FAQ: CDC Developmental Surveillance Milestone Checklists

The CDC Developmental Surveillance Milestone Checklists are not the same as screening tools or evaluation tools. The Developmental Surveillance Milestone Checklists are part of a larger collection of resources developed by the CDC, which includes books, growth charts, and an app.

The revision of the Developmental Surveillance Milestone Checklists began in 2019, and they were developed using an evidence-informed methodology. This process was based on 15 years of experience using the old checklists, perspectives of parents of children with disabilities, subject matter experts (i.e., pediatricians, psychologists, and a professor of special education and early intervention), and an extensive review of the literature. Standardized assessment tools such as the Bayley Scales of Infant and Toddler Development, Beery-Buktenica Developmental Test of Visual-Motor Integration, and Peabody Developmental Motor Scale were also reviewed. Each of the data sources was cross-referenced with the others to get a sense of the evidence base available to support inclusion of a milestone in the revised CDC Developmental Surveillance Milestone Checklists. The previous version of the CDC Developmental Surveillance Milestone Checklists created in 2004 “...were based mainly on clinical opinion, not on empirically informed evidence” (Zubler et al., 2022, p. 2).

The American Academy of Pediatrics (AAP) also established 11 criteria for the CDC Developmental Surveillance Milestone Checklists. These criteria were focused on using plain language and avoiding vague terms, making the checklists easy to use for families from different social, cultural, and ethnic backgrounds, and reducing confusion about whether a child was expected to demonstrate a milestone. A full description of the methods used to develop the CDC Developmental Surveillance Milestone Checklists is available in the AAP journal Pediatrics.

The 2004 Developmental Surveillance Milestone Checklists monitored each skill at the 50th percentile. This rating approach might have encouraged a “wait and see” approach. The 2022 Developmental Surveillance Milestone Checklists include opportunities for rating at the 75th percentile. The change was made to make clear what most children at a given age are expected to do and to reduce confusion about when to move forward with developmental screening.

The new CDC Developmental Surveillance Milestone Checklists have been revised so that:

• Duplicate milestones were removed
• Vague language that was unclear to families was removed
• Checklists now coincide with every well-baby/child check-up from 2 months to 5 years of age
• Additional social and emotional milestones were included
• Open-ended questions (e.g., Is there anything that your child does or does not do that concerns you?) were included to facilitate discussions between families and health professionals

The Developmental Surveillance Milestone Checklists were developed to facilitate discussions between families and health care professionals. Use of the Developmental Surveillance Milestone Checklists is not a substitute for diagnostic evaluations conducted by trained health care providers to evaluate or diagnose developmental delays.

Crawling is a complex skill that should be assessed by health care professionals. Occupational therapists will continue to assess children’s crawling with standardized screening and evaluation tools. The CDC Developmental Surveillance Milestone Checklists are meant to be used by parents and caregivers and do not require special training. Developmental Surveillance Milestone Checklists do not replace the need for formal developmental screening and evaluation tools by occupational therapists and other skilled health professionals.

It may be beneficial for occupational therapy practitioners to participate in future projects like this one. Therefore, AOTA is advocating for this at a few levels. Currently, there are two occupational therapists who serve as ambassadors for the “Learn the Signs. Act Early.” program. In addition, we are exploring ways to facilitate other occupational therapist and occupational therapy assistant content experts to apply for this opportunity.

The early identification of infants and children at risk for delays and disabilities occurs in many ways and in many settings. Many states have Child Find programs that engage in developmental monitoring and surveillance. Examples of these programs include Home Visiting, Women-Infants-and Children (WIC), and Early Education and Care (EEC). In some states families can self-refer to birth-to-3 early intervention programs and early childhood education programs.

OTPs can use the “Learn the Signs. Act Early.” tools to inform decisions about the need for screening or referral for a diagnostic evaluation. They may also share the materials with parents, caregivers, and community workers (e.g., librarians, preschool teachers) and participate in public health initiatives and programs such as Child Find.

As members of the interprofessional team, occupational therapy practitioners play a role in early identification. Occupational therapy practitioners are involved in both developmental surveillance and monitoring, and developmental screening and evaluation. The “Learn the Signs. Act Early.” program is used in many academic OT programs to educate OT students on the importance of early identification.

Occupational therapy practitioners can use the Occupational Profile Template to:

• Elicit conversations related to reasons the caregiver is concerned, occupations in which the child is successful, and barriers that impact success.
• Identify interests to encourage participation.
• Identify environmental factors that may support or inhibit engagement in occupation or development.
• Identify habits, routines, roles, and rituals that may support or inhibit engagement in occupation and/or development.
• Identify body structures and functions that may support and or inhibit engagement in occupation or development.