CDC Guidelines have changed for the first time since 2004. What does this mean for you and your child?

What are the CDC (Center for Disease Control) guidelines used for?

Developmental Milestones have served as an educational tool for parents and medical professionals to set reasonable expectations and goals as their child grows. They are age based, and also serve as a guide in socialization, play and interaction, appropriate to a child’s level of skill and understanding.

Why did they change? what are some changes? 

The most notable change is that previously published milestones were based on the 50th percentile (average for age milestone). Now the 75th percentile (majority of children within the milestone) are the baseline and therefore many milestones shifted expectations to an older age. For example, understanding “no” was previously published at the 9-month level and now is listed at 12 months, with an expanded description (“pauses briefly or stops when you say it”). “Eats with a spoon” was previously listed at 18 months and is now at 24 months. 

Concerns have been voiced that with the newer, later dates some delays may be missed. However, it’s important for parents and professionals to understand that the new ages represent when most (or three quarters) of children achieve these skills, not half as commonly published before.

Social-emotional development changes were also emphasized in this new update.

With the increased understanding and awareness of autism in early childhood, it has become recognized that children with autism may have delays in social engagement and communication from an early age. Prior milestone lists did not offer many social-emotional milestones. In contrast, the new cdc guidelines give extra attention to including markers of social development in order to aid in the early identification of this developmental condition.

Wait, why was crawling was removed as a milestone? 

There were also concerns with exclusions of some milestones, such as crawling. Real-world data shows a vast variance in the appearance of the crawling milestone. Thus, crawling is frequently excluded entirely from guidelines since many children skip this skill without any adverse consequences.

What does MST think about the changes in milestones?

Montclair Speech Therapy, although acknowledges these changes, do not necessarily agree with all of them. For example, crawling is seen as a key vital step for some children. The adverse consequences are challenges related to the vestibular system, upper extremity weakness as children are not weight bearing to gain proximal strength. Crawling also helps to promote crossing the midline, coordination, and vision. For speech purposes, lowering the count word of 50 words from 24 months to 30 months is concerning. Parents rely on these milestones in order to reach out for help or communicate their concerns. Early intervention can have waitlists, and if parents reach out at 30 months, instead of 24, they may lose on receiving one on one therapy in their home environment, or in a clinical setting. We encourage and advise all individuals to reach out as soon as possible if you feel your child is demonstrating delays rather than use the “wait and see” approach.

What does this mean for you as a parent or guardian? 

You know your child best. If you are worried your child is delayed, it is key to reach out to your pediatrician and also to contact the early intervention state department at 888-653-4463 (statewide, toll free).

The CDC milestones checklist is a helpful tool and can be found on the cdc website, along with the milestones for all the various ages.

Source References: CDC’s Developmental Milestones
Understanding Updated Developmental Milestones