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UPDATED PEDIATRIC MILESTONES
from CCC-0722
by ensembleiq
The CDC revises its developmental milestones for the first time since 2004
Pediatric specialists and providers have made important progress over the past 15 years to quickly identify and treat children with developmental and behavioral disorders. For the first time since 2004, the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC) and Prevention have revised the milestones used to identify developmental delays in the pediatric population.
Early Identification, Better Outcomes
In a 2020 clinical report on pediatric development in the AAP journal Pediatrics, the authors wrote: “Early identification and intervention for developmental disorders are critical to the well-being of children.” They went on to explain that said early identification can be achieved through regular developmental surveillance and screening by families and pediatric providers. According to the report, developmental surveillance should take place at every well-child visit and be implemented through use of standardized developmental screening tests. Through use of screening milestone checklists like the ones just revised by the AAP and CDC, children with known high-risk conditions or who have concerning screening results can be referred for early intervention.1
Limitations of Milestone Lists
The CDC’s 2004 Learn the Signs, Act Early campaign created developmental surveillance milestone checklists that included warning signs and exhortations for parents and pediatric providers to “act early” when addressing possible delays and concerns.2
The developmental milestone checklists used “average-age” milestones— goals that the 50th percentile (i.e., half) of children were expected to reach at a given time. Many providers and parents using the milestones chose to use a waitand-see approach, which sometimes led to delays in diagnosis and treatment.3
In a Pediatrics special article detailing the process behind the recent revisions, the authors explained that “[t]ypically, lists of milestones are uncited [and] are based on clinical opinion.” The articles went on: “Moreover, ages specified for individual milestones are inconsistent across sources.” Lists that give a median age at which children should reach a milestone can provide some insight into the behavior and development of an average child, but they can be too vague for many parents and pediatric providers. Notably, since average-age milestones predict what half of all children are expected to achieve by particular points in time, by the same token, they accept half of all children to not yet be at the milestones at the time they’re evaluated. This can lead to delays in the identification and treatment of potential issues.4
Updated Approach
Based on the past 15 years of use, three major areas of revision were identified by the CDC and AAP:4 • Criteria for checklists were established to evaluate existing checklists. • Milestones were expanded from representing the 50th percentile of children to the 25th percentile to ensure most kids can be expected to achieve the milestones by the relevant ages. • New checklists for the 15- to 30-month range were added to complete the full two-month-to-five-years series of surveillance across early childhood.
Other changes to their milestone guidance include:3
• “Identifying additional social and emotional milestones (e.g., smiles on their own to get your attention, age 4 months).” • “Removing vague language like ‘may’ or ‘begins’ when referring to certain milestones.” • “Removing duplicate milestones.” • “Providing new, open-ended questions to use in discussion with families (e.g., Is there anything that your child does or does not do that concerns you?).” • “Revising and expanding tips and activities for developmental promotion and early relational health.”
Paul H. Lipkin, MD, FAAP, a member of the AAP Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities, participated in the revisions. In an AAP press release, he stated: “The earlier a child is identified with a developmental delay the better, as treatment as well as learning interventions can begin. 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.”3 C
