While we often associate this as a problem for older children, communities nationwide including Philadelphia are experiencing high rates of 1- to 3-year-olds being suspended or expelled from preschools and day care centers. Preschools are expelling children at a rate three times higher than K-12 schools.

We spoke with Marsha Gerdes, PhD, a senior psychologist at PolicyLab at Children's Hospital of Philadelphia, who recently along with the Public Health Management Corporation participated in a webinar examining the issue.

In Philadelphia, 26 percent of child care settings reported in a survey PolicyLab conducted last year that they expelled at least one child, and 37 percent reported having suspended a child under the age of five in the 2015-2016 school year. Were these numbers surprising to you?
From my clinical practice and from hearing from CHOP primary care providers, I know that parents often report being asked to withdraw their child due to their behavior. I was less aware of the high incidence of suspension.

The most surprising finding was that toddlers (ages 12-36 month) were just as likely as preschoolers (ages 3 to 5 years) to be expelled or suspended. Because tantrums, emotional outbursts and even biting can be part of typical development at that age, it is sad to think that 2-year-olds are being excluded due to normal behavior.

What is the impact of the suspensions and expulsions?
Suspension and expulsions impact the child, family, teachers and child care center.

The child can experience sadness from this harsh exit, loss of early childhood learning experiences that are key to kindergarten readiness, and possibly further stressful experiences in other child care setting. Some children struggle and might even get expelled from the next child care center, and the stress on those children is even greater.

Parents experience stress from locating alternative care, loss of time away from work, and sometimes loss of employment. The process of obtaining support through public or private mental health or Early Intervention programs are time consuming and can be frustrating.

Additionally, parents often feel the stigma of having their child labeled and experience hopelessness in managing these challenges.

For teachers who expel children for behavior challenges, their perception of expulsion as a solution is wrongly confirmed and they are no more prepared to help the next toddler or preschooler with a behavior problem than they were before. Furthermore, the child care center might have less motivation to change their curriculum to support behavioral skills.

What is being done in Pennsylvania to address this issue?
Pennsylvania has taken important steps to reduce expulsions and suspensions in child care settings. Child care centers are now required to have a written policy about expulsion and suspension. The state also encourages these centers to be knowledgeable about community supports and implement social-emotional curriculum into their teaching. Also, counties across the state have been holding workshops to train child care workers.

Yet, there are still opportunities for improvement. Child care centers could use some more help from the state in funding evidence-based behavioral supports for children and on-site coaching for child care staff, such as Positive Behavioral Intervention and Supports (PBIS). Also, the state would benefit from setting up a registry of expulsions and suspension that would provide Pennsylvania with a way to track progress and an understanding of if our targeted initiatives are reversing the trends we're seeing.

What questions should parents ask about suspension and expulsion policies when looking at a preschool or day care?
Parents can look for a high-quality child care center by examining the state's Keystone STARS program, which identifies child care centers that utilize research-based best practices and promote quality learning environments for positive child outcomes.

Parents should also ask potential child care centers about their suspension and expulsion policies. They should be reassured if they hear that each classroom uses structure and routine, recognizes children for being "good," and has a positive approach to behavioral support. High-quality centers also commit to open communication with families about concerns and are willing to partner with families to identify any additional supports that might be a help for the child. It's important to see if the child care center has made a commitment to embrace all children, including those with behavior challenges.

As a parent, what can you do if your child is suspended or expelled from preschool? What can you do to address the behavior if it's ongoing?
First, don't panic. This might have been a rough time for your child and you first want to support them by spending time with them, talking with them, hearing about their experiences and playing with them at home. A little more positive attention at home will help a lot.

If your child is suspended, ask your child care center to contact Early Childhood Mental Health Consultation (ECMH) services in Philadelphia at 215-219-8967. They will send an early childhood specialist to your child's classroom to advise the teacher on ways to help your child fully participate in the classroom. If your child is expelled, you can ask for this service to begin in the next child care setting.

Contact Early Intervention (EI) at 215-685-4646 if your child is under 34 months and at 215-895-5500 if your child is older than 34 months. EI will conduct a multi-disciplinary assessment to learn more about your child's strengths and challenges and determine if they are the right agency to provide supports such as speech therapy or special instruction.

Contact Child Care Information Services (CCIS) in your area by calling 1-888-461-5437 and they can help you find a new child care setting.

If you are concerned that your child's challenging behaviors are more intense or more frequent than other children the same age, you might also want to seek help from a mental health provider. With young children, the best therapy includes the family. There are places in Philadelphia that offer Parent Child Interaction Therapy (PCIT), the most effective therapy for toddlers and preschoolers. You can find a therapist by calling your medical health insurance provider (usually listed on the back of your card) or if your child has insurance through Medicaid call 215-413-3100.

Dr. Gerdes is also a clinical associate professor of pediatrics at the University of Pennsylvania's Perelman School of Medicine. She has worked at Children's Hospital of Philadelphia for over 20 years ensuring positive outcomes for young children at risk for poor developmental outcomes.