face-to-face developmental assessment at 4 years (uncorrected age).

Denominator – the number of children born before 28+0 weeks' gestation.

Data source: Local data collection, such as the Royal College of Paediatrics and Child Health personal child health record ('red book') or the child health information system.

Outcome

Proportion of children born before 28+0 weeks' gestation with developmental problems and disorders identified at the developmental assessment at 4 years (uncorrected age) who have support provided.

Data source: Local data collection, such as the Royal College of Paediatrics and Child Health personal child health record ('red book') or the child health information system.

What the quality statement means for different audiences

Service providers (community paediatric services) ensure that systems are in place to identify children born before 28+0 weeks' gestation and to arrange a face-to-face developmental assessment as close to the child's fourth birthday (uncorrected age) as possible.

Healthcare professionals (educational psychologists, clinical psychologists and paediatricians with expertise in neurodevelopment) attend a face-to-face developmental assessment with children born before 28+0 weeks' gestation as close to the child's fourth birthday (uncorrected age) as possible. At the appointment they discuss with parents or carers whether they have any concerns and check for developmental problems and disorders. They use assessments to check for social, attentional, emotional and behavioural problems, and to check development and IQ. They ensure that orthoptic vision screening has been offered. If there are any suspected problems they investigate further or refer to the appropriate local pathway.

Commissioners (clinical commissioning groups) ensure that they commission services that have the capacity and expertise to provide children born before 28+0 weeks' gestation with the required developmental assessment. They undertake contract monitoring and seek evidence that service providers have this in place.

Children born before 28 +0 weeks have a face-to-face assessment as close to their fourth birthday (uncorrected age) as possible with a doctor and a psychologist to check their development and see if they have any problems. Their parents or carers will have a chance to talk about any concerns. If there are any suspected problems, the healthcare professionals will investigate further or refer them to local services.

Source guidance

Developmental follow-up of children and young people born preterm (2017) NICE guideline NG72, recommendations 1.3.3 and 1.3.13

Definitions of terms used in this quality statement

Developmental assessment at age 4 years

A face-to-face assessment that takes place as close to the child's fourth birthday (uncorrected age) as possible that should involve the following professionals:

  • an educational or clinical psychologist

  • a paediatrician with expertise in neurodevelopment.

This assessment should include as a minimum:

  • discussing with parents or carers whether they have any concerns about their child's development

  • include checks for developmental problems and disorders

  • measuring length or height, weight and head circumference

  • carefully evaluating and reviewing any developmental concerns reported by parents or carers or noted during the appointment or assessment

  • correcting for gestational age up to 2 years when assessing developmental history

  • considering further investigation or referral if a developmental problem or disorder is suspected or present

  • referring the child to the appropriate local pathway if needed

  • using the following parent questionnaires, to be completed by parents or carers beforehand and the results discussed during the assessment:

    • the Strengths and Difficulties Questionnaire (SDQ), to check for social, attentional, emotional and behavioural problems

    • the Ages and Stages Questionnaire (ASQ) 48-month questionnaire, to check for various aspects of development

      If the questionnaires are not suitable (for example, because of poor English language comprehension or the child being outside the validated age range), a suitable alternative assessment should be used

  • reviewing previous assessments and information from all other relevant sources

  • using a standardised test to assess IQ, such as the Wechsler Preschool and Primary Scales of Intelligence 4th Edition (WPPSI) test

  • Gross Motor Function Classification System (GMFCS) score if cerebral palsy has been diagnosed

  • ensuring that the child has been offered orthoptic vision screening as recommended by the National Screening Committee.

[NICE's guideline on developmental follow-up of children and young people born preterm, recommendations 1.3.7, 1.3.13 and 1.4.3 and expert opinion]

Equality and diversity considerations

The questionnaires used at the assessment might not be suitable for people with poor English language comprehension. In these circumstances a suitable alternative assessment should be provided, depending on the needs of the child.