In 2004, the Centers for Disease Control and Prevention published Developmental Milestone Checklists for Infants and Young Children to help parents track their child’s development and to intervene if a child seemed to be delaying.
The benchmarks, part of the development monitoring program “Learn the Signs. Act Early” by the CDC, remained unchanged for decades. That all changed on February 8, however, when the agency, in partnership with the American Academy of Pediatrics, announced the milestones were being revised.
Pediatricians and child development professionals say the changes were long overdue and should make it easier to spot problems like autism or other social communication disabilities. However, the changes prompted skepticism from people who suggested the update amounted to an attempt to cover up delays in child development related to the COVID-19 pandemic.
“The CDC and AAP are quietly changing developmental milestones for children… You should be wondering why…” read the caption of a Facebook post, along with an image that reads, “Crawling is no longer a milestone.” Walking has been changed from 12 months to 18 months. Reden changed from 12 months to 15 months.”
Another post was more direct, describing the changes as “dystopian.”
“Instead of emphasizing the harmful effects of masking and social isolation on young children, the CDC simply lowered the bar. Presto! No impacts!” it said.
However, there is no indication that the CDC and AAP changed the milestones due to any impact the COVID-19 pandemic may have had on children. The revisions, in the works since 2017, are a response to concerns from parents and educators about the early identification of children at risk for developmental delays.
The new milestones, published in the journal Pediatrics, were developed by a group of child development experts who were asked to revise the checklists — free materials made available to and used by physicians, families and early childhood education professionals used to monitor pediatric growth. These milestones explain what behaviors and motor skills a child should be exhibiting at a certain age. In the past, these milestones were created based on what research shows that about half of the children in a population by that age could reach.
However, clinicians reported that adherence to the 50th percentile guidelines often disadvantaged families who worried when their children did not meet these developmental expectations.
“In some cases, clinicians and families have opted for a wait-and-see approach, resulting in a delay in diagnosis,” the AAP said in a news release announcing the changes.
The newly revised developmental checklists now identify the behaviors that can be expected to be exhibited by 75% or more of children of a given age, based on data, developmental resources, and clinical experience. This gives parents and physicians a narrower set of criteria they can use to target children who might benefit from interventions.
The finding is that parents of a 12-month-old were previously told their child should start speaking, but the guidelines say the behavior is now expected of babies as young as 15 months. Because then, according to studies, at least 75% of the children do it. Likewise, the milestone for walking has shifted from 12 to 18 months.
“If you share a concern that your child will not be able to walk by 18 months, when 75% of children expect it to be, this is more indicative of a potential concern that requires action. In summary, a missed milestone expected by 75% or more of children is clearly more actionable than a missed milestone expected by only half of children of that age.”
dr Paul H. Lipkin, a member of the AAP Section on Developmental and Behavioral Pediatrics and the Council for Children with Disabilities who helped make the revisions, said the changes are aimed at enabling an ongoing dialogue between parents and their children’s health care providers .
“The earlier a child with a developmental delay is identified, the better, since both treatment and learning interventions can begin,” Lipkin said in the AAP press release.
Changes to the guide include:
Added checklists for 15 and 30 months of age, so there is now a checklist for each healthy child visit aged 2 months to 5 years.
Identifying additional social and emotional milestones, e.g. B. when an infant should smile spontaneously to get an adult’s attention.
Provide physicians with recommendations for open-ended questions to use when speaking to families about their children. For example, “Is there anything your child does or doesn’t do that worries you?”
Revision and expansion of tips and activities to promote child development and health.
The CDC said any claims that the update is an attempt to cover development delays caused by pandemic measures like masking and social distancing are unfounded.
“Work on revising the milestones has been ongoing for a number of years. CDC began discussing milestone revisions in 2017. The working group that developed the revised milestones began work on them in 2019. Evidence review and revisions were completed in 2019, and parental tests for comprehension and affiliation were conducted in the summer of 2020,” PolitiFact agency González said in an email. “With the revisions, the program aimed to address feedback from parents and early childhood education professionals over the years that more clarity is needed about when to take action on a potential developmental issue.”
“The CDC’s milestones are not developmental screening tools,” González added. “They are designed to encourage developmental monitoring to stimulate conversations between parents, physicians and early childhood providers about child development.”
Subject matter experts consulted in the AAP’s review of milestones include a neurodevelopmental pediatrician, a general pediatrician, a speech-language pathologist, a professor of special education and early intervention, a developer of developmental screening tools, and pediatricians and pediatricians for developmental behaviors and developmental psychologists, the CDC said.
While these revisions are unrelated, preliminary research shows that the pandemic appears to be having an impact on infant and child development, but social and economic disparities play a role in who is hardest hit.
For example, some babies born in the last two years could experience developmental delays due to a lack of social interaction during lockdown and stressed, overworked caregivers who are unable to provide adequate one-on-one times.
However, some children may have thrived in the pandemic, researchers found, if their caregivers were home for longer periods and there were more opportunities for siblings to interact with each other.
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