Did the CDC "Vanity Size" Our Children's Development?

On February 8th the whole therapy community went into a tail spin about the new CDC milestones checklist. Its taken me a few weeks to get my head around it and be able to give you my personal yet professional opinion. If you've read the abstract (I can't find the article without having to pay $25!! ), you will notice that it states they added 15 month and 30 month checklists which caused 26.4% reduction and 40.9% replacement of previous milestones. They also state that 1/3 of milestones were transferred to different ages - 67.7% were moved to older ages. You will also notice that there are 13 authors or contributors and none of them are PTs, OTs, or SLPs.

If you've seen any of the social media posts by therapy bloggers you already know we don't agree with several key changes that have been made. I'll get to the biggest - the omission of crawling- in a bit. First I want to make some statements before I make any claims. I want you to know that I am not a DPT or Doctorate of Physical Therapy. That degree became available long after I finished PT school in 1989 and because I am currently putting my own kids through college I don't have funding for a return to grad school for myself. (Lesson to every one - college is expensive. Start saving now.) The last research paper I did was my son's Trafton science fair project in 2011. It did not get picked up by any major or minor publications. What I am getting at is that I don't claim to be a genius but I have been working with children for the last 20 years. I give a lot of clout to the school of life and to hands on experience with children - that's what I have.

First thing lets define what this thing really is. Its a checklist or surveillance tool. Its NOT a standardized assessment tool. The old checklist is based on 50% of children meeting the particular milestone at the stated age. The new checklist is based on 75% of children (or 3 out of 4) meeting the milestone. In my book 75% is a "C" grade (like in school) instead of an "F", so I'm not against raising the bar to 75% of children should perform a skill at the stated age. It still leaves 25% of typical children that may not meet that skill on time.

They also added 15 month and 30 month checklists. I also like this change as it narrows any gaps where parents might be told at 12 months, "Lets wait and see" until 24 months. All therapy clinicians agree that "wait and see" is a really bad idea. The early months are when neuroplasticity exists and changes in the brain are made more quickly. Early intervention helps develop typical patterns for gross motor skills and prevent some of the compensations we are seeing that result in or from asymmetry in the body.

Here's where it gets a bit dicey. They removed many of the smaller milestones from the checklist. These are some of the important pieces or steps needed to gain "the Biggies". Being cued into those smaller missteps helps determine if early intervention is warranted. You see the oxymorons starting to take shape? The CDC says its trying to prevent Wait and See but when you take out some of the important minor milestones you may be throwing the baby out with the bathwater, so to speak. An example of this is the omission of back to belly rolling. Clearly the baby needs to roll both directions! Back to belly is innately harder, requires core strength and is preparation for coming to sitting. It is needed to sit, transition and get upright for standing. If we miss noticing that baby has a poor core how can we refer for early intervention?

Here's another issue I have with this new checklist. They moved many of the milestones back 1-3 months. I liken this to the adjustment of clothes sizes so that more people fit into the 4-6 category even if they have gained weight. They called this Vanity Sizing because people's egos were bruised when they no longer fit into the smaller sizes. It may not be a big deal with your jeans, but saying its all the sudden okay for your baby to be late on her milestones might not be the wisest. Again, the CDC says it is trying to eliminate Wait and See but they just made it okay to Wait and See another 1-3 months on many skills. Hmmmm????

Now let's get to that very important omission - CRAWLING. It is true, there are children that don't crawl and are just fine. But I would bet that those children did crawl a little bit, or they CAN crawl. While I was googling looking for the CDC guidelines and the research I found a statement that "not all babies crawl" and that "even if your child does not crawl, they'll likely find another way to get around." That last statement really bothers me because "another way" may often mean your baby is using a compensatory pattern to move like 3-legged crawl or buttocks scooting. This means there is an asymmetry in your baby's body and it needs to be addressed.

Crawling also strengthens the shoulders and hips. It works on reciprocal movement of the limbs and weight shifting needed to walk. Weight bearing on the hands helps form and strengthen the arches to help your child get ready for fine motor skills. Your baby learns to move in and out of hands and knees as a transitional movement. Hands and knees is how your child pulls up to stand. And by the way standing is now not addressed until 12 months.

My last issue with all this is that they state that this new checklist is based on "data" where as the old list was based on "expert opinion". As I stated earlier, I do believe there is validity in expert opinions because that's ME and my colleagues and we've been in the trenches with parents and we see minute details that lead us to our assessments. We want to be able to educate you about what we see and we want you to have easy access to us so we can help you. Since the pandemic it has become harder and harder to get services. Some of that is due to delays in insurance approvals; lack of staffing due to burn out; fewer referrals due to fewer children being taken to the pediatrician because of CoVid; longer wait times for appointments due to CoVid restrictions. Its a tricky time but the last thing we want is to let your child slip through the cracks.

Bottom line is that therapists are trying to empower parents. We all believe that you know your child better than anyone and if you have concerns or questions you deserve answers. We hope to keep dispelling the stigma of therapy. If you have concerns ask your pediatrician to refer you for a PT evaluation.