Reflections on the CDC Revamped Guidelines

Our therapists are continuously researching and pursuing professional development courses to help guide child development recommendations for your family. Therefore, we wanted to take a moment to discuss the recently updated CDC Guidelines regarding important milestones for children ages birth to five.

CDC Project Goal and ASHA

The goal of this CDC project is something which we firmly support: Arming parents with information on development in an effort to prevent delays and challenges down the road, as well as to prevent medical care providers from implementing a “wait and see” approach. However, some of these updated guidelines conflict with the intent of early intervention, as well as current research. As you may have heard, the speech-language pathology community, including the American Association of Speech-Language and Hearing Association (ASHA), has some concerns about the inconsistencies and specific milestones as well, including:

Speech-language pathologists were not represented in the group which created the lists of milestones
Some of their numbers/ages don’t add up: The milestones they provide are not supported/cited in the research and literature.

ASHA has reached out to the CDC about this matter, but we wanted to get you some additional information while that’s being sorted. The first three years of life are critical for brain development, specifically for learning language, thus setting children up for success when it comes time for academic learning down the road.

SLP Milestone Guide vs CDC Guidelines

Below are the milestones which our field uses, indicating skills mastered by 50-75% of children between 12 and 30 months of age. We ask that you use this as a guide rather than a rule, as not all children develop the same way or according to the same patterns. We’ve also attached the previous CDC guidelines for Communication Milestones and an article regarding a more in-depth analysis of the current controversy surrounding this topic.

Embracing Neurodiversity & Milestones

When considering any developmental milestones at Chatterboxes, we choose to honor neurodiversity. Milestones are aligned with the development of non-neurodivergent (e.g., non-autistic) children. Neurodiversity is an approach to education which describes the concept that there is not one ‘right’ way of thinking, learning, communicating and behaving. Rather, we feel that all brains are beautiful. We help our families celebrate their child’s differences and support the whole child and family, rather than viewing such differences as deficits. Interested in learning more about this topic? Stay tuned for more information on Chatterboxes upcoming live Webinar on Neurodiversity for parents/caregivers!

SLP Milestone Guide

Age in months	What the new CDC guidelines say:	What speech-language therapists and the research says:
12 months	Understand “no” Wave “bye bye” Call special caregivers by a name (Mama, Papa, MiMa, etc)	Understand “no” and other common phrases without visual cues/help Sound, gesture and action imitation
15 months	Look at familiar object when you name it Follow directions given both a gesture and words. For example, he gives you a toy when you hold out your hand and say “give me the toy” Try to say 1-2 words besides caregiver names. Points to ask for something to get help	Look at several familiar objects when named (e.g., shoe, cup) Follow 1-step directions without a gesture/visual cue Say/sign 5-10 words in addition to caregiver names, regularly and spontaneously. Follow a 2-step, related direction between 21 and 24 months Imitate words/signs Point to request Identify ~3 body parts Attend to books/pictures and beginning to point to some Babble/jargon
18 months	Follow 1-step directions without any gestures, such as giving you the toy when you say “Give it to me.” Try to say 3 or more words besides caregiver names	Find familiar objects not in sight Understand at least 50 words Use at least 15 different words/signs, with some studies indicate a minimum of 30 words Imitate 2- to 3-word phrases
24 months	Point to things in a book when you ask (e.g., “Where is the dog?”) Point to at least 2 body parts when you ask them to show you Say at least two words together, such as “more milk.” Use more gestures than just waving and pointing (e.g., blowing a kiss, nodding yes)	Identify at least 5 pictures when named Identify at least 4 body parts and clothing items Use at least 50 words, with many studies indicating a minimum of 156 words Use new words regularly Combine 2 words together frequently (e.g., Doggie eat) Combine 3 words together occasionally Use personal pronouns, such as “I” and “me”
30 months	Note: Language comprehension milestones not provided Say about 50 words Say 2 or more words with one action word, such as “Doggie run” Say pronouns such as “I,” “me,” or “we” Name things in a book when you point and ask “What is this?”	Use approximately 400 words/signs Use 3- to 4-word phrases Understand some size words/location phrases Respond to basic questions Use action words and negation Name at least 10 pictures

Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics. https://doi.org/10.1542/peds.2021-052138 The Rossetti Infant-Toddler Scales, by Louis Michael Rossetti

Additional Reading
The Informed SLP Article: There We No SLPs In the Room Where It Happened

We welcome your questions, feedback and thoughts on this topic. Should you like to discuss in more detail, please contact your clinician, or our Clinical Supervisor, Kelli Bavaro, M.S., CCC-SLP via email at Kelli@TeamChatterboxes.com

Reflections on the Revamped CDC Milestones by Kelli Bavaro M.S., CCC-SLP

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