Kids' Health

Pediatric Milestone Guidelines Recently Changed For The First Time In Decades

The Centers for Disease Control Prevention and the American Academy of Pediatrics updated their pediatric milestone guidelines for the first time in decades.

by Lizzy Francis and Tara Santora
A small girl sleeping on their mother's chest

The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) just revised the official checklist of developmental milestones for infants and young kids. This is the first time the checklist has been revised since 2004, and the changes aim to give doctors and parents clearer benchmarks for identifying whether or not their child could have a developmental delay or disability such as autism, so they can receive early treatment if they do.

“For kids, early intervention makes such a huge impact on their long-term wellbeing and development,” says Tiffany Munzer, M.D., a developmental behavioral pediatrician at University of Michigan Health C.S. Mott Children’s Hospital.

You could expect some nerves around any changes to the milestones — checklists for kids, after all, have long imparted undue worry to parents. But these updated milestones are changing for the better, Munzer says. The new guidelines, developed by a team of 13 experts, were designed to not only help uncover developmental delays earlier, but also to take unnecessary stress and confusion off parents’ plate.

“Overall, these changes are wonderful,” Munzer says. “It just makes it easier for families to recognize some of the signs where they potentially might want to bring it up to their pediatrician.” This is what parents need to know.

The New Developmental Milestones Checklist

The updated milestones aren’t just a few additions or deletions — they’re a complete overhaul. About 41 percent of milestones were replaced, according to the AAP. One-third of milestones that were kept were moved to a different age; most were pushed back to an older age, but some were moved forward to a younger one.

One of the reasons that there are so many changes in the developmental milestones checklist is that experts used different criteria to create them. In the last version of the checklist, only 50 percent of children were expected to meet a milestone for the age given. That doesn’t really help parents, because it’s a 50/50 shot and not a great clue as to whether a kid is experiencing a developmental delay. With the new checklist, 75 percent of kids will reach each milestone by the given age.

“Normal development represents such a wide range. So it can be really tricky to define what is that the cutoff where we should be worried, or where we want to be vigilant,” Munzer says. “By moving it to a 75% cutoff, if your child’s not doing that by that age point, that’s a really clear sign that you might want to talk to your pediatrician, so that they can help connect you to services that could potentially improve the wellbeing of your child.”

Another core change is to the language used in the checklist. Rather than using vague terms like when a child “may” or will “begin” to do something, the guide includes clear-cut behaviors that mean a baby is on track, or that they may be falling behind. The guidelines also explain what warning signs and behaviors to look out for if a kid is not meeting their milestones, and activities for kids to do with their parents in order to support meeting milestones.

Another major change is that the AAP added more social and emotional milestones, in contrast to language, cognitive, and physical milestones. For example, by 9 months, most babies look when their name is called, react when a parent leaves them, and smile or laugh when playing peek-a-boo. The AAP also added milestones that are typically reached by ages 15 months and 30 months, which were not previously included.

What If Your Child Misses a Milestone?

The world of baby milestones is a fraught one — one that can lead to parents being unnecessarily concerned about their child’s progress or even stress if their kid meets a milestone out of order, or meets it late, or doesn’t meet it at all. Ideally, these new guidelines will help parents clearly identify developmental delay concerns when they occur.

“When kids’ development is different from what we might expect, that can bring on a lot of stress for families. So I think having these clear-cut guidelines will help clarify clarify things for families and pediatricians so that they can figure out the exact kind of tailored therapy for each family,” Munzer says.

Missing a milestone doesn’t necessarily mean that your child has a developmental delay or disability. “If you’re noticing one lagging skill, it’s possible that your child could catch up pretty easily,” Munzer says. “If there are multiple, that might be more concerning.”

In any case, Munzer recommends talking to your pediatrician if your child misses a milestone. “Kids develop really at their own pace. But the age range of 0 to 5 years is the perfect time to figure out if there are any kind of delays, because there’s so much that’s happening in the brain that is still developing and still very neuroplastic. So if there’s even a little bit of a lag in any of those skills, having specific therapies to target those skills, can help a child catch up more quickly.”

If a child is only having problems manipulating objects, for example, occupational therapy could help. If they have a mild speech delay, speech therapy could be the answer. None of these necessarily means the child has a condition that will affect them long-term, Munzer says. But being able to track progress of those skills with a pediatrician and accessing early interventions can help get them back on a more typical developmental track.