In case you missed it, there are updated guidelines for your little one’s developmental milestones. Here’s what you need to know before her next pediatric appointment.
Tracking baby’s growth as a new parent comes naturally. During the first year especially, you’re looking for those monumental moments: the first smile, the first laugh, the first word, the first food, the first step. Your pediatrician is looking for these markers, too, along with a slew of other identifiers that affirm your baby is developing properly and within a normal timeframe.
These criteria have been in place for quite some time, but in February of 2022, for the first time in 18 years, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) updated guidelines for developmental milestones. These revisions were made in the Learn the Signs. Act Early. program (originally launched in 2004), which uses a series of checklists to give parents and health care providers the tools needed to better spot developmental delays earlier in young children.
Milestones are divided into four main categories: social-emotional, language/speech, cognition and motor. Previously, these guidelines were based on a 50th percentile scale, or average-age measurement. This approach automatically means only half of children can achieve the respective milestone by the specified age, which experts flagged as not helpful for families with concerns about child development.
According to a press release issued by the AAP, the new milestones are written in “family friendly language and identify the behaviors that 75 percent or more of children can be expected to exhibit at a certain age based on data, developmental resources and clinician experience.” Milestones are also meant to be more easily observed and used in a child’s natural setting, regardless of a family’s social, cultural and ethnic background.
This benchmark change may also encourage less of a “wait-and-see” approach from providers in identifying a delay, which can then lead to a late diagnosis. What’s more, this method opens up a continuous conversation between pediatricians and parents about their child’s health, in hopes that an earlier discovery can lead to earlier intervention and a better developmental outcome.
Key Differences to Know
There are more checklists.
Milestone checklists have been added for 15 and 30 months of age. This means baby development screenings will take place at every well-child visit from age 2 months to 5 years.
There are fewer milestones.
Previously, the CDC had 216 milestones across 10 checklists; there are now 159 milestones used across 12 checklists. Some of this reduction is due to duplicate milestones listed under multiple checklists. Updated guidelines also removed medical verbiage and vague language such as “may,” “can” and “begins” to better communicate when children should reach a specified milestone.
There are earlier screenings for autism.
Various milestone markers have been added to the lists to help identify signs for autism spectrum disorder (ASD) at a younger age. An example of an added social-emotional marker is at age 2 months, when an infant should calm down when picked up or spoken to. Another is an infant smiling on their own to get attention at age 4 months.
Crawling was removed as a milestone.
As odd as it may sound to some parents, crawling was plucked from the list of developmentally appropriate milestones for a baby. The logic surrounding the controversial decision holds that motor skills, unlike language and social skills, are not heavily influenced by parents and caregivers. Some babies roll, army-crawl, scoot around on their bottoms, or skip traditional crawling altogether. Not only that, but babies crawl at their own pace, and the range for when that happens is quite vast, which serves as another reason crawling didn’t make the final cut this time around.
The standards for language development were lowered.
The CDC originally suggested a 24-month-old would be able to say an average of 50 words, but new guidelines say that instead, a 30-month-old’s vocabulary should span 50 words. These milestones are intended to represent levels of concern, not averages, such as a 12-month-old not saying “mama” or “dada” or something similar for a parental figure. This change, in part, is why the 30-month mark was added to the list of well-check screenings.
You can read more about the changes to the CDC developmental milestones here.
What to Expect from Your Provider
Parents and pediatricians together are navigating these updates and revisions, so communication will continue to be key.
One charge for health care professionals is to ask more open-ended questions at well-visits that facilitate discussion within the family during baby’s first year and beyond. (Example: Is there anything that your child does or does not do that concerns you?) These inquiries—versus a simple yes-or-no question—encourage an environment of continual surveillance of baby’s development, so that no matter if you have a sleepy, snuggly 1-month-old that’s not doing much, or an active, babbling, energetic 8-month-old, you’re more likely to note and voice any perceived inconsistencies or worries.
Anticipate the addition of the aforementioned 15- and 30-month checklists, and know that your pediatrician is there to advise you with any questions or troubles you may come across as you review the updated guidelines for your baby.