A guide for health professionals working with
immigrant and refugee children and youth

Child Development:  Issues and Assessment

Key points

  • School readiness is important to long-term success.
  • Newcomer families may have diverse attitudes about child development and disabilities. This can affect how they respond to a child with a developmental delay.
  • Families may be reluctant to communicate concerns to health providers.
  • Use active questioning based on recommended tools to detect developmental problems, using an interpreter if possible.
  • Actively observe for developmental problems in young children using the resources available in your community, province or territory.
  • If an issue is detected, link the child and family to available preschools and intervention services.
  • Follow-up contact may be needed to ensure families use the referred supports.

Cultural context

In Canada, children with disabilities are included in most aspects of life and have opportunities to be valued members of society. Too often, this is not the case in other countries. Newcomers may come from backgrounds where knowledge and attitudes toward children with disabilities is very different from the experience of the Canadian-born population.

Newcomers may:

  • lack awareness of typical child development.
  • not know about resources and systems to help children with developmental problems.
  • not know that governments and schools provide supports and accommodations for people with disabilities.

Keep in mind that some families may be reluctant to identify concerns, for fear of affecting their success in applying for permanent status.

Children who enter school ready to learn adjust better to formalized schooling and are more successful over time. The Early Development Instrument (EDI) identifies populations more or less at risk at the time of school entry. Second language learners — children not proficient in English or French — may be equal in their physical readiness to learn, but behind in their language, general knowledge, communication and cognitive development.1

If a child has an additional developmental problem, it is important to link the child to programs that improve school readiness, such as structured preschool programs, as well as other developmental services. 

Identifying and managing developmental disabilities

When children arrive in Canada

At the initial assessment: Information about a child’s current development, where the family have come from, as well as any earlier educational experiences, can help to identify whether a child should be linked to support services. Some children may have had more intensive services than are available in Canada’s publicly funded system. Children may have been prescribed medication that is not available or not used in the same manner in Canada. An Internet search can identify the ingredients in uncommon medications.

Using structured approaches such as the Rourke Baby Record, Healthy ABCs/ABCdaire, or the Ages and Stages Questionnaires (ASQ) can help identify developmental issues in preschool children up to age 5. The ASQ is available in English, Spanish, Somali and Hmong, and the second edition is available in French.  Information is available on the Ages and Stages Questionnaires in other languages.

Information about educational experiences in older children can help reveal whether children had identified difficulties before coming to Canada.  Interpreter support can be very helpful in obtaining accurate information.

Developmental assessment

Health care professionals in Canada use ongoing processes to identify children at risk for a developmental problem in order to link them to additional community resources.  

In Ontario, there is emphasis on the 18-month well-baby visit to identify children believed to be at risk for a developmental problem, using the Nipissing District Developmental Screen. Active developmental surveillance is necessary to identify children who are behind.

The Rourke Baby Record or ABCdaire can provide a structure for assessment, but it is critical to link identified children to supports upon identifying a concern. Because the newcomer family may not be aware of an issue or understand the importance of getting support, obtaining agreement about contacting supports may require follow-up contact by the health care professional.

Assessing a school-aged child or adolescent new to Canada can be challenging because tools are typically available only in English or French. Tools that assess non-verbal skills may be useful. Resources are available from the Canadian Paediatric Society.   

Immigrant and refugee parents may face challenges that make it difficult to act on the health care provider’s advice, such as lack of support systems, grief at what they have sacrificed, shame about their child’s disability, or depression. They may be underemployed or working extended hours to provide a basic family income. In addition, many of the information resources for parents may only be available in English or French. These are additional risk factors that can aggravate the child’s condition.

When a developmental issue is identified, it is important to communicate and interpret it with the family in a cultural context. Child care may be provided by a relative who has little experience in promoting child development. In different cultures, it may not be seen as important for children to reach certain milestones — such as self-feeding or dressing — at a particular age. Sharing with parents that children are expected to have basic skills at school entry can give a rationale for actively teaching these daily living activities. Information for parents on developmental milestones is available from the Canadian Paediatric Society.

Most communities have services and programs for children and youth with disabilities. The family may be eligible for government benefits. Some families may not be aware of services provided at no cost. Once a developmental condition is identified, orienting a family to the Canadian system and linking to local services, while emphasizing the benefits relating to participation, is very helpful.

What health professionals can do

  1. During the initial assessment, use active questioning based on existing tools to detect developmental problems, using an interpreter if possible, and a culturally-competent approach.
  2. Actively observe for developmental problems in young children using the resources available in your province or territory, such as the 18-month well-baby visit in Ontario.
  3. When taking a medical history of children born outside Canada, consider infectious and non-infectious diseases that are uncommon in Canada but which may have developmental sequelae, such as cerebral malaria, vitamin B12 deficiency or lead toxicity.
  4. Link the child’s family to available preschool and/or intervention and support services
  5. A letter from a health professional outlining the child’s needs and diagnoses can be helpful for parents negotiating therapeutic service and the school system.

Selected resources

Parent handouts from the Canadian Paediatric Society’s Caring for Kids:

Position statement from the CPS

Webinar:  Child Development and Developmental Disabilities in Immigrant and Refugee Children: Approaches to understanding and helping families, January 27, 2015


1. Janus M, Hughes D, Duku E. Patterns of school readiness among selected subgroups of Canadian children: Children with special needs and children with diverse language backgrounds. Hamilton, Ont.: Offord Centre for Child Studies, McMaster University, 2010.


  • William Mahoney, MD
  • Cecilia Baxter, MD

Last updated: April, 2018

Also available at: http://www.kidsnewtocanada.ca/screening/child-development
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Caring for Kids New to Canada is a resource for health professionals. The information here is not a substitute for medical advice, nor does it indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

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