Milestone Changes

Did you know that the CDC recently changed the ages for some of the major milestones of child development? Here are some examples. Walking without support changed from 12 months to 18 months. Crawling is no longer a milestone. Before, a 24 month old was saying 50 words. Now, the expectation is that a 30 month old will say 50 words. Milestones now include ages 15 and 30 months. So, why did the CDC make these changes, and what does it mean?

Firstly, the main goal of these changes was to make it easier for primary care providers to identify children who are at risk for delays. The previous ages were based on when 50% of children would meet a milestone. This caused many providers to take a “wait and see” approach as only half of children would demonstrate a particular ability at a particular age. So, the new guidelines represent the age that 75% of children can do the activity. Therefore, if a child is not doing something that a vast majority of children are able to do, they should receive a referral to the appropriate specialist.

Milestone criteria

Here are some of the criteria that new milestones must meet:

• Milestones ages are the age most children (>75%) will demonstrate the milestone
• No longer include warning signs
• Are easy for families from different social, cultural, and ethnic backgrounds to use
• Can be answered with yes, not yet, or not sure
• Use plain language
• Are organized in developmental areas

what do therapists think?

To be honest, we are concerned. In theory, these changes should mean that more kids will have referrals to specialists early. But, many of us have concerns that some kids who are at risk for delays will have referrals later because of these changes. Let’s use walking as an example. Previously, the milestone said your child should be walking by 12 months of age. What that meant was that by 12 months of age, 50% of children were walking without support. That hasn’t changed. 50% of kids STILL walk without support by 12 months of age.

The new milestone says your child should be walking independently at 18 months (and taking a few unsupported steps by 15 months). This means that 75% of kids are walking independently at 18 months of age. So, if you child is NOT walking by 18 months, there should be no hesitation about receiving a referral to a physical therapist. Unfortunately, this may mean that a child who would have received a referral at 15 months (or sooner) is now getting a referral 3 months later. As therapists, we always say that the earlier a referral happens, the better.

Milestones don’t always tell the whole story. While the article does not specifically state why crawling is no longer a milestone, it is very likely that it is not included because 75% of kids will not crawl, not because the skill is not important. In addition, the vocabulary average for a 30 month old is closer to 450 words, NOT the 50 that is the the current CDC milestone.

What does this mean for parents?

Trust your gut. If you have concerns about your child’s development, talk to your primary care provider. Or, call MOSAIC to set up a free screen to discuss your concerns with one of our therapists who specialize in these areas. You can view the updated CDC Milestones here.

References

1. Evidence-Informed Milestones for Developmental Surveillance Tools