The CDC Has Worsened Developmental Delays

CDC guidance changes in 2022 worsened the impact of developmental delays by lengthening the time to intervention for more babies than before. Read on to find out why these updated guidelines are bad news for kids.

What Is a Developmental Delay?

Developmental milestones are specific functional skills or tasks that most children can do by a certain age. These include activities such as smiling, rolling over, sitting up, crawling, walking, speaking, responding to social cues, and other key indicators of cognitive, motor, and emotional maturation. These milestones are so ingrained in a baby’s development that a delay in achieving one or more of them is known as a developmental delay.

Pediatricians have been taught for decades to see these delays as red flags in a baby’s development because a child with delays is much more likely to be diagnosed with further challenges such as hypotonia, autism, ADHD, Sensory Processing Disorder, learning disabilities, dyspraxia/apraxia, and speech and language challenges.

What Are Common Examples of Developmental Delays?

Development occurs along several dimensions: social, emotional, language, cognitive, and motor. Recognizing a delay relies on observing how children progress over time compared to established benchmarks. Here are some typical areas where delays may be noticed:

• Gross-motor skill delays such as rolling over, sitting without support, crawling, creeping and walking
• Fine-motor skill delays such as transferring objects from one hand to another and grasping small objects with a pincer grip
• Speech and language delays such as babbling, saying first words and saying 50 words
• Social and cognitive delays such as making eye contact, responding to name and engaging in simple pretend play

How Developmental Delays Are Being Normalized by the CDC

In February 2022, the U.S. Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) revised the timeline and content of developmental milestones. These milestones were revised for three reasons, according to the CDC: “to align the checklists with the ages of the American Academy of Pediatrics’ recommended well-child doctor visits, to assign milestones to ages when most children would be expected to meet them and to address confusion about similar milestones across ages.“

While ostensibly the intent of this Learn the Signs, Act Early program was to improve screening for developmental delays, the Orwellian outcome is that it pushes out the time period of concern by raising the rate of expected behaviors from 50% to 75% of children.

Remind yourself when reading the examples of updated guidelines below that “normal” is not the same as “optimal.” For example, it may be normal that 93% of Americans are metabolically unhealthy, but those people surely are not in optimal health.

Crawling

Army crawling used to be typical by 7 months of age and crawling by 8-9 months of age. Crawling has now been dropped from official CDC/AAP guidelines. Even though a CDC spokeswoman said that its removal was because “scientific literature is inconsistent in how it defines ‘crawling’ and at what age it should be achieved,” the net (chilling) effect is that fewer and fewer pediatricians will see that as an important milestone.

It’s bad enough that unusual types of crawling such as butt scooting and crawling with a leg to one side aren’t seen as red flags when they should be, but from here on out, unless you go to an old-school pediatrician who has read and been trained on older versions of textbooks such as Nelson Textbook of Pediatrics, Rudolph’s Pediatrics or Principles and Practice of Pediatrics, you might not see your child’s neurodevelopmental disorder until it’s hit you upside the head.

Crawling is an extremely important gross-motor skill. Not only is it helpful for exploration and potential engagement with others, but the sheer act of crawling — especially on all fours — wires the body and brain together. Children who do not crawl, crawl unusually, don’t crawl for long enough or do very little cross-crawling (as opposed to army crawling) often have retained reflexes and problems with learning, attention and behavior that may not be so obvious when the child is a baby.

Cross-crawling, also known as creeping, is how a child’s visual-processing system gets wired correctly to the body. Babies who don’t crawl properly, as described above, will often have visual-processing challenges such as convergence insufficiency that can be corrected by working with a developmental/behavioral optometrist for vision therapy, as detailed in this webinar with Bryce Applebaum OD FCOVD

As an example of how important crawling is to development, one of the fundamental types of therapies for children with neurodevelopmental disorders is to have them do crawling exercises, as Sarge Goodchild explained in this webinar.

Walking

Previously expected by 12 months of age, the CDC now considers it “normal” up to 18 months. A baby who takes this long to walk may have retained reflexes that inhibit this development, a poor vestibular sense, a poor proprioceptive sense and often hypotonia and poor core strength. These are often the kids who slouch when seated or standing and “W” sit on the floor. Watch as Sonia Story explains in this webinar how and why this happens (and what can be done to help these kids).

Speech

Previously (see pediatric textbooks listed above), 50 words by 21 months was typical; the CDC now sets this milestone at 30 months. Speech is such a complex fine-motor skill that to have it delayed creates a growing list of developmental, social and academic challenges for any child with them. Because of this guideline change, a two-year-old with fewer than 20 words might not now qualify for services.

What Effect Does This New Guidance Have?

The redefinitions may seem abstract, but their impact is very concrete—affecting everything from when and if a child is referred for assessment to whether families receive early intervention services under federal or state programs. Following are examples of potential outcomes of pushing out developmental delay timelines:

• Parents often rely on guidelines for reassurance or as a prompt to seek help. If milestones are set later, warning signs may be missed or dismissed.
• Pediatricians may tell concerned parents, “That’s still within normal limits,” when previously they might have initiated screening or specialist referral.
• Children who once qualified for speech, occupational, or physical therapy may now be deemed ineligible because their delays will now be categorized as “within normal range.”
• Educational support and individualized planning in preschool years may also be reduced if delays are normalized rather than flagged.
• Federal programs such as IDEA (for early intervention) and local birth-to-three and zero-to-three initiatives often use CDC milestones as a screening tool. By redefining delays as normal, eligibility shrinks.
• In our experience, the longer the time to intervention, the more complicated and often expensive the interventions will be.

In Conclusion

By now making more children “normal”, even though they are now delayed compared to older guidance, we are missing many children who have developemental delays. These children are getting lost in the system because doctors will now tell parents that, “According to the CDC, your child is normal.” Given the increasing numbers of children diagnosed with developmental delays, this means that more children will have less time to get early interventions.

About Maria Rickert Hong CHHC

Prior to working on Wall Street, she was a marketing specialist for Halliburton in New Orleans, where she also received her MBA in Finance & Strategy from Tulane University.

She is the author of the bestselling book Almost Autism: Recovering Children from Sensory Processing Disorder and the co-author of Brain Under Attack: A Resource for Parents and Caregivers of Children with PANS, PANDAS, and Autoimmune Encephalitis. She is a co-author of Reversal of Autism Symptoms among Dizygotic Twins through a Personalized Lifestyle and Environmental Modification Approach: A Case Report and Review of the Literature, J. Pers. Med. 2024, 14(6), 641.

Maria is also a Certified Holistic Health Counselor. Her work can be found on DocumentingHope.com, Healing.DocumentingHope.com, Conference.DocumentingHope.com and MariaRickertHong.com

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