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Diagnosis and Management of Global Development Delay: Consensus Guidelines of Growth, Development and Behavioral Pediatrics Chapter, Neurology Chapter and Neurodevelopment Pediatrics Chapter of the Indian Academy of Pediatrics

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Abstract

Justification

Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices.

Process

Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP.

Guidelines

GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9–12 months, 18–24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18–24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/pediatric neurologist.

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Funding

Funding: None; Competing interests: None stated.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Maulana Azad Medical College, New Delhi, India

    Monica Juneja, Arpita Gupta, Smitha Sairam, Ridhimaa Jain, Seema Kapoor & Devendra Mishra

  2. Department of Pediatrics, Christian Medical College, Ludhiana, India

    Monika Sharma

  3. Niramaya Hospital and Guidance Clinic, Chembur, Mumbai, Maharashtra, India

    Anjana Thadani

  4. Ummeed Child Development Centre, Mumbai, Maharashtra, India

    Roopa Srinivasan

  5. Rainbow Children’s Hospital, Hyderabad, India

    Lokesh Lingappa

  6. Indian Academy of Pediatrics, Neurodevelopment Chapter, Mumbai, India

    Shabina Ahmed & K. S. Multani

  7. Department of Pediatrics, MP Shah Government Medical College, Jamnagar, Gujarat, India

    Pankaj Buch

  8. Department of Pediatrics, MGM Medical College, Kolkata, West Bengal, India

    Nandita Chatterjee

  9. New Horizons Child Development Centre, Mumbai, Maharashtra, India

    Samir Dalwai

  10. Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Madhulika Kabra

  11. GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India

    Prarthana Kharod Patel

  12. Department of Medical Genetics, Kasturba Medical College, Manipal, Karnataka, India

    K. M. Girisha

  13. Mumbai Port Trust Hospital, Mumbai, Maharashtra, India

    Madhuri Kulkarni

  14. Department of Pediatric Neurology, Medical College Thiruvananthapuram, Kerala, India

    P. A. M. Kunju

  15. Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Prahbhjot Malhi

  16. Ummeid Group of Child Development Centers, Bhopal, Madhya Pradesh, India

    Zafar Meenai

  17. Center for Child Development & Disabilities (CCDD) Bengaluru, Karnataka, India

    Nandini Mundkur

  18. NIMS-SPECTRUM-Child Development Research Centre (CDRC) NMS Medicity, Thiruvananthapuram, Kerala, India

    M. K. C. Nair

  19. Christian Medical College, Vellore, Tamil Nadu, India

    Samuel Philip Oommen

  20. ASHA, Centre for Autism and Intellectual Developmental Disorders, Chandigarh, India

    Chhaya Prasad

  21. All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

    Arun Singh

  22. Bharati Vidyapeeth Medical College & Hospital, Pune, Maharashtra, India

    Leena Srivastava

  23. Child Development Centre, Sir Gangaram Hospital, New Delhi, India

    Praveen Suman

  24. The Children’s Neurodevelopmental Centre, Patna, Bihar, India

    Rahul Thakur

  25. Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India

    Monica Juneja

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  1. Monica Juneja
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  2. Arpita Gupta
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  19. P. A. M. Kunju
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  24. M. K. C. Nair
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  26. Chhaya Prasad
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  27. Arun Singh
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  28. Leena Srivastava
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  29. Praveen Suman
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  30. Rahul Thakur
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Contributions

All authors have contributed to the initial draft of the manuscript, made important intellectual contribution in the framing of the guidelines and finalization of the manuscript, and approved the final manuscript.

Corresponding author

Correspondence to Monica Juneja.

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Additional material related to this study is available with the online version at www.indianpediatrics.net

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Juneja, M., Gupta, A., Sairam, S. et al. Diagnosis and Management of Global Development Delay: Consensus Guidelines of Growth, Development and Behavioral Pediatrics Chapter, Neurology Chapter and Neurodevelopment Pediatrics Chapter of the Indian Academy of Pediatrics. Indian Pediatr 59, 401–415 (2022). https://doi.org/10.1007/s13312-022-2522-5

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