As caregivers, we want to provide the best care for our charges. But what happens when you work with a child who behaves or learns in ways that fall outside of your experience? Most importantly, when should you voice your concerns to their parents?
A caregiver may need to inform parents if they observe behavior that is “dangerous to the child or others,” says Kristin Carothers, Ph.D., a clinical psychologist and cognitive behavioral therapist in Atlanta.
She also adds that caregivers should speak up if they notice changes in a child’s behavior or when they have concerns a child is not meeting developmental milestones “like walking, talking, showing interest in others, toileting.”
But what qualifies as unsafe behaviors, developmental delays and signs a child may have different needs? And how do you raise the topic with parents? Experts share their insights below.
Signs and symptoms that something is ‘different’
While it is not the place of a caregiver to provide medical or psychiatric advice, there are a few behaviors or challenges to pay attention to:
Struggles with social interaction
Sometimes, kids are shy. And sometimes, kids are very independent. But are there signs that your charge’s behavior is more than that? Mitch Nagler, MA, LMHC, director of Bridges to Adelphi Program and part of the Adjunct Faculty at Gordon F. Derner School of Psychology in Garden City, New York, says caregivers can monitor their charges for:
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Difficulty responding when their name is called.
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Disinterest in communicating at length or at all.
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Lack of eye contact.
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Overreacting to loud noises, crowds, etc.
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Avoiding physical affection.
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Avoiding new situations or new things (i.e. clothing, foods, etc.).
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Hyperfixating on objects rather than people.
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Preferring to play alone rather than with other kids.
Trouble learning
According to Nagler, many kids with ADD, ADHD or learning disabilities exhibit behaviors that indicate frustration or lack of understanding. While every kid learns in a different way, caregivers should pay closer attention if their charge has:
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Difficulty absorbing new information (i.e. struggling to remember information, frustration when asked what they’ve learned, etc.).
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Difficulty speaking or learning new words.
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A tendency to find distractions when they should be focusing on something.
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Problems “switching gears” from one task to the next.
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Negative reactions to reading or learning activities (i.e. tantrums, refusal to participate, etc.).
Inflexible behaviors and routines
According to Robert Johnson, a therapist and child psychologist at Better Support Service in Miami, caregivers should also keep an eye on charges who must stick to a routine or who must do things in a certain way. Johnson explains that, sometimes, autism spectrum and behavioral disorders show up in behaviors like:
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Repetitive behaviors and actions (doing things in the same order, following the same routine every day, etc.).
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Distress over small changes in their surroundings.
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Refusal to try new foods, new activities, or meet new people.
Diana Fitts, an occupational therapist and founder of the Sensory Toolbox, says caregivers who are new to a family may be especially aware of the above signs. This is because they bring change and may not know the “right” way to do something.
Fitts says that, while many kids have separation anxiety and act up with a new caregiver, “Striving to stick to a strict routine and having a meltdown if it isn’t followed can be a sign that something bigger than separation anxiety is going on.”
Physical hyperactivity
Kids are naturally hyper, but caregivers may have concerns that their charge is overstimulated or “hyperactive.” What would that look like? According to Nagler, there are certain stimulating behaviors that kids with hyperactive disorders (like ADD and ADHD) may exhibit, like:
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Flapping their hands.
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Jumping up and down.
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Spinning.
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Tapping legs (especially when seated at a desk or table).
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Drumming fingers.
Talking about your concerns
If you have something to be concerned about, it’s time to have that conversation with parents and then talk to the real experts. Telling a parent or family about our opinions or concerns can be scary, but as caregivers it’s actually our job to make sure that our charges get the best care possible. So stop worrying about whether or not you should, and let’s talk about how.
1. Keep it simple
When you first introduce the topic of your concerns, don’t overdo it.
“Be very gentle about it,” says Dr. Nikola Djordjevic, of Belgrade, Serbia. “Start by describing the child’s behavior. This might be enough for the parents to start thinking about it themselves.”
Licensed child and family psychologist and expert writer at ParentingPod.com Ana Jovanovic also suggests that you use nonjudgmental language when describing your concerns.
“If you’ve seen a child smash and throw things if they lose patience, do not attach ‘aggressive,’ ‘hyperactive’ or other adjectives to it,” she says.
2. Ask for their experience
Jovanovic also recommends that you bring parents into the conversation. Start the conversation with something like: “I wanted to share some of my observations and get your feedback on them. I’ve noticed that, in the past month, your child has [insert behavior]. Have you noticed this as well?”
Asking parents for feedback on your observations can be useful, Jovanovic explains, because it can sometimes shed some light on certain behaviors. Maybe the parents know something you don’t that can help you better care for the child, such as a traumatic event that the child is still working through or how they are working to manage certain behaviors.
“Also, with an open invitation to provide you with their feedback, you are acknowledging their role as responsible and observant parents who pay close attention to their child’s needs, rather than presenting yourself as a critic,” Jovanovic says.
3. Make a plan to monitor the child together
When you first bring up your concerns, keep in mind that it’s simply going to be a conversation that gets you and the parents on the same page. From there, you can monitor the child and work together to find solutions.
Jovanovic offers a great tip to recruit parents in your efforts. She says to tell the parents: “If you agree that [child’s behavior] is a concern, I will pay close attention to it and how it changes while we’re together. I would really appreciate if you could give me updates on whether you’re seeing anything similar while you are spending time together.”
4. Remind parents that you are not the expert
After the initial conversation, parents may ask you if you’ve noticed any changes or if you think a child has a specific diagnosis. This is where it’s important to admit your limits: You’re not a doctor or an expert. You can always provide resources, like relevant (and expert) blogs, books, etc. to help guide the conversation, but always recommend they speak to an expert if there are more specific concerns or questions.
“When our nanny had concerns about our child’s behavior, I trusted her opinion so much” says Eryn Mangiers, mom of a daughter on the autism spectrum from Thornton, Colorado. “I just wanted to know what to do and asked a ton of questions. I think I ended up freaking her out a little. After a few days of skirting around the issue, she asked that I talk to a doctor or make an appointment with my kid’s school counselor. I realized that I was asking for answers she couldn’t give me, but I’m glad she directed me to the resources we really needed.”
5. Be patient
Don’t expect the first conversations about your concerns to lead to an immediate evaluation or a mad dash to fix “all the things.” Some parents may not be ready to do anything right away; some require a little time to warm up. Don’t take this personally, or assume the worst of them.
“When I first started working with my newest charge, I noticed she was really focusing on objects rather than faces when someone spoke to her,” says Jenny Ochoa, a day care teacher and nanny from Miami. “I didn’t know the family well enough yet, so I held back my questions for a few weeks. Once I broached the subject (gently), they immediately said that she was just a baby and that it was totally normal to not look at faces.”
Ochoa conceded to the parents’ opinions and let it go until one day when the mom asked if Ochoa felt her daughter’s eye contact had improved. This led to an open conversation about how they could work together to assess the child’s reactions and to talk to the family pediatrician about their concerns.
Focus on what’s best for the child
Regardless of which behaviors or symptoms you’re concerned about, the age of your charge or what your relationship is with his or her parents, it’s your job as a caregiver to advocate for them.
“Encourage parents to get professional support and intervention,” says Nagler. “Interventions can begin as early as 18 months.”
He says this can make all the difference for children with a wide range of challenges.
Of course, this can be an emotional time for both you and the family, but as Djordjevic explains: “Don’t push the topic. Show that you are well-meaning and kind and that you sincerely care for the child.”
