Changes in Practice, Perspective on Developmental Milestones for Children: Paul Lipkin, MD


The director of medical outpatient services at the Kennedy Krieger Institute provided insight on how clinicians have typically assessed children who fail to meet milestones, and how that might change with new guidelines. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"While parents were having concerns, the professional didn’t have a good foundation to steer them towards the next steps in the process. That next step in the process ends up being really critical for the healthcare professional, for the child neurologist, and for the specialty pediatrician, because that means that will begin a cascade of further interventions, further evaluations, [and] further treatments in one way or another."

In 2004, the Centers for Disease Control’s (CDC) Learn the Signs. Act Early. Program created free developmental surveillance milestone checklists that included developmental warning signs for parents, pediatricians, and early childhood professionals; messaging to “act early” by addressing concerns. Like most milestone lists, the original sources of the milestones were uncited, and adaptations were based mainly on clinical opinion, not empirically informed evidence.

Fifteen years later, the CDC and the American Academy of Pediatrics convened an expert working group to revise these developmental checklists using the latest evidence-based research. The experts identified 11 criteria for the milestone checklist, with the biggest change that each milestone is now based on the 75th percentile instead of 50th percentile. This change allows clinicians to use their judgment on performing additional developmental screenings, as well as prevent potential wait-and-see approaches.

Published in February 2022, the milestones were the first to align empirically informed milestones on parent-completed surveillance tools with objectively defined criteria agreed upon by SMEs.1 To learn how clinicians traditionally approached child developmental milestones, and how these new guidelines could change the clinical space, NeurologyLive® sat down with Paul Lipkin, MD. Lipkin, the director of outpatient services at the Kennedy Krieger Institute, and a member of the expert group, discussed how children who fail to meet these milestones have been typically assessed.

1. Zubler JM, Wiggins LD, Macias MM, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022;149(3):e2021052138. doi:10/1542/peds.2021-052138
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