Remote developmental screening in early childhood: Identifying missed milestones
Triagem do desenvolvimento na primeira infância de forma remota: Identificando marcos não alcançados
Rafaela Caroline Bacelar, Maria Beatriz Martins Linhares
Abstract
The present study examined childhood development, focusing on the prevalence of suspected developmental delay and its associations with child, maternal, and social factors. The sample comprised 497 mothers and their 557 children (aged 1 to 65 months) living in Brazil. The child development outcome was evaluated online using the Survey of Well-Being of Young Children screening tool. The predictor variables were the following: child age, sex, and birth status; maternal adverse childhood experiences, depressive symptoms, parental sense of competence, and education level; and family income. According to mothers’ perceptions, 26% of children presented suspected developmental delay. Among mothers, 21% reported depressive symptoms, and 80% had a history of childhood adversities, with a high parental sense of competence. In this study sample, the logistic regression revealed that children’s male sex and preterm birth were risk factors for developmental delay. In contrast, maternal older age, higher education, and income were protective factors. These findings highlight the need for targeted preventive interventions that account for these factors.
Keywords
Resumo
O presente estudo examinou o desenvolvimento infantil, com foco na prevalência de suspeita de atraso e em suas associações com fatores infantis, maternos e sociais. A amostra incluiu 497 mães e 557 crianças brasileiras (de 1 a 65 meses de idade). O desenvolvimento foi avaliado online por meio do instrumento Survey of Well-Being of Young Children. As variáveis preditoras foram as seguintes: idade, sexo e condição de nascimento das crianças; fatores maternos relativos a experiências adversas na infância, sintomas depressivos, senso de competência parental e escolaridade; renda familiar. De acordo com as percepções maternas, 26% das crianças apresentavam suspeita de atraso. Entre as mães, 21% relataram sintomas depressivos e 80% adversidades na infância, com alto senso de competência parental. Nessa amostra de estudo, a regressão logística indicou que o sexo masculino e a prematuridade foram fatores de risco, enquanto a maior idade materna, a escolaridade e a renda foram fatores protetores. Os achados destacam a necessidade de intervenções preventivas direcionadas.
Palavras-chave
References
Adina, Japheth, Morawska, Alina, Mitchell, Amy, & McBryde, Melinda. (2022). Effect of parenting interventions on perinatal depression and implications for infant developmental outcomes: A systematic review and meta-analysis. Clinical Child and Family Psychology Review, 25(2), 316-338. PMid:34580804. https://doi.org/10.1007/s10567-021-00371-3
Batalle, Dafnis, Hughes, Emer, Zhang, Hui, Tournier, Donald, Tusor, Nora, Aljabar, Paul, Wali, Luqman, Alexander, Daniel C, Hajnal, Joseph V, Nosarti, Chiara, Edwards, A David, & Counsell, Serena J. (2017). Early development of structural networks and the impact of prematurity on brain connectivity. NeuroImage, 149, 379-392. PMid:28153637. https://doi.org/10.1016/j.neuroimage.2017.01.065
Bessa, Francilena, Viana-Cardoso, Katia, Martins, José, Moreira, Rafaela Silva, Alves, Claudia Lindgren, & Castro Magalhães, Lívia. (2026). Screening for developmental delays in primary health care in Northeastern Brazil. Journal of Developmental and Behavioral Pediatrics: JDBP, 47(1), e66-e73. PMid:41081544. https://doi.org/10.1097/DBP.0000000000001427
Black, Maureen, Pérez-Escamilla, Rafael, & Rao, Sylvia. (2015). Integrating nutrition and child development interventions: Scientific basis, evidence of impact, and implementation considerations. Advances in Nutrition, 6(6), 852-859. PMid:26875208. https://doi.org/10.3945/an.115.010348
Black, Maureen, Walker, Susan, Fernald, Lia, Andersen, Christopher, DiGirolamo, Ann, Lu, Chunling, McCoy, Dana, Fink, Günther, Shawar, Yusra, Shiffman, Jeremy, Devercelli, Amanda, Wodon, Quentin, Vargas-Barón, Emily, & Grantham-McGregor, Sally. (2017). Early childhood development coming of age: Science through the life course. Lancet, 389(10064), 77-90. PMid:27717614. https://doi.org/10.1016/S0140-6736(16)31389-7
Bornstein, Marc, Putnick, Diane, & Suwalsky, Joan. (2018). Parenting cognitions → parenting practices → child adjustment? The standard model. Development and Psychopathology, 30(2), 399-416. PMid:28625208. https://doi.org/10.1017/S0954579417000931
Chaudry, Ajay, & Wimer, Christopher. (2016). Poverty is not just an indicator: The relationship between income, poverty, and child well-being. Academic Pediatrics, 16(3, Suppl.), S23-S29. PMid:27044698. https://doi.org/10.1016/j.acap.2015.12.010
Cuartas, Jorge, McCoy, Dana, Sánchez, Juliana, Behrman, Jere, Cappa, Claudia, Donati, Georgina, Heymann, Jody, Lu, Chunling, Raikes, Abbie, Rao, Nirmala, Richter, Linda, Stein, Alan, & Yoshikawa, Hirokazu. (2023). Family play, reading, and other stimulation and early childhood development in five low- and middle income countries. Developmental Science, 26(6), e13404. PMid:37114644. https://doi.org/10.1111/ desc.13404
Dagvadorj, Amarjargal, Ganbaatar, Duurenbayar, Balogun, Olukunmi, Yonemoto, Naohiro, Bavuusuren, Bayasgalantai, Takehara, Kenji, Mori, Rintaro, & Akahira-Azuma, Moe. (2018). Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia. BMC Pediatrics, 18(1), 68. PMid:29458342. https://doi.org/10.1186/s12887-018-1017-y
Dosman, Cara, Andrews, Debbi, & Goulden, Keith. (2012). Evidence-based milestone ages as a framework for developmental surveillance. Paediatrics & Child Health, 17(10), 561-568. PMid:24294064. https://doi. org/10.1093/pch/17.10.561
Draper, Catherine, Barnett, Lisa, Cook, Caylee, Cuartas, Jorge, Howard, Steven, McCoy, Dana, Merkley, Rebecca, Molano, Andres, Maldonado-Carreño, Carolina, Obradović, Jelena, Scerif, Gaia, Valentini, Nadia, Venetsanou, Fotini, & Yousafzai, Aisha K. (2023). Publishing child development research from around the world: An affair playing field resulting in most of the world’s child population under-represented in research. Infant and Child Development, 32(6), e2375. https://doi.org/10.1002/icd.2375
Dube, Shanta, Felitti, Vincent, Dong, Maxia, Chapman, Daniel, Giles, Wayne, & Anda, Robert. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564-572. PMid:12612237. https://doi.org/10.1542/peds.111.3.564
Faruk, Tasnuva, King, Catherine, Muhit, Mohammad, Islam, Md Kafiul, Jahan, Israt, Baset, Kamran Ul, Badawi, Nadia, & Khandaker, Gulam. (2020). Screening tools for early identification of children with developmental delay in low- and middle-income countries: A systematic review. BMJ Open, 10(11), e038182. PMid:33234622. https://doi.org/10.1136/bmjopen-2020-038182
Felitti, Vincent, Anda, Robert, Nordenberg, Dale, Williamson, David, Spitz, Alison, Edwards, Valerie, Koss, Mary, & Marks, James. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258. PMid:9635069. https://doi.org/10.1016/S0749-3797(98)00017-8
Fernald, Lia, Prado, Elizabeth, Kariger, Patricia, & Raikes, Abbie. (2017). A toolkit for measuring early childhood development in low- and middle-income countries. Washington, D.C.: World Bank. Retrieved in 2026, May 6, from http://hdl.handle.net/10986/29000
Gibaud-Wallston, Jonatha, & Wandersman, Lois. (1978). Development and utility of the parenting sense of competence scale. In Paper presented at the Annual Meeting of the American Psychological Association, Toronto, Canada.
Guimarães, Marina, Magalhães, Lívia, Moreira, Rafaela, Bessa, Francilena, & Alves, Claudia. (2022). Survey of well-being of young children (SWYC): Preliminary norms for screening for developmental delay in Brazilian children younger than 65 months. Journal of Developmental and Behavioral Pediatrics: JDBP, 43(9), e614-e622. PMid:36443923. https://doi.org/10.1097/DBP.0000000000001133
Hughes, Karen, Bellis, Mark, Hardcastle, Katherine, Sethi, Dinesh, Butchart, Alexander, Mikton, Christopher, Jones, Lisa, & Dunne, Michael. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet. Public Health, 2(8), e356-e366. PMid:29253477. https://doi.org/10.1016/S2468-2667(17)30118-4
Inder, Terrie, Volpe, Joseph, & Anderson, Peter. (2023). Defining the neurologic consequences of preterm birth. The New England Journal of Medicine, 389(5), 441-453. PMid:37530825. https://doi.org/10.1056/ NEJMra2303347
Instituto Brasileiro de Geografia e Estatística – IBGE. (2022). Censo demográfico 2022: Identificação étnico racial da população, por sexo e idade. Rio de Janeiro: IBGE.
International Business Machines – IBM. (2023). IBM SPSS statistics for Windows (version 29.0.1). Armonk: IBM Corporation. Retrieved in 2026, May 6, from https://www.ibm.com/br-pt/products/spss-statistics
Korpilahti, Pirjo, Kaljonen, Anne, & Jansson-Verkasalo, Eira. (2016). Identification of biological and environmental risk factors for language delay: The Let’s Talk STEPPS study. Infant Behavior & Development, 42, 27-35. PMid:26700576. https://doi.org/10.1016/j.infbeh.2015.08.008
Kroenke, Kurt, Spitzer, Robert, & Williams, Janet. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. PMid:11556941. https://doi.org/10.1046/ j.1525-1497.2001.016009606.x
Linhares, Maria, & Gaspardo, Claudia. (2017). Escala de senso de competência parental [Parenting sense of competence scale]. Ribeirão Preto: USP. Tradução da versão original.
Lipkin, Paul, Macias, Michelle, Norwood Junior, Kenneth W., Brei, Timothy J., Davidson, Lynn F., Davis, Beth Ellen, Ellerbeck, Kathryn, Houtrow, Amy, Hyman, Susan, Kuo, Dennis, Noritz, Garey, Yin, Larry, Murphy, Nancy, Levy, Susan, Weitzman, Carol, Bauer, Nerissa S., Childers Junior, David, Levine, Jack, Peralta-Carcelen, Ada, Smith, Peter, Blum, Nathan, Contompasis, Stephen H., Korb, Damon, McGuinn, Laura J., & Voigt, Robert. (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), e20193449. PMid:31843861. https://doi.org/10.1542/peds.2019-3449
Madlala, Hlengiwe, Myer, Landon, Malaba, Thokozile, & Newell, Marie-Louise. (2020). Neurodevelopment of HIV-exposed uninfected children in Cape Town, South Africa. PLoS One, 15(11), e0242244. PMid:33206724. https://doi.org/10.1371/journal.pone.0242244
Martinez-Torteya, Cecilia, Katsonga-Phiri, Tiamo, Rosenblum, Katherine, Hamilton, Lindsay, & Muzik, Maria. (2018). Postpartum depression and resilience predict parenting sense of competence in women with childhood maltreatment history. Archives of Women’s Mental Health, 21(6), 777-784. PMid:29860623. https://doi.org/10.1007/s00737-018-0865-7
McCoy, Dana, Peet, Evan, Ezzati, Majid, Danaei, Goodarz, Black, Maureen M, Sudfeld, Christopher, Fawzi, Wafaie, & Fink, Günther. (2016). Early childhood developmental status in low- and middle-income countries: National, regional, and global prevalence estimates using predictive modeling. PLoS Medicine, 13(6), e1002034. PMid:27270467. https://doi.org/10.1371/journal.pmed.1002034
Moreira, Rafaela, Magalhães, Livia, Siqueira, Cláudia Machado, & Alves, Cláudia. (2019). Cross-cultural adaptation of the child development surveillance instrument “Survey of Wellbeing of Young Children (SWYC)” in the Brazilian context. Journal of Human Growth and Development, 29(1), 28-38. https://doi. org/10.7322/jhgd.145001
Moura, Darlene, Sousa, Emanuela, Santos, Walberto, & Sousa, Sophia Lóren. (2020). Escala de senso de competência parental (PSOC): Evidências de validade e precisão em contexto brasileiro. Revista Psicologia, 11(2), 71-80. https://doi.org/10.36517/10.36517/revpsiufc.11.2.2020.7
Munhoz, Tiago, Santos, Iná, Blumenberg, Cauane, Barcelos, Raquel, Bortolotto, Caroline, Matijasevich, Alicia, Santos Júnior, Hernane, Santos, Letícia, Correa, Luciano, Souza, Marta, Lira, Pedro, Altafim, Elisa, Macana, Esmeralda, & Victora, Cesa. (2022). Fatores associados ao desenvolvimento infantil em crianças brasileiras: Linha de base da avaliação do impacto do Programa Criança Feliz. Cadernos de Saúde Pública, 38(2), e00316920. PMid:35170705. https://doi.org/10.1590/0102-311x00316920
Ongílio, Fernanda, Gaspardo, Cláudia, & Linhares, Maria. (2023). Maternal history of adversity and subsequent mother-child interactions at early ages: A systematic review. Trauma, Violence & Abuse, 24(5), 3412-3432. PMid:36367204. https://doi.org/10.1177/15248380221130355
Osório, Flávia, Mendes, Ana, Crippa, José, & Loureiro, Sonia. (2009). Study of the discriminative validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care. Perspectives in Psychiatric Care, 45(3), 216-227. PMid:19566694. https://doi.org/10.1111/j.1744-6163.2009.00224.x
Perrin, Ellen, Sheldrick, Chris, Visco, Zach, & Mattern, Kathryn. (2016). The Survey of Well-Being of Young Children (SWYC) user’s manual (version 1.01). Tufts Medical Center. Retrieved in 2026, May 6, from https:// www.teamupcenter.org/wp-content/uploads/2025/01/swyc-manual-v101-web-format-33016-1.pdf
Putnick, Diane, Bornstein, Marc, Eryigit-Madzwamuse, Suna, & Wolke, Dieter. (2017). Long-term stability of language performance in very preterm, moderate-late preterm, and term children. The Journal of Pediatrics, 181, 74-79. PMid:27745750. https://doi.org/10.1016/j.jpeds.2016.09.006
Rao, Nirmala, & Fisher, Philip. (2021). The impact of the COVID-19 pandemic on child and adolescent development around the world. Child Development, 92(5), e738-e748. PMid:34569058. https://doi. org/10.1111/cdev.13653
Richards, Jennifer, Drews-Botsch, Carolyn, Sales, Jessica, Flanders, William, & Kramer, Michael. (2016). Describing the shape of the relationship between gestational age at birth and cognitive development in a nationally representative U.S. birth cohort. Paediatric and Perinatal Epidemiology, 30(6), 571-582. PMid:27781289. https://doi.org/10.1111/ppe.12319
Rodrigues, Juliana, Gaspardo, Cláudia, & Linhares, Maria. (2022). Development of neonatal high-risk preterm infants in comparison to full-term counterparts. Applied Neuropsychology. Child, 11(4), 840-849. PMid:34663137. https://doi.org/10.1080/21622965.2021.1988601
Sheldrick, Christopher, Marakovitz, Susan, Garfinkel, Daryl, Carter, Alice, & Perrin, Ellen. (2020). Comparative accuracy of developmental screening questionnaires. JAMA Pediatrics, 174(4), 366-374. PMid:32065615. https://doi.org/10.1001/jamapediatrics.2019.6000
Silva, Sílvia, & Maia, Ângela. (2008). Versão portuguesa do Family ACE Questionnaire (questionário de história de adversidade na infância). In Actas da XIII Conferência Avaliação Psicológica: Formas e Contextos. Braga: Psiquilibrios Edições.
Sousa, Artemizia, Claro, Maísa, & Rondó, Patrícia. (2022). Screening for neuropsychomotor and social emotional development in children under 24 months of age in the Brazilian semi-arid region. Revista Paulista de Pediatria : Orgão Oficial da Sociedade de Pediatria de São Paulo, 40, e2020172. PMid:34076203. https://doi.org/10.1590/1984-0462/2022/40/2020172
Synnes, Anne, & Hicks, Matthew. (2018). Neurodevelopmental outcomes of preterm children at school age and beyond. Clinics in Perinatology, 45(3), 393-408. PMid:30144845. https://doi.org/10.1016/j. clp.2018.05.002
World Health Organization – WHO. United Nations Children’s Fund – UNICEF. (2021). Nurture care handbook: Operationalizing nurture care framework. Geneva. Retrieved in 2026, May 6, from https://nurturing-care. org/handbook/
Submitted date:
05/06/2026
Accepted date:
09/30/2026
Facebook
LinkedIn
Mendeley
Reddit
Email