Whether you’re a parent, a teacher, a caregiver, or a therapist you may feel a bit confused when it comes to the new CDC milestone changes. If so – don’t worry! You’re not alone!
In this post, you’ll learn more about the new updates to the CDC milestones and you’ll hear from pediatric occupational and physical therapists about what they really mean.
You may also be aware of the updated CDC milestones (read them here on the Centers for Disease Control and Prevention website), which are the first changes to these developmental guidelines in over 20 years. Recently, we took a good hard look at the new milestones in order to decide whether we needed to make any updates to our developmental milestone resources based on the CDC changes.
Looking for a more detailed overview of milestones for babies and young children? Check out our developmental milestones page!
The CDC Milestone Changes…
Several changes were made to the original CDC milestones as part of the organization’s Act Early Initiative.
Here is a summary of the changes to the CDC Milestones:
- One-third of the original milestones were moved to a different age on the basis of the research and 21 of the 31 milestones were transferred to an older age.
- Duplicate milestones were removed.
- There were new checklists added for ages 15 months and 30 months.
- Vague language that wasn’t as definite was removed (“may”, “begins”) and replaced with more concrete statements of what the child IS doing at the indicated age.
- There are fewer developmental milestones for each age group.
The old CDC guidelines indicated a 50% criteria for children to meet the milestone, meaning that half of children could be expected to meet the milestone at the indicated age. The new guidelines indicate that 75% of children will meet the milestones at the given age.
The CDC’s reasoning for the changes is that the 75% criteria may be more helpful in identifying more serious developmental problems or disabilities in a child, because if they are not meeting one of the new milestone areas, it means that they are functioning in the lower 25% of children for that area. This would be the group of children that providers would want to refer for early intervention services.
You can find a great review of the CDC milestone changes from the OT Dude.
Our Takeaways on the CDC Milestone Changes…
As therapists, our main takeaway after going through all of the new milestone recommendations is that the CDC deleted many milestones (57 of the original 216) that we feel are still appropriate to use when we perform developmental screenings or evaluations. We believe that the milestones that are left represent an incomplete and way-too-basic overview of motor skill development.
Concerns about early identification of delays
Additionally, we share the concerns we have heard from other professionals that the new guidelines may inhibit early identification and early intervention that could prevent developmental delays from becoming bigger issues as the child grows and develops. A parent or caregiver who waits until their child is not meeting a milestone with a 75% criteria may be missing a crucial window to access early intervention services.
Concerns about CDC milestones not aligning with school expectations
Further, we feel that these new guidelines may not match up with some of the higher level skills that are being expected of children in early intervention and preschool classrooms.
Concerns over the lack of a multidisciplinary approach
Finally, some have expressed concern that professionals from the disciplines of occupational therapy, speech therapy, and physical therapy were not included as subject matter experts on this project. Both AOTA (the American Occupational Therapy Association) and ASHA (the American Speech-Language-Hearing Association) have released statements on the updated milestones. You can find links to both of those statements below.
What the CDC milestones really mean…
For parents, we think that the CDC developmental milestone markers provide a general knowledge base about what kids should be doing at each age marker. This list is a great tool to have in the back of your mind so that you are aware and prepared to talk to your health care provider about any concerns that might arise as your baby grows. At the end of each milestone description, parents will find a list of open-ended questions that they can review with their pediatrician to guide the conversation about their child’s development.
For clinicians, it’s clear that these milestones are not meant to be used for evaluation or screening. We have much more involved lists of developmental milestones and assessment tools for those purposes. Instead, checklists of developmental milestones are meant to be guides and not an end-all-be-all resource related to child development. All children progress and gain skills on their own timeline, with some excelling with language first and others taking off walking before they ever crawl.
Speaking of crawling….
There’s a hot debate in the therapy threads on Facebook and other platforms about crawling being removed from the updated CDC developmental milestones. The debate extends further with an argument about whether or not crawling was ever even included in the first place!
The American Academy of Pediatrics reports that the following line was removed from the old guidelines:
6 months – Rocks back and forth, sometimes crawling backward before moving forward.
While this statement doesn’t speak directly to crawling as a form of mobility, it definitely alludes to the baby’s ability to maintain an all fours position and coordinate their arms/legs reciprocally to move.
We can definitely argue that most pediatric physical therapists think that crawling is a very important indicator of the progression of core strength, bilateral coordination, balance, reciprocal movement, weight bearing, motor planning and integration of reflexes.
Do all babies crawl? Nope! And that’s okay, too. Here are some playful ideas for encouraging crawling!
What does this mean for our milestone resources?
After a careful review of the CDC milestone changes and all of the documents from the CDC and AAP, as well as a careful review of our own resources, we have decided not to make any revisions to our developmental milestone handbook or our developmental milestone handouts.
We feel that our comprehensive lists are the perfect visuals for prompting thoughtful conversations about a child’s development as well as developmental monitoring of kids by parents and professionals.
Summary
- The new guidelines represent skills that 75% of children will demonstrate at the given age rather than the former guidelines, which indicated skills that 50% of children would demonstrate at the given age.
- Other changes were made to the previous milestones to remove vague language and to remove duplicate milestones. Some milestones were moved to a different age on the basis of the research and overall, there are fewer milestones for each age group.
- Many professionals believe that the new guidelines may inhibit early identification and early intervention that could prevent developmental delays from becoming bigger issues as the child grows and develops.
- Both AOTA (the American Occupational Therapy Association) and ASHA (the American Speech-Language-Hearing Association) have released statements on the updated milestones.
- The CDC developmental milestone markers provide a general knowledge base about what kids should be doing at each age marker, but are not evaluation or screening tools for therapists. Much more thorough assessment tools are needed for these purposes.
- In their statements, both ASHA and AOTA note that it may be beneficial for speech-language pathologists and occupational therapists to be involved in future projects like this one.
Other information…
CDC’s Developmental Milestones
Pediatrics journal article about the Developmental Milestones Updates
American Occupational Therapy Association statement on the CDC milestones update
American-Speech-Language-Hearing Association statement on the CDC milestones update
The Developmental Milestone Handbook
The Developmental Milestones Printable Handout Pack
The Most Common Developmental Red Flags for Infants
