"Learn the Signs. Act Early.": Updates and Implications for Physical Therapists.
Kari S Kretch, Sandra L Willett, Lin-Ya Hsu and 3 others
PMID 35876833WHAT IT FOUND
The updated CDC milestone checklists move some skills to later ages because they now use a 75% attainment criterion rather than the average.
This is a change in how delays are flagged, not a lowering of standards. Crawling was removed due to a lack of normative data and evidence it is essential.
Key findings
01Milestones were moved to later ages because the new checklists apply a consistent 75% attainment criterion, whereas the old version often listed skills at the average or median age of attainment.
02Crawling was removed from the checklists because of inconsistent definitions, variability in onset, and a lack of evidence that all typically developing children crawl.
03The updated surveillance milestones do not affect a child's eligibility for early intervention services, which remains based on validated screening and assessment tools.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a narrative review and expert opinion piece. It does not report original data, patient outcomes, or a systematic search, so it cannot prove that the new guidelines improve clinical outcomes or referral rates. The authors acknowledge that the evidence base for the new milestones relies partly on clinical opinion and that the importance of crawling is not settled science.
Declared interests
The authors are physical therapists. The work was supported by the National Institutes of Health (Extramural). No other conflicts of interest are declared.
The easy way to misread this
Do not conclude that the removal of crawling from the CDC checklist means crawling is irrelevant to therapy or development. The authors state that the evidence supports the role of independent mobility in general, and that the importance of crawling is not settled science. The change reflects a lack of normative data for surveillance, not a finding that crawling is harmful or useless.