For the first time since 2004, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) have made major updates to surveillance guidelines used to screen babies and toddlers for developmental delays. The changes, which are a part of the CDC’s Learn The Signs. Act Early. program, expand the age ranges for some milestones, introduce brand new ones and eliminate outdated and unclear guidance. Here’s everything parents and caregivers need to know about how the updates were made and what changes to expect on their child’s developmental milestone checklist.
What are the changes to the developmental milestones?
The new AAP and CDC guidance applies to checklists for developmental surveillance, which is the criteria that helps parents and doctors identify kids who may be at risk for a developmental delay. Experts reviewed all of the existing milestones, compared them to empirical data on child development and revised the lists for clarity. The changes to the guidelines include the following:
- Basing recommendations on the age children are most likely to achieve the milestone.
- Adding checklists for ages 15 and 30 months, so there is now a checklist for every well visit from ages 2 months to 5 years.
- Adding new social and emotional milestones, such as smiling independently by 4 months old.
- Removing unclear language like “may” or “begins to.”
- Removing duplicate milestones.
- Providing open-ended questions to prompt better discussions between parents and doctors.
- Revising and expanding tips to promote healthy development.
The complete list of milestones for each age group can be found on the CDC website. The CDC also offers a free Milestone Tracker App that incorporates the checklists for child development in play, learning, speaking and movement up to age 5. The app alerts parents to any missed milestones with a prompt to talk to their child’s pediatrician about any concerns.
Why did the milestones change?
According to an AAP press release, previous milestone checklists used 50th percentile, or “average age,” milestones, meaning only about half of children achieved the milestone by the suggested age. As a result, it wasn’t always clear when a missed milestone indicated a potential concern. These broad targets were not only confusing for families worried about their child’s development, but they also led to some doctors adopting a “wait and see” approach that created delays in proper screening and diagnosis.
The new guidance is intended to eliminate this confusion and make it possible to seek necessary interventions sooner. “The revised developmental milestones are written in family-friendly language and identify the behaviors that 75% or more of children can be expected to exhibit at a certain age based on data, developmental resources and clinician experience,” the AAP states.
“The revised developmental milestones are written in family-friendly language and identify the behaviors that 75% or more of children can be expected to exhibit at a certain age based on data, developmental resources and clinician experience.”
— AMERICAN ACADEMY OF PEDIATRICS, PRESS RELEASE
The CDC also presented the new, revised milestones to parents and caregivers of different educational backgrounds, income levels and racial groups to make sure they were easy to understand and follow.
How were these changes decided?
The updates were decided based on a broad review of available literature on child and infant development up to March 2019. The data was reviewed by a team of eight experts in different fields of child development chosen by the AAP Systems of Services for Children and Youth With Special Health Care Needs. The group includes developmental-behavioral, neurodevelopmental, and general pediatricians; child and developmental psychologists; and a professor of special education and early intervention.
Together, these experts developed a set of criteria that all developmental guidance should meet, including rules like:
- Guidance must be easy for families of different social, cultural and ethnic backgrounds to observe and use.
- Milestones should be set at the age children are most likely to achieve them.
- Milestones should not be repeated across multiple checklists.
- Checklists should use clear language.
- Checklists should include information on how to act early if there are concerns.
The experts then reviewed existing milestones and used those as a foundation for their new recommendations. According to Paul H. Lipkin, an associate professor of pediatrics at the Johns Hopkins University School of Medicine and a member of the AAP who assisted with the revisions, the ultimate goal of the updated milestone surveillance checklists is to clarify what families and doctors should look for at certain ages and to get help earlier for kids who need it.
“The earlier a child is identified with a developmental delay, the better, as treatment as well as learning interventions can begin.”
— PAUL H. LIPKIN, ASSOCIATE PROFESSOR OF PEDIATRICS
“The earlier a child is identified with a developmental delay, the better, as treatment as well as learning interventions can begin,” Lipkin says in a press release. “At the same time, we don’t want to cause unnecessary confusion for families or professionals. Revising the guidelines with expertise and data from clinicians in the field accomplishes these goals.”
Most importantly, he adds, these changes encourage more communication between doctors and parents. “Review of a child’s development with these milestones opens up a continuous dialogue between a parent and the health care provider about their child’s present and future development,” Lipkin says.
