Evidence on language monitoring in primary healthcare: a scoping review

Teixeira, Ivana Vieira de Resende; Valadares, Ana Carolina Andrade; Lemos, Stela Maris Aguiar

doi:10.1590/2317-1782/e20240189en

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Critical Review or Scoping Review • CoDAS 37 (4) • 2025 • https://doi.org/10.1590/2317-1782/e20240189en linkcopy

Evidence on language monitoring in primary healthcare: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To map scientific productions on language monitoring in primary healthcare.

Methods This scoping review was guided by the following research question “What is the evidence of language development in early childhood in primary healthcare surveillance?”. Studies were searched from February to November 2023 in the MEDLINE, LILACS,Cochrane, Scopus, Web of Science, and EMBASE databases. It included original research articles and reviews with no restriction on time or language and excluded samples with suspected or confirmed diagnoses of intellectual disability, hearing loss, and global developmental delays. Two researchers independently screened titles and abstracts and read the full text of the articles. References were managed in Rayyan.

Results The search found 436 studies, of which 220 were excluded for being duplicates and 177 for not answering the research question. Hence, 39 articles were read in full text, of which 31 were excluded for not addressing the topic. Eight articles were included in the review (six original research articles and two reviews). The studies collected data from children aged 1 month to 5 years who visited primary care units for vaccinations or consultations, and during home visits. The use of instruments and clinical observation were the strategies used to investigate language development. The prevalence of language delay ranged from 2.5 to 31%.

Conclusion Language development is not yet regularly monitored in child health surveillance in primary care.

Keywords:
Language Development; Public Health Surveillance; Primary Health Care; Child; American Speech-Language-Hearing Association

Database	Search strategy
Lilacs	(“Desenvolvimento da Linguagem” OR “Language Development” OR “Desarrollo del Lenguaje” OR “Développement du langage oral” OR “Aquisição da Linguagem” OR “Linguagem Infantil” OR “Child Language” OR “Lenguaje Infantil” OR “Langage de l'enfant” OR “Linguagem da Criança” OR “Language Acquisition”) AND (“Atenção Primária à Saúde” OR “Primary Health Care” OR “Atención Primaria de Salud” OR “Soins de santé primaires” OR “Vigilância em Saúde Pública” OR “Public Health Surveillance” OR “Vigilancia en Salud Pública” OR “Surveillance de la santé publique” OR “Plano de Vigilância em Saúde” OR “Vigilância da Saúde” OR “Vigilância da Saúde Pública” OR “Vigilância em Saúde”)
MEDLINE via PubMed	(“Language Development” OR “Child Language” OR “Language Acquisition”) AND (“Primary Health Care” OR “Public Health Surveillance”)
Cochrane
Scopus
Web of Science
EMBASE	('language development' or 'child language' or 'language acquisition') and ('primary health care' or 'public health surveillance')

Authors	Study design	Country/ Period	Sample characteristics
Authors	Study design	Country/ Period	Total N	Age	Assessment characteristics	Instruments	Aspects assessed	Main outcomes
Frelinger et al. (2023)(²¹)	Retrospective	United States of America	14.559	12-60 months	Nosological diagnosis	ICD-101	ASQ2 or clinical observation	14.2% language and speech delays.
Alakeely et al. (2022)(⁵)	Cross-sectional	Saudi Arabia	250	12-60 months	Clinical assessment and self-administered questionnaire for parents/guardians	Questionnaire for parents/guardians and the Arabic Language Milestone Screening Test	Language development milestones	22.2 to 31% prevalence of language delay among those 1 to 5 years old. The absence of breastfeeding was related to the likelihood of language delays (p = 0.014).
Santos-Alvarez et al. (2021)(²⁵)	Cross-sectional	Mexico March 2018 to November 2019	69	22-59 months	Clinical observation and questionnaire for parents/guardians	EDI3	Gross motor Fine motor Social Language Learning	Developmental delay: 13%. Risk of delay: 16%. Language was the domain with the highest risk of delay (p = 0.00).
Wagner et al. (2017)(²⁴)	Prospective longitudinal	Brazil March to August 2015	25	1-12 months	Questionnaire for parents/guardians	Questionnaire to monitor hearing and language in the first year of life	Hearing and language milestones	4% of the sample had RFHL4 and 4% had to be referred for EOA5 retest in the absence of RFHL.
van der Linde et al. (2016)(²²)	Cross-sectional	South Africa	201	6-12 months	Clinical assessment	RITLS6	Pragmatics Gestures Play Language comprehension and expression Interaction-attachment	The study identified 13% of language delays, of which 58% had a delay in one communication domain and 4% in five domains. Expressive language was the domain with the greatest delay (84.6%). Having more than three siblings (p = 0.054), informal housing or staying with other people (p = 0.024), and maternal age under 18 or over 35 years old (p = 0.035) were significantly associated with language delays.
Hannus et al. (2009)(²³)	Retrospective	Finland 1989 to 1999	2.480	0-180 months	Nosological diagnosis	ICD-9 and ICD-10¹	Language comprehension and expression	2.5% prevalence of language development delay and language disorder.

Authors	Study design	Country/ Period	Database	Total N	Main outcomes
Jullien (2021)⁽⁶⁾	Scoping review	Germany	Cochrane	11 reviews, laws, and protocols	The screening tools used to assess speech and language delay in primary healthcare had a wide range of accuracy.
Jullien (2021)⁽⁶⁾	Scoping review	November 2019	Cochrane	11 reviews, laws, and protocols
Nelson et al. (2006)⁽³⁾	Systematic review	United States of America	MEDLINE, PsycINFO, and CINAHL	87 articles	There was an absence of gold-standard instruments to screen speech and language delay.
Nelson et al. (2006)⁽³⁾	Systematic review	November 2004	MEDLINE, PsycINFO, and CINAHL	87 articles

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[TFN1] ¹
International Statistical Classification of Diseases and Related Health Problems

[TFN2] ²
Ages and Stages Questionnaire

[TFN3] ³
Evaluación del Desarrollo Infantil

[TFN4] ⁴
Risk factors

[TFN5] ⁵
Evoked Otoacoustic Emissions

[TFN6] ⁶
Rossetti Infant-Toddler Language Scale