What to Do When You Have Concerns About the Development of a Child in Your Care
by Marny Helfrich, M.Ed
White House, TN

As a child care provider, you observe every day the wide variety of ways that children learn, grow, and develop. You delight in the emergence of individual differences and personalities and assure anxious parents that children ones are doing just what they should. You respect children as individuals and don't expect them to follow cookie-cutter patterns in their growth or temperament.

From time to time, though, a child may catch your eye whose development or behavior seems not just unusual but inappropriate. He seems to be dragging behind his peers. While a wide range of developmental patterns are considered "normal" and o.k., there are also children who need extra help and attention to catch up with peers and to learn to compensate for special challenges.

Between five and 10% of children from birth to age five have delays or disabilities in one or more developmental areas that may require help. Some of these children, such as those with Down's syndrome, are diagnosed at birth or shortly thereafter. Many others, however, are identified as they get older and fail to meet developmental milestones. Child care providers play an important role in recognizing when children have special needs and connecting them and their families to resources.

• First, trust your instincts. You probably have good reason for feeling there is a problem. (see "What to do" below).
• Trust parents. Often parents sense a problem but cannot identify it specifically. Persistent concerns, especially from experienced parents, should never be dismissed. Help connect these parents to resources for a thorough evaluation.
• Notice muscle tone. Experienced caregivers know how infants and toddlers should feel when held. As with any other indicator, there is a wide range of "normal," but a child who seems unusually "floppy" or "stiff" and is late to meet milestones like rolling over, sitting up, and standing may need further evaluation.
• Be aware of vision and hearing. Failure to respond to voices, inability to track objects, persistent ear infections should be thoroughly investigated. An assessment by an experienced doctor or audiologist is recommended; the "clap behind the baby's head" test is not accurate enough. Because sensory losses can effect all areas of development, early intervention is crucial.
• Pay attention to receptive language. What a child understands is an important indicator of language and cognitive development. A child who follows simple directions, points to objects on request, and seems to understand what is said to him at a year or eighteen months is probably doing ok, even if he or she is not saying many words. A child who does not seem to understand may have a hearing loss, language delay, or other concern and should be watched carefully.
• Forget Einstein. Parents whose older toddlers are not talking are frequently told not to worry, because "Einstein didn't talk until he was four." Whether or not this is true, it is not particularly helpful. A two-year-old who does not have at least 10 - 20 single words, or a three-year-old who does not use many three- and four-word phrases should probably be assessed further, especially if the child doesn't seem to understand well, seems frustrated or socially withdrawn, or has a history of ear infections.
• Be alert to regression. Any child may exhibit behavioral regressions, especially following a stressful event and development may plateau in particular areas from time to time, especially when learning a lot of new skills in other areas. However, the true loss of developmental skills, such as a child who was walking well begins to fall frequently, a child stops using words or uses significantly fewer, can be an indicator of serious problems and should be investigated.

These are not the only signs of developmental challenges. Failure to crawl, late talking and late toilet training often cause anxiety, but are less likely to be indicators of serious problems.

When providers have concerns about a child's development, having a partnership with the family is very important. Before approaching the family, document your concerns with clear, specific examples of the behavior the child is exhibiting or not exhibiting. Don't try to diagnose the problem; say "I've noticed that Susan is having trouble sitting up and her muscles seem very stiff," or "Joey doesn't use any words at school and doesn't seem interested in the other children," instead of "I think she has cerebral palsy" or "He's autistic." Doctors and psychologists, not teachers, have to make those kinds of diagnosises. However, if a parent asks about a specific disorder, certainly share any information or experience you may have with that condition or help the parent find more information. Be sure to include information about the child's strengths and abilities in the discussion as well.

Connect the family to resources for more information and further evaluation of the child. If the child is under age three, contact your local Early Intervention agency. You can find the agency in your area by contacting the National Information Clearing House for Handicapped Children and Youth (NICHCY) at 1-800-695-0285. If the child is three or over, contact your local public school system and ask to speak to someone about the Child Find program. These agencies will provide a thorough developmental evaluation at no cost to the family and will also provide services, such as speech, occupational, or physical therapy, special education, if needed. The child care program can be an important source of information during the evaluation and should be an integral part of any treatment plan that is developed. Remain in close contact with family throughout the process and offer to participate in any assessments or planning meetings.

Telling parents that their child may have a developmental challenge is never easy, and some parents may react angrily. Most, however, will appreciate your concern and insight, and many may in fact be glad to hear someone else put their unspoken concerns into words. Some parents may feel that the provider is looking to "dump" the child and will need reassurance that you are committed to working with them and their child if further evaluation reveals that there is a problem. Families and child care programs working together can identify young children who face developmental challenges and provide them with the special support they need to grow, learn, and develop to their maximum potential.

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