What to Know About the CDC’s New Developmental Checklists

On February 8, 2022, the Centers for Disease Control and Prevention (CDC) published an update for the first time since 2004. The new milestone checklists were developed in partnership with the American Academy of Pediatrics (AAP).  

This article examines what changed, why it changed, and how the experts decided on the new milestones. 

Why Do the AAP and CDC Publish Developmental Checklists? 

When parents and clinicians track milestones together, they can build a picture of a child’s developmental history. While every child develops in a unique way, understanding what is typical can help to identify delays and disabilities early. Screening tools like developmental checklists can inform clinical decision-making and lead to better outcomes. 

In updating surveillance checklists, the AAP and CDC said one goal was to reduce the “wait and see” approach that can keep children from getting early treatment if a delay doesn’t self-resolve or a disability is diagnosed (Zubler et al., 2022). The new checklists aim to make it easier to identify which children could benefit from early interventions.  

What Changed? 

Perhaps the biggest change is in how the age for each milestone was determined. The new checklists are based on the skills and abilities that most children—75% or more—will have developed by a specified age. Previous checklists were based on average or median ages. That meant only half of children would be expected to reach the milestone by the specified age. Using the new approach, if 50% of children achieve a milestone by 15 months and 85% reach it by 18 months, that skill would appear on the checklist for 18 months.  

In addition to moving away from the average child to most children, there are new checklists for 15 and 30 months. That’s because health supervision visits (also called well-child visits) are recommended for children at those ages.  

The new checklists:

• cut the number of milestones from 216 to 159, partly because some milestones appeared more than once on earlier versions;  
• include many new milestones—roughly 40% of the milestones are new, including new social and emotional milestones; 
• move some milestones to a different age category—around a third of the 94 milestones that the CDC kept from the earlier checklists were moved to a new, mostly older, age category;  
• reduce the use of vague terms such as “may” and “begins to”; and
• feature an open-ended question designed to spark conversation: “Is there anything your child is doing or not doing that concerns you?” (Schering, 2022; Zubler et al., 2022). 

How Were the New Milestones Determined? 

The AAP established a team of subject matter experts, including pediatricians, psychologists, and academic professors, to review the research and recommend changes. 

The team examined: 

• normative data from published studies; 
• existing checklists from parent and educator resources;
• milestones included in developmental screening and diagnostic evaluation tools; and
• published clinical opinions.

After compiling the data and revising the milestones, the team worked to make them more accessible to parents, caregivers, and educators. The team simplified the language and added examples to make milestones easier to understand. They reviewed the lists for cross-cultural sensitivity and tested them with diverse groups of parents across different geographic regions. 

Are the Changes Pandemic-Related? 

According to a video abstract released by the AAP, the process of updating the milestones began in 2019. The AAP partnered with the CDC to revise the milestones. The new checklists were tested with parent groups in 2020. 

The timing of the release prompted several online claims that the CDC had “lowered standards” in response to changes brought about by the pandemic. Some suggested that mask wearing and social distancing may have caused delays in speech development, leading the CDC to lower the number of words a child should know at a certain age. The timeline for the review process does not support that claim (Dupuy, 2022).  

You can find the CDC’s developmental surveillance resources for healthcare providers here.  

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