What “Wait and See” May Actually Cost You
When it comes to development, every parent desires to see their child hit those milestones–first words, first steps, and those funny faces covered in first foods. But what happens when those skills don’t come as you might expect? Earlier this year, the CDC rewrote the milestones to reflect what most kids (75%) should be doing by a certain age1. On the surface, this may be helpful for assuring parents who are concerned when their child hasn’t done something by an expected age. However, this approach may come with a cost. Let’s explore more.
Current Standards for Milestone Observation
The CDC originally implemented the campaign “Learn the Signs. Act Early” to help with surveillance of developmental milestones. It was recognized that these were not expert informed and did not provide clarity on when referral for further intervention and screening was necessary. In 2019, the CDC convened a group of pediatric experts consisting of developmental-behavioral, neurodevelopmental, and general pediatricians; psychologists; and a special education/early intervention expert. The group was primarily aimed at identifying early intervention of delays by reducing the confusion on when a child should be referred for services. They added more milestone checklists to correspond to all recommended well-child checks in addition to clarifying what skills should be achieved when. While the intention was in the right place, you can probably guess that the list of experts is missing a few–namely pediatric physical, occupational, and speech therapists.
Concerns from Pediatric Experts
In addition to being left off the contributing list, pediatric developmental therapists noted some concerning statistics3:
Over a quarter of the milestones were reduced, and nearly half were replaced
A third of the retained milestones are transferred to different ages
80% of milestones have one or no source for reference
In addition, less than 40% of children actually received surveillance in the last year, and those numbers drop dramatically when it comes to families who don’t speak English2. Thus while these commonly referred to gold-standards exist, they should be used as a guide and not a screening tool or recommendation on when services should be initiated.
The Risks of Wait and See
Research supporting the importance of early intervention across all areas of development has been out for nearly a decade5. Importantly, we have seen the effects of things like delays in sitting in crawling and how they affect cognition and social skills for example. Development doesn’t happen in a vacuum–meaning the things in one area will affect things in another area. Over time, delayed skills that are not mediated will create a larger gap in other skill areas. Imagine what a child learns by being able to crawl over to the cabinet and open and close it. Imagine how much language they may miss out on if they never are exposed to new items to learn. While this gap may seem small, or you may know other families whose children have “grown out of it”, the research doesn’t support this as an overall effective tool for development. Getting into a pediatric expert in your area can give you a firm answer in where your child’s development stands as well as peace of mind with a clear plan on how to proceed.
Your Local Pediatric Experts
Despite the concerns, the list provides a great place for primary care to start. We believe your medical team should be the experts in your child’s medical care, and therapists and developmental support should be the experts in development. When your mom-gut says something is off or just needs peace of mind from an expert, your local developmental team can assist in providing clarity and screening for developmental concerns in their area of expertise.
Your local early intervention program may be one of many places to start. This service, offered free of charge for all families, is a great resource for supporting developmental needs in your home–where your child’s learning will be easiest to carry over in a familiar environment. Like any free service, this program can have it’s short-comings. Often times, waits are long, and cut-offs to qualify for services may be more stringent due to limited resources. You as a parent can always choose to get another opinion or seek private services.
All Together Wellness provides our families with the tools they need to thrive. We aim to create confident and healthy families–and our developmental screenings as well as therapy services and age-appropriate play groups are all tools to ensure our parents have the right resources led by the experts to give a clear path to successful development for any child. Book a call if you want to know how our services might support you and your child’s development.
References
Jennifer M. Zubler, Lisa D. Wiggins, Michelle M. Macias, Toni M. Whitaker, Judith S. Shaw, Jane K. Squires, Julie A. Pajek, Rebecca B. Wolf, Karnesha S. Slaughter, Amber S. Broughton, Krysta L. Gerndt, Bethany J. Mlodoch, Paul H. Lipkin; Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics March 2022; 149 (3): e2021052138. 10.1542/peds.2021-052138
Hirai AH, Kogan MD, Kandasamy V, Reuland C, Bethell C. Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. JAMA Pediatr. 2018;172(9):857–866. doi:10.1001/jamapediatrics.2018.1524
McNeilly, L. 2022, March 15. CDC Milestones Are Intended as Tool, Not Screening, Agency Officials Clarify. The ASHA LeaderLive. https://leader.pubs.asha.org/do/10.1044/2022-0314-cdc-milestones-update/full/
Kretch K, Willett S, Lin-Ya, Sargent B, Harbourne R, Dusing S. “Learn the Signs. Act Early.”: Updates and Implications for Physical Therapists. Pediatric Physical Therapy: October 2022 - Volume 34 - Issue 4 - p 440-448
Lobo, M, Harbourne R, Dusing C, Westcott McCoy S, Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore, Physical Therapy, Volume 93, Issue 1, 1 January 2013, Pages 94–103
