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Developmental Monitoring and Screening

Act Early Oregon promotes developmental monitoring tools and practice as a support for developmental screening and early referral and services for young children who might benefit from additional developmental services.

Screening Technical Assistance and Referral Center (STAR CENTER)

The STAR Center seeks to improve the health, wellness, and development of children through practice and system-based interventions to increase rates of childhood screening, counseling, referral, and follow-up for developmental milestones, perinatal depression, and social determinants of health. For more educational materials and resources and free CME on-line trainings, click here.

The STAR Center also offers a monthly newsletter and screening and referral technical assistance.

All early childhood professionals interested in receiving the STAR CENTER newsletter can email

If you are a pediatric health care provider and wish to receive free assistance on improving early childhood screening referral and follow-up in your practice or health care system and/or subscribe to the STAR CENTER monthly newsletter, please email


Developmental Monitoring (Surveillance) and Screening

Both developmental monitoring and developmental screening should be done for all young children. Developmental monitoring, also known as developmental surveillance, means observing and noting specific ways a child plays, learns, speaks, acts, and moves every day, in an ongoing way. Developmental monitoring often involves tracking a child’s development using a checklist of developmental milestones.


The Act Early resources are educational tools that guide parents and caregivers in monitoring the development of a child 2 months old to 5 years of age. Through the process of checking off milestones that a child develops over time, the parent begins to see their child’s growth through a developmental lens.

This builds parental capacity and confidence to engage in conversation with their child’s medical provider and other early childhood professionals.

The Milestone Tracker app and Milestone Moments Booklet (available in English and Spanish) also serves as a communication tool when parents talk with their medical provider. Evidence indicates that through this process a parent is more likely to follow through on referral recommendations when indicated.

New free training available: Watch Me! Celebrating Milestones and Sharing Concerns.

Visit to access this FREE, 1-hour online, continuing education course to help you monitor the development of children in your care and talk with parents about developmental concerns. Upon completion of all 4 modules, print out your certificate of completion and submit to Oregon Registry Online (ORO) for professional development credit.

Developmental screening is a more formal process done by medical providers and other early childhood professionals using a validated screening tool at specific ages to determine if a child’s development is on track or whether he or she needs to be referred for further evaluation.


AAP Poster–Ask about Emotional Development, English

AAP Poster–Ask about Emotional Development, Spanish


Developmental Monitering

Involves the following key steps to assess how a child is growing in relationship to the age-appropriate milestones.

  • Eliciting parental concerns, such as by asking questions like “Do you have any questions about how your child is learning, behaving or developing?”

  • Documenting and maintaining a developmental history, including information about the child’s holistic growth. Milestone checklists such as the Milestone Moments Booklet, Milestone Checklists, and the CDC’s Milestone Tracker are helpful monitoring tools. (Spanish version here

  • Observing the child to ensure their progress in developmental milestones in communication, cognitive processing, fine and gross motor skills, as well as behavior.

  • Identifying risks and protective factors, to address the family’s specific needs and circumstances.

  • Maintaining an accurate record of findings over time, including input from others (childcare, preschool, etc.).

Developmental Screening

Is the use of brief and objective standardized tools to identify children at risk for developmental delay and the need for referral for evaluation. It is a formal process that occurs at defined intervals according to national standards, at points of entry into services, and any time a child is identified to be at risk through surveillance. Screening may occur at a primary care practice, a mental health agency, a Head Start program or in other early care and education settings. The American Academy of Pediatrics recommends that all children receive a developmental screening at the 9, 18, and 24 and 30 months well child visits. Interpretation of screening and recommendations for further evaluation and referral should include consideration of other child and family contextual factors, such as lack of opportunities or family financial, housing, or food stresses.

Oregon has adopted the high-quality developmental screening tool, the Ages & Stages Questionnaires®: Third Edition (ASQ-3™) for developmental screening. Oregon’s Quality Rating and Improvement System (QRIS) recommends all children entering an early childhood setting receive a developmental screening. Professionals conduct screenings to uncover areas of concern and identify children who are at risk for developmental delay or other behavioral or social emotional challenges in an accurate and cost-effective manner.

The Ages and Stages Questionnaires®: Social Emotional-Second Edition (ASQ:SE-2) is a questionnaire focusing solely on social and emotional development in young children. Accurately identifying behavior through ASQ:SE-2 helps to ensure that any behavioral concerns or social or emotional challenges are identified as early as possible, allowing the child a greater chance to reach his or her full potential.


How do screening tools work?

Screening tools usually take the form of a series of questions or checklists used to track children’s development relative to milestones achieved by a larger group of children of the same age. A home-grown checklist won’t do; developmental screening tools must be carefully validated by research. These questionnaires prompt parents or other caregivers to answer a series of simple questions regarding their child’s abilities (e.g., Does your child climb on an object such as a chair to reach something he wants? When your child wants something, does she tell you by pointing to it?). Children whose development appears to fall significantly below that of their peers are flagged for further attention.

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