Monitoring children’s development through primary health care in Europe and Central Asia

Directions for policy and practice

Infant is carefully listening to the doctor during medical examination.


A large amount of scientific knowledge has accumulated on the importance of early childhood development (ECD) for societal prosperity. Early childhood is the period that sets the foundations for health, well-being, learning, and productivity over the course of a person’s life, and has an impact on subsequent generations.

Awareness of the importance of ECD is reflected in the United Nations Sustainable Development Goals. The World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) have also launched the Nurturing Care Framework (NCF), which clarifies that ECD efforts need to be theory- and framework-based and holistic.

The NCF indicates that good health, adequate nutrition, safety and security, responsive caregiving and opportunities for early learning are all central to the development of children. This framework aims to provide governments and societies with strategic directions for the holistic support of children’s well-being and has inspired multiple sectors, including health, education, labour, finance and social and child protection, to consider what they can do to promote the development of children. 

Despite the long-established importance of ECD, the translation of theory into practice is still slow and uneven. The Lancet ECD series points to an unacceptably high number of children who are unable to fulfil their developmental potential, with a large number living in low- and middle-income countries. Being unable to fulfil one’s developmental potential stands for a suboptimal developmental trajectory, decreased school readiness and learning abilities, and ultimately, decreased adult productivity. Any condition that puts a child at risk of suboptimal development, or that causes a child to have a developmental deviance, delay, disorder or disability is defined as a developmental difficulty. A wide array of conditions resulting in deficiencies in one or more components of the NCF may adversely affect a child’s well-being during this period and result in developmental difficulties. 

The true global prevalence of developmental difficulties is unknown; however, it is estimated to be high, given its broad definition. Surveys of developmental disability provide us with an estimate that one out of every six, or 17%, of children in the United States have a developmental disability. Estimates of the prevalence of developmental difficulties based on proxy measures of stunting and poverty point to a prevalence of 43% in low- and middle-income countries.

Public health measures in most countries have programmes for the primary, secondary and tertiary prevention of the causes of developmental difficulties. A detailed discussion of these prevention measures is beyond the scope of this publication; however, interested readers are referred to an exemplary model for the prevention of developmental difficulties provided in Annex 2, which is an excellent resource that may help advocates, clinicians, researchers and policy makers to think holistically about the programmatic aspects of prevention.

Irrespective of their causes, developmental difficulties in early childhood often manifest with delays in language, relating, play, motor function or self-help skills. A systematic, holistic and comprehensive approach embedded in the bioecological theory of early childhood development must be pursued to prevent, identify and address developmental difficulties as early as possible.

Developmental monitoring represents such an approach, and means to keep track of, and support, every child’s development. This approach aims to maximize every child’s developmental potential through ECD promotion, early identification of developmental difficulties and the provision of timely early intervention. The text below outlines the tenets of developmental monitoring based on seminal publications published in the last two decades.

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