Unfolding a fresh chapter in pediatric health, we’re eyeing up the freshly inked new CDC child development milestones, yet a cloud of professional worry hovers, whispering a cautionary tale that these tweaks may well leave a bitter aftertaste of harm instead of anticipated good.
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Get to know the Signs Act. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) have updated their early guidelines for developmental milestones for the first time in almost 20 years. Free checklists of child developmental milestones and symptoms of developmental delays were included in the initiative launched in 2004. The revised version includes updated standards for detecting autism and other problems in development in young children.
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“The sooner a child’s developmental delay is recognized, the sooner treatment and educational initiatives can begin to help the youngster,” said Paul H. Lipkin, M.D., a member of the AAP. We also don’t want to leave families or professionals scratching their heads. These objectives can be met by revising the guidelines in light of the knowledge and experience of practicing doctors. Reviewing a child’s progress against these milestones can also facilitate ongoing communication regarding the kid between a parent and a doctor.
Twenty years of new research on kid growth led to the updates. This decision comes as parents are beginning to wonder if the COVID-19 outbreak has stunted their children’s growth. Learn all about the latest CDC milestones here, parents!
Children’s Developmental Milestones Are Down at the CDC
The CDC and a group of child development specialists recently released an article in the journal Pediatrics in which they detailed the typical ages at which children achieve certain developmental milestones, the kind of new skills they should exhibit at each milestone, and the criteria that clinicians should use to identify children who may be experiencing delays.
The revised recommendations are easier to read because medical jargon has been eliminated. They also got rid of words like “may” and “begins” which may be interpreted in several ways so that parents would know for sure what their children should have accomplished by a given age.
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The criteria were revised significantly to have fewer milestones for each age. The CDC has eliminated over half of an initial 216 milestones across 10 checklists. Some milestones were shown more than once, which may be indicative of growth across a large age range. For example, “tries to use things the right way, like a phone, cup, or book,” was seen many times.
There are now two additional baby checklists, one for 15 months and another for 30 months. There are a total of 159 benchmarks across 12 checklists, with one for each well-child visit for children aged 2 months to 5 years.
Including or Omitting Key Events
There are four primary types of developmental milestones: social-emotional, linguistic/speech, cognitive, and motor. Clearer indicators of autism have been added to the list of milestones. Two-month-olds are considered socially and emotionally mature since they can relax when spoken to or lifted up. At four months, most infants will start smiling for attention on their own. At 15 months, kids should be able to show their enthusiasm by clapping.
Fine motor skill development, for example, has been moved to a later age by around a third. Children’s developmental delays may become more severe as a result of the setback, says pediatric occupational therapist and TheraTree Pediatric Therapy employee Jessica Hatfield, MS, OTR/L.
Someone who was already one standard deviation behind the norm is now two standard deviations behind because of the late hour, and Hatfield has to work even more to bring them up to speed. She warns that the costs of extended therapy and other complications from delayed diagnosis could add up quickly.
Crawling’s demotion from a required CDC developmental milestone is another point of contention. Hatfield argues that crawling should not have been eliminated because it develops a wide range of reflexes, including those necessary for walking and controlling one’s neck. Eliminating crawling as a milestone could result in the missed warning sign of a problem like poor strength and muscle tone, a delay in reaching other, less obvious milestones, or a physiological difference in the baby’s feet or legs.
Reduced Expectations for Language Progression
Language acquisition has been identified as one of the most significant shifts in CDC developmental milestones. Specifically, the CDC pushed back the age at which children should be able to understand and use simple sentences and simple phrases. Previously, the CDC recommended that a 24-month-old would have a vocabulary of 50 words; the current standards advise that a 30-month-old should have the same amount of vocabulary. The CDC’s recommendations for language milestones have been criticized by pediatric speech-language pathologist Kassie Hanson, CCC-SLP, who claims they will slow down the process of detecting developmental problems in young children.
“That’s a huge discrepancy, considering you should have roughly 450 words between paragraphs 2 and 3. In my line of work, I see far too many pediatricians wait to see if a child can catch up before taking action. Therefore, I find this to be deeply disturbing,” adds Hanson. She is concerned that the CDC’s lowered language criteria may make parents and doctors more hesitant to seek help for their children right away.
And while Hanson is accurate that 24-month-olds should begin mixing two words, this runs counter to their claim that 30-month-olds have a vocabulary of 50 words. It is generally accepted that a vocabulary of 50 words is necessary before you can begin mixing words. So until they have learned 50 or 60 words, your child will not begin to form two-word conversations.
Early this week, the American Speech-Language-Hearing Association (ASHA) issued a statement on Facebook expressing concern over the new guidelines involving speech and language, arguing that they lack scientific evidence and suggesting that the CDC work with speech-language pathologists in setting guidelines.
Hanson warns that lowering the bar in the realm of speech and language could lead to a kid being denied an IFSP. If necessary funding is cut, the kid may not have an IEP in place in time for the start of school, delaying his or her ability to get the assessments and services they need.
Fewer children may reach developmental milestones.
It may take longer for some children to reach particular developmental milestones than for others. According to Howard Phillips Center for Children & Families occupational therapist Lora Torres, OTR, the new CDC recommendations reflect the premise that there is a range of fulfilling developmental milestones.
The new modifications will provide more precise time frames for when children should demonstrate particular behaviors and will also increase the bar for the typical age at which a given milestone is achieved. Before, recommendations were set at the 50th percentile, meaning roughly half of the children were expected to attain that milestone by a given age. Now, at least 75 percent of children are expected to do that behavior by that age.
The revised criteria will help find the remaining 25% of children at risk for developmental delays faster so they can receive the help they need. These new guidelines aim to identify children on the lower end of the spectrum and reassure worried parents that their child is not behind schedule but is being monitored closely.
But some worry that only the most severe delays are being identified and addressed. Children who score in the 25th to 45th percentile are no longer being flagged for special developmental monitoring. That is to say, the instrument is less sensitive, and some children may slip through the cracks.
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