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The early detection of speech and language delays has been an important feature of the child health services in the Netherlands for some 15 years. During this period ideas about both the purpose of screening and the methods themselves have changed considerably. There are four key outstanding issues: What is the best age to identify children? What screening measures are available? How can we detect speech and language delays in multilingual children? Which groups are best able to detect speech and language difficulties: parents, teachers, playgroup leaders, doctors, nurses, or speech and language therapists? These questions are influenced by social, demographic developments and an increase in the understanding of language delay. This article examines the Dutch solutions to these problems. The conclusion reached is that early language screening can only be part of the answer to early detection both because the available measures are not yet sufficiently accurate and because the growing group of multilingual children (e.g. in Amsterdam more than 50% of the children under the age of 4 years are multilingual) makes the application of specific measures at a population level unworkable. An alternative method is suggested, namely primary prevention by giving information and support to parents, playgroup leaders, doctors, etc.