Evidence-based milestone ages as a framework for developmental surveillance

Abstract

Developmental surveillance is the process of monitoring child development over time to promote healthy development and to identify possible problems. Standardized developmental screeners have greater sensitivity than milestone-based history taking. Unfortunately, Canadian screening guidelines, to date, are sparse, logistical barriers to implementation have slowed uptake of screening tests and physicians continue to rely on milestones. When using clinical impression as a framework for surveillance, clinicians may not know when to consider a milestone delayed because developmental attainments exist within an age range and there is an absence of referenced percentiles on available published tables, which are particularly problematic for the cognitive and social-emotional sectors, which are less familiar to physicians. A novel, five-sector milestone framework with upper limits, referenced to the best available level of evidence, is presented. This framework may be used in teaching and may help physicians to better recognize failed milestones to facilitate early identification of children at risk for developmental disorders.

A Proposed Functional Abilities Classification Tool for Developmental Disorders Affecting Learning and Behaviour

“…Nonetheless, clinicians generally have a working understanding of skills as they occur typically across chronological ages from clinical experience and utilize the many developmental trajectory references available in the literature (Dosman et al, 2012;Kliegman et al, 2016;Scharf et al, 2016). The need for a comprehensive assessment in addition to milestone history taking is clear.…”

Recommendations on screening for developmental delay

“…12,22 Thus, the recommendation applies to children for whom there is no concern about failure to sequentially acquire age-appropriate developmental milestones for gross and fine motor, social, emotional, language and cognitive domains (Box 3). Milestone ages should be based on the oldest age by which the skill should have been achieved.…”

“…Milestone ages should be based on the oldest age by which the skill should have been achieved. 22 This recommendation does not apply to children who present with signs, symptoms or parental concern that could indicate delayed development or to whose development is being closely monitored because of identified risk factors, such as premature birth or low birth weight.…”

Speech and language support: How physicians can identify and treat speech and language delays in the office setting

“…The word-milestone chart reflects the gold standard for word and utterance-length milestones at 12, 18, 24, 30 and 36 months of age, which are similarly used in the Rourke Baby Record, Nippissing District Developmental Screener and Ministry of Child and Youth Services' Communication Checklist (32). These commonly used milestones range from the 10th to 50th percentiles and are largely based on the MacArthur-Bates Communicative Development Inventories (32,33). These milestone percentiles will ultimately identify some nondelayed children as false positives.…”

“…These milestone percentiles will ultimately identify some nondelayed children as false positives. This strategy ensures immediate help for children with true delays and, for falsely identified children, communication interventions suggested in the tool would not be wasted because they are essential to parent-child relationship and, thus, crucial to healthy social-emotional and intellectual development (33).…”