Tracking Developmental Milestones | Skills Pool
Tracking Developmental Milestones Applies ASQ and CDC milestone tracking with referral criteria for developmental delays. Use when tracking development, screening for delays, or documenting milestone achievement.
CaseMark 12 Sterne 05.03.2026 Beruf Kategorien Projektmanagement Applies ASQ-3, ASQ:SE-2, and CDC milestone checklists to systematically track gross motor, fine motor, language, cognitive, and social-emotional domains across well-child visits. Produces a developmental surveillance report with referral triggers for Early Intervention and subspecialty evaluation.
Why This Skill Exists
Developmental delays affect approximately 1 in 6 children, yet fewer than half are identified before school entry. AAP Bright Futures guidelines mandate structured developmental surveillance at every well-child visit and formal screening with validated tools at 9, 18, and 30 months. Autism-specific screening is required at 18 and 24 months. This skill ensures no screening window is missed and referral criteria are applied consistently.
Checkpoint A — Intake Verification
Required Intake Questions
What is the child's corrected age (if born preterm < 37 weeks, correct until age 2)?
What is the visit type (well-child, developmental concern follow-up, Early Intervention referral)?
What developmental concerns, if any, has the parent/caregiver raised?
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Tracking Developmental Milestones npx skillvault add CaseMark/casemark-skills-skills-med-tracking-developmental-milestones-skill-md
Sterne 12
Aktualisiert 05.03.2026
Beruf
Is there a history of prematurity, NICU stay, neonatal complications, or known genetic conditions?
What is the child's language exposure (monolingual, bilingual, primary language at home)?
Has the child previously received Early Intervention or developmental therapy services?
Were prior screening scores in any concerning zone?
Required Documents
Previous well-child visit notes with developmental documentation
Prior ASQ-3 and/or ASQ:SE-2 score sheets (if any)
Early Intervention (EI) evaluations or progress notes (if applicable)
Subspecialty reports (developmental pediatrics, neurology, audiology) if applicable
Completed parent questionnaire for current visit
Use corrected age for all milestone assessments in preterm infants until 24 months of age.
Step 1 — Developmental Surveillance (Every Well-Child Visit) At every visit, document the following per Bright Futures:
Four Surveillance Components
Eliciting parental concerns — Ask open-ended: "Do you have any concerns about your child's development, learning, or behavior?" Document verbatim.Maintaining a developmental history — Update milestone achievements since last visit across all domains.Observing the child — Document directly observed behaviors (e.g., "reaches for objects," "speaks in 2-word phrases," "walks independently").Identifying risk factors — prematurity, lead exposure, adverse childhood experiences (ACEs), family history of ASD or intellectual disability.
CDC Milestone Expectations by Age Age Gross Motor Fine Motor Language Social 2 mo Lifts head prone Hands open 50% Coos Social smile 4 mo Holds head steady upright Reaches for toys Laughs Responds to affection 6 mo Sits with support, rolls Transfers objects Babbles Recognizes familiar faces 9 mo Sits independently, crawls Pincer developing "Mama/dada" nonspecific Stranger anxiety 12 mo Pulls to stand, cruises Pincer grasp mature 1-2 words with meaning Waves bye-bye 18 mo Walks independently Stacks 2-4 blocks 10+ words Points to show 24 mo Runs, kicks ball Stacks 6 blocks 50+ words, 2-word phrases Parallel play 36 mo Pedals tricycle, stairs alternating Copies circle 3-word sentences, "why" Takes turns
Any milestone not achieved by the upper age limit triggers formal screening — do not adopt "wait and see."
Administer the ASQ-3 at the AAP-recommended ages:
ASQ-3 Administration
Ensure correct age-interval questionnaire is selected (corrected age for preterm)
Five domains scored: Communication, Gross Motor, Fine Motor, Problem Solving, Personal-Social
Each domain yields a raw score compared to cutoff values
Above cutoff : development appears on scheduleMonitoring zone (between 1 and 2 SD below mean): provide developmental activities, rescreen at next visitBelow cutoff (≥ 2 SD below mean): refer for formal evaluation
ASQ:SE-2 (Social-Emotional Screening)
Administer at 9, 18, 24, and 30 months (or any age with behavioral/emotional concern)
Scores above cutoff indicate need for further social-emotional evaluation
Consider concurrent PHQ-2 or Edinburgh for caregiver — maternal depression impacts child development
Step 3 — Autism-Specific Screening (18 and 24 Months)
M-CHAT-R/F Administration
Administer M-CHAT-R at 18 and 24 months universally
20 yes/no items scored; total score 0-20
Low risk (0-2) : no further action unless surveillance concern at future visitMedium risk (3-7) : administer M-CHAT-R Follow-Up Interview; if still positive, referHigh risk (8-20) : refer directly for diagnostic evaluation; do not wait for Follow-Up
Red Flags for ASD at Any Age
No babbling by 12 months
No gesturing (pointing, waving) by 12 months
No single words by 16 months
No spontaneous 2-word phrases by 24 months
Loss of previously acquired language or social skills at any age (regression)
Any regression in language or social skills is an urgent referral — do not rescreen.
Step 4 — Referral Pathway Determination Based on screening results, determine the appropriate referral:
Early Intervention (birth to age 3)
Refer when any ASQ-3 domain falls below cutoff or clinical concern is present
Referral must be made within 7 days; EI has 45 days to complete evaluation by federal mandate (IDEA Part C)
Document referral date, agency name, and domains of concern
School-Based Services (age 3+)
Transition from EI to school district evaluation at age 3 (IDEA Part B, Section 619)
Begin transition planning at 2 years 6 months
Parents must consent to referral; provide written information about rights
Subspecialty Referral
Developmental-behavioral pediatrics : global delay, ASD evaluation, complex behavioral presentationsPediatric neurology : motor delays with abnormal tone, seizures, regression, microcephaly/macrocephalyAudiology : any speech-language delay (hearing must be assessed before attributing to developmental cause)Genetics : dysmorphic features, global delay without clear etiology, family history of genetic conditionsPediatric ophthalmology : visual fixation concerns, nystagmus, strabismus
Step 5 — Documentation and Follow-Up Plan
Visit Documentation Must Include
Corrected age (if applicable) and chronological age
Parental concerns (quoted verbatim if possible)
Milestones achieved and not yet achieved, organized by domain
Screening tool administered, version, date, and scores per domain
Risk zone classification for each domain (on schedule / monitoring / referral)
Referrals placed with dates and agencies
Anticipatory guidance provided (age-appropriate developmental activities)
Next screening schedule date
Follow-Up Timeline Result Action Timeline All domains on schedule Continue surveillance next well-child visit Per Bright Futures schedule Monitoring zone (1+ domain) Provide activities, rescreen 1-2 months Below cutoff (1+ domain) Refer to EI/school + rescreen Within 7 days (referral), 1-2 months (rescreen) ASD screen positive Refer for diagnostic evaluation Within 2 weeks Regression Urgent specialty referral Same day / next business day
Checkpoint B — Tracking Review Before finalizing the developmental milestone report:
Quality Audit Item Requirement Pass? Age accuracy Corrected age used for preterm; correct ASQ interval selected Surveillance completeness All four surveillance components documented Screening timing ASQ-3 at 9, 18, 30 mo; M-CHAT at 18, 24 mo Domain coverage All 5 ASQ-3 domains scored and classified Referral compliance Below-cutoff domains referred within 7 days Regression protocol Any regression flagged as urgent with same-day referral Parent documentation Concerns documented verbatim, not paraphrased Follow-up plan Next screening date and actions explicitly stated Bilingual consideration Language milestones assessed across all languages No unexplained [VERIFY] tags All flagged items resolved or escalated
Guidelines
Follow AAP Bright Futures 4th Edition for developmental surveillance schedule and content
Use ASQ-3 (Ages and Stages Questionnaire, 3rd Edition) as the primary screening tool per AAP
Use M-CHAT-R/F per Robins et al. for universal autism screening at 18 and 24 months
Apply corrected age for preterm infants per AAP guidance (correct until 24 months chronological)
Follow IDEA Part C (birth-3) and Part B Section 619 (3-5) for referral obligations
CDC "Learn the Signs. Act Early." milestone checklists supplement — but do not replace — validated screening tools
Do not use parental reassurance as a substitute for formal screening when concern exists
Bilingual children may have distributed vocabulary across languages — total vocabulary across both languages is the relevant metric
Escalate to attending for any regression, loss of skills, or parental distress about development
This skill produces documentation for clinical tracking; it does not replace clinical judgment
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Checkpoint A — Intake Verification
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