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An Independent Pediatric Clinic Finds a Digital Solution to Screening Barriers

The research is clear: developmental screening is critical in the first years of a child’s life.1

Despite research findings, screening rates remain as low as 17% in some states,2 and many pediatricians don’t screen using American Academy of Pediatrics recommended tools such as the PEDS-DM or the ASQ.3 According to a survey of California pediatricians, 95% agreed that developmental screening is important, but only 37% said they were performing screenings using validated tools.4

What challenges are pediatricians facing? Pediatricians cite time as a significant barrier to performing screenings.4 Physicians who are screening usually only have time to do so informally at well-child visits, but they are unable to access reimbursement for informal screenings.  Furthermore, valuable time that could be spent educating parents on developmental milestones, discussing parent concerns, or referring a child-in-need is wasted on screening and scoring, which can take 5 or more minutes of a short 15-minute visit.

As a family-run practice providing pediatric care to children in Los Angeles County, Kidz Kare Doc decided to try BabyNoggin to see how a digital tool could improve workflow efficiency, increase parent engagement, and help them access reimbursement for the high-quality care they were already providing. 

Read about BabyNoggin’s impact in our case study with Kidz Kare Doc.

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1.Burak, E.W. and Odeh, M. (2018) Developmental Screenings for Young Children in Medicaid and the Children’s Health Insurance Program. Retrieved from

2.Hirai, A.H., Koganm M.D., Kandasamy, Veni., Reuland, C., Bethell, C. (2018) Prevalence and variation of developmental screening and surveillance in early childhood. Jama Pediatrics, 172(9), 857-866. Retrieved from

3.American Academy of Pediatrics. Screening Tools. Retrieved from

4.Silicon Valley Foundation. (2017). From the Doctor’s Office: California Pediatrician Survey on Early Childhood Developmental Screening. Retrieved from:


From Screenings to Better Outcomes

Learn how digital platforms streamline the child development screening process. You can find our slides at here.

Hosts Patricia Herrera, Director of Developmental Screening and Care Coordination at 211 LA, and Dr. Jin Lee, founder and CEO of BabyNoggin share how Pediatricians can access reimbursement, better engage parents and direct them to timely intervention services.

Slides include:

● Streamlining the developmental screening process
● How to receive reimbursement easily for performing screenings
● How to engage and connect parents to timely and effective intervention services

Patricia Herrera is a trained social worker and mental health professional with a career dedicated to the development of innovative, cost-effective models of care coordination to improve the health outcomes for children.

Interested providers seeking to get more information and special offers for physicians and families living in LA County should contact BabyNoggin now to take advantage of 211 LA services.

Never Fall Behind Webinar Follow-up FAQ

Never Fall Behind Webinar Follow-Up FAQ with Dr. Emily & Dr. Jin Lee


Q: Are there recommendations from the AAP for developmental screening and surveillance? Can you clarify these guidelines?

A: Dr. Jin Lee: The AAP recommends developmental surveillance at every single well-child visit. What they call developmental surveillance/surveillance is basically another word for developmental monitoring. In contrast, developmental screening requires using a structured, formal screening tool that’s validated such as PEDS, ASQ, and others specified on the AAP website at 9, 18, and 30 months. Screening for autism should take place at 18 and 24 months.

Check out our blog on the roles of screening and surveillance in developmental monitoring.

Q: Is there a minimum age for neuropsychological testing? Would babies who suffer neonatal abstinence syndrome be a candidate for this or would standard developmental screening and surveillance suffice?

A: Dr. Emily: There really isn’t a minimum age requirement for a neuropsych evaluation. Prior to going into private practice, I spent time working in a neonatal intensive care unit (NICU) and saw little ones as soon as they were born in order to begin this process of monitoring development closely. Of course, there is a huge range in terms of what you can screen for depending on a child’s age. With infants, there is a lot less that you are expecting them to do, and can, therefore, screen for, compared to older children. But, there really isn’t a minimum age at which a neuropsychological evaluation becomes appropriate or at which point it is appropriate to involve a neuropsychologist. What is often a limiting factor is that there are a lot of neuropsychologists who have not undergone training in how to work with infants or very young children. This is why you may sometimes come across providers who say they will not work with a child until about 4 or 5 years of age. I think this is a shortcoming with a lot of providers in my field because we know that working with children from a very very young age is incredibly important to make sure that we are setting them up to be on the right developmental track.

In terms of the second part of the question, children who are undergoing withdrawal from substances that they were exposed to in utero are at high risk of experiencing developmental issues. As such, it will be important to monitor their development closely. In my experience, these infants are also often irritable, which also makes parenting much more of a challenge. I think that it’s also really good to involve a neuropsychologist, again, early on, to help monitor development. As I mentioned, there are tests that allow us to measure skills in infants that begin at birth and allow us to monitor development moving forward. This close monitoring, especially during those early childhood months and years, really allows us to make sure that we’re not running into any developmental hiccups. What I often see with families when they’ve had a baby in the NICU is that once they are discharged from the NICU they have this idea often that they are out of the woods developmentally, that their child is now healthy enough to go home. They often have a very limited understanding or awareness of some of the developmental risks that may be associated with any medical issues or, indeed, just with premature birth in and of itself.

Q: A challenge when taking action early is that, when referrals are made, many of these kids do not qualify for early intervention. This causes a lot of anxiety for parents during the waiting period for rescreening. What sorts of actions would you recommend during the waiting period?

A: Dr. Lee: I have a daughter who is 22 months ago and a few months ago she was diagnosed with speech delays, at low risk. This diagnosis was made only after I pushed for an evaluation through my pediatrician, who didn’t believe she was delayed. I insisted and then I actually self-referred myself to a regional center in CA, a free intervention center offered by the state. They are required by law within 45 days to see my child because I have given them an issue of concern. So I always recommend folks to refer themselves to these centers.

14% of children are low risk for developmental delays, and in my case, the regional intervention center gave me 5 pages of activities that I can do to practice different ways of speaking with my 22-month old daughter in a way that is fun and activity-based. Without self-referring myself to that center, I would not have gotten that information because the information I initially was given by my doctor was only a page, not nearly enough for an anxious mom like myself. At BabyNoggin, which I am the founder of, we have incorporated a lot of these activities within the app, so that when parents go through the app and screen their kids and find out their kids are either low, medium, or high risk, we actually provide recommendations for the parents on what to do next. For low and medium kids we typically give their parents activities to do and, for those at high risk, we give their parents phone numbers and addresses for their early intervention services nearby them so that they can self-refer.

A: Dr: Emily: This is something that is a major source of frustration for me. Often, when we are looking at the denial of a delay or somebody saying that a delay is not significant enough, it is usually government-based agencies that are doing this, whether it is an early intervention program or whether it is school-based services when a child is 3 or older. A lot of these denials stem from children not meeting thresholds that have been somewhat arbitrarily set for what’s considered a delay and what isn’t. A lot of my frustration around that tends to be that the cut-off points that are considered are really not grounded in scientific data. School systems and early intervention programs tend to wait until a delay is hugely evident before they will actually jump in and do something about it. So they are essentially waiting for a child to fail before they feel that the evidence is substantial enough for them to intervene. As you have probably seen now from what Dr. Lee and I have talked about, this is not something that is backed up by the research at all. The research really says that we need to intervene as soon as possible. In addition to pursuing the supports available through early intervention programs or the school system, I encourage families to pursue private evaluations (through their health insurance or private pay) because you’re going to get a more thorough and complex screening by somebody who knows that even if a delay is not critical, that there’s often a lot that we need to do to help ensure it does not become critical.

Q: What parents should do when regional centers do not assess within 45 days?

Dr. Lee:  I’m based in San Francisco, where there is a family advocacy group locally, called Support for Family, and they usually train families saying when it’s close to maybe 35 days, 40 days, and you haven’t received a call or email from the local regional center or wherever your early intervention service might be to gently call or email and say, “Hey, I know the 45 day deadline is coming up, I just want to check in and see what the status of my child is.” Just give them a gentle reminder, because, if you empower yourself with the legal implications, they will feel a little bit more threatened and want to help. They are flooded with concerns all the time, which is why it’s many times difficult to meet that 45-day deadline. However, when they do not meet it, they are given a lower score in when they are given an annual performance review by the state, which typically means lower funding dollars to them.  So, they absolutely want to do everything they can to meet the 45 days, but just be mindful that it might not happen all the time. I know in San Francisco, especially at the beginning and end if the school year, they get super busy. In the summer and holiday season they are not as busy, so you might be able to get the kids in earlier.

Q: What kinds of things are done in ABA therapy?

Dr. Emily: ABA or applied behavior analysis therapy is an approach that is taken to help support development in children with autism. There is a fair amount of research that it is an effective intervention for decreasing problem behaviors and increasing behaviors that you want to see more often (for example, communicating). ABA is a very structured way of interacting with children to help teach them the link between their actions and the responses of others. It’s a very repetitive approach to building skills that emphasizes reinforcing the behaviors that you do want to see and practicing that behavior until it becomes more and more automatic. While there is a lot of data out there suggesting it is beneficial for autism, it actually has a number of appropriate applications for children with other developmental issues as well. In fact, it’s one of the first-line treatments recommended by the American Academy of Pediatrics for children under the age of 5 years who have been diagnosed with ADHD. Here, it can help with some of that behavioral and emotional regulation that young children with ADHD will sometimes struggle with. It can also be a helpful intervention for children who have intellectual disabilities or who have substantial language delays where again that kind of structure and consistency is often really important in helping them make progress.

Q: What suggestions are there for how to present these services without triggering resistance within the stigma of developmental delays?

Dr. Emily: I think this is where apps like BabyNoggin can play a big role because if parents are tracking development closely, they will be the ones who bring up developmental concerns to you. When a situation arises where you, as a provider, have concerns that are not shared by the parents, I think you need to discuss your concerns. Sometimes, parents may not have concerns because this is their first child and they may not have much awareness of what typical development looks like. Here, as a provider, part of your role is to start to gently introduce a family to what you are seeing (or not seeing). Once you start this conversation, you may find that a family is very receptive to taking steps to help establish if delays are present. If you encounter some resistance, then it may take your bringing this up several times to the family across several different visits and also providing them with information about child development before they are ready to take the next step.

Q: For pediatricians moving to a new state where would be a good place to start investigating community resources for parents with kids with delays?

A: Dr. Lee: For children 0-3 years old, contact your local early intervention system to find out about community intervention resources.  You can find your state’s early intervention contact information here. To learn more about early intervention for children under 3, click here. For children 3 years old or older, contact your local public school system.  To learn about the available services and process for children over 3, click here.

Q: Does early intervention exist for anxiety disorders and if so, what does it look like?

A: Dr. Emily: There really isn’t an established protocol for how to address early signs of mood disorders (e.g., anxiety, depression) in young children. As with many conditions, a child is at higher risk of developing a mood disorder if family members also have the condition. This means that you need to watch for signs of an emerging mood disorder and take prompt action if you see concerns.

If your child is not yet showing significant signs of anxiety, one of the things that you might want to do is look at ways to help your child develop a healthy relationship with anxiety so that it is something that does not limit their progress. For example, work on praising your child for the effort that they put into something rather than the outcome. Similarly, celebrate your child trying new things even if they do not necessarily succeed. Having a whiteboard at home where everyone can write down the new things that they have tried can be a fun way to celebrate times when your child pushes through anxiety to try something new.

Pay attention to how you express your emotions. Model what it is like to make and recover from mistakes (for example, overcooking dinner or forgetting to pay a bill on time) in a healthy way. This can help normalize the experience of making mistakes for your child. You can also look for safe opportunities that can help your child learn that it is okay to fail. Playing board games or family sports games can be great ways to do this. You can model how to cope with losing or missing a shot and give your child practice managing these things as well. When your child is distressed, it’s perfectly appropriate to validate their feelings of distress, but you also want to encourage them to push through the disappointment and try again.


Dr. Emily is an Oxford-trained, board-certified neuropsychologist.  Dr. Emily is an expert in child development and brain function and has a practice in Atlanta working with infants and children who are at-risk of (or have) developmental delays or complex medical issues. She has published research on supporting quality of life in children and on the cognitive strengths and weaknesses of children with medical conditions including epilepsy, brain tumors, and genetic disorders.  For more information about Dr. Emily and the work she is doing, visit

Dr. Jin Lee is the CEO of BabyNoggin. She is an Oxford-trained child psychologist and has over a decade of experience in healthcare, innovation, and research. She has worked in the innovation and venture arms of Humana and Providence St. Joseph Health. Dr. Lee has been featured on numerous healthcare blogs and has showcased her work at multiple child health-related conferences such as the Aspen Institute Children’s Forum and National Early Head Start. To learn more about Dr. Lee and the work she is doing, visit


Myths in Pediatric Practice


Myths in Pediatric Practice 

by Caitlin Iglehart and Dr. Patricia Gellasch

Myth #1: All pediatricians conduct developmental screenings

The Department of Health and Human Services reports that as many as 25% of children are at moderate or high risk for developmental, social, or behavioral delays yet as many as 50% of US children are not being screened for delays at their visits.  In states like California, the statistic is even more alarming.  According to a preliminary report conducted by the Silicon Valley Community Foundation, only 37% of California pediatricians report using an evidence-based screening tool to screen for developmental delays.  In contrast, 96% of pediatricians agreed it is important to use a formal tool at recommended intervals.

Why aren’t pediatricians employing evidence-based tools?  According to the preliminary report, pediatricians state several barriers: 86% report lack of time, 73% report cost, 64% report lack of referral services, 62% report unfamiliarity with tools, and 55% report lack of training.  This brings us to our next myth.

Myth #2:  Surveillance and screening are the same!

Clearly, there is a need for greater understanding of the developmental screening process among pediatric providers.  One misconception surrounds what qualifies as a screening. Many clinicians consider surveillance and screening synonymous or believe that simply asking informal questions about developmental milestones at a well-child visit qualifies as screening.  This misconception leads parents and healthcare providers to believe that children are being appropriately screened for developmental and behavioral delays when they are not. (For more information about the costs of failing to properly screen, visit our blog on The Economics of Developmental Screening.)

Though surveillance and screening are similar in their overarching goal of monitoring developmental health, they are not equal.  It is important to understand their differences, limitations, and when each is appropriate. Let’s start by understanding the concept of surveillance.


The ongoing informal process of surveillance occurs at all clinical encounters. The American Academy of Pediatrics (AAP) describes developmental surveillance as “a flexible, longitudinal, continuous, and cumulative process whereby knowledgeable healthcare professionals identify children who may have developmental problems.” Surveillance is important for identifying when developmental screening tools should be administered outside of the recommended AAP well-child visits.  

The AAP lists 5 components of developmental surveillance:


In contrast to the continuous process of surveillance, the AAP describes developmental screening as “the administration of a brief standardized tool aiding the identification of children at risk of a developmental disorder.”  Developmental screening tools are designed to identify children who may have developmental issues and serve as a tool to refer children for diagnostic evaluation or early intervention services.  

Whenever a problem is identified during developmental surveillance, developmental screening that targets the area of concern is administered.  Two to six times more children will be identified when validated developmental/behavioral screening tools are administered compared to when clinicians rely only on their clinical judgment (Hix-Small et. al, 2007, Jee et. al, 2010, Jee et. al, 2010, Schonwald et. al, 2009).  According to Glascoe (2000), using only clinical judgment detects fewer than 30% of children who have intellectual and language disabilities or other developmental problems.

The AAP has approved specific screening tools that have been validated to detect developmental delays.  These tools include, but are not limited to those listed below. The “General Tools” are validated broadband measures that screen for several types of delays, making them appropriate for developmental screening.  The preferred screening measure chosen by the provider must be properly administered which includes completing all questions and scoring according to the authors/publishers instructions. Results must be reported back to the patients’ families in a timely manner.  Failure to use validated measures (psychometrically tested) or failing to administer or score a validated tool as it was intended for (i.e., altering questions) will not qualify as developmental screening.

General Developmental Screening Tools:

Language Screening Tools

Social-Emotional Screening Tools

Autism Screening Tools

So when should we employ surveillance methods and when should we employ screening methods?

Surveillance and screening are both needed to successfully monitor development.  The AAP recommends “developmental surveillance at every well-child visit and developmental screening using formal, validated tools at 9, 18, and 30 months or whenever a parent or provider concern is expressed.”  In essence, surveillance is an ongoing, longitudinal informal process of monitoring the developmental well-being of a child.  In contrast, screening is the formal process of administering a validated instrument (either parent or provider completed) to assess the child’s developmental skills and behavior.  Screening should occur at recommended AAP well-child visits, but may also be conducted before or between these encounters, if a concern is raised.

When delays are detected, children should be referred for a diagnostic evaluation or connected directly to intervention services, many of which are free.  Intervention services can be found here.  

For further reference, here is the AAP’s algorithm for screening and surveillance:


Myth #3: Screening is expensive!  

While purchasing screening tests can be expensive, each state reimburses healthcare providers for conducting screenings as do many private health insurers.

Baby Noggin contains validated developmental/behavioral screening tools (Modified Checklist for Autism in Toddlers-Revised and Parents’ Evaluation of Developmental Status: Developmental Milestones) that are AAP approved and widely used by pediatric clinicians. The use of these measures can minimize the cost associated with screening while improving workflow.  For more information about developmental screening and to learn about how we are improving the developmental screening process attend our webinar and visit the websites of BabyNoggin, PEDS, and M-CHAT-R.


Watch CEO of BabyNoggin Dr. Jin Lee, Dr. Diana Robins, and Dr. Patricia Gellasch explore the ins and outs of two AAP-approved screening tools, M-CHAT-R and PEDS here.



American Association of Pediatrics. (2018). Screening tools. Retrieved from  

American Association of Pediatrics. (2018). Description and Policy. Retrieved from

Glascoe, F. (2000). Early Detection of Developmental and Behavioral Problems. Pediatrics in Review, 22(8).

Hix-Small, H., Marks, K., Squires, J., & Nickel, R. (2007). Impact of implementing developmental screening at 12 and 24 months in a pediatric practice. Pediatrics, 120, 381-389.

Jee, S. H., Conn, A., Szilagyi, P. G., Blumkin, A., Baldwin, C. D., & Szilagyi, M. A. (2010). Identification of social-emotional problems among young children in foster care. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 51(12), 1351-1358.

Jee, S. H., Szilagyi, M., Ovenshire, C., Norton, A., Conn, A.-M., Blumkin, A., & Szilagyi, P. G. (2010). Improved detection of developmental delays among young children in foster care. Pediatrics, 125(2), 282-289.

Mackrides, P. & Ryherd, S. (2011). Screening for Developmental Delay. American Family Physician. 84(5), 544-549. Schonwald, A., Horan, K., & Huntington, N. (2009). Developmental screening: Is there enough time? Clinical Pediatrics, 48(6), 648-655.

Silicon Valley Foundation. (2017). From the Doctor’s Office: California Pediatrician Survey on Early Childhood Developmental Screening.

The National Academy for State Health Policy. (2016). The Nuts and Bolts of Medicaid Reimbursement for Developmental Screening: Insights from Georgia, Minnesota, and North Carolina. Online.

The Economics of Developmental Screening and How Screening is Protecting Children’s Health

The Economics of Developmental Screening: How Developmental Screening Protects Children’s Health and Increases Revenue 

American children are currently facing a health epidemic: developmental delays affect 1 in 4 children under age 5. Although developmental screening is recommended by the American Association of Pediatrics, many doctors are unable to give kids timely developmental screenings. In the state of California, a survey of several hundred pediatricians reported that fewer than 1 in 3 children received timely developmental screenings. There are many reasons for this; time, high costs, training accessibility, and inefficient paper-based based tools are just some. In 2017, BabyNoggin surveyed 118 medical practitioners at the AAP National, in order to acquire data on current screening methods. Lack of training and an inability to integrate current tools with EMR systems was cited as a primary driver behind professionals not using AAP-approved screening tools. An overwhelming 76% reported using only paper-based screening tools to administer tests. More data can be viewed in this survey summary: BabyNoggin-AAPNationa2017-SurveySummary.

Young brains are extraordinarily plastic, particularly from birth to three years of age. The brain grows to about 80% of adult size by 3 years of age, and more than a million neural connections are happening each second. Not surprisingly, if developmental delays are found and treated early, parents and health care providers are given the opportunity to not only prevent further delayed development in children but, in many cases, ensure that children actually improve in functionality from the point of their developmental diagnosisAccording to the Center for Disease Control and Prevention, rehabilitative efforts can help children to not only compensate for but also overcome their setbacks.

Catching delays early also yields promising recovery and improved functionality. According to Griffiths & Hochman (2015), all systems within young children are constantly interacting to reach their developmental milestones; in other words, for children to be able to develop healthy speech patterns, they need a variety of developmentally appropriate skills. Here is an example: if children are not properly engaged in their environment, they will not undergo the cognitive pattern detection process that is necessary for language development. Similarly, if children lack motor control over their tongue and mouth, they will be unable to practice speech and fall behind due to a lack of practice. These cognitive and motor skills interact to produce speech and decreased functionality in one domain will ultimately spill over and negatively impact another domain. During infancy and toddlerhood, children experience sensitive periods for a range of skills; therefore, providing children with the appropriate experience during these time-sensitive “windows of opportunity” is paramount to proper development. While damage to the child accumulates when intervention efforts are delayed, the child’s ability to be successful compounds when intervention efforts are implemented.

In addition to the hordes of developmental issues that can arise due to delayed detection, there is yet another area that is heavily impacted by neglecting prevention: finances. When at-risk kids are screened early and receive early intervention, everyone benefits! The ROI of early screening and early intervention are clear:

All children deserve the opportunity to be their best selves. When we conduct proper developmental screenings, we not only save money and resources, but we also set children and families up for success. The Center for Disease Control and Prevention estimate that 1 in 4 children under 5 has a developmental delay, but, if we treat them early, we can provide better outcomes for America’s children and future.


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