Developmental milestones for children have changed for the first time in nearly 20 years

By Dr. Edith Bracho-Sanchez, CNN

Infants and toddlers should be screened more for developmental delays, according to updated US guidelines released last week.

The US Centers for Disease Control and Prevention and the American Academy of Pediatrics updated the checklists of developmental milestones used to monitor infant and young children’s development in an effort to give parents and pediatricians clearer benchmarks that will make it easier to identify developmental delays early.

A group made up of eight experts in different areas of child development reviewed and updated the checklists, which are used around the country, for the first time since their 2004 release as part of the CDC’s developmental surveillance campaign, “Learn the Signs. Act Early.”

The checklists, familiar to many parents as part of regular checkups at the pediatrician’s office, previously used 50th percentile milestones, meaning only half of children were expected to achieve the milestone at a given age. The revised checklists will now inquire about milestones 75% or more of children can be expected to achieve at a given age, eliminating unnecessary confusion and alarm while ensuring children who need additional evaluation and resources are properly identified.

“The earlier a child is identified with a developmental delay the better, as treatment as well as learning interventions can begin,” said Dr. Paul H. Lipkin, a member of the AAP Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities, who assisted with the revisions, in a news 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,” Lipkin said.

Additional changes to the guidelines include the following:

• Adding checklists for children at ages 15 and 30 months so that there is now a checklist for every checkup visit from 2 months to 5 years of age

• Identifying additional social and emotional milestones children should meet (including smiling on their own to get your attention at 4 months old)

• Removing vague language like “may” or “begins” when referring to certain milestones

• Removing duplicate milestones

• Providing new, open-ended questions to use in discussions between parents and pediatricians. One example: Is there anything that your child does or does not do that concerns you?

• Revising and expanding tips and activities to promote kids’ development

The CDC’s free Milestone Tracker App incorporates the checklists with the aim of helping parents track developments in the play, learning, speaking and movement of children up to 5 years old. The app alerts parents to missed milestones with a prompt to talk to their pediatrician about any concerns.

Child development expert Dr. Jenny Radesky said, while she’s pleased to see the changes, parents should keep in mind that milestones are not everything.

“They are ways that we try to figure out which children might have a developmental delay,” said Radesky, a developmental behavioral pediatrician at the University of Michigan C.S. Mott Children’s Hospital, via email.

Parents should also trust their own knowledge about their kids, Radesky added, including what brings them joy, what overstimulates them, and when parents feel most connected to their children. “These aspects of parent-child relationship are not measured through milestones, but are crucial to children’s mental wellbeing,” she said.

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