Could New CDC Developmental Milestones Leave Some Children Behind?

It can be tough for parents and caregivers to know if their child is “on track”–and what that even means. At 12 months old, one child might be taking steps and saying words. Another is happy to crawl and babble. Concerns might creep in: Is my toddler developing in line with others their age? If not, will they catch up on their own, or do they need some support? To provide guidance to families, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) created the Learn the Signs. Act Early. program in 2004. It provides checklists of developmental milestones–how children play, learn, speak, act, and move–to help determine when a developmental screening might be needed. For example, the guidelines state that by age 6 months, a baby should be trying to imitate sounds. By 18 months, they should be following verbal directions. If not, a screening could be recommended to determine if therapy or other support is needed.

After several years of research and discussion, the AAP updated these guidelines in February 2022. However, the American Speech-Language-Hearing Association and many speech therapists have expressed concerns with the new milestones. Our goal is to intervene as early as possible to help children struggling with speech and language. Unfortunately, we believe the new milestones could end up leaving some children behind.

What changed with the CDC developmental milestones?

The guidelines have been improved in many ways. For instance, the language was changed to be more “parent-friendly.” The AAP removed confusing terms and nonspecific language–always a good thing! Plus, two new checklists were added for ages 15 months and 30 months, to correspond with well-child checkups that happen at those times.

The AAP’s main goal was to reduce a “wait-and-see” approach to screening by providing clearer guidance for when further screening and evaluation should happen. That’s a goal that speech therapists wholeheartedly share! However, we’re concerned that these new guidelines could actually delay screening–and treatment–for some of the kiddos who need it most. Here’s how.

A central update to the guidelines involved changing key milestone benchmarks for children. The milestones now represent what 75% (most children) should be able to do at a certain age, instead of 50% (the average number of children).

The AAP believes that because the previous milestones were expected for only 50% of children, this often led to a wait-and-see approach for screening and treatment. For example, if 50% of kids were expected to be saying several words by 18 months, and your child wasn’t, your pediatrician might tell you to wait awhile before considering speech therapy–since only half of kids typically meet this milestone.

The new guidelines aim to make it easier for professionals to determine when screening is needed. If a majority (75%) of children are expected to be saying several words by 18 months, those who don’t will more clearly need screening.

Why speech therapists are concerned about the CDC milestones

Language and communication development is a core part of these milestones. Unfortunately, speech-language pathologists were not included in the group of experts who made the revisions. With the change in benchmarks from 50% to 75% of children, we’re concerned about the impact to early intervention, which is proven to help children more quickly reach communication milestones. The longer intervention is delayed, the higher the chance that some children will fall further behind their peers–and need more treatment as a result.

It’s important to note that closing developmental gaps doesn’t just mean catching up to a specific milestone. The milestones all build on each other, somewhat like a staircase. As a child masters one step, they move up to the next. So if a child is behind, they can’t simply make progress at the normal developmental pace. They need to be moving faster so they can truly close the gap and not fall further behind their peers, who continue to move up the stairs.

In addition to shifting the benchmarks from 50% to 75%, the new milestones push out several key goalposts. One example: The milestones now have children saying 50 words by 30 months old, instead of the previous 24 months old. The problem is that the remaining 25% of children who don’t reach the 50-word mark by 30 months may not have progressed developmentally on their own. These guidelines essentially delay intervention for these at-risk children, and that could have harmful results. For example:

• A problem that may have required 6 months of speech therapy if caught at an earlier age might take double the time if diagnosed later.

• Children entering preschool with untreated speech delays may have trouble communicating with their teachers and peers. They may have behavioral problems that speech therapy could have helped prevent.

• Delayed diagnosis can affect academic success later on. Children who don’t have the language and phonological skills expected for their age are more likely to struggle with early literacy.

Finally, we’re concerned about the research supporting some of these changes, such as the 50 words by 30 months milestone. None of the AAP’s sources seem to support this number. In fact, multiple sources list 50 words as a 24-month milestone.

So what should parents and caregivers do?

It’s worth emphasizing that milestones are based on neurotypical development, and all children are unique. Some reach their milestones at different times. Some don’t reach every milestone. Not meeting a milestone by a certain age doesn’t mean something is “wrong” with your child.

However, you know your child best! If you believe you’re seeing the signs of a speech delay, or you have any concerns at all about their development, talk to your pediatrician and ask for a referral to a specialist. Check out these helpful articles covering expected speech and language milestones for children ages 0 to 12 months, 12 to 24 months, and 2 to 3 years.

The AAP says that further research is needed to understand if these new checklists will support early identification of developmental delays. In the meantime, we continue to champion early intervention, especially before age 3! The earlier a child receives help and support, the more quickly they can make progress–setting them up for success in their ability to communicate.