CUSP (Comprehensive Under-5 Screening Program)

Introduction And Core Philosophy

Comprehensive Under-5 Screening Program (CUSP) is a structured, multi-dimensional clinical framework designed for early identification of developmental delays, nutritional deficiencies, sensory impairments, and congenital or acquired disorders in children from birth to 60 months.
Operationalized as the expanded Rashtriya Bal Swasthya Karyakram (RBSK) 2.0 under the Ministry of Health and Family Welfare (MoHFW) in May 2026.
The first five years represent a critical window of maximal neuroplasticity; CUSP shifts child healthcare from a reactive treatment model to a proactive, preventive strategy.

Expanded Scope: Extends the original RBSK framework of the "4 Ds" (Defects at birth, Diseases, Deficiencies, Developmental delays) to screen for over 32 common conditions.
New Integrations: Mandates screening for emerging non-communicable diseases (NCDs) like diabetes, hypertension, and obesity, alongside early mental health and behavioral red flags.
Digital Linkage: Integrates with the U-WIN portal to track developmental outcomes, minimize dropout rates in follow-up, and ensure seamless linkage to tertiary care.

Screening Domain	Clinical Metrics And Standardized Tools
Anthropometric & Nutritional	- Tracks Weight-for-Age, Height/Length-for-Age, and Head Circumference on WHO Growth Charts.- Severe Acute Malnutrition (SAM) screening using MUAC < 11.5 cm (6–59 months).- Clinical screening for nutritional anemia, Vitamin D (rickets), and Vitamin A (Bitot's spots) deficiencies.
Neurodevelopmental	- Longitudinal surveillance at 2, 4, 6, 9, 12, 18, 24, 36, 48, and 60 months.- Utilizes standardized tools like the Trivandrum Developmental Screening Chart (TDSC) and Denver Developmental Screening Test (DDST-II).- Mandates M-CHAT-R/F at 18 and 24 months to detect Autism Spectrum Disorder (ASD).
Sensory (Hearing & Vision)	- Universal Newborn Hearing Screening (UNHS) using TEOAE and AABR.- Infant vision screening via Brückner test (red reflex) for cataracts or retinoblastoma.- Visual acuity testing in toddlers (3–5 years) using Snellen E-charts or Lea Symbols.
Congenital & Systemic	- Clinical screening for developmental dysplasia of the hip (Barlow/Ortolani maneuvers), clubfoot, and undescended testes.- Critical congenital heart disease (CCHD) screening via routine pulse oximetry.- Targeted heel-prick screening for congenital hypothyroidism, G6PD deficiency, and hemoglobinopathies.

Tier 1 (Community Level): Frontline community health workers (ASHA, Anganwadi workers, and mobile health teams) perform basic tracking of physical growth, visible birth defects, and gross milestone delays at homes, schools, and Anganwadi centers.
Tier 2 (Primary Health Facility): Medical officers or primary pediatricians review referred children utilizing formal screening toolkits and parental questionnaires.
Tier 3 (Specialized Early Intervention): Multidisciplinary teams (developmental pediatricians, neurologists, speech therapists) at District Early Intervention Centers (DEICs) conduct definitive diagnostics and initiate customized, free early intervention plans.

Indian Academy of Pediatrics (IAP 2025–2026): Strongly endorses CUSP integration into well-child visits.
Recommends developmental surveillance at every visit and formal screening at 9, 18, 24, 30, and 36 months.