Chapter 8: DEVELOPMENTAL MILESTONES & ANTICIPATORY GUIDANCE

KEY NOTES & CONCEPTS

For the American Board of Pediatrics (ABP) Initial Certification Board Exam, KNOW THE DEVELOPMENTAL MILESTONES WELL! This is a CRITICAL SECTION. Many pediatricians avoid this section and rely on their clinical training to get them through these questions. THAT IS A BAD IDEA! You must know small details to get these questions correct. Rote memorization of this section is difficult. Mnemonics have been provided to help you memorize key milestones. However, they DO NOT ENCOMPASS every milestone listed in the tables. Also, please note that milestones checklists were updated by the American Academy of Pediatrics and the CDC in 2022. The previous CDC checklists included milestones that only 50% of children would be expected to achieve. This meant there was a 50% chance that a child who not meeting those milestones may be normal. There was a concern that this led to children receiving delayed formal evaluations and interventions due to a “wait and see” approach. The updated checklists include milestones that at least 75% of children would be expected to achieve. When a child is not meeting these surveillance milestones, further developmental screening with validated tools is recommended. If developmental screening reveals concerns, the patient should be referred to the state’s early intervention program. This chapter includes the latest list of surveillance milestones in the areas of cognitive, language and communication, movement and physical, and social and emotional. To see the official list, you may visit www.pbrlinks.com/cdc-milestones.

PEARL: For the exam, you should be able to identify a child’s age based on milestones reached. When presented with a list of milestones for a child, look at the most ADVANCED milestone and assign an age to that child based on that milestone. So, if a child has milestones of a 4-year-old and a 5-year-old, select “5 years old” as the age of the child and assume the child is not meeting other age-related milestones.

AN IMPORTANT NOTE ABOUT PBR’S MILESTONES CHECKLISTS

This chapter focuses heavily on including the surveillance milestones specified by the AAP and CDC in the 2022 surveillance checklist updates. These are meant to encourage professionals to “act early” rather than have a “wait and see” approach. Mnemonics have also been created to focus on those milestones. Additional milestones may also be tested by the American Board of Pediatrics (ABP). Screening tools, such as the Ages & Stages Questionnaires®, include numerous milestones for over 20 different ages. Including every milestone in this chapter would be overwhelming. Instead, I (Ashish Goyal) have chosen to include certain additional key milestones and age-related findings that I believe could be tested. These additional milestones are listed in tables titled “MILESTONES TO KEEP ON YOUR RADAR.” For some of these milestones, there is NOT agreement across the various screening tools that exist. For this reason, when reviewing online resources, question banks, and other board review books, you will find variability. The lack of consensus among subject matter experts is why these milestones may not have been included in the surveillance milestones checklists updated by the AAP and CDC. However, these milestones have served PBR members VERY well over the years on the American Board of Pediatrics (ABP) exams. I encourage you to stick to one resource to learn the milestones (this one).