American Academy of Pediatrics and the Centers of Disease Control’s Developmental Milestones Chart: What It Is, and What It Means For Parents
If you became a new parent after 2022, you might have missed all the hubbub around the American Academy of Pediatrics (AAP) and Centers of Disease Control’s (CDC) update to their pediatric developmental milestones chart. In this article I’ll dive into the purpose of the milestone chart, the purpose of the update, its reliability, some of its critiques, as well as my thoughts on it and what it means for your role as a parent.
Who Made the “Bright Futures Milestones and Anticipatory Guidance” Chart?
The “Bright Futures Milestones and Anticipatory Guidance” Chart was created by the AAP in partnership with the CDC as a part of the CDC’s “Learn the Signs Act Early” program. The resources and materials distributed through this program are intended to help parents and caregivers identify developmental delays in their children(1,2). You can find the milestones listed categorized by your child’s age here.
What Is The Purpose of The Bright Futures Milestone Chart and Why Was It Updated?
The main purpose of the milestone chart is to encourage parents and caregivers to monitor their child’s development so that any delays can be caught early and the child can undergo immediate developmental screening/testing. Earlier screening for developmental delays will likely lead to earlier diagnoses and treatment. This positively impacts the amount of support a child with delays receives and improves their long-term outcomes (1).
The milestone chart was updated to improve parent’s and doctors ability to identify delays earlier and take action promptly. The previous milestone chart was based around normative data that supported 50% of children being able to complete a specific milestone by that time frame. The updated chart uses much of the same normative data but shifted the percentile range to 75 (3).
To clarify: the updated chart lists milestones that 75% or more of children aged 0-30 months in the normative data sets were able to reach by the detailed time period (3).
The team of 8 child development experts that worked with the AAP to update the milestone chart did this to discourage pediatricians and other specialists from the “wait-and-see” approach. Knowing that 75% of babies are completing something at a given time frame vs 50% prompts a more intensive look if a child is missing a milestone or series of milestones. It increased clarity about when a child should be referred for further developmental screening(3).
The update was also done to improve broad understanding. Milestones were reduced, simplified, and described in a fifth to sixth-grade reading level so that parents of all cultures and socioeconomic backgrounds can easily interpret what each description means(3). Children in lower socioeconomic households have an increased risk of developmental delays. The update improved readability and access, which are critical to improving health communication to at-risk populations(4).
Ultimately, the update aimed to increase conversations between caregivers and pediatric health professionals around development to improve timely developmental screenings(3).
How Reliable is the Information?
The updated milestones chart was developed by a team of 8 child development professionals selected by the AAP who completed a literature review and found 34 scholarly articles (including the existing CDC milestones) that provided normative data or expert opinion for milestones and the age-range they should be achieved. Of the articles that contained normative data, “58.3% of them described populations within non-english-speaking countries”(3).
A scholarly literature review is a robust form of scientific evidence. These types of research studies use strict criteria to include “peer reviewed” articles that share results on a specific topic (in this case, developmental milestones for children aged 0-30 months). This means that they are very detailed about what they are looking for and that all of the articles they have included were written by experts, published to the broader scientific community, and validated by other experts.
Given the robust review performed by the AAP, this resource is pretty solid. It is worth noting that many of the normative data sets described children in non-English-speaking countries. This means that more than half of the studies that included normative data were conducted outside of the United States. There are a lot of cultural differences across the globe that can influence how and when a child is meeting milestones. This in no way invalidates the milestone chart as a helpful tool for developmental monitoring— but it does help support the fact that you shouldn’t be leaning on any one tool to be the ruler you rigidly hold against your child’s development. Every child is going to develop at a slightly different pace than others, and have areas where they excel easily and others where they have more challenges.
What are some Critiques of the Updated Milestones Chart?
Initially the updated developmental milestones caused a bit of uproar among pediatric specialists. Most of the milestones were moved to a later time-frame, causing many to assume the bar was being lowered for our children. However, once the reasoning for the change was widely understood, the results have been mostly positive.
There are still two main concerns among professionals that I’ve come across. They are that:
No pediatric Occupational Therapists (OT), Physical Therapists (PT), or Speech Language Pathologists (SLP) were represented in the group of 8 “subject matter experts” that conducted the literature review(3). (However, one of the developmental behavioral pediatricians was dually trained as a SLP(5).)
The “subject matter experts” did include developmental-behavioral, neurodevelopmental and general pediatricians as well as child psychologists, developmental psychologists, and a professor of special education and early intervention (3).
OT’s, PT’s and SLPs each have a unique knowledge base and could have provided valuable insight as to what milestones would be important to include to prompt referrals to therapies and improve patient outcomes.
Crawling is not included in the new list “as the current evidence suggests that crawling is highly variable and not essential for development”(6).
Let me tell you something… if you want to see a pediatric OT or PT explode you say to them, “crawling is not essential for development”. This couldn’t be further from the truth and I’m going to dive into why in a future article. But to give you the quick gist of things— crawling is completely necessary for sensory motor development. How, when, and for how long a baby crawls is a huge indicator for OT and PT practitioners that something is impeding optimal neurological development.
The subject matter experts appointed by the AAP used their clinical experience as well as the available evidence to decide whether a milestone would be included and at what age only when they reached a unanimous agreement(3). I would argue that had an OT or PT been present, they would have fought for a unanimous decision to include crawling.
How Do I Apply it to My Parenting?
You’re likely to run into the CDC’s “Learn the Signs Act Early” resources during your routine visits to your child’s pediatrician.
The main thing to remember here is that these materials are NOT intended to screen for or diagnose your child with developmental delays.Their sole purpose is to encourage you to monitor your child’s development and prompt conversations with your pediatrician about any concerns you may have regarding milestones. If you and your pediatrician detect a delay, it’s time to discuss a referral for a developmental screening. This is a big win for you and your child because you can feel peace about them getting the support they need in a timely fashion.
The CDC’s milestone chart, and any other milestone charts for that matter, are valuable tools to have in your parental toolbox when appropriately used for their intended purposes.
I’d also encourage you to let checklists inspire how you play with your baby. Take a peek at what you can anticipate them being able to do in the next month or so and challenge them appropriately during play. This simply means that you structure their play environment in a way that makes it so they could achieve the milestone if they are able to do it. Give them opportunities on the floor to move freely. Engage with them socially often. Present them with simple toys and demonstrate their use.
If any education or parenting tool is causing you more anxiety than peace… it’s likely because you either don’t understand it well enough, or you have spent too much time obsessing over it. If you fall into the former category— get clear on what you don’t understand. Ask your pediatrician or another child development expert for clarification. If you are the latter and you spend all of your baby’s play time obsessing over whether you’ve seen them demonstrate a skill exactly when the milestone chart says they should…. You need to take some deep breaths. Trust that you know the information well enough to know if you are seeing any red flags in your child’s development. Call a friend or family member and laugh with them over your over-the-top intensity.
You’re a good mom. I know that because you made it to the end of this article. Thank you for your dedication to your child and their healthy development!
As always, I’m happy to answer any questions this sparked! Send me a message!
Resources:
