CDC Updated Milestones (2022) for Occupational Therapy Practice

Introduction

The CDC has updated and revised the developmental milestone checklist for children on their website. The last update was almost 20 years ago from the CDC and the American Academy of Pediatrics. The updates are part of the Learn the Signs. Act Early program which was created in 2004 provides a free checklist of developmental milestones for infants which contains warning signs of developmental delays.

Why the Change

One of the main reasons for the change is because the old checklist was based on a 50 percent criteria for children to meet the milestone, which may not be as helpful for parents as it was determined based on a 50/50 chance of experiencing developmental delays. The new checklist is more pertinent to the population of children because essentially, 75% of children will reach each milestone compared to 50%. This means that the cutoff may help to detect if something is more seriously wrong and for parents to seek help with services. Overall, more social and emotional milestones were added compared to language, cognitive, and physical milestones.

Keep in mind that developmental milestones are broad guidelines and can have a lot of variation. They reflect the ‘neurotypical’ or the ‘neuromajority’ but children outside of these categories may have differences, but this is not necessarily a sign of a problem. When considering milestones, children may skip milestones, have delays in them, take longer than their peers but overall, may turn out fine. These new CDC guidelines suggest a different kind of focus that there is kind of a range of meeting developmental milestones. I think these changes will have an effect on many things such as the statistics for future research, outcome measures, and even for occupational therapy interventions in practice as well as the services that children receive. As it is more ‘inclusive’ in terms of the statistics, it will be more pertinent for parents, but one change – that of pushing the milestones back in age will shift our practice as well as children getting services. While this video is not a deep dive of every change, here are some of the general revisions for the CDC milestone checklists.

The Changes

  • The language and jargon were made to be more reader-friendly.
  • Vague language such as “may” and begins” were removed; for example, “begins to pass things from one hand to another” was removed and was included as “moves things from one hand to her other hand”.
  • Each age group contains fewer developmental milestones compared to before.
  • 57 CDC milestones (26.4%) were removed, which was more than half of the original 216 milestones.
  • 94 of the 159 milestones are from the original with 65 new ones being added.
  • 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 and repetitive language were removed.
  • Two new checklists were added at 15 months and 30 months.
  • A checklist for every wellness visit for children from 2 months – 5 months were added.
  • There are now a total of 159 milestones contained in the 12 checklists.
  • In terms of the domains, cognitive milestones decreased by 50%, language decreased by 9%, and motor decreased by 6%.
  • 77 of the developmental warning styles in the original checklist had a 77% corresponding milestone on the new checklist.[1]Evidence-Informed Milestones for Developmental Surveillance Tools Jennifer M. Zubler, MD; Lisa D. Wiggins, PhD; Michelle M. Macias, MD; Toni M. Whitaker, MD; Judith S. Shaw, EdD, MPH, RN; Jane K. … Reference List

Controversy

Now that we know the changes, how does this affect children and occupational therapy? According to a parents.com article,[2]Solis-Moreira, J. 2022. The CDC Updated Their Developmental Milestones for Kids—Here’s What Parents Need to Know. Retrieved from … Reference List occupational therapist Jessica Hatfield believes that moving milestones such as fine motor skills to older ages will make it harder to provide early intervention. Potential problems may not be caught early on resulting in more future problems such as developmental problems for the child.

Crawling was also removed as a developmental milestone. This is a pretty big one as crawling involves many developmental skills from coordination, reflex, strength, vision, basically the whole body. This may be a very controversial change as one side – crawling is seen as very important for development, and on the other side, it may have not been seen as significant enough to include in the checklist. Some babies do skip crawling and use other methods for locomotion such as scooting, slithering, and rolling. Others may just move directly to other milestones such as pulling up, standing, cruising, then walking.

Discussion

What do you think of these new changes? The checklists can be accessed on the CDC website.

There is also an app based on this information called Milestone Tracker.

References

References
1 Evidence-Informed Milestones for Developmental Surveillance Tools Jennifer M. Zubler, MD; Lisa D. Wiggins, PhD; Michelle M. Macias, MD; Toni M. Whitaker, MD; Judith S. Shaw, EdD, MPH, RN; Jane K. Squires, PhD; Julie A. Pajek, PhD; Rebecca B. Wolf, MA; Karnesha S. Slaughter, MPH; Amber S. Broughton, MPH; Krysta L. Gerndt, MPH; Bethany J. Mlodoch; Paul H. Lipkin, MD
2 Solis-Moreira, J. 2022. The CDC Updated Their Developmental Milestones for Kids—Here’s What Parents Need to Know. Retrieved from https://www.parents.com/toddlers-preschoolers/development/behavioral/everything-parents-need-to-know-about-the-updated-cdc-guidelines-on-developmental-milestones/
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.