GDD : definition

• Significant delay in at least two developmental domains : 

• Gross or fine motor 
• Speech/language 
• Cognition 
• Social/personal 
• Activities of daily living 
• Reserved for children <5 years old 

Stacey A. Bélanger, Joannie Caron. Paediatr Child Health 2018, 23(6):403–410.

 Epidemiology of GDD

Affects 1%–3% of the population of children under 5 years of age

One of the most common presenting conditions in paediatric clinics;
Causes are :
• exogenous,
• genetic (non-metabolic) or
• genetic (metabolic).

Mithyantha R, Kneen R, McCann E, et al. Current evidence-based recommendations on investigating children with global developmental delay. Arch Dis Child 2017;102:1071–1076.
Survaillance & Screening
• Developmental surveillance
• Done at every office visit,
• An informal process comparing skill levels to lists of milestones.
• If suspicion of developmental or behavioral issues recurs, further evaluation is
warranted
• Surveillance does not have a standard, and screening tests are necessary.
• Developmental screening
• Use of standardized screening tests, to identify children who require further
diagnostic assessment.
• The AAP recommends the use of validated standardized screening tools at three
of the health maintenance visits: 9 months, 18 months, and (24) 30 months.
Diagnostic approach (tools) of
developmental process in Indonesia
1. Survailance : every visit in medical staff, milestones
2. Pre Screening : KPSP
3. Screening : standardized tools, performed anytime if noted with
developmental problem
4. Assesment
Vitrikas Kirsten, et al. Developmental Delay : When and How to Screen. American Family Physician. 2017 July 1;96(1): 36-43
Vitrikas Kirsten, et al. Developmental Delay : When and How to Screen. American Family Physician. 2017 July 1;96(1): 36-43
Developmental surveillance
At 9 months of age, many issues
involving motor skills development can
be reliably identified. A 9-month
screening provides an additional
opportunity to attend to the child's
visual and hearing abilities

Eighteen months of age: Delays in

communication and language
development are often evident by 18
months of age. Mild motor delays
that were undetected at the 9-month
screening may be more apparent at
18 months of age.
By 30 months of age, most motor, language,
and cognitive delays may be identified with
screening instruments, leading to evaluation of
and intervention for those children with
delayed development
Schedule for Screening in
Indonesia

Pedoman pelaksanaan Stimulasi Deteksi dan Intervensi Dini Tumbuh Kembang Anak. Kemenkes RI 2016
Nelson 20th ed.
Nelson 20th ed.
Nelson 20th ed.