Earlier this year, the CDC updated their infant milestones timeline, and physical therapists, occupational therapists, speech language pathologists, and some chiropractors have some strong opinions. As a pediatric chiropractor, I think it is important to weigh in on the subject.
Change is hard for everyone, but it challenges us and the way we think which is a good thing! Science is always changing, that’s why it’s called science! The adjustment phase is going to be hard and remembering the new nuances will be challenging but providers always adapt.
The CDC is attempting to eliminate the “wait and see” approach that many pediatricians use to determine if a child needs to be evaluated by a specialist. This can be a valuable change, and I hope that parents will feel more heard when they bring up milestone concerns.
Parents- I do think it is important to advocate for your child in every situation and I hope this doesn’t discourage you to continue to do so if you think there is something bigger going on in your child’s life. Hearing someone dismiss you with “let’s wait and see what happens by their next appointment” when you have brought up the issue several times can be draining but the reality is, many children DO hit all the appropriate milestones without any extra intervention. This is exactly what the CDC observed and why the guidelines were changed.
This is not to say I agree with all of these changes because I do think that while many children will eventually do all of these things on their own, these changes have the potential to delay treatment, increase the amount of time of treatment and, due to the shift in time expectations, some children will age out of early intervention services (this is only for children ages 0-3) before they even have the chance to utilize the service. Last time I was treating a child that needed these services, they were able to get an evaluation quickly but from the time of referral to the actual first treatment for the child it was 3+ months. Just like many public health initiatives, there are often not enough providers available to complete the caseload of the area they are serving and I know this is exactly the situation happening all across the country right now.
So let’s talk about the actual changes that happened recently. First of all, many were pushed back in regards to what age children were expected to demonstrate a skill. The easiest explanation for this is that the old guidelines were for when it was expected that 50% of children would achieve this and the new guidelines are for when 75% of children will achieve that particular milestone. In general, the timelines for motor milestones have been pushed back 1-3 months. The big change that has several providers very upset is the removal of crawling as a milestone completely. My assumption is that the CDC has observed more than 25% of children not crawling and then functioning fine as adolescents and adults. While there are certainly people in the world that did not crawl, I think this number is an overestimate of those that truly skip a traditional crawl. Yes, there is always time to go back and learn that skill but let’s talk about crawling impacting other life functions for a minute. Crawling, just like all milestones, is the building block for other more complicated things later on in life. Crawling helps to develop and strengthen a strong trunk and shoulder girdle, helps with balance and body awareness, increases coordination bilaterally and helps with visual tracking.
As far as speech goes, it is now recommended that children know approximately 50 words by 30 months. In my opinion, the new speech recommendations have the most potential to prevent a child from accessing specialists that they need prior to aging out of early intervention. Some areas have a 6 month wait for an evaluation and 36 months is when a child is no longer eligible for early intervention. Yes, I understand this could be alleviated by more accessibility but currently this can be very problematic.
Obviously the motor milestones are the most directly related to care I provide but if you have other concerns, chiropractors are making referrals to other health care providers on a very regular basis and the pediatric population is no different. If you have any questions about this, feel free to ask me!