Health Care for ECD
Thematic Area :
Developmental Monitoring For Early Child Development

This article illustrates Serbia’s experience in introducing developmental monitoring — the process of tracking when and whether a child reaches the milestones that are expected by specific ages. Was it worth it? Yes. However, it is necessary to do a lot more to adequately monitor the development of all children in Serbia, and implement activities to help them achieve their full potential. 

A vignette about developmental monitoring is described below

I met Petar when he was 18 months old. His parents were concerned because Petar was not using words and often did not respond when called by his name, especially when watching TV. His parents did not talk to him much and did not read with him, but they took him to the park every day and played with him at home. Both parents work long hours, and a nanny looks after the boy. When the parents return home, they are often overworked, trying to finish various chores around the house and during that time the boy would use a tablet and watch TV — often for several hours during the day. 

We instructed the parents to talk to Petar as much as possible during everyday activities, read and tell him stories, play with him, stop using tablets and watching TV, and hire someone to help them with household chores so that they could spend more time with him We also checked his hearing and found that Petar could hear well. When the parents brought Petar back for a well-child visit two months later, we observed that Petar had made significant progress in his speech development and was much more interested in the people around him. After four months his speech development was age-appropriate, and today Petar is a lively, smiling boy who initiates communication with his parents and others. 

Tools for monitoring child development 

In 2014, thanks to cooperation between UNICEF and the Association of Paediatricians of Serbia, we held the first training  on the international Guide for Monitoring Child Development (GMCD) with Professor Ilgi Ertem from the University of Ankara, Turkey. About 20 doctors and psychologists from Belgrade, Novi Sad, Niš, and Kragujevac were trained. Since then, we have been using it to monitor the development of children up to 42 months. In Serbia, doctors at the secondary and tertiary levels of health care use the GMCD.

The following year, another 42 health workers and other professionals were trained to apply the Ages and Stages Questionnaire (ASQ-3). The standardisation of the questionnaire was carried out by the Association of Paediatricians of Serbia and the Institute of Psychology of the Faculty of Philosophy in Belgrade, with the support of the Ministry of Health of the Republic of Serbia, the Open Society Foundation, and UNICEF. Between December 2017 and April 2019, 69 paediatricians from 44 health centres and 1,390 parents and children participated in the process of standardising the questionnaire. These trainers subsequently replicated the training for 580 health professionals (paediatricians, paediatric and home visiting nurses) and other professionals. Out of the total number, 70% were from primary health care, 25% were professionals from preschool institutions, and 5% were from welfare centres.

Development counselling centres and teams 

With support from  UNICEF, 19 development counselling centres were strengthened and equipped, and 19 family-oriented early intervention teams were formed. Health workers and associates from health centres, preschool institutions, and centres for social work are involved in these teams. Children identified by a group of selected paediatricians at  the primary health care level as having deviations in their development are referred to the Developmental Counselling Centres, where family-oriented early intervention is applied, and their development is further monitored.

We recognise that future doctors need to learn more about early development within medical studies. The Faculty of Medicine of the University of Belgrade and Novi Sad has introduced the elective course "Early Development of Children." We advocate that education on early development and monitoring of early development become a part of the mandatory curriculum of the Paediatrics course in general medical studies and the curriculum within the specialisation in paediatrics.

We plan to have all paediatricians at the primary care level trained to administer the ASQ-3 to screen all children in Serbia aged 9, 18, and 30 months to detect children with developmental problems and apply early intervention as soon as possible so that they can achieve their full potential.


Introducing developmental monitoring

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