INTRODUCTION:

Child development is a complex and continuous process involving the acquisition of motor, cognitive, language, and socio-emotional skills. These developmental milestones serve as critical indicators of a child’s neurological and psychological health. Developmental delay refers to a condition in which a child fails to achieve expected milestones within a specified age range, affecting one or multiple developmental domains.¹

Globally, developmental delay has emerged as a significant public health concern. According to recent global estimates, millions of children under five years of age are at risk of not reaching their full developmental potential due to factors such as poverty, malnutrition, inadequate stimulation, and limited access to early childhood care services.^2,11 In low- and middle-income countries, including India, the burden is further compounded by socio-economic disparities and lack of structured screening programs.¹²

The early years of life represent a critical window for brain development, characterized by rapid neuronal growth and synaptic plasticity. Evidence suggests that early identification and timely intervention during this period can significantly improve cognitive, behavioral, and functional outcomes.^3,13 Conversely, delayed identification may lead to long-term disability, poor academic performance, and reduced quality of life.⁴

Nurses, as frontline healthcare providers, play a crucial role in bridging this gap. Their continuous interaction with children and families in both hospital and community settings places them in a unique position to monitor developmental milestones, identify early warning signs, and initiate appropriate interventions.^5,14

Therefore, understanding the role of nurses in early identification and intervention is essential for improving developmental outcomes in children.

OBJECTIVES:

The objectives of this review are:

To identify early signs and risk factors of developmental delay in children

To evaluate commonly used screening tools for early identification

To examine the role of nurses in early detection and intervention

To identify barriers and strategies for improving early identification

METHODS:

This narrative review was conducted to explore the role of nurses in the early identification of developmental delay among children. A comprehensive literature search was performed using electronic databases including PubMed, Google Scholar, and official reports from the World Health Organization (WHO) and UNICEF.

A three-step search strategy was adopted, including an initial limited search, followed by a comprehensive database search, and manual screening of reference lists of selected articles.

Relevant articles published between 2015 and 2025 were included in the review. Keywords used for the search included “developmental delay,” “early identification,” “pediatric nursing,” “screening tools,” and “child development.” Boolean operators such as AND and OR were used to refine the search results.

Inclusion criteria consisted of peer-reviewed articles, review papers, and guidelines focusing on developmental screening, early intervention, and the role of nurses in pediatric care. Studies not available in English, duplicate articles, and those not directly related to the topic were excluded.

The quality of included studies was assessed using standard appraisal methods to ensure the reliability and validity of findings. Relevant studies were critically evaluated based on methodological quality and relevance to the review objectives.

Data were extracted from selected studies using a structured format, including study design, sample characteristics, methodology, key findings, and conclusions.

The primary outcomes of this review included early identification of developmental delay, effectiveness of screening tools, and the role of nurses in early detection and intervention.

The selected literature was carefully reviewed and analyzed to identify key themes related to types of developmental delay, screening tools, nursing roles, barriers, and strategies for early identification. The review followed a narrative synthesis approach to summarize findings.

Types of Developmental Delay:

Developmental delay can affect one or more domains of a child’s development. Understanding these domains is essential for early identification and appropriate intervention.

Gross Motor Delay: refers to delays in large muscle movements such as sitting, standing, and walking. Children with gross motor delay may show difficulty in maintaining posture or achieving mobility milestones.

Fine Motor Delay: involves difficulties in small muscle activities such as grasping objects, holding a pencil, or performing hand-eye coordinated tasks.

Speech and Language Delay: is one of the most common developmental concerns, where children may have difficulty in understanding or expressing language appropriate for their age.

Cognitive Delay: affects a child’s ability to think, learn, and solve problems. These children may show difficulties in memory, attention, and understanding instructions.

Social and Emotional Delay: involves challenges in interacting with others, expressing emotions, and adapting to social environments. This may be seen in conditions such as autism spectrum disorder.

Risk Factors for Developmental Delay:

Developmental delay can result from a combination of prenatal, perinatal, and postnatal factors.

Prenatal Factors include maternal infections, malnutrition, substance abuse, and exposure to toxins during pregnancy. Poor antenatal care can significantly increase the risk.

Perinatal Factors such as birth asphyxia, prematurity, low birth weight, and complications during delivery are major contributors to developmental delay.

Postnatal Factors include infections, malnutrition, lack of stimulation, and environmental deprivation. Socio-economic factors such as poverty and limited access to healthcare services also play a significant role.

Screening Tools for Early Identification of Developmental Delay:

Early identification of developmental delay depends on the use of standardized and reliable screening tools. These tools help in assessing developmental milestones and identifying children at risk at an early stage.

The Denver Developmental Screening Test (DDST) is one of the most widely used tools for children from birth to six years of age. It assesses four domains: gross motor, fine motor-adaptive, language, and personal-social development. It is simple, quick, and suitable for use in both clinical and community settings.

The Trivandrum Developmental Screening Chart (TDSC) is a cost-effective and easy-to-use tool developed in India. It is widely used in primary healthcare and community settings, especially by nurses and health workers, for screening children up to six years of age.

The Ages and Stages Questionnaire (ASQ) is a parent-completed screening tool that evaluates communication, motor skills, problem-solving, and personal-social domains. It promotes parental involvement and provides insights into the child’s development in the home environment.

The Modified Checklist for Autism in Toddlers (M-CHAT) is specifically used for early detection of autism spectrum disorders in children aged 16 to 30 months. It helps identify early behavioral signs and facilitates timely referral for further evaluation.

These tools are primarily screening instruments and not diagnostic tools. Their effectiveness depends on proper use, interpretation, and timely referral, which highlights the critical role of nurses in the screening process.

Despite the availability of these validated tools, their utilization remains inconsistent in many primary healthcare settings due to lack of training and standardized implementation protocols.¹²

Table: Comparison of Screening Tools

Tool	Age Group	Domain	Key Feature
DDST	0–6 years	All domains	Quick screening
TDSC	0–6 years	Motor, language	Cost-effective
ASQ	1–66 months	Multiple	Parent-based
M-CHAT	16–30 months	Autism	Early ASD detection

Role of Nurses in Early Identification of Developmental Delay:

Nurses play a comprehensive and multifaceted role in the early identification and management of developmental delays. Their responsibilities extend beyond clinical assessment to include education, advocacy, and coordination of care.

In clinical settings, nurses perform developmental surveillance and screening during routine visits such as immunization clinics and well-child check-ups. The use of standardized tools such as DDST, TDSC, and ASQ allows nurses to systematically assess developmental domains and identify deviations from normal patterns.^4,6

In addition to screening, nurses provide parental education and counseling, which is essential for early detection. Educating caregivers about developmental milestones, stimulation techniques, and red flag signs empowers them to actively participate in their child’s development.^9,15

Nurses also play a critical role in early intervention and referral systems. Once a delay is suspected, timely referral to specialists such as pediatricians, speech therapists, or occupational therapists is initiated. Early referral has been shown to significantly improve developmental outcomes and reduce long-term disability.^10,16

Furthermore, nurses contribute to community-based screening programs, particularly in rural and underserved areas. Through collaboration with ASHA workers and Anganwadi centers, nurses help identify at-risk children and ensure access to healthcare services.¹²

The integration of digital health tools and telehealth services has further expanded the role of nurses in developmental screening, allowing remote monitoring and follow-up care.¹⁷

These findings highlight the need to strengthen nursing competencies and incorporate developmental screening as a routine component of pediatric healthcare services.¹⁴

Barriers in Early Identification of Developmental Delay:

Despite the importance of early detection, several barriers hinder timely identification of developmental delays. One of the major challenges is the lack of awareness among parents and caregivers regarding normal developmental milestones. Many parents fail to recognize early warning signs or delay seeking medical advice.

Another significant barrier is the limited training of healthcare professionals, particularly nurses working in primary healthcare settings. Inadequate knowledge and lack of confidence in using standardized screening tools reduce the effectiveness of early detection.

Resource limitations also play a critical role, especially in low-resource settings. Lack of screening tools, high patient load, and time constraints make it difficult to conduct routine developmental assessments.

Socio-cultural factors and stigma associated with developmental disabilities may prevent families from seeking early intervention. Cultural beliefs and misconceptions often delay diagnosis and treatment.

Additionally, the lack of integration of developmental screening into routine healthcare services leads to missed opportunities for early identification.

Strategies for Improving Early Identification:

Improving early identification requires a multi-level approach involving healthcare systems, professionals, and communities. One of the key strategies is strengthening training programs for nurses, including workshops and skill-based education on developmental screening tools.

The implementation of standardized screening protocols in healthcare settings is essential. Integrating developmental screening into routine services such as immunization clinics and well-baby visits ensures early detection.

The use of digital health technologies, including mobile applications and telehealth services, can enhance screening and follow-up, particularly in rural and underserved areas.

Community awareness programs are crucial for educating parents about developmental milestones and the importance of early intervention. Involvement of ASHA workers and Anganwadi workers can improve outreach.

Strengthening referral systems and multidisciplinary collaboration ensures timely intervention and continuity of care.

DISCUSSION:

Early identification of developmental delay is critical for improving long-term outcomes and reducing the burden of disability in children. This review highlights that developmental delays are influenced by a complex interaction of biological, environmental, and socio-economic factors, particularly in low- and middle-income countries.^2,11

The availability of standardized screening tools such as DDST, TDSC, ASQ, and M-CHAT has significantly improved early detection; however, their effectiveness is highly dependent on proper implementation and trained personnel.⁴ In this context, nurses play a central role due to their accessibility and continuous engagement with children and families.

Nurse-led screening programs have been shown to improve early detection rates, parental awareness, and timely referral for intervention.^14,15 However, gaps in training, lack of standardized protocols, and limited healthcare resources remain major challenges, particularly in rural and underserved areas.¹²

The integration of digital health technologies and telehealth services offers a promising solution to improve accessibility and efficiency of developmental screening.¹⁷ Strengthening nursing education, implementing structured screening programs, and promoting community awareness are essential strategies to enhance early identification.

Overall, a multidisciplinary and system-level approach is required to ensure effective early detection and intervention, with nurses playing a key role in bridging the gap between healthcare services and the community.

Future research should focus on implementing structured nurse-led screening models in primary healthcare settings.

LIMITATIONS

This review is limited by inclusion of only English-language studies and reliance on previously published literature. Variations in study design and methodology across included studies may affect the generalizability of findings.

PRACTICAL IMPLICATIONS:

The findings of this review emphasize the importance of integrating nurse-led developmental screening into routine healthcare services. Training programs, standardized protocols, and community-based interventions can significantly improve early identification and intervention outcomes.

CONCLUSION:

Early identification of developmental delay is essential for promoting optimal child growth and development. Nurses, as frontline healthcare providers, play a pivotal role in screening, early detection, referral, and community-based interventions. Strengthening nursing education, integrating standardized screening protocols, and enhancing healthcare infrastructure are crucial for improving early identification and intervention outcomes. A coordinated, multidisciplinary approach is required to ensure that every child achieves their full developmental potential.

CONFLICT OF INTEREST:

None declared.

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Received on 24.03.2026 Revised on 15.04.2026

Accepted on 05.05.2026 Published on 27.07.2026

Available online from August 01, 2026

Asian J. Nursing Education and Research. 2026;16(3):184-188.

DOI: 10.52711/2349-2996.2026.00037

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.