Four smiling young children

Helping Childcare Providers Monitor Children’s Development Using Learn the Signs. Act Early.

What was this study about?

The purpose of this study was to learn whether it is easy, appropriate, and useful to do developmental monitoring using research-based Learn the Signs. Act Early. resources in childcare settings.

What is Learn the Signs. Act Early.?

The Centers for Disease Control and Prevention (CDC) developed Learn the Signs. Act Early. to support developmental monitoring. Studies show that parents like Learn the Signs. Act Early. materials, and materials helped parents learn about developmental milestones and about what to do if there was a concern.1 Learn the Signs. Act Early. includes free print and online materials for parents and providers. It also includes a free online training for childcare providers. Learn the Signs. Act Early. resources are designed to:

  • Increase knowledge about developmental milestones
  • Support parent-professional conversations about child development
  • Increase awareness of signs of developmental delay
  • Increase knowledge about what to do next when there is a concern about a child’s development

What questions did the study address?

  1. How appropriate do childcare providers and parents think it is to do developmental monitoring using Learn the Signs. Act Early. in childcare settings?
  2. How does an online training impact childcare provider knowledge and attitudes about developmental monitoring?
  3. What makes it easy for childcare providers to do developmental monitoring?


Act Early Wisconsin

Act Early Wisconsin aims to support state and regional efforts to promote early identification and intervention for children with signs of autism spectrum disorders and other developmental disabilities. The website offers access to Learn the Signs. Act Early. resources, including free materials customized for Wisconsin.

“Watch Me! Celebrating Milestones and Sharing Concerns” Training

This free, online training course provides childcare providers with tools and best practices to help them monitor the development of children in their care and talk about children’s development with their parents.

For More Information

Gail Chödrön, PhD

What is developmental monitoring and why is it important?

Developmental monitoring means observing children over time and tracking how they reach milestones. Developmental monitoring helps parents and professionals notice when children are not reaching milestones that are typical for their age. When this happens, a trained professional can do a developmental screening to see if there is a concern.

The Individuals with Disabilities Education Act (IDEA 2004) requires states to have a comprehensive Child Find system to identify children who have developmental delays or disabilities.2,3 These children may qualify for intervention services that can improve outcomes for children and their families.4,5 However, the majority of children with developmental disabilities do not access these services before school entry.6,7 Research suggests children with developmental delays are much more likely to receive early intervention when both developmental monitoring and developmental screening are done.8 If more professionals who work with young children do developmental monitoring, children with developmental delays may access intervention sooner.

Why study developmental monitoring in childcare settings?

Over half of U.S. children under the age of 5 attend some form of childcare, so childcare providers may be among the first to notice developmental delays.9 Most childcare providers don’t have access to the training or tools to do developmental screening, but they can still play a role in tracking children’s developmental milestones and talking with families.

Learn the Signs. Act Early. resources include a free online training for childcare providers (“Watch Me! Celebrating Milestones and Sharing Concerns”) and other materials that are designed to be easy to understand and use. Although high-quality resources like this are available for developmental monitoring,
it was not clear how easy and impactful it is to use these resources in the childcare setting. This study was conducted to determine whether developmental monitoring with Learn the Signs. Act Early. can be an easy, appropriate, and useful way to do developmental monitoring in childcare settings.

A man reads a book to three young children in his lap


Milestones are skills such as taking a first step, smiling for the first time, and waving “bye bye.” Children reach milestones in how they play, learn, speak, act, and move (crawling, walking, etc.).

Developmental monitoring means observing how children are reaching milestones in how they play, learn, speak, act, and move every day. Parents and professionals can both observe milestones. Developmental monitoring often includes keeping track of milestones using a checklist.

Developmental screening is a formal process. Trained professionals use a standardized, validated tool at specific ages to determine if a child is at risk for developmental delay. A concerning screening result suggests more information should be gathered to determine whether intervention is needed.

Child Find is a component of IDEA that requires states to identify, locate, and evaluate all children with disabilities (ages birth to 21) who need early intervention services.2,3

How did we study this topic?

We completed three related studies:

1. What do parents and childcare providers like about using Learn the Signs. Act Early?

We talked to parents and childcare providers to learn how to use Learn the Signs. Act Early. appropriately in childcare settings. A total of 17 parents and 11 childcare providers participated in group interviews, also called focus groups.

2. What is the impact of training?

Individual childcare providers across the country answered an online questionnaire before and after completing the “Watch Me!” training. The questions measured the impact of training on knowledge, attitudes, and practice. If participants wanted to use Learn the Signs. Act Early. materials after that, they needed to order them from the CDC. A total of 400 childcare providers participated in this study.

3. What makes it easy to do developmental monitoring in childcare?

18 childcare programs were recruited to have all program staff complete training and use Learn the Signs. Act Early. Participating childcare programs got help to develop a plan for program-wide implementation. Programs got a supply of all the Learn the Signs. Act Early. materials they needed. Programs also got help addressing any questions or challenges that came up. The childcare providers in each program completed the “Watch Me!” training and answered the online questionnaires before and after. We also collected data through interviews with the program director and a questionnaire for parents to answer at the end of the nine months. A total of 18 program directors, 153 childcare providers, and 156 parents participated in this study.

What did we learn?

Many childcare providers believed it was important to monitor children’s development even before taking the “Watch Me!” training, but very few knew about Learn the Signs. Act Early. resources.

Childcare providers worried parents would not want them to talk about developmental concerns or to refer parents to the doctor. However, parents were comfortable with childcare providers talking about milestones and referring to the doctor.

Training and use of Learn the Signs. Act Early. materials increased childcare provider comfort with talking to parents about milestones and concerns. Childcare provider knowledge about developmental monitoring increased, too.

Developmental monitoring was much more likely to happen when childcare providers were part of a program where all providers got trained and used Learn the Signs. Act Early. resources.

What does this mean for childcare?

Childcare providers can be reassured that most parents feel comfortable with developmental monitoring in childcare settings.

Completing the “Watch Me!” training can help childcare providers gain the knowledge and confidence to do developmental monitoring.

Planning for program-wide developmental monitoring may make it easier to use Learn the Signs. Act Early. in childcare settings.

What comes next?

We are putting together a childcare “toolkit” to make it easy for childcare programs to get started with developmental monitoring. This toolkit will be available online in late 2018.

We are conducting a new study about the impact of Learn the Signs. Act Early. in Early Head Start programs.


This evaluation was conducted in collaboration with Kris Barnekow, PhD, UW-Milwaukee; Steve Viehweg, MSW, MSW, ACSW, LCSW, IMH-E®, Indiana University; and Joan Ershler, PhD, Waisman Center, UW-Madison. Quantitative analysis was completed with consultative support from Brian Barger, PhD, Georgia State University. This evaluation study was supported by funding from the Disability Research and Dissemination Center (DRDC) through its cooperative agreement number 5U01DD001007 from the Centers for Disease Control (CDC) and Prevention and by the Clinical and Translational Science Award (CTSA) program. Data analysis was supported in part through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the DRDC, the CDC, or the NIH.


1  Daniel K, Prue C, Taylor M, Thomas J, Scales M. ‘Learn the signs. Act early’: A campaign to help every child reach his or her full potential. Public Health. 2009;123. doi:10.1016/j. puhe.2009.06.002.

2  Early Intervention (Part C of IDEA) – Articles, Cases, Resources, Info & Support from Wrightslaw. Wrightslaw. dpuf. Accessed May 15, 2018

3  20 U.S.C. §1412 State Eligibility Accessed May 15, 2018

4 Croft C. Talking to families of infants and toddlers about developmental delays. YC Young Children. 2010;65(1).

5 Guralnick MJ. Why Early Intervention Works. Infants & Young Children. 2011;24(1):6-28. doi:10.1097/iyc.0b013e3182002cfe.

6  ECTA Center. Part C National Program Data. ECTA: Early Childhood Technical Assistance Center. Published April 2018. Accessed May 15, 2018.

7  Macy M, Marks K, Towle A. Missed, Misused, or Mismanaged. Topics in Early Childhood Special Education. 2014;34(2):94-105. doi:10.1177/0271121414525997.

8  Barger B, Rice C, Wolf R, Roach A. Better together: Developmental screening and monitoring best identify children who need early intervention. Disability and Health Journal. 2018. doi:10.1016/j.dhjo.2018.01.002.

9  Office of Planning, Research & Evaluation (OPRE). Number and Characteristics of Early Care and Education (ECE) Teachers and Caregivers: Initial Findings from the Survey of Early Care and Education (NSECE). Office of Child Care | ACF. and. Published November 5, 2013. Accessed May 15, 2018.