Health care providers in the primary care medical home are uniquely positioned to identify and initially evaluate developmental differences in young children. They are familiar with aspects of the family history and with psychosocial factors that may place a child at higher risk for developmental delay. Primary health care providers are aware of birth events and usually provide for the care of newborns. For those developmental disabilities that are identifiable prenatally or at birth or that result from perinatal complications, early detection is possible. Finally, and most important, the primary care medical home provides a headquarters for longitudinal anticipatory care during which alterations in developmental course can be recognized, investigated, and managed. For most parents, the primary care physician is the first and most trusted respondent to their worries or concerns about their young child's development. It is important that all primary care physicians feel comfortable with this responsibility, confident in their skills at developmental surveillance and screening, clear about the resources for intervention and further evaluation, and knowledgeable about management, care coordination and advocacy.

This chapter provides an overview of the approach to the child with a developmental delay or disability from the perspective of the primary care medical home. Taking a generic approach that is intended to complement the specific guidelines of other chapters, we review the epidemiology of developmental disabilities. Developmental screening in the medical home is discussed, with guidelines for referral to community-based agencies and for further medical evaluation.