The Role of Pediatricians in Early Intervention: Supportive Allies or Missed Opportunities

Posted in Disability Disparities Policy

In the United States, about 15% of children under the age of 3 are referred to early intervention services, but only 8% are found eligible and receive services (U.S. GAO, 2023). One of many barriers to accessing early intervention services is the gap between the number of children identified with developmental delays by pediatricians and the number of children who receive EI services. Some factors contributing to this gap are:

  • Limited awareness
  • Communication barriers between pediatricians, parents, and EI providers
  • Family receptivity
  • EI service accessibility and availability
  • Systemic disparities (low-income and minority families)
  • Pediatricians’ time constraints
  • Financial barriers of reimbursement and access to evaluation/screening services

In 2012, the article, Missed Opportunities in the Referral of High- Risk Infants to Early Intervention a study was conducted using a statewide, population-based dataset to evaluate how high-risk infants with developmental delays are referred to early intervention services in California through neonatal follow-up programs. Findings showed that only 6% of infants with low developmental concern were referred to early intervention, while just 28% of those with high concern received referrals. Even when including referrals to private therapy, 34% of high-concern infants were not referred for any services. These referral rates were similar at a second follow-up visit. The results highlight a critical gap: although neonatal follow-up programs are intended to identify and support high-risk infants, many potentially eligible children are not being connected to early intervention services.

The study pointed out that:

  • Pediatricians can be essential in early identification and referral of children with developmental delays
  • Under-referral to EI is significant despite the high need
  • EI (Part C) referral rates were lower than individual therapy sessions referrals
  • Disparities based on socioeconomic status and demographic factors exist
    • Children with public insurance (Medi-Cal) were more likely to be referred to EI
    • Individuals from non-English speaking households and with lower maternal education were more likely to have developmental concerns, but this did not translate to consistently higher referral rates
  • It is vital to improve integration and training on EI programs in order to provide service to more children

Why It Matters—Across Communities
 These missed opportunities don’t exist in a vacuum—they ripple across communities, especially those already facing systemic inequities. In rural areas and under-resourced communities, where specialists are few and waitlists are long, the pediatrician’s voice can be the sole influence in a parent’s decision to seek services. When that voice says “wait and see,” it often results in delayed intervention or no intervention at all. The consequences are not just developmental—they’re social, educational, and economic.

Imagine a system where pediatricians routinely made timely referrals to early intervention or collaborated directly with EI professionals. If families viewed these professionals with the same trust and credibility often reserved for physicians, we could shift the landscape entirely. More children might receive support in that crucial birth-to-three window—especially those in households that face barriers related to access, resources, or navigating complex systems.

What is needed is a paradigm shift. One where pediatric care doesn’t stop at diagnosis but continues into coordinated action. Where early intervention is not an afterthought, but a core part of a child’s health and developmental plan. When referrals are delayed or overlooked, children miss out on valuable opportunities for growth, connection, and support during the most critical years of development.

Cassidy Wilson, OT, Eva Perez, SLP, Begum Karaman, Psych, Stephanie Sullivan, SLP, and Allison Bower, DPT,      (GUCEI’25)

References

United States Government Accountability Office (U.S. GAO) (2023). Special education: Additional data could help early intervention programs reach more eligible infants and toddlers. https://www.gao.gov/products/gao-24-106019

‌Tang BG, Feldman HM, Huffman LC, Kagawa KJ, Gould JB. Missed opportunities in the referral of high-risk infants to early intervention. Pediatrics. 2012 Jun;129(6):1027-34. doi: 10.1542/peds.2011-2720.