Why Child Development is MORE Complicated than a Developmental Milestone Checklist

Why More is Needed than a Developmental Milestone Checklist to Evaluate a Child's Development

Why Child Development is MORE Complicated than a Developmental Milestone Checklist

For years I have said to families and friends…… Pediatricians are developmental screeners. THEY ARE NOT THE EXPERT. Neither do I want them to be. I want my pediatrician to be able to diagnose my child if they have a serious medical disorder. They should be able to screen for developmental issues and refer out if a more thorough evaluation is warranted.

They must also be able to evaluate the QUALITY OF MOVEMENT beyond those developmental checklists. And if they can not, that is where all developmental therapists (pediatric occupational therapists, physical therapists, speech-language pathologists, and developmental therapists) step in.

Pediatricians Versus Developmental Therapists

I am a highly educated woman who is surrounded by educated women who read and know how to make decisions for themselves. However, I am always amazed at how these women also expect their doctors to know everything.

One time I discussed some basic child nutritional concepts with my friend and she stated but “My pediatrician didn't tell me that”. This is an IVY league educated woman. A dr should not be expected to discuss everything at a well-child visit. (See above, I want them to discover my child's serious medical diagnosis!) but we need to stop pretending they SHOULD or CAN.

We need to stop paying our therapists so little and keep cutting funding and let them do what they were trained to do. We take neuroanatomy with medical students in many cases. We deserve more respect. And honestly have so much more to offer.

Drs see these children for MAYBE 30 minutes for a well-child visit. As a therapist, I am in a family's home for at least an hour every week. Sometimes 3 hours A WEEK. Our judgment and ability to screen children from this knowledge are far beyond those of pediatricians.

New CDC Developmental Milestone Checklist

What is a Developmental Milestone?

Developmental milestones are the abilities a child develops normally. These include smiling, waving hi, saying first words, sitting independently, etc.

What Changed in the CDC Developmental Milestones Chart?

The Centers for Disease Control and Prevention’s (CDC) Learn the Signs. Act Early program has moved the developmental milestones on their chart from when 50% of the children achieve the skill to when 75% of children will naturally achieve the ability.

See the full CDC Developmental Milestone checklist here.

Why Does it Matter?

Moving developmental milestones to older ages achieves their goal of reducing unnecessary concerns in many parents. But I will argue that unless the quality of movement is also considered, many children will miss out on a much-needed referral.

The new CDC developmental milestone update also takes out crawling. It is understood that many children do not crawl. So if you must take it out to avoid a child being referred for further physical therapy or occupational therapy evaluation based just on them not crawling, fine.

But are they moving around on their own? Ok, if they are not. Then PLEASE refer.

How does Crawling or Moving Around in the Environment Help a Child Develop?

Moving throughout the environment independently helps children develop depth perception, independence, play skills, the list goes on. 

Additionally, If a child does not crawl AND did not go through the stages of pushing up on their arm, they are at risk of decreased upper extremity strength later on. As a pediatric occupational therapist I am trained to further evaluate this area. 

Not crawling can also be a sign of sensory processing disorder. As some children do not want to touch the floor. SPD is easily missed in a developmental checklist. But it can affect the rest of a child's development. 

Case Study: Sam

Let me tell you the story of a very dear friend's child named Sam. As a pediatric occupational therapist, I knew there was an issue the minute I met him. He was only a few days old.

When he was a month old. He wasn't holding his head up at all and wasn't focusing well visually. 

BUT his very well-respected pediatrician took a wait-and-see approach.

When he was 9 months old I remember encouraging my dear friend to push the pediatrician a bit harder for a referral to therapy. (I wasn't working in that state's early intervention system at that point and was unaware she could have self-referred.) But like many parents who aren't as well versed in child development, they solely depended on their doctors and pediatricians for EVERYTHING. If her pediatrician said he not to worry, he was fine.

I knew otherwise. Sam was NOT SITTING even propped with pillows at 9 months. We were in a weekly playgroup with our 3 years olds, so I saw this child more than once a week. This child was starting to lack in all areas of development because his world was so limited by his low muscle tone.

The pediatrician wanted to wait again, but because of my nagging, she insisted on a referral for PT. But he only got PT.

What is worse later (around 18 months) this child was not communicating at all. Not uttering a sound. The PT called the pediatrician to try and get him a speech referral. But the Dr refused.

I watched him struggle to learn to eat, (and stuff his mouth which was related to his extremely low tone), and learn how to communicate. So much time wasted and so much heartbreak. It was really hard to watch.

Because of all this waiting, he wound up with an Autism Spectrum Disorder a few years later. I'm not sure if that diagnosis is correct, or if his issues are just related to his developmental delays.

Final Thoughts

As pediatric therapists we must continue to advocate for our profession, our knowledge, our clients, and all children at risk of developmental delays. We must show our worth and our knowledge base. We must do more research to show the value of early intervention.  More is needed than a developmental milestone checklist to evaluate a child's development.

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