Use of Developmental Screening Tools and Referral Rates by Pediatricians in Maharashtra

A BSTRACT Background: The Indian Academy of Pediatrics recommends use of standardized screening at 4 of the 12 well-child visits in the first three years. The proportion of pediatricians referring children with developmental delay based on these guidelines and conducting developmental screening in Maharashtra is unknown. Objective: This study aimed to (1) assess the use of developmental screening tools among pediatricians in Maharashtra, (2) determine referral rates for children younger than 3 years, and (3) examine associations between pediatricians’ attitudes, knowledge, and reported barriers to these practices. Method: Using nonprobability self-selection, pediatricians providing care for children under three years, filled out a 30-item survey, assessing referral practices, attitudes toward screening tools, current tool use, barriers, knowledge of child development and screening, and training needs. Results: Of the 176 participants, 65% reported using at least one developmental screening tool, Pediatricians with positive attitudes toward screening were 3.6 times more likely to use a tool (OR = 3.63, 95% CI [1.96, 6.74], P < 0.001), and those with greater knowledge were twice as likely (OR = 2.20, 95% CI [1.37, 3.53], P = 0.001). Referral rates were higher among female pediatricians ( P = 0.001), while urban practice ( P = 0.036) and more years of experience ( P = 0.016) were associated with fewer referrals. The top reported barriers were time (58.5%), parent literacy (41.5%), and limited staff (34.7%). Conclusions: Knowledge and attitudes influence developmental screening practices. Barriers highlight the need for training and supportive resources. This study provides initial evidence to guide training and policy for improving early detection and referral.