What the CDC's Developmental Milestone Updates Mean for Your Family

Parenthood often feels like a competition and making sure your child meets all of their developmental milestones on time can play a big part in that. According to the Centers for Disease Control and Prevention (CDC), one in six children ages 3 to 17 years old has a developmental disability, i.e., a range of conditions that affect how children behave, learn, move, play, or speak.

While tracking developmental goals can make even the calmest of parents nervous, identifying developmental delays early is less about identifying problems and more about finding solutions to help your child thrive. Many kids aren't identified as having a developmental disability until school age. Yet research shows that intervention before this time (known as early intervention) can make a huge difference to a child's ability to learn new skills. It can also reduce the need for expensive future interventions.

Unfortunately, parents often receive what feels like conflicting advice, and many pediatricians adopt a “wait and see” approach. This can lead to delayed intervention, meaning kids aren't getting the support they need as quickly as they need it. To help address these issues, the CDC and American Academy of Pediatrics (AAP) updated their guidelines for developmental milestone monitoring for the first time since 2004. The revised guidelines were rolled out on Feb. 8, 2022, as part of the Learn the Signs. Act Early (LTSAE) campaign. The program aims to improve the early identification of children with autism and other developmental disabilities so children and families can quickly get the services they need.

What Are the Developmental Milestones?

The CDC's new guidelines include benchmarks for social, emotional, language, communication, cognitive, movement. and physical development milestones. They're broken down by age, from 2 months old through 5 years old, and provide a guideline for a child's development. Each stage (there are 12 in total) has several developmental milestones associated with it. You can view them all on the CDC's website.

For instance, by the end of age 2 months, most babies look at your face, smile when you talk to them, react to loud sounds, look at a toy for several seconds, and move both arms and both legs.

By the end of age 3 years, most children calm down within 10 minutes of being dropped at daycare, say their first name when asked, draw a circle when shown how, and put on some clothes independently.

How Have the Developmental Milestones Changed? 

Previously, all key milestones were based on what 50% of children can be expected to achieve by a certain age. In other words, there was always a 50/50 chance that a child would or wouldn't meet a milestone on time. So if a particular child was a little late, it didn’t seem like anything to worry about and many providers didn’t recommend an evaluation for early intervention. 

“Before this revision, the milestones listed were based more or less on the consensus opinion of where the average was,” says Kelly Fradin, MD, a pediatrician and author of Parenting in a Pandemic: How to Help Your Family Through COVID-19. "But as you consider who needs assistance and referral, it doesn't make sense to require half of all children to be considered delayed."

The revision means that all the milestones reflect what 75% of children can expect to achieve by a certain age. If a child hasn’t met a milestone, it’s easier to flag it as a potential delay.

Other significant changes include the addition of milestone suggestions for ages 15 months and 30 months, which were always standard well-child visits. (The 30-month visit may not have been available or standard in all clinics depending on insurance payments, Dr. Fradin adds.) There are also new suggestions for every well-child visit from ages 2 months through 5 years. The CDC also added new milestones related to emotional and social skills.

Finally, the CDC and AAP included new open-ended questions for providers to ask families at well-visits, as well as new and revised tips for parents, and activities for supporting their child’s developmental growth. They also eliminated vague language and duplicate milestones and revised language so that everything is written in a way that makes it easy to understand.

Notably, some milestones like learning to crawl were "dropped," though this doesn't mean that they aren't important skills and valuable achievements. "It's more that the data about the correct age and how effective the crawling milestone relates to referral for developmental assessment was not as clear at this time," Dr. Fradin says.

What Do These Changes Mean For Parents?

Hopefully, the revised milestones mean more clarity for parents and providers. "By tying milestone information to the 75th percentile, parents and pediatricians can identify children who are really in need of evaluation and refer them immediately instead of watchful waiting," explains Dr. Fradin. "Hopefully this will result in less unnecessary worry and more prompt referral for the children who really need it."

Dr. Fradin also points out that this is a public health and education change, and it won’t affect the cutoff for who is eligible for services. That is often determined by the local programs that provide the services.

How Will This Help With Early Diagnosis of Developmental Disabilities? 

The American Academy of Pediatrics recommends that every child is screened for general development at 9, 18, or 30 months and for autism at 18 and 24 months, or whenever a parent or provider has a concern.

The revised CDC/AAP guidelines for developmental milestone monitoring equips parents with more accurate information for their child's developmental status. It also allows pediatricians to identify developmental delays more quickly and usefully so they can help families access the resources they need for early intervention.

Hopefully, these changes will ease the concerns of some parents, or at least reassure them that their children will get the help and support they need to thrive.