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CDC, AAP update developmental milestones for surveillance program

February 8, 2022

The Centers for Disease Control and Prevention (CDC) and the AAP have revised developmental milestones in the Learn the Signs. Act Early. program, which helps parents identify autism and developmental delays in their children.

The CDC asked the AAP to convene a group of experts to revise several developmental milestone checklists, which use 50th percentile, or average-age, milestones. Using this approach means only half of children can be expected to achieve that milestone by that age. Clinicians reported that following the guideline often was not helpful to families who had concerns about their child’s development. In some cases, clinicians and families chose a wait-and-see approach, leading to a delay in diagnosis.

The revised developmental milestones are written in family-friendly language and identify the behaviors that 75% or more of children can be expected to exhibit at a certain age based on data, developmental resources and clinician experience.

The process behind the revised milestones is detailed in an article titled “Evidence-Informed Milestones for Developmental Surveillance Tools” published in Pediatrics Tuesday.

Paul H. Lipkin, M.D., FAAP, a member of the AAP Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities, assisted with the revisions. He also provides clinical services at Kennedy Krieger Institute’s Center for Development and Learning.

“The earlier a child is identified with a developmental delay the better, as treatment as well as learning interventions can begin,” Dr. Lipkin said in a press release. “At the same time, we don’t want to cause unnecessary confusion for families or professionals. Revising the guidelines with expertise and data from clinicians in the field accomplishes these goals. Review of a child’s development with these milestones also opens up a continuous dialogue between a parent and the health care provider about their child’s present and future development.”

Changes to the guidance include:

  • Adding checklists for ages 15 and 30 months; now there is a checklist for every well-child visit from 2 months to 5 years.
  • Identifying additional social and emotional milestones (e.g., smiles on their own to get your attention, age 4 months).
  • Removing vague language like “may” or “begins” when referring to certain milestones.
  • Removing duplicate milestones.
  • Providing new, open-ended questions to use in discussion with families (e.g., Is there anything that your child does or does not do that concerns you?).
  • Revising and expanding tips and activities for developmental promotion and early relational health.

The CDC presented the revised milestones to parents and caregivers of different educational backgrounds, income levels and racial groups to determine how easy they were to understand and follow.

Since 2005, Learn the Signs. Act Early. has provided free resources to families, health care providers, early childhood educators and others to support early identification of children with developmental delays and disabilities.


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