In February 2022, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) updated developmental milestones for infants and toddlers. With this update, there were some positive changes but also some changes that raise concern from some medical professionals. The last time the milestones were updated was more than 20 years ago. The positive changes in the updated milestones include: -Medical jargon has been removed and more family-friendly language
is used.

• Checklist has been added for 15 months old and 30 months old. With 15 and 30 months added, there is now a developmental checklist for every well visit at the pediatrician’s office.
• Additional social and emotional items have been added to aid in early detection of autism.
• Duplicate items and vague wording have been removed.
• Open-ended questions are provided to aid medical professionals to facilitate open discussions with families about their child’s development.
• Expanded and revised suggestions to promote developmental milestones.

There are also fewer milestones. Prior to the update, there were 216 milestones across 10 checklists for ages. Adding 15 and 30 months created 12 checklists, but now there are only 159 milestones.

Previously, milestones achievements were based on the 50th percentile of children (average) at the particular age listed. With the 2022 update, the mastery of milestones is now based on 75 percent of the population. This was changed to encompass a wider range of “typical” ages of development to ease parents’ concerns; however, medical professionals are concerned that only the low end (25th percentile) of children will be identified. A majority of the children in the 25th-45th percentile range, who would likely benefit from early intervention, will potentially be overlooked.

One negative impact of the milestones being moved to the 75th percentile may tend to lead parents and pediatricians to take a “wait-and-see” approach. This could in turn cause parents to prolong pursuing early intervention. One of the ongoing concerns that early interventionists have faced is that many pediatricians have a wait-and-see approach. Lowering standards will likely cause an increase in wait-and-see approaches from pediatricians as well as parents.

For infants and toddlers, early intervention is one of the most important services for young children due to the neuroplasticity in the young child’s brain. Neuroplasticity, which is at its greatest prior to age five, allows brain pathways to change, learn, and adapt, and creates new pathways that strengthen neural connections. This means that early intervention can aid a child in achieving and learning new developmental skills that will directly become permanent changes in the brain and further the child’s development. This is one of the main reasons why a wait-and-see approach can cause crucial time to be lost and negatively impact a child’s development.

Two of the biggest disagreements that early intervention therapists have with the CDC and AAP changes are crawling being removed as a developmental milestone and speech and language milestones being pushed back to later ages. OTs and PTs consider crawling a critical skill for building strength in the core, upper, and lower body; integrating primitive reflexes; developing palmar arches in the hand; exploring the environment; and developing motor planning skills. Speech-language pathologists (SLPs) are concerned with the number of words that a child is expected to have. Previously, a 24-month old should have 50 words in his/her repertoire; however, the new milestone is 30 months. SLPs are concerned that this will cause a delay in identifying children with early intervention needs.

With the CDC and AAP updated developmental milestones, there are a few positive outcomes; however, from an early intervention perspective, it is concerning that a greater number of children will not be identified and potentially miss the opportunity for early intervention, when neuroplasticity is at its greatest. Parents should be aware that milestones occur in ranges, and not all children will master them at the same time. Pathways.org is a useful tool that provides age ranges of milestones, is family friendly, and very thorough. Parents should always monitor their child’s progress, and if they are concerned with development, seek out a screening or evaluation with an OT, PT, or SLP early interventionist.

Kimberly Bradley, MS, LOTR, a pediatric occupational therapist, writes the “Wiggle Room” column. She owns Kim4Kids in Metairie and can be reached at kim4kidsnola.com.