Earlier this year, the U.S. Centers for Disease Control & Prevention (CDC) updated its developmental milestones guidelines used to identify potential red flags indicating a child may need early intervention services. This process was initiated long before the pandemic, and finalized in February.

After taking some time to consider the impact of these new standards, our FOCUS Therapy team has some concerns that we hope parents and local providers will pay attention to when weighing whether a child may require early intervention, such as speech, occupational, physical, feeding, and ABA therapies.

What Are CDC Developmental Milestones?

The milestones guidelines put forth by the CDC are essentially a point-by-point list of activities or skills that most children can do or have mastered by a certain age (primarily between birth and age 5). It includes skills that fall under one of the following categories:

• Social/emotional
• Language/communication
• Cognitive
• Movement/physical development

Examples of identified milestones would be things like waving “bye-bye” or saying words besides “mamma or dada” or taking a first step.

The old milestones can be found here.

The updated milestones can be found here.

Why Did the CDC Update the Milestones?

The CDC, along with the American Association of Pediatricians (AAP) said that the updates were conducted by a group of its experts, with changes required because the standards had not been revisited since 2004.

A spokeswoman for the CDC told Reuters that the agency had been discussing revising the milestones back in 2017, and that the work began in 2019. Analysis of parent understanding and relatability was conducted in mid-2020.

The goal, say agency leaders, was to make the guidelines more helpful to families. The language contained in the previous guidelines was reportedly vague, with parents on many fronts urged to take a “wait-and-see” approach. That approach is now broadly understood to no longer be the best course of action when children are delayed on key developmental milestones.

The updated version now includes checklists for 15 and 30 months, and milestones that are considered “standard” when 75 percent or more kids can be expected to those skills. That differs from the previous standards, which were based at 50 percent mastery.

Why Our FOCUS Therapists Have Concerns About the New Milestones

Certainly, eliminating a wait-and-see approach to any concern regarding kids’ developmental milestones is important. We now know that prompt intervention therapies (speech, occupational, physical, and ABA) are the critical when there are concerns about a child’s development. Early intervention is strongly correlated with optimal long-term prognoses for these kids.

The CDC says that by resetting the bar, they are able to pinpoint kids whose delays are clinically significant and who unquestionably should be funneled into the pipeline for early intervention services. This is as opposed to “worrying families whose children may developing normally at a slower rate than average.”

Our concern at FOCUS Therapy, however, is that in moving the milestone bench marker from “this is the age at which 50 percent of kids have this skill” to “this is the age at which 75 percent of kids have this skill,” the CDC has effectively lowered the standard for who may qualify for early intervention. In turn, that could mean kids who truly need these services may end up waiting even longer than they are now to obtain them.

“We want parents – at the earliest sign of an issue – to start raising the question, pushing for answers from doctors, and getting the ball rolling for evaluations and early intervention therapy services,” said FOCUS Therapy Owner/Founder Jennifer Voltz-Ronco. “This is especially important in regions like South Florida, where it could take months just to get an evaluation, let alone an appointment to see a pediatric developmental specialist and get therapies lined up from there. We don’t want them waiting any longer than they have to because it is already going to take many months to secure these services. All the while, they’re going to be falling further and further behind their peers. The concern with these updated developmental guidelines is that is exactly what’s going to happen.”

There’s also a worry that health insurance companies may not approve treatment for kids if they’re slightly younger than what’s identified in the new guidelines – even if we as parents, therapists, and other health care providers can clearly see the benefit and need for services.

“Our recommendation, if you have any concerns about your child’s development, is to raise them to your child’s pediatrician and press them for a referral to specialists who can conduct assessments,” Voltz-Ronco said. “The earlier we can intervene for kids who have a delay, the better the long-term outcomes.”

FOCUS offers pediatric speech therapy, occupational therapy, feeding therapy, physical therapy, and ABA therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.

Additional Resources:

CDC’s Developmental Milestones, CDC

More Blog Entries:

A New Diagnosis: Pediatric Feeding Disorder & How Fort Myers Feeding Therapy Can Help, June 27, 2022, Fort Myers FOCUS Therapy Blog