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. 2019 Dec;144(6):e20190374.
doi: 10.1542/peds.2019-0374. Epub 2019 Nov 14.

Establishing New Norms for Developmental Milestones

R Christopher Sheldrick  1 , Lauren E Schlichting  2 , Blythe Berger  3 , Ailis Clyne  3 , Pensheng Ni  4 , Ellen C Perrin  5 , Patrick M Vivier  2
Affiliations

Establishing New Norms for Developmental Milestones

R Christopher Sheldrick et al. Pediatrics. 2019 Dec.

Abstract

Background and objectives: Pediatric surveillance of young children depends on providers' assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment.

Methods: We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC).

Results: A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that "most children pass" and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should "act early." An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided.

Conclusions: Detailed normative data on individual developmental milestones can help clinicians guide caregivers' expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Drs Sheldrick and Perrin are cocreators of the Survey of Well-being of Young Children, an instrument that was used to collect data for this study; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Moderators of developmental status by child age in months. DQ = age estimate on the basis of developmental milestones ÷ chronological age (adjusted for state). Although for clinical purposes, chronological age is typically adjusted for prematurity, for the purposes of this study, it was defined as the date of screening minus the date of birth. Therefore, DQ < 1 suggests milestone attainment below expectations for age; DQ = 1 suggests milestone attainment as expected for age; and DQ >1 indicates milestone attainment exceeding expectations for age.
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References

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