If a child is not doing something you expected, has stopped using a skill, or development concerns you, write down the specific observation and discuss it with a qualified health professional. This guide explains how to use milestone information, prepare for that conversation, and ask about screening or further evaluation.
Editorial disclosure: Research, drafting, and verification use the Educators Support automated editorial workflow. This article provides general educational information and does not imply human or clinical review. It cannot assess an individual child or replace advice from a qualified professional.
Key point: A milestone checklist supports a conversation; it is not a pass/fail test. If a child has lost a skill, is not meeting one or more milestones, or something about development concerns you, share the observation and ask about validated developmental screening.
Contents
Monitoring, screening, and evaluation are different
At well-child visits, healthcare providers ask about development and interact with children to assess whether they are meeting milestones that most children their age can do (Centers for Disease Control and Prevention).
Developmental monitoring and screening work together to identify concerns so children and families can access services and support as early as possible (Centers for Disease Control and Prevention).
CDC milestone checklists are communication tools for ongoing conversations and can help identify a possible need for additional screening. They are not developmental standards, screening tests, or diagnostic tools; when concerns arise, the next steps are formal screening, evaluation, or referral (Centers for Disease Control and Prevention).
The checklist milestones were assigned to well-child-visit ages using a 2019 peer-reviewed literature review and expert clinical judgement so that about 75% or more of children would be expected to show each one (Centers for Disease Control and Prevention).
For an age-based overview, see Child Development Milestones Parents and Teachers Should Understand.
Patterns worth discussing
A missed milestone can be a sign of a developmental delay (Centers for Disease Control and Prevention). Record the exact observation, where it occurred, and whether it has appeared more than once.
If a child stops using a previously acquired skill, contact a qualified health professional. Note which skill changed, when the change was first noticed, and what the child can still do.
Most children speak their first word at around 12 months and use two-word phrases by 24 months, and these milestones are the same regardless of how many languages they hear or use (American Academy of Pediatrics). Learning multiple languages does not cause speech or language problems (American Academy of Pediatrics). Record communication across all the child’s languages when discussing a concern.
Reduced hearing in one or both ears can significantly affect speech and language development, and hearing loss can be progressive or acquired rather than identified through newborn screening (Singapore Medical Journal). Ask whether a hearing assessment is appropriate when discussing a communication concern.
Turn an observation into a useful note
Use this five-part note before speaking with a health or education professional:
- Skill or behaviour: Describe only what you observed.
- Context: Record where it happened, who was present, and which language or communication method was being used.
- Timing: Note when you first noticed it and how often it occurs.
- Change: State whether the skill is emerging, unchanged, inconsistent, or no longer used.
- Question: Write down what you want to ask about screening, evaluation, or referral.
Sample wording: “Since [date], I have noticed [specific observation] during [activity or setting]. It happens [frequency]. Could we discuss whether screening or a referral is appropriate?”
Prepare for the appointment
Before an appointment, parents can complete an age-appropriate milestone checklist and discuss their concerns with the child’s doctor (Centers for Disease Control and Prevention). If you already have a completed general developmental screening questionnaire, share the questionnaire and its results with the doctor (Centers for Disease Control and Prevention).
- Bring two or three specific examples, including when and where each occurred.
- Ask another caregiver or educator for observations from a different setting.
- List the child’s languages and relevant health, hearing, or vision information.
- Write your questions before the appointment.
- Record the agreed next step, who will arrange it, and when to follow up.
Question to use: “Would a validated developmental screen or referral be appropriate, and when should I follow up?”
When developmental screening is recommended
For children receiving care in the United States, the American Academy of Pediatrics recommends standardized, validated developmental screening at 9, 18, and 30 months and autism screening at 18 and 24 months. Screening can also be done whenever a parent or provider has a concern (Centers for Disease Control and Prevention, American Academy of Pediatrics).
Outside the United States, ask a qualified local health professional which screening schedule and referral route apply.
How to seek developmental support
When a parent or clinician thinks a developmental delay may be present, referral to a specialist can provide a more complete evaluation (Centers for Disease Control and Prevention, American Academy of Pediatrics).
In the United States, further evaluation through the state early-intervention system is often a next step after a developmental concern is identified, and families may refer themselves directly for assessment (Centers for Disease Control and Prevention).
Outside the United States, ask the child’s health professional or the relevant local health or education authority where to request an assessment.
Support while waiting for assessment
- Continue ordinary talking, shared reading, movement, play, and familiar routines.
- Use the communication methods the child already uses, including gestures, pictures, assistive communication, and home languages.
- Offer accessible activities without repeatedly testing or drilling a difficult skill.
- Share relevant observations and participation preferences with caregivers or educators.
- Keep scheduled appointments and write down any changes noticed while waiting.
Online guidance cannot assess an individual child or replace an indicated professional evaluation. Ask a qualified professional about decisions specific to the child.
Related Educators Support guides
- Child Development Milestones Parents and Teachers Should Understand
- Child Development guides
- Age & Stages guides
Sources
- Centers for Disease Control and Prevention: Developmental monitoring and screening
- Centers for Disease Control and Prevention: Concerned about your child’s development?
- Centers for Disease Control and Prevention: Key points about developmental milestone checklists
- American Academy of Pediatrics: Milestones matter
- American Academy of Pediatrics: Children learning multiple languages
- Singapore Medical Journal: Speech and language delay in children
