Come in with specific, dated observations, meet privately, lead with the child’s strengths and describe what you see without labels or diagnoses. Then ask what the family sees at home, agree on one next step, like asking the pediatrician about a developmental screening, and follow up.

By our editors · Facts checked October 7, 2026. This guide is general information, not medical advice.

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The short version

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Why speaking up matters

About 1 in 5 children has a developmental delay or disability, according to the Centers for Disease Control and Prevention (CDC). You see a child for hours a day, next to a room full of same-age peers, so you may notice things first.

And in Massachusetts, it isn’t optional. Licensing rules (606 CMR 7.06) say special problems and significant developments must be documented and brought to parents as soon as they arise, not saved for the next progress report.

Before the meeting: do your homework

  • Talk about development all year. The CDC advises discussing progress regularly, not only when you’re worried. Then a concern isn’t the first hard conversation.
  • Gather observations for a week or two. Write down what the child did, the date, the activity and what helped. For behavior, note what happened right before and after.
  • Use a milestone checklist. The CDC suggests completing its free checklist for the child’s age so your comments rest on what you observed.
  • Loop in your director first. Massachusetts group programs must have a written referral plan covering how staff report concerns, how behavior is observed and recorded, how the program meets with parents and a current list of community referral contacts.
  • Plan the setting. Pick a private, unhurried time, not pickup in a busy hallway. Invite both caregivers if the family wishes, book an interpreter if needed and have contact information ready.

The conversation, step by step

  1. Start with strengths. Share something specific the child loves or does well.
  2. Say why you asked to meet. “I want to share a few things I’ve noticed and hear what you see at home.”
  3. Describe what you saw. Give two or three concrete examples and, for development, the milestone you’d expect at this age.
  4. Ask about home. Kids can act differently in different places, so the family’s view matters.
  5. Listen. Make eye contact, repeat back what you heard and ask how the parent feels.
  6. Agree on one next step. For example, the parent asks the pediatrician about a developmental screening, and you try one new classroom strategy.
  7. Set a check-in date. The CDC suggests following up in a few weeks.

What to say, and what never to say

Instead ofTry
“I think he has autism.”“I’ve noticed he rarely looks up when I call his name. What do you see at home?”
“She’s aggressive.”“This week she bit classmates three times, mostly during transitions.”
“He’s behind.”“Many children his age are combining two words. I haven’t heard that yet.”
“You need to get her tested.”“Would you be open to asking her doctor about a developmental screening?”
“Don’t worry, he’ll grow out of it.”“Checking early is the best way to know. If all is well, that’s good news too.”

Skip guessing at causes at home, comparing the child with siblings or classmates by name and promising what an evaluation will find. If the concern is behavior, our classroom playbook for biting, hitting and defiance has strategies to try while you talk.

What if the family gets upset?

Strong feelings are normal. The CDC advises acknowledging those feelings, saying you share the same goal and offering to talk again.

Don’t argue. Keep sharing what you observe and supporting the child in class. The decision about next steps belongs to the family.

Culture and language

How to suggest a screening or referral

You can describe what you see and explain where families can get answers. You can’t diagnose. The CDC encourages families to share concerns with the child’s doctor and ask about a developmental screening. If the doctor says to wait and the family is still worried, they can contact Early Intervention directly, no doctor’s referral needed.

Child’s ageWhere families can goCost
Under 3The Massachusetts Early Intervention (EI) program for their city or townNo out-of-pocket costs for families
3 and olderThe local public school district; ask for the Administrator of Special EducationEarly childhood special education is free to families

Massachusetts EI says anyone can refer a child. But state licensing rules require your program to get the parent’s consent before requesting information about a child from EI, the school district or other providers. The simplest path: give the family the contact information and offer to help them make the call.

For the signs families often ask about, point them to our guides on early signs of autism and ADHD and how to get an evaluation and when kids start talking and the signs of a speech delay.

Follow up

  • Check in after a few weeks: Did they talk with the doctor? How are things at home?
  • Document the meeting, any referrals and the results in the child’s record.
  • Keep supporting the child in class while the family decides. Don’t wait for an evaluation to try new strategies.
  • If the child qualifies for services, ask the family’s permission to share notes with the team.

For children who need extra support

If a child already has an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP), talk with the family about progress toward its goals and, with permission, coordinate with the therapists. Massachusetts programs must help develop and review the plan with EI or the school district when parents agree, and name an educator as the child’s liaison.

For behavior concerns, a state-funded early childhood mental health consultant can observe, coach you and help build a plan with the family. More: supporting IFSP and IEP goals in the classroom, IEP vs. 504 plan and our inclusive care guides.

Common questions

Can I refer a child to Early Intervention myself?

EI accepts referrals from anyone, but Massachusetts licensing rules require parent consent before your program contacts an outside provider about a child. Encourage the family to call, and offer to help.

What if the doctor told the parents to wait?

The CDC notes that families can contact Early Intervention directly, without a referral, to find out if their child is eligible. For kids 3 and older, families can contact their school district.

Should I tell parents what I think is wrong?

No. Share specific observations and how they compare with typical milestones. Only a qualified professional can diagnose.

How soon should I raise a concern?

Soon. State rules say significant concerns go to parents as soon as they arise. Take a week or two to gather clear observations, then ask for a meeting.

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