This paper outlines the prevalence of developmental delay in children and discusses the recent literature regarding the benefits of early identification and evidence based strategies for developmental surveillance and screening. We describe a systematic approach to the child with developmental delay and the optimal methodology for arriving at the etiologic basis for the delay. A review of the most upto date and relevant literature was completed using Pub Med, online databases, and texts. The medical evaluation with specific emphasis on the most recent recommendations for genetic, laboratory and imaging studies is described. The American Academy of Pediatrics algorithm for developmental surveillance and screening is discussed with consideration for the importance of culturally relevant screening tools across populations. In addition, specific screening tools are briefly discussed that may prove beneficial to the primary care provider as he/she implements routine surveillance and screening.