Much Awaited - Development Milestone Checklists Updated by CDC & AAP

Dr.Reepa Agrawal
Much Awaited - Development Milestone Checklists Updated by CDC & AAP 14 Feb, 2022

A team of experts selected by AAP (American Academy of Pediatrics) has revised the CDC development milestone checklists. Well, the CDC got the development surveillance list revised to help families and health care workers for early diagnosis and hence early intervention if any developmental delay or concerns.

Previously, the checklist was based on the 50th percentile or average-age milestone which means that half of the kids would be able to achieve that particular milestone at that particular age. However, now this includes milestones that 75% or more of kids are expected to achieve at that particular age based on developmental resources, clinical experience, and available data. This would reduce the “wait and see approach” which was delaying early diagnosis and early intervention.

The methodology for coming up with this guidance is explained in “Evidence-Informed Milestones for Developmental Surveillance Tools”, Pediatrics journal (published on 8th Feb 2022). The development experts included 11 criteria including the 75th percentile and thoroughly evaluated the normative data for milestones, development resources, and clinical opinions. They found 34 articles, 24 out of which were normative data and 10 were clinical opinions. Substantial changes to CDC milestones were made:

- 26.4% reduction in the total number of CDC milestones.

- One-third of retained CDC milestones were moved to different ages.

- 40.9% of the final milestones were new.

Approximately 80% of final milestones had normative data from more than 1 source. Social-emotional milestones also require further research.

The CDC has mentioned the updated milestones in Learn the Signs. Act early program. This program is providing free resources since 2005.

Changes to the guidance include (as mentioned on the CDC website)

  • 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.

It's quite important to understand that serial development screening is essential to pick up developmental delays and concerns. There are professional screening tools also available. At the community level, this update will help in early referrals, diagnosis, and early intervention. The “Learn the Signs. Act early” pdf is available on the CDC website and it’s a good idea to make the best use of it. Further research in this field is ongoing.


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