Children from bilingual backgrounds are sometimes overidentified with language impairment (LI) because educators do not have appropriate developmental expectations. At other times bilingual children are underidentified because educators wait to identify difficulties while children learn the second language. In this review we discuss data on language acquisition from several sources including cross-linguistic studies of typical first language acquisition and LI in monolingual and bilingual children. Based on this literature we discuss problems with current assessment approaches. We then propose a decision-making framework for identification of bilingual children who are at risk for LI. A key feature of this proposal is the importance of clinical markers for identification of LI.