Nursing Practices for Young Children with Developmental Delay and Stigma: An Integrative Review
Main Article Content
Abstract
Developmental delay can affect children’s later learning and functioning, while stigma may
discourage families from seeking or continuing support. This integrative review synthesized evidence
on nursing-related practices for children aged 0-6 years with developmental delay and examined how
stigma affects families’ access to care. Following Whittemore and Knafl’s framework, we searched
nine international and Thai databases for English- or Thai-language sources published from 2015 to
2025. Nineteen evidence sources met the criteria. Empirical studies were appraised with the Mixed
Methods Appraisal Tool, and findings were synthesized thematically. Five themes emerged: early
identification and screening; stigma-related effects on children and families; family-centered caregiver
support; individualized developmental care and respectful communication; and coordinated referral and
follow-up. Reports described benefits of nurse-led education and developmental monitoring, while
stigma was associated with distress, social withdrawal, and unmet care needs. Nursing care should
combine routine developmental monitoring with respectful communication, caregiver coaching, and
active referral follow-up. Because the evidence was diverse and often focused on autism, findings
should be applied cautiously to other developmental conditions.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
[1] UNICEF, Early childhood development, 2020, Available online in December 2, 2025, Available from: https://www.unicef.org/earlychildhood-development
[2] World Bank, Early childhood development overview, 2024, Available online in December 2, 2025, Available from: https://www.worldbank.org/en/topic/earlychildhooddevelopment
[3] M. M. Black, S. Grantham-McGregor, L. C. H. Fernald, C. T. Andersen, A. M. DiGirolamo, C. Lu, et al., Early childhood development coming of age: Science through the life course, The Lancet 389(10064) (2017) 77 – 90. https://doi.org/10.1016/S0140-6736(16)313897.
[4] T. Wondmagegn, B. Girma, Y. Habtemariam, Prevalence and determinants of developmental delay among children in low- and middle-income countries: A systematic review and meta-analysis, Frontiers in Public Health 12 (2024) 1301524. https://doi.org/10.3389/fpubh.2024.1301524.
[5] A. Kerebh, M. L. Endalifer, M. Y. Birhanu, A. T. Telayneh, L. K. Abate, Z. Adissie, et al., Child developmental delay and its associated factors among children aged 12–59 months in Dembecha district, Northwest Ethiopia: A community-based cross-sectional study, Frontiers in Public Health 12 (2024) 1464121. https://doi.org/10.3389/fpubh.2024.1464121.
[6] Centers for Disease Control and Prevention, Data and statistics on developmental disabilities, Available online in December 6, 2025, Available from: https://www.cdc.gov/ncbddd/developmentaldisabilities/data.html
[7] World Bank, Fertility rate, total (births per woman) – Thailand, 2023, Available online in December 6, 2025, Available from: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=TH
[8] T. L. Khanh, T. L. A. Mai, P. A. Hoang, Stigma among parents of children with autism: An integrative review, Pacific Rim International Journal of Nursing Research 27(3) (2023) 530 – 548. https://doi.org/10.60099/prijnr.2023.261650.
[9] N. Khanlou, A. Khan, C. Kurtz Landy, R. Srivastava, S. McMillan, S. VanDeVeldeCoke, et al., Nursing care for persons with developmental disabilities: Review of literature on barriers and facilitators faced by nurses to provide care, Nursing Open 10(2) (2023) 404 – 423. https://doi.org/10.1002/nop2.1338.
[10] N. Mitter, A. Ali, K. Scior, Stigma experienced by families of individuals with intellectual disabilities and autism: A systematic review, Research in Developmental Disabilities 89 (2019) 10 – https://doi.org/10.1016/j.ridd.2019.03.001. 21.
[11] K. E. Zuckerman, O. J. Lindly, N. M. Reyes, A. E. Chavez, M. Cobian, K. Macias, et al., Parent perceptions of community autism spectrum disorder stigma: Measure validation and associations in a multi-site sample, Journal of Autism and Developmental Disorders 48(9) (2018) 3199 – 3209. https://doi.org/10.1007/s10803-018-3586-x.
[12] N. Mitter, A. Ali, K. Scior, Stigma experienced by family members of people with intellectual and developmental disabilities:Multidimensional construct, BJPsych Open 4(5) (2018) 332 – https://doi.org/10.1192/bjo.2018.39. 338.
[13] World Health Organization, Nurturing care for early childhood development: Country profiles and guidance, 2021, Available online in December 12, 2025, Available from: https://nurturing-care.org
[14] UNICEF, Programme guidance for early childhood development, 2017, Available online in December 12, 2025, Available from: https://www.unicef.org/media/107616/file/UNICEF-Programme-Guidance-for-EarlyChildhood-Development-2017.pdf
[15] T. D. Mestre, M. J. Lopes, D. M. Mestre, R. F. Ferreira, A. P. Costa, E. V. Caldeira, Impact of family-centered care in families with children with intellectual disability: A systematic review, Heliyon 10(7) (2024) e28241. https://doi.org/10.1016/j.heliyon.2024.e28241.
[16] M. Zgambo, J. Blamires, M. Foster, M. AlMotlaq, T. A. O’Sullivan, D. Houghton, E. Mörelius, Child and family centred care: A three-phased principle-based concept analysis, Journal of Advanced Nursing 81(8) (2025) 4542 – https://doi.org/10.1111/jan.16846. 4565.
[17] T. Smythe, J. D. Adelson, S. Polack, Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low- and middle-income countries: State of the evidence, Tropical Medicine & International Health 25(5) (2020) 508 – 524. https://doi.org/10.1111/tmi.13388.
[18] R. Whittemore, K. Knafl, The integrative review: Updated methodology, Journal of Advanced Nursing 52(5) (2005) 546 – 553. https://doi.org/10.1111/j.13652648.2005.03621.x.
[19] Y. Dai, E. Zou, Y. Ji, X. Chen, M. Chen, K. Chen, et al., A nurse-led parental selfefficacy promotion program in parents of children with autism spectrum disorder: A quasi-experimental protocol, Frontiers in Psychiatry 16 (2025) 1411518. https://doi.org/10.3389/fpsyt.2025.1411518.
[20] D. Ding, H. Xu, X. Du, X. Su, L. Huang, X. Zhang, et al., Effects of a nurse-led family education intervention on the daily living skills of children with autism, Frontiers in Psychiatry 16 (2025) 1706047. https://doi.org/10.3389/fpsyt.2025.1706047.
[21] V. Thaineua, S. Sirithongthaworn, S. Kanshana, S. Isaranurak, O. Karnkawinpong, A. Benjaponpitak, et al., A 9-year retrospective cohort study of the monitoring and screening of childhood developmental delay in Thailand, Child: Care, Health and Development 50(2) (2024) e13233. https://doi.org/10.1111/cch.13233.
[22] M. A. Rasheed, W. Mughis, K. N. Elahi, B. S. Hasan, A family-centered intervention to monitor children’s development in a pediatric outpatient setting: Design and feasibility testing, Frontiers in Health Services 1 (2021) 739655. https://doi.org/10.3389/frhs.2021.739655.
[23] T. Faruk, C. King, M. Muhit, M. K. Islam, I. Jahan, K. Ul Baset, et al., Screening tools for early identification of children with developmental delay in low- and middleincome countries: A systematic review, BMJ Open 10(11) (2020) e038182. https://doi.org/10.1136/bmjopen-2020-038182.
[24] M. Ndayizigiye, R. McBain, C. Whelley, R. Lerotholi, J. Mabathoana, M. Carmona, et al., Integrating an early child development intervention into an existing primary healthcare platform in rural Lesotho: A prospective casecontrol study, BMJ Open 12(2) (2022) e051781. https://doi.org/10.1136/bmjopen2021-051781.
[25] H. Sheel, L. Suárez, N. V. Marsh, The use of the parents’ evaluation of developmental status and developmental milestones in screening children for developmental delay in India, Children 11(12) (2024) 1530. https://doi.org/10.3390/children11121530.
[26] C. S. M. Ng, S. S. L. Ng, A qualitative study on the experience of stigma for Chinese parents of children with autism spectrum disorder, Scientific Reports 12 (2022) 19550. https://doi.org/10.1038/s41598-022-23978-0.
[27] H. Chen, Y. Ding, D. Xu, Z. Xiong, Resilience and affiliate stigma among parents of children with autism spectrum disorder: The mediating role of life satisfaction and the moderating role of ostracism, Psychology Research and Behavior Management 18 (2025) 1519 – https://doi.org/10.2147/PRBM.S524580. 1529.
[28] M. Zuurmond, A. Naami, L. AdwanKamara, C. Stephen, S. Basnet, C. Vanderick, et al., Stigma reduction in a disability and mental health programme in Ghana: Lessons in participation, African Journal of Disability 14 (2025) a1508. https://doi.org/10.4102/ajod.v14i0.1508.
[29] M. P. Opoku, E. Pearson, H. Elhoweris, N. Alhosani, A. Mustafa, M. Efstratopoulou, R. Takriti, Fidelity of family centered care model to early disability diagnosis and rehabilitation in the United Arab Emirates, PLOS ONE 19(4) (2024) e0301094. https://doi.org/10.1371/journal.pone.0301094.
[30] J. Jeong, E. E. Franchett, C. V. Ramos de Oliveira, K. Rehmani, A. K. Yousafzai, Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis, PLOS Medicine 18(5) (2021) e1003602. https://doi.org/10.1371/journal.pmed.1003602.
[31] Y. Shin, E. J. Park, A. Lee, Early intervention for children with developmental disabilities and their families via telehealth: Systematic review, Journal of Medical Internet Research 27 (2025) https://doi.org/10.2196/66442. e66442.
[32] American Academy of Pediatrics, Developmental surveillance and screening in early childhood, Available online in December 18, 2025, Available from: https://www.aap.org.