Learn the Signs, Act Early is a program of the Centers for Disease Control and Prevention. It offers activities and materials that foster recognition of developmental milestones. The CDC Act Early website has free online materials for parents, credit-bearing professional development for early educators and health professionals. Examples include:

• For Parents in Spanish and English: Amazing Me-It’s Busy Being 3! Download the FREE iBook or PDF version or order a FREE print copy at www.cdc.gov/AmazingMe
• For Early Educators: Watch Me! Celebrating Milestones and Sharing Concerns is a FREE, 1-hour online continuing education course. The engaging videos are in 4 modules that take a total of an hour to view. They show how teachers/caregivers monitor the development of the children in their care and talk with parents about developmental concerns. For the continuing education credit, users must complete all 4 modules, each quiz and a final evaluation. Access the training at www.cdc.gov/WatchMeTraining Reviewed and reaffirmed 3/2018.

The Centers for Disease Control and has created a 14 page Go Out and Play! Kit for use in early learning programs as part of its "Learn the Signs, Act Early" Campaign. The kit coordinates developmental milestones with games and activities for preschool children. In addition to tips for making outdoor activities fun and educational, the kit includes information for caregivers/teachers to use and for parents to engage in at-home play.  Reviewed 3/2018 

Easter Seals is offering a free online version of the Ages and Stages Questionnaire (ASQ) developmental screening tool. Both parents and child care providers can use the ASQ to track children's development through age five. The tool can identify concerns for which children should receive appropriate services to be ready to enter K-12 school. The ASQ online does not include the component that evaluates behavior. However, it is widely accepted for basic screening. Many Keystone STARS programs are using a version of the ASQ now.

General information about ADHD for parents and caregivers. See Managing Chronic Health Needs in Child Care and Schools, 2^nd Edition available from the bookstore of the American Academy of Pediatrics at https://shop.aap.org/ or search www.healthychildren.org for more information. In PA, please send your health and safety request with your name and phone number to This email address is being protected from spambots. You need JavaScript enabled to view it..

Is there a child in the early education program who is more active than the other children? Is this a child who doesn't seem to pay attention or follow directions? Such children are very hard to handle!

Teachers/caregivers, the child's family and the child will benefit from seeking guidance about how to care for a child with this behavior. Teachers should talk with a supervisor about a good way to share their concerns with the child's family. The family may have similar concerns and not know where to turn for help.

Behavioral problems, inattention, hyperactivity, or impulsivity are symptoms of attention-deficit/hyperactivity disorder (ADHD). The American Academy of Pediatrics publishes clinical practice guidelines. One of these specifies how to assess, diagnose and treat children as young as 4 years of age who have ADHD symptoms. The guideline says that the child's health care provider should do an assessment that includes a complete health history, vision, hearing and developmental-behavioral screening and a physical exam. The assessment may reveal one or more problems that require further evaluation.

With parent consent, the early education staff should offer to share with the child's health care provider any information the program has collected about the child. Include any developmental-behavioral screening or observations. You can use the Behavioral Data Collection Sheet, a form in the Tools tab of the ECELS website. This sharing of information can be a valuable contribution to the health professional's assessment.

The initial treatment for preschool-aged children with ADHD is evidence-based family and/or teacher-administered behavior therapy. Plan with the child's therapist and family how the program staff should handle the child's behavior. Consistent approaches at home and in the education program usually work well. The best way to do this is to have a written Care Plan.

Pediatric health professionals will be aware of local options for behavior therapy for young children. A good starting point for families and teachers/caregivers to learn about "challenging behaviors" is to go to the PA Promise for Children website, www.papromiseforchildren.com. Click on the "Help Your Child Grow" heading on the home page. Then select "Dealing with Challenging Behavior". Caring for a child's challenging behavior is difficult. However, the child will benefit when program staff, the child's family and the child's health care provider make and carry out a plan together.

Contributed by Beth DelConte, MD, FAAP - ECELS Pediatric Advisor

Reference: Center for Disease and Prevention (CDC)/Attention Deficit Hyperactivity Disorder (ADHD) http://www.cdc.gov/ncbddd/adhd/guidelines.html

Observers of early education programs often hear background music played by an electronic device. Some of these devices have screens; some do not. Unless the music plays a role in the activity, turn it off.

Recently, ECELS Pediatric Advisor Dr. Susan Aronson asked nationally recognized Developmental-Behavioral Pediatrician, Dr. Heidi Feldman, MD, PhD to share what she knew about the impact of background music or noise in general on language learning. Dr. Feldman noted that environmental audiologists have measured the ratio of signal (what we want children to hear) to noise in class-rooms. She noted: “It is shockingly small, 3 to 5 decibels.” For children with weak language or attention, she said that this minimal difference in sound level makes listening and understanding language challenging.

Tips for parents and caregivers addressing the causes and solutions for common behavior concerns in young children. Reviewed and reaffirmed 4/2018.

Good health includes social, emotional, and behavioral wellness. Use approaches to support positive behavior in young children. This will encourage wellness for all children in your care. Teach children appropriate ways to manage their own behavior. The goal is to teach and guide children, not to punish. Strategies include using clear rules and supportive language. Offering alternatives to undesirable behavior and natural consequences are excellent options.
Common challenging behaviors in child care can include biting, defiance, and tantrums. Some behaviors persist and raise concerns. The child may not respond to appropriate positive interventions. Persistent difficult behaviors may include excess anger, aggression, and social withdrawal. What steps should be taken?

Why do children misbehave? What resources are available to prevent suspension or expulsion from child care? Learn about strategies to help manage children with challenging behaviors. Pediatric health expert, Dr. Nathan Blum, Chief of the Division of Developmental and Behavioral Pediatrics at The Children's Hospital of Philadelphia and Julia Slater, MEd, Educational Consultant, Early Intervention Technical Assistance presented this webinar with ECELS on January 14, 2016.

This professional development session is designed for child care program directors, family child care providers, health professionals, child care health consultants, child care health advocates, supervisory staff, Regional Key staff, instructors and MIECHV home visitors.
Participants will receive 1.5 hours of professional development credit for participating and submitting an evaluation. PA Key credit is available for the recorded version. To listen to the recording click here

Participants will learn how to:
1. Explain factors that lead to challenging behaviors
2. Describe resources to use to help families whose children are at risk for suspension or expulsion from child care
3. Identify strategies to help manage children with challenging behaviors
4. Identify policies to promote behavior management

Reviewed and reaffirmed 8/22

This updated online self-leaning module will help you to promote mental health in young children. Learn about biological and environmental risk factors for challenging behaviors. Use tools to review for behaviors related to childhood development. Find out strategies to help manage children with challenging behaviors and identify policies to help prevent suspension and expulsion of children. Understand the importance of open communication with parents and use resources to help children with challenging behaviors and their families. Reviewed and reaffirmed 8/2022

This form is intended to be used by teachers/caregivers to document a child’s behavior that is of concern to them. The behavior may warrant evaluation by a health care provider, discussion with parents/legal guardians, and/or consultation with other professionals. This documentation facilitates communication by recording the observations of the child and the circumstances in which the observations were made. Reviewed and reaffirmed 4/2018.

New research shows parents whose children are in child care gain more than freedom to pursue adult-only activity. They reap social, psychological, and financial rewards. Collectively, these rewards are called “social capital.” They add to the benefits of early education for children. This is especially true for low-income mothers. Advocates can use this new evidence to seek universal access to quality early education.

Mario Small at the University of Chicago found that many mothers benefit from relationships with staff and other families.  The data came from four sources. The first was a national survey of 3,500 mothers in 20 large U.S. cities. The second source was a survey of 300 child care centers in New York City. The third was 67 in-depth interviews with mothers who enrolled children in child care. The fourth source was 23 case studies and observations in specific centers.  They didn’t study what fathers gain from having their children in child care. However, the benefits for mothers are likely to help them too.

Having common problems to solve leads parents to form a support network of friendships. These relationships go beyond interactions at the child care facility. Some parents talk to other parents and staff about feeling guilty. Some aspects of U.S. culture foster parents’ feelings of guilt. Many people think parents who need and want to share the care of children outside are less competent than those who share care only within the family. Most parents know they shouldn’t “drop and run” in the morning, but it happens.  Families may have something come up that makes it hard to pick up their children on time. All these situations contribute to feelings of guilt. Parents  who use child care develop trusting relationships with other parents. This helps them make back-up arrangements with one another. Centers that have strict drop-off and pick-up times foster interfamily friendships by bringing family members to the facility at around the same time. Field trips involving parent volunteers and special family events at the child care facility encourage a sense of extended family too. Families may share concerns with one another about discipline, child-rearing practices or needed services. Some parents find when they share their concerns, child care staff and other families offer good advice and refer them to helpful resources and services. This benefit is particularly valuable in poor neighborhoods.

The Office of the Administration for Children and Families (ACF) in the U.S. Department of Human Services has brought together a list of resources related to developmental screening and referral for early intervention. The materials listed in the collection are from a group of federal agencies. The content on the website is separated into the materials most helpful to specific users: early care and education providers, primary care providers, early intervention and special education providers, families, communities, child welfare, home visitors, behavioral health providers, and housing & homeless shelter providers.The website offers a compendium of evidence-based developmental screening tools, everyday tips for early care and education providers to support child development, and guides for finding services in the community. As ACF says: "Effective promotion of healthy child development and wellness is best achieved early in a child’s life with well-coordinated, multi-sector coordination of services and communication with families. Public awareness of typical child development and risks for delay, developmental and behavioral screening, early identification of delays as well as linkages to referral and follow up services can be delivered anywhere young children and families spend time--in the home and in communities through a range of programs and services." Access the English version of the resources at http://www.acf.hhs.gov/programs/ecd/child-health-development/watch-me-thrive. For the Spanish description of the resources go to Del nacimiento a los 5! Informacion y Destacados at https://www.acf.hhs.gov/sites/default/files/ecd/b_to_5_one_pager_spa.pdf. For the Early Care and Education Providers Guide in Spanish, go to Providors Cuidado y Educación Infantil at https://www.acf.hhs.gov/sites/default/files/ecd/ece_providers_guide_spanish_508.pdf. Reviewed and reaffirmed 3/2018. 

Tips for parents and caregivers on managing human or animal bites. See Managing Infectious Diseases in Child Care and Schools, 5th Edition available at https://shop.aap.org  or search www.healthychildren.org for more information. In PA, please send your health and safety request with your name and phone number to This email address is being protected from spambots. You need JavaScript enabled to view it..

This form facilitates communication from health care providers to other professionals who work with the child and family as part of formulating a coordinated and consistent plan of care for children with behavioral concerns. Reviewd and reaffirmed 7/2018.