Episode 151: CDC Milestone Updates - Beneficial or Bogus?

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started hello friends and welcome to episode 151 of the Untethered Podcast. It is your host Allie Balkan, and today we're going to talk about milestones. Now some of this is going to be right in line with the motor milestones, feeding myo airway tots type of things that we normally talk about. But we're also going to touch a lot today on how the CDC has missed the mark. Now, what do I mean? Well, if you're not aware, the CDC recently updated their milestones for the first time in years. Now, the types of milestones that they updated involve gross and fine motor milestones, receptive and expressive speech, language, developmental milestones, play, social skills, listening, attention, feeding, you know, all these oral motor, all these different types of milestones. Except for they did not have one specialist in any of these areas on their committee of individuals who were in charge of updating the milestones. No, they had doctors and PhDs, PhDs and MDs were basically who made up the cohort of individuals who updated these milestones. Which in my opinion is a problem. Because if they're seeing a lot of delayed developmental milestones, that doesn't mean that we need to change our typical milestone charts. That means we need to be asking why. We need to get down to the root cause of why are we seeing so many kids with delays? Oh, hey, maybe it's because we've been in a pandemic for two years. Maybe it's because children have been wearing masks. I don't know. Maybe there's some research to do there. Maybe it's because children just haven't had the same opportunities and children who are already at risk before the pandemic were even more so at risk and unfortunately have potentially fallen behind given the pandemic. So we should not be lowering the bar and changing our milestones. We should be asking, why haven't these children received the help that they deserve and they need? Why hasn't anybody flagged this child sooner? Why hasn't, why hasn't more federal funding been provided to allow for children to receive services through their local school programs? Whether that's an infant and toddler program or a preschool based program, you know, whether it's an IFSP or an iep. And I'm not going to get into the differences of those. Why isn't insurance approving more coverage for children with developmental delays? Especially given the state of emergency that many places are still in some. So many questions, right? Will we ever get answers? Probably not. But instead of finding the root cause of the issue, as I often talk about, we're just going to slap a band aid on it, change the milestones. Then maybe people won't ask so many questions. Then we can decrease the load of children who need services since there just aren't enough providers out there to serve them right now. That's really what it comes down to, does it not? Let's talk about specific milestones I have gone through. I've got a speech and language milestone chart that I have used for since 2014. Okay. And I've not seen any research that supports what they have stated in terms of changing their milestones. I have not seen any research to support these changes. All the research that I'm familiar with basically ties into what I'm going to share with you. This chart that I made in 2014. It was a chart that I used in educating educators, teachers who work with infants and toddlers and preschoolers and directors of these programs, parents who are curious to know if their children are on track or what they should be working on with them, what's reasonable to expect of a child. And also with keeping in mind that we've always said there's a range, no one single child is going to have every single box checked on this, probably, but they're going to have. It's. They're going to have a range, right? They may be at the beginning of the range and maybe in the middle of the range, they may be at the end. And what do I mean by a range? Well, one to three months. Between one to three months we will see X, Y and Z. Between three to six months we'll see A, B and C. Between six to nine months we'll see G. You know, excuse me, G, H and I. The point is, right, instead what they did was they, they went back and they kind of hid their changes by saying oh, well, instead of sharing with you milestones that we expect 50% of children to have on average, which is how their old milestones used to read, we're going to tell you what we expect 75% of children to have by a certain age. And that sounds good in theory. And that would be okay if the milestones that they listed for these ages were accurate, because many of them are not. Like, at least 50% of what I have flagged is wrong. And I'm going to just go through, I don't know, maybe a dozen or so examples, maybe more, maybe less. But I went through and highlighted specific things that I think are problematic. There are certain things I'm like, you know what? Okay, like, yes, it's important, but if they get it a little later, is it going to really completely throw them off track? I don't know. Maybe, maybe not. But then there are certain things I'm like, oh, no, no, no. This, this is a big. This is a big problem. This is a big problem. Problem. For example, a child who is not vocalizing with cooing and gurgling between one to three months or babbling with puh, ba da huh and wa, P, B, D, H and W, or responding differently to caregivers versus strangers between three to six months, or using reduplicated babbling, which is like, baba, no, no, go, go right with, like, to communicate with adults between 6 to 9 months. Children who aren't doing these things are. The research shows they're already at risk for other issues related to sounds. Right. What do I mean by that? Speech sounds. Speech sound disorders, reading, phonetic issues, phonological issues. There's all kinds of data and research to support this. And it boggles my mind that this was just completely disregarded in them deciding, oh, hey, hey. Yeah, we're just going to. We're just going to shift some things around here. So specifically, like between one to three months of age, I mentioned making vocal sounds. Cooing, gurgling. Yeah, that wasn't listed. That wasn't listed as something that they should have achieved by three months of age. And I don't mean 75% of them should be achieving that. No, I mean, like all children should ultimately be achieving that between three to six months of age. They should also be turning towards familiar sounds. Okay. And they should be. They mentioned that they should look at faces from, like a social skill standpoint, but also between one to three months of age, they should be copying facial movements, like sticking their tongue out. They have something, these, like, motor neurons where they mirror, like, what you're doing. So, for example, when my daughter Mia was two months of age, and I. And I thought, I've got evidence. I've got proof of this. She was copying me, suctioning my tongue to my palate and making click sounds like she was copying me doing that. Right? That's a big deal. And that's not something that they highlight. It's something that either appeared in their milestones much later or not at all. If I'm highlighting it, it's because they have missed the mark on these skills, and these are important skills. For example, if we're not vocalizing between one to three months of age or by three months of age, why? What's going on? Why is this baby so quiet? Can the baby hear properly? If they're not turning toward familiar sounds, we should question whether or not the baby is hearing properly and. Or is something else going on. Do they not have full range of motion of their neck? Right. What is the root cause of them not being able to do these things? It's not always cognitive based. It could be motor based. It could be both. Right? Who knows? But by not including certain things or pushing them much later, we are wasting precious time. And if I sound like I am fired up, it is because I am. Okay? And I just got ovaryngitis. I didn't have a voice. So if my voice sounds a little funny right now and different than usual, that's why. And I'm still getting on here to share this information with you because I don't want to wait two weeks to put this podcast out. I want it to go out immediately the following Monday after I record this. Okay? Now let's. Let's move onward to the next Ms. Mark. They write that crying stops. I'm sorry, they. We're talking now, like, between three to six months of age. Okay? So this is the focus. They've missed the mark on certain. Certain skills. For example, crying. A baby will stop crying usually when a voice is heard. If they don't stop crying, why are they not hearing the voice? Are they highly dysregulated? What's going on? This could be a piece of a larger puzzle, and it's not even. It's not even mentioned. They begin to understand. Mommy, daddy, bye, bye, want the bottle. Like simple questions, simple nouns, important things in their life, right? Their caregivers, when they leave, asking if they want their breast or bottle, they start to make a connection. From a receptive language standpoint, this is not addressed at all in their milestones Very interesting. They respond differently to a caregiver versus a stranger, which I mentioned before. Again, between three, six months and definitely by six months. And then babbling. They didn't even mention babbling. Maybe I'm tired and I missed it. Somebody tell me if I'm wrong. Babbling is, like, not even in there. We should be babbling. As I mentioned that. P, B, D H, W, P, B, D. Huh? What? We should be babbling that by six months of age. If we're not, we need to look into why. We need to look into why. This is totally missing. Also, turning their head to respond to a name should happen between three to six months. And they say you should have this by nine months. What? No, again, we're missing the mark here. If they can't do it, they're not turning their heads towards familiar sounds between one to three months and to their name by three to six months. Why? We need to be asking why? And how can we support them in developing the skill? Now let's move on to six to nine months. Okay, so, you know, I'm not going to say that everything they said is not helpful and not good. There was some helpful advice in there and there were some milestones that were on track. There's also so many that are dangerously off track that that's warranting this podcast. Okay. For example, responding to no should happen between 6 to 9 months of age. And by 9 months of age. Not for 50 to 75% of kids. For all children. They should be able to respond to no. Meaning if we say no to them as an adult, they should understand what that means and have some sort of a response. Doesn't mean they have to comply. Right, but there should be some kind of a response to know whether they agree with us or not. They say that this should come by 12 months. No, no, no, no. Responding to no should come by nine months. Thank you very much. Okay, reduplicated babbling. So they did mention this, like, baba. No, no. Go, go. Okay. We're duplicated babbling to communicate with the adults or their caregivers. It says that most. So most babies should do this by nine months of age. Well, really. No, sorry. All babies should be doing this between six to nine months of age. Again, they're backing up the timeline here. And this is dangerous because if children are not developing the communication skills from a receptive and expressive language standpoint and their speech sounds as they should, we have a big problem. And now that's being promoted by pediatricians, the AAP, and the cdc. And I'm not, I'm not happy. Happy. You can't tell in my voice. I'm not happy. And not only do they respond to no at this point, they should also be shaking their head for no. So they're responding to no and they're telling us no. Okay, by shaking their head and they're saying that this is a skill that 75% of kids develop by 12 months of age. No shaking my head right now, they should develop this by nine months of age. Okay? Now in terms of vocalizing in response to their name, they should start doing that about 50% of the time by nine months of age. And again, this, this goes hand in hand with some of those earlier skills, like turning towards a familiar sound turn, you know, by three months, turning their head to respond to their name by six months and then vocalizing in response to somebody saying their name 50% of the time by the time they're nine months of age. This should happen between six to nine months of age. It's a pretty wide range already a three month range. So nine months should be like the tail end of when this should happen. So even acknowledge this, this one. Okay, let's move on to 9 to 12 months of age. And I'm just checking because I also. Oh, let me back up real quick. So they said that by four months of age, right, we should have steady routines for sleeping and feeding. They don't explain what this means. And I think this can be very misleading to parents because, yes, I think routines are important. Like, okay, before bed, we do every, you know, we read a book, we take a bath, we sing a song, we rock in the rocking chair. Maybe we, maybe we have our last feeding for the, you know, for those waking hours before we do the bath. Right? You've got like a routine in place, that's fine, but. And for feeding as well. But when I first read this, and I'm a specialist in the space, I read this as what they want the baby sleeping through the night. I don't know why that's where my brain went, but that was my interpretation. And so I think they need to better explain, explain what they mean by this because a parent is not going to necessarily understand what they mean by a routine. Right. I think a parent is going to generally read this and go like, my baby should be sleeping through the night by 4 months of age and like, you know, be on like a strict feeding schedule. Well, I know some people do that, but also I know some people don't. Right? Maybe they have a Feeding a relatively like common feeding schedule. But sleep babies are not sleeping through the night at this age. And so it can also make it challenging to keep two routines. And I think it's an unrealistic expectation to put on a parent of a four month old. So I think setting routines are important, but I think that we need to explain this further and better support our parents. And when it comes to anything like sleep training and gentle sleep parenting and all that, I let Taylor Kulik take the grab the bull by the horns on this topic. So she's the expert in this. I've been on her podcast, she's been on mine. So. So definitely somebody worth checking out. But I just wanted to make a comment on that because it's also right after the time that a lot of parents are thrown back into the workforce, especially mothers who have just given birth. And so I think again that we need to be providing information that's helpful to parents and that's not vague and unrealistic. So just gonna throw that out there. Okay. One thing I did like. Yay. I liked something. No, like I said, they did have some milestones that were. That were I was in agreement with. I'm really highlighting a lot of the ones that I wasn't or that I felt were missing, like big ones that were missing. I do like that they recommended introduction of solid foods around six months of age. So thank you the CDC and AAP for that. Very thankful for that. They do state that breast milk or formula is the most important source of food for the baby. And again, I think that yes, this is where the bulk of the calories and nutrients may be coming from at this point. And that's important that they should still be coming from that source. But again, we need a little more information. Like we need to highlight that food before one is not just for fun. Food before one is actually critical to our sensory oral motor development. What do I mean by that? Our sensory system, our oral motor skills. Right, our motor system. They're these combined systems that like work together. We really can't piece them apart. Like everybody tries to. People try to look at them and assess them and treat them in silos and. And maybe we can assess them kind of sort of in silos, but we can't really treat them in silos. We really need to treat holistically when it comes to. And when I say holistically, I mean from like an approach of like a whole child approach. Anyways, diverting my own attention here, but food before one is not just for fun. It's actually extremely critical to a child's developmental milestones when it comes to sensory, oral, motor, feeding, when it comes to motor skills. And that impacts the baby's mouth in general. It impacts their digestion. Right. It's much further reaching. I always say we're connected from the tip of our tongue down to the tip of our toes. That also applies here. Okay, go listen to episode 43 of the Untethered podcast. Or like to hear more just about like how food before one is not just for fun. I go into detail there. All right, I don't love that they're still saying that you should offer pacifier at 6 months of age because we should be weaning the pacifier by then. But that's not a hill that I'm going to die on in this podcast today. Save that for another day. All right, so then looking at the nine months of age. Okay, so they missed the mark on some language skills around 9 to 12 months of age. So they say that they should just be waving bye bye at 9 by like 12 months of age. Yeah, no, they should actually be saying bye bye like around 12 months of age. Like that's where they start to develop. And maybe it's like a little bit after that. Maybe that's not their first word. But a lot of kids do have their first word before 12 months of age and they have a couple words and you know, bye bye is one of those earlier ones, especially on requests. Right. If we, if we say bye bye on request. So if we say say bye bye say bye bye and they go bye bye or like. Right, that's them saying bye bye on request. Okay, I'm not saying they're saying it completely like volitionally. Some kids might. But that's not what we're expecting by 12 months of age. They're saying that they just waive bye bye by 12 months of age. I'm sorry, but again, I disagree. Okay, so taking turns in conversation through like babbling should be happening between 9 to 12 months of age as well as responding differently to like the adults and versus children that you're interacting with. That also begins to happen between 9 to 12 months in age. These are majorly skills that were missed. Oh, and by the way, my feet. The peds screener, if you go to. What is it? Pediatric. No ped FeedingsCreener.com PD Feeding Screener.com you'll get the. You can download my free pediatric feeding screening packet and I have a milestone chart in there. And they missed the mark on some things Here. And I'm not, I'm not going to go down like the massive rabbit hole. But a couple of things I want to mention, like, one, for example, is spoon eating. Yeah. That should be happening between 6 to 12 months of age. We should be handing them a spoon and allowing them to get messy and clay and feed off of a spoon with the ability to feed themselves with a spoon by 12 months of age. Like, yeah, it might be messy, but that's okay. They're, you know, they're littles. They're little ones who are still learning to do this. Yeah, no, they have like them trying to use a spoon, like, much later on. I think it's closer to 18 months. I'm sorry. No, they have children eating with a spoon by 24 months of age. That 75% of children that they expect to eat with a spoon independently by 24 months of age, when most children can do it by 12 months of age. What? Okay, yeah, no, we expect them to eat with a fork by, you know, 20. Around 24 months of age or so. Like between 18 to 36 months of age, we expect them to be eating with a fork already. And this is basically when they had them spoon eating with a fork coming much later in their, in their chart. So that's a little problematic, you know, in my opinion. By the way, there's a lot of milestones that I'm not going to comment on. I could probably bring one of my OT or PT colleagues on here to talk about how they missed the mark on a lot of the gross motor and other fine motor milestones that I'm not mentioning. But those also play into feeding. Major, major issue here. Okay, let's see in nine months. Gosh, I'm getting like all garbled over this. I'm so, like, fired up. At nine months, they say that you, they say find out about choking risks and safe foods to feed your baby. Let him practice feeding himself with his fingers and using a cup with a small amount of water. Sit next to your baby and enjoy mealtime together. Expect spills. Learning is messy and fun. Yes. Expect spills. Yes. Learning is messy and fun. But you need to let them play in their food way earlier than nine months of age. Like major oy here. Okay. Major oy. We should be letting them play in food as soon as we introduce it. At six months of age. We should be giving them a spoon and letting them explore with it much earlier than nine months of age. As I mentioned a moment ago. Also open cup. Yeah. That also should be given to them to experiment with at 6 months of age. And most children by 12 months of age are able to independently use an open cup if they've been given the opportunity to do so and the prior six months. Okay. And many of them can do it pretty well without spilling too. It's pretty impressive when given the opportunity. But they're saying, like, introduce that at nine months. I'm going, no, no, we're already three months behind here. What are we, what are we saying? What are we recommending here? Now let's fast forward to 12 to 18 months of age. So I'm looking here. Oh, let me back up one more time. They have guidance on, like, help your baby get used to foods with different tastes and textures. Okay, great. And they say foods can be smooth, mashed, finely chopped. Okay, well, we can also have different presentations of a baby's ready for it. Like, what if, what if we want to give it to them? Like a meltable and a different shape or a cube that's not like finely chopped. Maybe it's a little bit of a bigger piece because they're ready for that. Or maybe we want to give the piece of food and a strip of food. Like, where were the feeding specialists on this recommendation? This is not okay. It says give her chance to try foods again and again. Okay, yes, great. Where. And, but where's the guidance on also, like introducing foods for allergy and intolerance? Like testing, like, you know, it just says basically introduce foods. It doesn't say what or how. It would be really helpful if they either had another handout on that or they included just like some basic information in this. Since they're providing so many other, you know, little tidbits of their best advice. It doesn't start at 12 months. Like, the next thing I want to mention, which is more language related, they mentioned talking or singing to your baby about what you're doing at 12 months of age. No, no, no. We do that at birth. We're now a year behind here. For example, like, mommy's washing your hands. Okay, fine, yes, we can do that. But also, like, we can talk to our child when we're out for a walk and they're now a bit alert. We can even do it before they're alert. We can do it when they're newborns. We can do it when they're three months old. We can do it when they're sitting up in the stroller. We should be talking about our surroundings and what we're doing all the time. This is how children learn language ok, so. And singing. The same goes for singing. So just thought I'd throw that in there. Ok, now let's move forward here. So some other ones I'm going to point out between 12 to 18 months of age on my chart is that children should be pointing to three body parts when asked by 18 months of age. They say we should start teaching body parts at this age and that they should not be needing to point to body parts until, I don't know, age 2 or something. I have to go back and look. But no, by age 2 they should be pointing to 5 body parts. Again, we're missing the mark here. They should know at least three body parts that they can point to independently when asked. Okay, so yes, they're prompted by us asking. But then they should be able to carry it out on their own by 18 months of age. Not two, not two. All right, how about using three to 20 single words, like mostly one to two syllables in length. What do I mean by that? Cat go. Right. That's a one syllable word. Da. Da. That's two syllables. Okay. Mama. It's repeated but it's still two syllables. Right. If they said baby, that's two syllables. Right. It's one word but two syllables. So they should be using three to 20 single words between 12 to 18 months of age and definitely by 12 T or definitely by 18 months of age. And they're over here saying no. They try to say three or more words at this age range like besides mama or dad. Dad, I'm going, oh no, no. We're now going to have a lot of children start falling through the cracks is what's going to happen. And this is completely horrifying, to be honest with you. Let's fast forward to two to two and a half years. Okay. I know I kind of jumped over the 18 months to 2 year range, but the way that they grouped things, it just, I just was like, ah, like they should be saying 50 words by 18 months to 2 years of age. They should be shaking their head yes and no to respond. They should be producing most vowel sounds and M, B, P, K, G, W, H, N, T and D or M, B, P, K, G, W. Huh. Okay. All those sounds, they're not mentioning any of this. About 60 to 65% of their speech should be understood around this time. They should be naming familiar objects and some body parts. Right. They should be putting two to three words together. Okay. At this point, like most kids by age two on average will put two words together. It doesn't mean they should Start putting two, two words together at age two. Most kids are actually producing two to three word phrases by the time they turn two. So there's also a whole bunch of other things too that I'm not even going over now. Between two to two and a half years of age, they should be saying 200 words. Okay, the CDC says they should say about 50 words. What? What? I mean, this is a major disconnect. I don't, I don't even understand. I am absolutely like beside myself here. Like, where do we, why are we getting rid of 150 words that they should be saying at this age? Why do we want our kids not to communicate as much as they should be? I really don't understand. The average phrase length at this point is 3.1 words. Which means if I were to take a sample of like 50 phrases that your child says, okay, over, let's say 25 minutes of us playing, playing together, and I write them all down and I count the words and I divide them by the total number of words. Right? There's a way to do this. I'm going to get an average phrase length and that phrase length is 3.1 words. Which means that children are not just speaking in two word phrase phrases between two to two and a half years of age. They're probably speaking in anywhere from like one word once in a while to two words a lot of the time to three words onwards up, onwards up of like, I don't know, four or five words, five word phrases by two and a half years of age, maybe not commonly, but once in a while enough to drive that average length of their phrase up to 3.1 words. Okay, they should also be rote counting to 5. Why do I share this? Because they had shared. Well, I'll go into the counting one shortly, but yeah, now we're again missing the mark here. And then answering what and where questions is a skill that they should be doing between two to two and a half years of age. Like, what is that? Where did it go? Where did mommy go? Where did the doggy go? Oh, where is he? Oh, he's outside. What is that? Oh, it's an apple. Oh, what does a dog say? Right, These are things that two to two and a half year olds should be answering. They mark this as a skill that children should have by four years of age. We just lost a year and a half of life here. What? Again, mind blown. I don't understand who's coming up with these, these milestones. They are inaccurate and I'm not Happy about this. I also understand that a number of people have now written letters to the CDC and the AAP with zero response. Clearly. Obviously, you know, do we expect a response? I don't know. I don't even know. Okay, what else can I tell you? Oh, so they had, around age two, they mentioned play with your child outside by playing ready, set, go. For example, pull your child back in a swing, say ready, set, and then wait for them to say go so that you can then push the swing. Yeah, no, we should actually be doing this around like a year, because children will do this around a year. 18 months. Like this is not something we should be introducing at age two. This is something we should be introducing much earlier. And we should be expecting them to fill that in if it's something we've worked on with them over time and done. And play with them. Whether it's like ready, set, go. Playing with a car. Ready, set, go. Pushing them in a toy. Ready, set, go. On a swing. Yeah, again, majorly missing the mark here. Between or by two and a half to three years, they should be saying 500 words. But keep in mind, by two and a half years, they said they only need to be saying 50 words. And I told you it should be 200 because look how much it jumps. Between two and a half years to three years, we go from 200 to 500. So what, we're supposed to go from 50 words to 500 words in just like six months time? Yeah, that doesn't, that's not typically. I mean, it might for some kids, but that's not typically how fast it climbs. It climbs drastically, drastically after three years of age. But during this window, it's about 200 to 500. And how are we going to jump from 50 to 500 in six months time? Just somebody please, please explain that to me. Enlighten me. I'd love to know. Okay, so also, they can use words like. We can teach them to use words to share their emotions towards adults and their same aged peers around two and a half to three years of age. This suggestion that they made, the CDC made, recommends age five, five. They want us to expect a child to talk about their emotions and discussing them with them. We can have more advanced conversations at age 5 about emotions and more advanced emotions, but the whole topic of emotions was completely missing. We need to be talking about that in the toddler and preschool years that there are curriculums surrounding this. This is social skills, these are play skills. This is like being a human. I don't understand again, like I'm completely mind boggled here. I just, I can't. It's beyond me. All right, so skipping forward, they're now going to say about 800 words around three to three and a half years of age. About a thousand words around three and a half to four years of age. And now at this point also like they, their average sentence length by three to three and a half years has jumped to 4.3 words. Okay, that's their average like phrase or sentence length of how many words they have meaning. Like they're using much longer phrases at times too, sometimes shorter, sometimes longer. And they just have like they've got some way more advanced skills than they're being given credit for. Like at four to four and a half years of age they should be saying 1500 words and by four and a half to five, five years of age they should be saying 2000 words. Okay, going back to the four to four and a half year framework, they should understand most WH questions. Rhyming and alliteration. The CDC says and the AAP say that rhyming should be a skill that 75% of children have by age five. Again, we're missing the mark by at least six months here. They also say that they will have the skill of story retell, like telling a story or retelling a story by age five. Yeah, no, they should be, they should have that between four to four and a half years of age. They mentioned they should be able to rote count to 10 by age. Let me see, I made a comment here so I could try and tell you these things quickly. They should wrote count to 10. I think they said like it was either between four and a half to five years of age or by age five. They should wrote count to 10 and. No, no, actually they should be rote counting to 20 by age 5. Now obviously I'm being picky about certain things, but these are things that jumped out at me because I have a child who is turning four in on the 18th of February. So in three days, three days after I'm recording this and a couple of days prior to this episode airing and I have a six year old and I know what they did. I know also what they did during a pandemic. I know what my 6 year old did being homeschooled by me and completely like having to catch up and like the areas of math and reading because of the pandemic. But I also know what was still expected of her and what other supports we were told by her receiving school in first grade this year like that we needed to put in place to help her close the gaps because of what she missed out on during the past couple years. Right. What she missed out on when her pre K went virtual and it became a joke and it wasn't something she was willing to pay attention to and it wasn't really even teaching her much anyways at that point. And then our schools not being open like at all for kindergarten. So you know, I, I struggle with this because obviously she may be a, she may be more advanced and maybe she, maybe it's more, it's a lot easier for her than some other kids to catch up. But my, this drives my point home because while some kids can catch up, other kids need supports. And we've given her supports. She's not just easily caught up on everything. She's caught up on like reading. But math was something that we had to give her a lot of additional support in and she is now caught up with those supports in place. But that's also because we recognize that at her age she should be doing more than she was able to do. And who knows, maybe it would have been this way with or without the pandemic. No one will ever know. But a lot of it was, we know that she did just, she was missing out on things that she just wasn't taught. Okay, my fault she didn't learn those things. So, you know, I share this because these kids were again at risk already or who are not going to close the gap as quickly are now going to be put at a, in a much worse position where the gap is going to be allowed to be created, a much larger gap is going to be created and it's going to make it that much harder for these children to one, not fall between the cracks and to close, close that gap and catch up to age appropriate skills. And the other disclaimer that I want to make here is that I also think that in the schools, a lot of school systems, not all school systems, but a lot of school systems that I personally encountered expect too much of children. I think they're already teaching advanced skills, skills that are ahead of where most children are functioning outside of a pandemic. They're expecting way too much of them. In kindergarten we say first grade is the new kindergarten, kindergarten is the new pre K, Pre K is the new preschool. So what children used to be expected to know in pre K, they're now expected to know when they're three years old and four years old. Before entering pre K, what children used to be Expected what they used to expect children to know in kindergarten, they now expect them to know in pre K. They expect them to know that information entering kindergarten instead of learning it in kindergarten and so on and so forth. And there's this, like, trickle effect and snowball effect. And it's a big problem, especially for our children who are developmentally delayed. Especially, especially for our children who easily fall between the cracks, especially for our children who are already at risk for a number of reasons. And so I share this and I'm passionate about this topic because I think that this is a big fu to parents and to professionals in this space who are working hard with their children and working hard with children. Right. Whether it's your child or you're working with these children to close the gaps. And now they're basically just going to come out with some arbitrary milestones that don't make any sense and further screw this up for children because, oh, hey, you know what? The fact that your child doesn't have that like this now supports their whole let's wait and see approach. Let's wait and see. Let's give them a little more time to see if they catch up, even though they have these 10 things that are working against them right now because, oh, hey, you know what? New milestones, it says it's okay to wait because your child shouldn't know that yet. No, these milestones are wrong. Your child should have had that six months ago. Because that's what I'm seeing. And I was seeing this before they updated the milestones. And now I think this just really works in the favor of pediatricians. Sorry to my peds, who are friends of mine. And I know this is not all pediatricians, but those who take the wait and see approach, this really favors them. And insurance companies who don't want to cover therapy for children who have developmental disabilities, developmental delays who don't, who have congenital issues at birth. Right. Because you got to read those insurance policies before you sign up for them because the fine print can really come to kick you in the butt. And it's really a shame how much we have to fight already before these milestones being changed to get children the services they both need and deserved so they can coexist and interact and socialize with their family, with their same aged peers, with their classmates, with their playmates, at, you know, playgroups, with the caregivers that they interact with outside of, like, you know, their parental or caregiver guardian units at home. It's just. It's awful. This is completely Awful and horrifying. It is horrifying. Whoever made these changes should be absolutely ashamed of themselves. And I will say this is a hill I am willing to die on. This is absurd. So I know that I've ranted about this now for a good period of time, but clearly you can tell how upset I am over this situation. I just think that we need to do better by our children. And arbitrarily delaying milestones is harmful. Whatever happened to do no harm? Pediatricians, doctors, medical providers sign an oath, right? And they sign an oath that says, you know, they will do no harm. This is creating harm. This is absolutely doing and will cause greater harm than we've ever seen if these new like checklists of ages and skills are actually like what gets used in pediatric practices. So I have a milestone chart. I am happy to share it with anybody who wants me to share it. I honestly haven't updated in years, but I also haven't seen a need to because this is research based. This is what we've always known to be true. And does research get updated? Can milestones get updated? Sure. Yes, they can. But show me the research outside of this two year pandemic that shows that we should be delaying these skills. Because I'm not seeing that in my private practice. I am not seeing that with the children that we work with. I am not seeing that these children, typical developing children, are not gaining these skills earlier at the dates that I mentioned compared to what the CDC and AAP have mentioned. So consider this a challenge. Show me the research. I also know that there is that a lot of like PTS, as I mentioned, and OTs are very unhappy about the gross motor and fine motor milestones and how they've been pushed back in these developmental milestone guides that they've created. So maybe we'll bring one of them on, we'll further this conversation. But I'd be really curious to know if you've reviewed this in what you think about it. It's 24 pages long. They have suggestions for parents. You know, look, if it's one thing to be on your own growth curve, right, or your own trajectory, if you're delayed and you're gaining your skills on it on a delay, you know, three months behind, six months behind, so on and so forth, that's, that's one thing. I'm not talking about that. I'm talking about like the typical traditional normative milestone chart. And if they are seeing changes, just because it is common in their practice doesn't mean it's common in everybody's practice. And it also doesn't mean it's normal. So we need to remember that common does not equal normal. Common does not mean we can change norms. Normative data is gathered through sound research. So show me the research that shows that prior to 2020, children were actually demonstrating, typically developing children were demonstrating these milestones at much later ages. You can't show me that the research either hasn't been done or it's not going to demonstrate that because that's not what we actually see in real life. So we're going to go ahead and wrap that up here. But you can just Google CDC developmental milestones and you'll get the new updated milestones. You'll see exactly what I'm talking about. And you know, it's just, it's really a frustrating shame. So I encourage you to send a letter and advocate if you feel that you also are in disagreement with the milestones that I've discussed and many others like the speech sounds, they fail to mention they should have, and a whole bunch of other, you know, receptive expressive language skills, speech sounds, listening, attention, social skills, play, oral motor, fine motor, gross motor, all the things, right, Utensil usage, as I mentioned, like, and so on and so forth. Please, please advocate for our little ones. They need, they need me to advocate. They need you to advocate. Hopefully something gets changed because this is just, like I said, absolutely horrifying. All right, we'll end on that note and maybe I can. If you're an OT or PT who would like to continue this conversation, send me a message. Let's continue this conversation from your perspective. I would love to have you on. Thanks for listening to this podcast. If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page at halibalkin Biz, on Instagram at Alibulcan, and you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes where you can also subscribe to be kept up to date on the latest podcast episodes.