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Quantitative Evaluation of Content and Age Concordance Across Developmental Milestone Checklists

Wilkinson, Carol L. MD, PhD*; Wilkinson, M. Jackson AB; Lucarelli, Jennifer MD; Fogler, Jason M. PhD*; Becker, Ronald E. MD*; Huntington, Noelle PhD

Journal of Developmental & Behavioral Pediatrics: June 04, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/DBP.0000000000000695
Original Article: PDF Only

Objective: Clinicians and caregivers rely on milestone checklists as tools for tracking a child's development. In addition, medical students and residents use milestone checklists to learn about normal child development. However, there are multiple published milestone checklists that vary qualitatively in structure and content, hindering their effective use in developmental surveillance and medical education. This project systematically evaluated the consistency and variability between commonly used milestone checklists.

Methods: A team of child psychologists and developmental pediatricians reviewed a total of 1094 milestones derived from 4 published checklists (2 developed for providers, 2 developed for caregivers) to create a comprehensive set of 728 discrete developmental observations, with each observation mapped to corresponding milestones. This observation-milestone relational database was then used to determine the degree of content overlap and milestone age range concordance across milestone checklists.

Results: Of the 728 discrete developmental observations, 40 (5.5%) were mapped to milestones in all 4 milestone checklists, and an additional 90 (12.4%) were mapped to 3 checklists. Among these 40 “universal” observations, most (42.5%) were in the motor domain. Of those 130 observations mapped to milestones in at least 3 of the 4 checklists, 26.9% (35/130) were mapped to milestones that were discordant in their associated age range.

Conclusion: Four commonly used developmental milestone checklists were found to have limited overlap in content, and those that overlapped were inconsistent in their associated age ranges. The resulting observation-milestone relational database could be used to further validate age estimates of milestones and facilitate milestone surveillance through the electronic health record.

*Division of Developmental Medicine, Boston Children's Hospital, Boston, MA;

Pediatric Healthcare of Newton Wellesley, Wellesley, MA;

The Harvard Clinical and Translational Science Center, Harvard Medical School, Boston, MA.

Address for reprints: Carol L. Wilkinson, MD, PhD, Division of Developmental Medicine, Boston Children's Hospital, 1 Autumn St, 6th Floor, Boston, MA 02215; e-mail:

C. L. Wilkinson was supported by the National Institutes of Health (1T32MH112510).

Disclosure: The authors declare no conflict of interest.

Received November 27, 2018

Accepted April 24, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.