Hi! We're Kate and Amanda, the developmental therapists behind Bold Child Co, LLC. With a combined 22 years in field, Kate is pediatric physical therapy and Amanda is pediatric occupational therapy. Our entire careers, we have practiced under the Center for Disease Control's (CDC) 2004 Milestones Checklist to help families navigate what is normal and what is delayed in regards to their child's developmental milestones. Needless to say, when an update to the checklist was planned for 2022 that was touted to have more comprehensive milestone check-ins and suggested activities to help families keep their LOs on track, we waited with much excitement to see the end result. And then the day came...and while it's been six months since the update was published, we are even more upset about it now than we were then.
Before we dive in, let's up front answer one really important question:
Are we upset because this effects our cash-based, concierge pediatric therapy business? Nope! This actually increases our business for reasons we will discuss later, but the overall point is that it has already made early access to mainstream services harder which in turn drives business to private practices such as ours, who are not bound by insurance guidelines...because we do not bill insurance (except Tricare as a service to military members). So in all actuality, this change has been BETTER FOR OUR BUSINESS >>> its just not better for the birth-5 year old demographic as a whole.
So what happened with the 2022 update you ask? Let's first explore the when and who behind the updates. On February 8, 2022, the CDC, in collaboration with the American Academy of Pediatrics (AAP), released their joint update on developmental milestones. In a video release explaining the update, one of the contributors states little published research on developmental milestones was found and published expert opinion was also included in decisions on adjusting or removing developmental milestones. Here is what you need to know:
Updates were completed by eight experts: pediatricians, psychologists, a professor of special education/early intervention, a developmental screening tool developer, an editor of Bright Futures, and an author of a 2020 AAP report on development.
NO DEVELOPMENTAL PHYSICAL THERAPISTS, OCCUPATIONAL THERAPIST OR SPEECH THERAPISTS WERE INCLUDED IN THE EXPERTS
26.4% of the milestones from the 2004 checklist were removed
1/3 of the 2004 milestones kept were moved (67% of those to later ages)
40% of the milestones on the 2022 list were new to the list.
Significance of this is we do not have historical data on where it was expected by according to the CDC but many of these added milestones are later than many standardized testing tools have them recorded.
Redefined the criteria for a motor skill to be a milestone from what 50% of children do to what 75% of children do at that age.
Reported WHY it Happened:
Early Intervention is known to be best and an increasing “wait and see” trend is leading to later diagnosis and intervention of children who are at risk or mildly delayed.
No milestones were listed for 15 and 30 mo but well checks happen at that age.
Some milestones are no longer common such as crawling (now achieved by less than 75% of all children)….more on this in our later talking points.
Why Developmental Therapists are Concerned:
The changes fixed a symptom, not a cause for later development of critical developmental milestones.
It's like treating the fever symptom of a bacterial disease that also causes diarrhea…the diarrhea (another symptom) will continue and eventually lead to other problems.
Milestones have only changed for western society…this is not a shift in all of humanity, this is a shift in what our current culture is creating.
Current culture: containers, keeping kids quiet at the table or the DMV, screen time, less floor time, less free play and shift to more structure.
Removing crawling as a milestone removes one of the most common “whistle blower” milestones for children who are likely to have future delays. Not every child who skips crawling will be delayed but it is often the first missed or significantly delayed milestone in children who experience a widening gap between them and peers abilities with age.
Age when 20 milestones were achieved has been shown to be directly linked to adult IQ by research.
Obviously some exceptions but overall high correlation.
Biggest one is preschools have gradually placed earlier and earlier expectations on children for school performance (writing name, taking tests, etc). These expectations are not likely to be revised based on the milestones update BUT those same kids who are now "not delayed" will not have access to traditional services due to need to meet criteria for insurance to cover. So now that we have punted out language development to only expecting 50 words by 30 months…how do we think those two forces will collide when that child with only 50 words at 30 months now goes to preschool?
How This Impacts Families/Children 0-5yo:
Removing whistle blower milestones that usually signal further delays are coming will delay many families access to therapy until several milestones are missed.
This is even more significant as well checks transition to every 6 mo-year at age 18 mo.
Will effect insurance willingness to cover early intervention on a milestone such as delayed sitting, walking or talking - completely eliminates addressing children without a diagnosis at risk for delay based on current milestone achievement…many times those children become later and later "bloomers" as child ages (ex: a few months late on standing sometimes may lead to delayed ability to jump or ride a two-wheeled bike).
Does not impact children with significant delays or a primary diagnosis that qualifies for therapy…which is good because families already have trouble enough getting services, much less services with a competent, evidenced-based clinician.
What Families Can Do To Buffer Themselves from these Changes:
Get involved with developmental play groups - in person, online
Follow developmental accounts that are evidenced-based like @boldchildco
FLOOR TIME FLOOR TIME FLOOR TIME, FREE PLAY FREE PLAY FREE PLAY, LLIIIIIMMMMMMIIIIIIITTTTT CONTAINERS AND SCREENS.
Seek out a developmental wellness assessment from a PT/OT/SLP the first time mom-gut says something is off…no WAIT AND SEE…CHECK AND SEE!
We hope you found this beneficial. We value all of you and love being a small part of your journey wether you just follow us on @boldchildco, consult with us, sharpen us as other developmental clinicians, or trust us with the care of your child. Go, be BOLD!
Kate + Amanda
* The above information is not intended to treat or diagnose. The information and other content provided in this blog, on the boldchildco.com website or in any linked materials are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment.