Cassie is a 9-month-old infant who has been in your program for several months. She is unable to sit without support yet, and seems to favor using her left hand only.

Max is a 2 and 1/2-year-old who just started in your program. He does not speak, has poor eye contact, and likes to play with a truck--he continuously spins its wheels, and would do so all day long if allowed. He shows no interest in the other children, or any other activity.

One concern for early childcare and education providers is whether or not the children in your care are developing normally. And for good reason! When children fail to develop properly, they may not reach their full potential.

A developmental delay occurs when the child is delayed in achieving one or more milestones, affecting speech, language and feeding, fine and gross motor skills, and/or personal and social skills. Providers also become concerned when a child demonstrates unusual or disruptive behaviors.

What can you do about a possible developmental delay or behavioral problem? A step-by-step approach can help guide your actions regarding a child’s development or behavior. Using an approach that incorporates observation, communication, cooperation, and caring can help the child obtain the attention and services needed for optimal growth and development.

Increase awareness Because of your experience with young children, you may be the first person to pick up on a possible delay. There are wide ranges and great variations of “normal” in skills and milestones in every age group. If you are concerned about a particular child’s development or behavior, you should follow your instincts and take the next steps.

Observe The first step is observe the child and document your observations. Write down only what you are observe. Do not include your own opinion; for example, write something such as: “Max was observed during play. For 15 minutes, he continuously spun the wheels of a truck; did not respond to verbal encouragement to join the other children in singing; he does not make eye contact even when the teacher sits close and tries to engage him. His speech did not include words today; consisted of grunt-like noises only.” Avoid making a diagnosis: do not write: “I think that Max is autistic.”

Document The next step is to organize and clearly document your observations, including dates and times. Keep a log or notebook readily available, and document observations over a period of time, preferably a week or two. Include observations of the child alone, with other children, and with adults. Also, observe different times such as arrival and departure, indoor and outdoor play, and during various activities.

Identify the concern Your documentation may provide enough information to review and determine a suspected problem. Look for patterns, triggers of the behavior, or consistent themes. If these clues support your concern, further attention is warranted.

Confer with others Confer with others such as your director, co-workers, and/or health consultant to discuss your observations and obtain objective feedback regarding your concerns.

It may turn out that there really was not a problem with the child. Perhaps the child was exhibiting developmentally typical behavior but you unwittingly had unrealistic expectations for this child.

For example, a caregiver who thinks that all 2-year-olds should be toilet-trained will usually be disappointed, possibly labeling some of the toddlers as uncooperative or stubborn when the children were developmentally normal.

Meet with parents If your concerns are validated by your co-workers or director, it is time to discuss concerns with the parent(s). Communication with parents should always be handled with care, but this is especially true when you are dealing with a sensitive issue such as a possible developmental delay or behavioral concern about a child.

Plan the meeting at a time convenient for the parents. Convey respect and understanding, encouragement, and support. Be gentle and compassionate in your approach--try to see the situation from the parent’s point of view.

Protect the family’s confidentiality and privacy; and above all, remain positive. The parents will be more receptive if you establish a foundation of trust and respect. Explain the purpose of the meeting, and present your observations. Avoid offering opinions or diagnoses, but rather concentrate on the observations, emphasizing positives while presenting your specific concerns.

For example, regarding Cassie, the 9-month-old who is not sitting, you could say: “Cassie is such a delight to have in my room! We really enjoy her. I have observed that she is not able to sit up by herself yet. What have you noticed?” Be prepared for a range of possible responses, including defense mechanisms such as disagreement, denial, and even anger.

Refer for screening, evaluation, and consultation The next step may be referring the child to professional resources for evaluation. The child’s health care provider is a key resource for initial evaluation of any health or behavioral concerns.

Infants and toddlers may be referred to an Early Intervention program. Part C of the Individuals with Disabilities Education Act (IDEA) provides early intervention services for infants and toddlers with disabilities, ages birth through age 2 years, and their families. School districts can be helpful in identifying resources for evaluation and services for preschoolers as well as older children. Ask your health consultant or childcare resource and referral agency for recommendations regarding specific resources in your community.

Implement a Special Needs Care Plan This plan helps with safe, successful, and developmentally appropriate intervention. The child’s health care provider or other professional involved with the child’s care management should complete a Special Needs Care Plan which includes actions, instructions, and specialized care to be followed by you and the parents.

When possible, it is preferable that intervention with the child includes him/her in normal daily activities. If there are special training needs for the childcare staff, these should be identified in the care plan. For example, a professional may recommend specific activities for you to do with Cassie (the infant who is not sitting) to promote her development. Having a plan to guide the child caregiver can maximize the opportunity for optimal development of the child.

Talk with the parents Constant communication with the parents is essential to the success of this process and allows for the exchange of updated information important for quality care for the child. Your positive and supportive attitude will be key to the child’s optimal development and well-being. Remember, this is a partnership that depends upon your commitment, patience, and cooperation.

Also, keep the child’s health care provider informed of therapy plans or observations of the child so he or she can continue to provide the best care during medical visits.

Patti Lucarelli, RN, MSN, CPNP
Child Care Resources, New Jersey

To find a local early intervention program, contact National Early Childhood TA Center, Campus Box 8040, UNC-CH, Chapel Hill, NC 27599-8040; 919-962-2001; www.nectac.org/idea/idea.asp

Zero to Three, National Center for Infants, Toddlers and Families, 2000 M St., NW, Ste. 200, Washington, DC 20036; 202-638-1144; www.zerotothree.org

American Academy of Pediatrics, www.aap.org/topics.html

Born Learning, www.bornlearning.org

Centers for Disease Control & Prevention, www.cdc.gov/ncbddd/autism/ActEarly/default.htm

Center on the Social and Emotional Foundations for Early Learning, www.csefel.uiuc.edu

First Signs, www.firstsigns.org