Understanding Developmental Milestones Without Creating Unnecessary Parental Anxiety

By Birth & Baby University · Last updated: October 2026 · 7 min read

Milestone charts are everywhere: on pediatric office walls, in baby apps and in group chats where one parent’s baby is “already” doing something another’s is not. They exist for a good reason, because catching developmental concerns early matters. They also generate worry, especially in the first months when differences between healthy babies are large. Postpartum doulas sit in the middle of this, asked “is that normal?” about everything from head control to smiling. The right posture combines accuracy about what milestones are and are not with a clear route to the baby’s clinician. This article summarizes how the CDC checklists were revised in 2022, what the American Academy of Pediatrics (AAP) recommends for surveillance and screening, and how a doula can talk about milestones without fueling anxiety or false reassurance.

Key takeaways

Quick answer: milestones are skills most children are expected to reach by a given age. They are a tool for noticing concerns, not a ranking of babies. Developmental surveillance is a clinician’s job at every well-child visit, with standardized screening tests at the 9-, 18- and 30-month visits and whenever a concern arises. Parents who are worried should say so to the pediatric provider rather than wait.

• The CDC revised its milestone checklists in 2022 with an AAP expert group, using milestones that most children (75% or more) would be expected to achieve by specific health supervision visit ages, and clarifying when most children reach a milestone to discourage a “wait-and-see” approach.
• The revision removed 26.4% and replaced 40.9% of previous CDC milestones, moved about a third of retained milestones to different ages (67.7% of those to older ages), and found social-emotional and cognitive milestones had the least normative data.
• The AAP’s clinical report recommends developmental surveillance at every health supervision visit and standardized screening at the 9-, 18- and 30-month visits, with screening or referral whenever surveillance raises a concern.
• The CDC tells parents: if a child is not meeting one or more milestones, has lost skills, or you have other concerns, act early, talk with the child’s doctor and ask about developmental screening.

What the research says

Where milestone lists come from. Zubler and colleagues’ 2022 report in Pediatrics describes how the CDC’s Learn the Signs. Act Early. program funded the AAP to convene an expert group to revise its developmental surveillance checklists. The group set 11 criteria, including that milestones should be ones most children (75% or more) would be expected to achieve by the health supervision visit age and that are easily observed in natural settings. They also wanted to clarify when most children can be expected to reach a milestone, to discourage waiting and seeing. After the revision and the addition of 15- and 30-month visits, 26.4% of previous milestones were removed and 40.9% replaced, a third of retained milestones were moved to different ages, and about 80% of final milestones had normative data from at least one source. Social-emotional and cognitive milestones had the least normative data. Two points follow for anyone teaching parents. First, milestone lists are revised as evidence accumulates, so an older book or app may show ages that the CDC no longer uses. Second, the 75% criterion means a minority of healthy children have not reached a listed milestone by the listed visit, and the design intent is that a missed milestone triggers a conversation, not a diagnosis.

What clinicians are advised to do. Lipkin, Macias and the AAP’s Council on Children with Disabilities’ 2020 clinical report models a universal system of surveillance and screening for conditions that affect development, including autism, hearing loss, intellectual and motor disabilities and behavioral conditions. It states that developmental surveillance is supported at every health supervision visit, that standardized screening tests are administered at the 9-, 18- and 30-month visits, and that concerns elicited at any visit should be followed by standardized screening or direct referral to intervention and specialty care. Early identification and intervention are described as critical to the child’s well-being. So the system does not rely on a parent’s checklist alone. It is meant to combine parental concern, clinician observation and structured screening.

What parents are told. The CDC’s milestones page (reviewed February 2026) defines milestones as skills such as taking a first step, smiling for the first time and waving bye-bye. The page could be read only through a text-extraction fetch. It advises: don’t wait; if a child is not meeting one or more milestones, has lost skills or you have other concerns, act early by talking with the child’s doctor, sharing the concerns and asking about developmental screening; and if needed ask for a referral to a specialist and contact the state or territory early intervention program to determine eligibility. The tone is deliberately action-oriented, which supports early help but can also feel alarming to a parent who sees a baby that has not yet done one listed thing.

What this means for doulas

• Talk about ranges, not deadlines. Babies vary, and milestone charts describe what most children do by a given age. Avoid telling a parent that a baby is “behind” or “ahead.”
• Do not diagnose or reassure on development. A doula can describe what they observe (for example, “she turns toward your voice”) but should not say a baby is developmentally typical or delayed. That is for the pediatric provider.
• Encourage parents to raise concerns. The CDC’s message to not wait is consistent with the AAP’s, and both identify parent concerns as meaningful. A parent who senses something is off should be supported in calling.
• Be careful with apps, charts and comparisons. Lists change over time and differ by source, and social-emotional milestones have the least supporting data. Point to the CDC checklist and the pediatrician.
• Remember prematurity. Preterm babies are usually assessed by corrected age, and the sources reviewed do not cover this, so refer to the care team.

Putting the evidence into practice

1. Ask what the parent is noticing and what is worrying them, before offering any general statement.
2. Suggest a single reliable source. The CDC’s current checklists and the baby’s own pediatric visits, instead of several apps and posts.
3. Offer play and interaction as good for the baby, not as a test. See Tummy Time: What the Evidence Says About Motor Development and The Importance of Responsive Interactions in Early Brain Development.
4. Help prepare for visits. Write down questions and observations, including skills the baby has lost, which the CDC specifically flags.
5. Refer. Loss of skills, a baby not meeting one or more milestones, or any parental worry should go to the pediatric provider, as the CDC advises.

Limits and uncertainty

The CDC’s current milestone checklists could not be read directly, so this article does not list individual milestones or ages. Normative data are incomplete, especially for social-emotional and cognitive skills, as the revision team itself reported. The AAP report is a clinical report, not a trial of screening outcomes, and only its abstract was read. The CDC page was read through a fetch tool. This article does not review research on parental anxiety, social media, or screening accuracy, so statements about parents’ worry here reflect the design intent of the guidance and general professional experience, not measured findings. Culture, language and prematurity affect development and its assessment.

The bottom line

Milestone checklists are tools for noticing concerns early, built from evidence that is still incomplete and revised as it improves. The AAP puts surveillance and screening in the hands of the clinician at every visit, and the CDC asks parents to speak up and not wait. A doula can ease anxiety by explaining that milestones describe ranges, avoiding comparisons or verdicts, and making it easy for any worried parent to call the pediatric provider.

Birth & Baby University’s For Doulas page brings together its postpartum doula training, recertification and mentorship for doulas who support families through the newborn weeks and early development. Confirm that any program meets your certifier’s, employer’s or state’s requirements before you enroll.

This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work. For concerns about a baby’s health, contact a pediatric provider or emergency services.

Sources and further reading

• Zubler JM, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics (2022). Read the source
• Lipkin PH, Macias MM; AAP Council on Children with Disabilities. Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics (2020). Read the source
• Centers for Disease Control and Prevention. Developmental milestones (Learn the Signs. Act Early.; page reviewed February 2026). Read the source

More for professionals: the Professionals Blog.