New CDC Developmental Milestone Checklist: What does it mean?
Why the Change?
The new CDC guidelines appear to have been created with the goal of making it easier for medical professionals to identify children who require further intervention. Previously, the guidelines mostly represented the “average” child, or the child that fell in the 50th percentile. The new guidelines, however, seek to provide ages by which >75% of children would expect to meet a milestone. Therefore, a child who does not meet a milestone by the new CDC guideline age would fall into the bottom 25%, warranting the need for immediate screening and referral. To clarify, the new CDC guidelines are organized in a way that easily identifies areas of concern for pediatricians and other medical professionals, rather than a representation of the average age a child is expected to achieve a milestone.
As physical and occupational therapists, we see how important early intervention can be when working with children with developmental delays on a daily basis. Oftentimes, there is a reason a child has motor delays, whether that be tight neck and trunk muscles, low tone, or even challenges visually. Early screening, assessment, and intervention can set babies and young children on the pathway for success. The “wait and see” approach, which is sometimes utilized by health care professionals, may put a parent’s mind at ease temporarily, but ultimately doesn’t provide the best guidance to support early development. These new guidelines were created in the hopes of eliminating the “wait and see” approach; however, if used incorrectly, children are at a greater risk of being overlooked for early intervention services due to the fact that multiple milestone ages were pushed to a later age to encompass >75% of children having achieved that skill.
Furthermore, the new CDC guidelines eliminated the milestone of “crawling or creeping” altogether. This is concerning to rehabilitation professionals because crawling (or creeping) is important to the development of a huge number of skills. Crawling is a challenging skill that requires a coordinated effort between the upper and lower, right and left sides of the body; in order to crawl efficiently, a baby must have adequate strength and endurance through his/her core muscles. Crawling provides our babies with strengthening opportunities through the head/neck, trunk, shoulders, hands, hips, and legs- it is truly a full body workout! Crawling also promotes trunk flexibility and the development of rotation and crossing midline skills; it is highly influential in the development of bilateral coordination (i.e., the two sides of the body working together). Furthermore, crawling helps develop motor planning, coordination, and visual motor skills as a baby problem solves how to navigate obstacles in their environment. By eliminating this important skill from the milestone checklist, the new CDC guidelines may influence providers to overlook babies who could greatly benefit from occupational or physical therapy services.
There is certainly a wide range of normal development amongst babies and children. Developmental milestones can be useful for identifying children in need of support services, and the new CDC guidelines are aimed at providing more specific guidance to identify those children. Often, however, a mother’s (or father’s) intuition knows best! If you have concerns regarding your child’s development, don’t hesitate to reach out to your pediatrician or seek out a physical or occupational therapy evaluation!
