Do I agree with the new CDC milestone checklist? Read on
The last CDC Milestone Update was done in 2004.
Infant and child milestones have long been an important assessment at Pediatric well-visits. At every check-up, your child’s clinician should be discussing your child’s development. These discussions are meant to flag any concerns that would warrant intervention such as speech, therapy, feeding therapy, occupational therapy, and/or physical therapy. Now, there is a CDC Milestone Update for the first time since 2004. If you want to see them all, check it out here. But honestly, it may be a bit overwhelming as I know milestones can be that way. So read on for my commentary!
The updated changes are part of the “Learn The Signs. Act Early Program.”
The CDC asked the AAP to convene a group of experts to revise several developmental milestone checklists, which use 50th percentile, or average-age, milestones. Using this approach meant only half of children can be expected to achieve that milestone by that age. Clinicians reported that following the guideline often was not helpful to families who had concerns about their child’s development. In some cases, clinicians and families chose a wait-and-see approach, leading to a delay in diagnosis.
The goals of the task force were to identify evidence-informed milestones to include in CDC checklists, clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach), and support clinical judgment regarding screening between recommended ages.
Officially, a “milestone” is a developmental skill most children should do by a certain age.
However, that actual SKILL can occur over a large range. For example, the range of walking alone can be from 8 months to 18 months; and the “milestone” according to the CDC website is considered 15 months.
The agency raised the percentage of children who typically meet certain milestones without intervention from 50 percent to 75 percent, an important adjustment signifying that the majority of children are capable of certain behaviors and achievements at specified ages.
So, when looking at the CDC website, if your child is not meeting that milestone by the listed time; it should be brought up to your clinician as 75% of children that age should be reaching that milestone.
Although this can seem like a comparison game, it is really data driven to assure that interventions are in place if needed.
Do remember, however, that development is a big-picture game.
Many times, I will see a slight delay in a CDC milestone, but I will discuss with a parent WHEN and WHAT I need them to monitor and HOW to engage with their child.
Sometimes it will mean a referral, but other times it means close monitoring with me with education (I do this because infant/child development is my niche/passion and I know what to closely monitor).
If your child is not meeting a milestone per the new CDC Milestone Updates, you should either have the tools to foster that skill OR be seeing a specialist in the area to guide you.
I was planning on going over every single addition to the CDC milestone checklist, but this was cumbersome AND would honestly cause your more confusion.
Here are some major highlights and comments on the CDC Milestone Update
- They added a milestone guide for 15 months and 30 months which is great because these are important developmental months. There is usually a 15-month and 30-month visit so having designated milestone markers for these ages and stages are helpful.
- They added more social and emotional milestones such as “smiles on their own to get attention at four months.” I do appreciate the additions to this as I do believe the social/emotional domain of development doesn’t get as much love as language or motor development. (Check out The New Mom’s Survival Guide for more on why I love talking about infant social/emotional and cognitive development).
- They made language more direct, removing words like “may” to make it less ambiguous.
- They added more open-ended questions rather than “yes/no” type questions for every age, which I do love. Development is NOT always a yes/no response, so this can give us more of a big picture answer when determining if there are concerns.
- At four months, they changed “laughs” to “Chuckles and not yet fully laughing when you try to make them laugh.” I agree with this as many developmentally on-target babies do not fully laugh at four months. They added laughs to the six-month checklist instead which does make sense.
- They changed cooing from two months to four months. I usually do like to see some cooing my three months of age, but this makes sense since the four-month visit is the next well-visit.
- They added pushing up onto elbows and forearms when on tummy at four months. I think this is a great addition for motor developmental skills as precursor to crawling.
- They changed squealing from four months to six months. Remember, this means that if your baby is NOT squealing by six months; please bring it up to your clinician. I do commonly see squealing at the four-month visit, but we would want to know if it’s not happening by the six-month visit.
- They moved rolling to six months (instead of four months). This makes sense as many babies who do not need intervention roll at 6 months or slightly later. Also, do remember that a lack of rolling is not ALWAYS an automatic red-flag. We will also look at their ability to sit up unassisted and their core strength.
- They moved “look for things he sees you hide like a toy under a blanket” which is object permanence from nine months to one year. Remember, these new guidelines mean that if your child is not showing object permanence by one year, to speak to your child’s clinician. I do like to see object permanence by one year at the latest. I do believe it’s an important cognitive developmental milestone.
- For the language and communication milestone at 15 months, they state “they try to say 1 or two words beside mama or dada,” which I think is also great. Many parents panic when their 15-month old isn’t speaking a lot and this is okay. All the other milestones at this age matter too.
- They included pointing at 15 months instead of 18 months, which is also an important precursor to language development, so I do like that they moved it to 15 months.
- They include taking a few steps on their own in the 15-month milestones, which makes sense as we do see normally developing toddlers walk past one year.
- At 18 months, they state “three or more words besides mama or dada.” I do agree with this if the child is also pointing and showing other signs of pre-verbal communication like following commands. I know many speech therapists on social media think this will lead to delayed intervention, but remember; this is the “milestone” they expect 75% of children to do. If your child isn’t doing this by 18-months, a more in-depth conversation and potential evaluation may be needed. This is 100% reasonable in my opinion and experience. I have seen sooooo many parents of 18-month olds panic when their child isn’t speaking loads of words. My own son also only had about 5 words at 18-months, but he was pointing and following commands and we were properly engaging with him, so I knew the language would come.
- For the two-year milestones, they don’t include how many words a child should be saying, but they do mention the child should be using two words together. They instead moved the 50+ word milestone to 30 months. I think it would still be best to speak to your clinician at 2 years if your child has less than 50 words. 24 months to 30 months is a long time and we would want to make sure that language progression is occurring in these critical months. Having less than 50 words at 2 years is not an automatic speech therapy referral for me, but a full discussion on development is important including education on HOW to engage speech and what to monitor until the 30-month visit. I do believe 18 months to 30 months is a critical window for monitoring language development, so having a good conversation is important to assess need for intervention.
- They added “Avoids danger like not jumping from tall heights from a playground” to 4-years. I think this is reasonable as at 4-years a child should have some level of spatial/risk awareness.
Overall, do remember that this new CDC Milestone Update asks that if your child is NOT doing that by the age listed; that you bring it up to your child’s clinician. Your child’s clinician should guide you on the next steps. In my opinion, if your child is not meeting the milestone, you should either get a developmental referral to assess from a specialist OR your child’ clinician should provide you with a concrete educational plan of engagement and when to follow up.
Tune in, to this podcast episode where I talked to a Pediatric Speech Language Pathologist, Occupational Therapist, and Physical Therapist and further discussed this new CDC milestone update.
And remember, the goal of these changes is for families to feel supported either through closer monitoring or early intervention services to provide the best outcomes for your child’s developmental trajectory.
Interestingly enough, my Milestones to Monitor Guide, coincides with the new CDC Milestone Update in your child’s first year (as I list the LATEST a child should be doing a developmental skill by).
If you have a child who is under one, check out the PedsDocTalk First Year Milestone to Monitor Guide. If you have a toddler, check out the PedsDocTalk Toddler Milestones to Monitor. I like to use the term “Milestones to Monitor” as milestones do occur across a range.
