Behavioral issues in children can emerge as early as infancy and be clearly apparent by toddlerhood and preschool age. Though pediatricians see infants and young children for up to a dozen well-child visits during the first two years of life, such problems are often not appreciated or identified, and consensus is lacking on a reliable and valid way to determine quickly whether a concern is significant enough to warrant a referral for further assessment/intervention. Given the pediatrics developmental surveillance and anticipatory guidance models, these visits provide an important opportunity for both prevention and early intervention efforts in the behavioral health domains. A few screening tools that reliably identify behavioral health problems in young children can help pediatricians begin the conversation, substantiate parental concerns, validate clinical impressions, inform immediate care, facilitate appropriate referrals, and, ultimately, potentially change the trajectory of a child’s life. Follow-up after screening is essential to increase likelihood of linkage to care. This chapter describes the primary health care context and examines the role of primary care pediatricians in caring for young children with behavioral health problems. Next, it gives a brief overview of the problems typically seen in this age range. Then, screening tools available to primary care pediatricians are reviewed, noting the reliability and validity data for each tool. Summary recommendations for useful screening strategies are given and the limits of what is available to primary care providers are addressed.
