Four Simple Steps

Administering the checklists is very simple and can be easily adapted to any clinic flow.

Below is how checklists are typically integrated into certification and mid-certification assessment appointments. Keep in mind that the checklist can also be used during other appointments or any time a parent or WIC staff has a concern or question about a child’s development.

The WIC staff member offers the parent the opportunity to complete an age-specific checklist for each child being certified that day. For virtual appointments, WIC staff members can encourage the parent to fill out the age-specific online checklist and email the results to the WIC clinic or fill out the checklist via the CDC Milestone Tracker App and email the summary to the WIC clinic. The WIC staff can then review the checklist at the next WIC visit. WIC staff can also send information to parents on how to fill out the online or app-based Milestone Checklists.

If a child was born prematurely (<37 weeks gestation), offer the checklist that fits his or her corrected age. Find instructions for calculating corrected age here: https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Corrected-Age-For-Preemies.aspx
If a child is between checklist ages, always use the younger checklist. For example, if the child is 20 months old (actual or corrected age), use the 18-month checklist rather than the 2-year checklist.
If the parent informs you that their child has already been diagnosed with a developmental delay or is receiving specialized services for developmental concerns (e.g., speech/language therapy, early childhood special education, or other early intervention like speech therapy), there is NO need for the parent to complete a checklist or provide a referral to the doctor. Often, this can be indicated in a child’s record so the checklists are not brought up with the parent in the future.
Refer to the Deskside Reference Guide for examples of simple, clear language staff can use with parents:
- “You may have noticed the graphics on the walls and floor about child development and milestones. Tracking milestones that (child’s name) is reaching is an important way to help your child learn and grow.”
- “We are using this checklist to help track children’s development. Thinking about how ______ plays, speaks, learns, acts, and moves is just as important as measuring his/her height and weight.”
- “So let’s go through this checklist of developmental milestones and see how he/she is progressing. Let’s answer these first two questions together about what most children do at this age. Does ______ copy others, especially adults and older children? Does he/she get excited around other children?”
- “Go through the rest of the checklist and be sure to ask me if you have any questions. Start by putting ______’s name and age on top, along with today’s date.”

This can be done while information is entered into your data system, if applicable, thus taking advantage of some “down time” for parents during an appointment.

When the parent has finished, the WIC staff member notes whether there are any missing checkmarks alongside the milestones, or any parental concerns written or otherwise. This makes determining the need for a referral simple:

 When ALL milestones on the checklist are checked and there are NO concerns written or otherwise expressed, this indicates the child is reaching his or her developmental milestones. You can reassure the parent by saying:
- “It looks like ______ is on track for meeting these developmental milestones.”
- “Take this checklist with you and share it with your family so they can see how great ______ is doing.”
- “If you ever have any concerns or questions about ______’s development, be sure to talk to his/ her doctor.”
- “If you haven’t already, download the FREE CDC Milestone Tracker app and keep tracking ______’s milestones. Share the milestone summary within the app with the doctor at your child’s next visit.”
Check the first two items under “Your Next Steps” to encourage the parent to “share this checklist with the doctor” and to “keep tracking milestones” and then return the checklist to the parent.
Check the first box under “Your Next Steps” to encourage the parent to “share this checklist with their doctor” and to “keep tracking milestones”. Suggest the parent read over the WIC specific parenting tips and then return the checklist to the parent.

Potential developmental concerns are indicated by a missing checkmark alongside ANY milestone OR ANY parental concern, written or otherwise, about the child’s development. In any of these situations, the child should be referred for developmental screening and follow-up.

REMINDER: Developmental milestone checklists are not screening tools nor are they indicators of developmental delay or disability. Rather, they are designed to engage parents in monitoring children’s development and to help staff and parents decide when to refer for developmental screening.

Unless there is another referral protocol in place, refer the parent to the child’s doctor for review of the checklist and for developmental screening:

“Great job completing your child’s milestone checklist, we know you want to support your child’s development…

“…It would be a good idea to talk with your health care provider about this checklist. I really care about what the doctor has to say about _____’s development.”
“…Please call _______’s doctor to schedule a follow-up appointment for developmental screening.”
“…I am going to write ______’s doctor’s name on it so you can give it to the doctor and he or she will know exactly what you want to talk about.”
“…I’d like to know what the doctor has to say the next time you come for your WIC appointment.”

Pro Tip: Record the Referral, Set an Alert!

When possible, note the referral in the child’s record. If available, an alert can be set as a follow-up reminder for staff to ask the parent about the outcome of this referral at the next visit. If appropriate in your state, following up on the referral can be included as a participant-centered goal.