Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1086 (doi:10.1542/peds.2004-1655)

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COMMENTARY

Supporting Vulnerable Preschool Children: Connecting the Dots Before Kindergarten

Michael E. Msall, MD

Department of Pediatrics
University of Chicago Pritzker School of Medicine
Comer Children’s and LaRabida Children’s Hospitals
Chicago, IL 60637

Forty-one years ago, the infant son of President John F. Kennedy died at Children’s Hospital in Boston after being born 5.5 weeks prematurely and weighing 2.1 kg.¹ At that time, there were no regional systems of maternal transport and neonatal care, no National Institute of Child Health and Human Development or program projects supporting research in developmental biology, no screening for genetic disorders that cause mental retardation, no Head Start programs, and no laws ensuring that children with challenges would have the supports required to succeed in school and the community. Three decades later President George H.W. Bush, who had lost a daughter to leukemia and had a son who struggled with reading, convened a conference of governors from all 50 states. These leaders unanimously agreed on a most ambitious goal that by 2000 all children who entered kindergarten would be ready to learn.² Now in a decade of revolutionary advances in molecular, developmental, and systems biology, we as a pediatric community face 2 major challenges. First, how can we ensure that developmental and behavioral supports exist for families after benefiting from advances in pediatric care? Second, how can we ensure that young children in families struggling with poverty access quality health and preschool developmental supports?³

The study by Roth et al⁴ in the September issue of Pediatrics builds on advances of regionalization of Florida’s nurseries, collaboration between health professionals and social scientists to link information on birth certificates to subsequent school success, and policy initiatives of the Chiles Center for Healthy Mothers and Babies. Of the 120 554 children born in 1990–1991 with links to kindergarten data, biomedical risk included 0.3% with birth weights of <1000 g, 0.7% with birth weights of 1000 to 1499 g, 6.1% with birth weights of 1500 to 2499 g, and 1.3% with congenital anomalies. These medical conditions contributed $19 300 000 to extra kindergarten costs. The social risks were much higher: 37% were born into poverty, 28% had parents who did not complete high school, 15% had teen mothers, and 7% had less than optimal prenatal care. These social risk factors were responsible for almost $129 000 000 in extra kindergarten educational resources. It is tragic that at this time <1 in 3 children in poverty had access to Head Start. Similarly, there are major gaps for children in poverty with all degrees of low birth weight to accessing comprehensive early intervention services.⁵

In an era of debates about health and educational reform, this study has an important lesson to teach: poverty is not a developmental enhancer. If we are going to test all elementary school children, we must also release report cards that examine gaps in accessing quality medical homes and home visiting, early intervention, early start, and early childhood programs. We must work together to connect the dots of biopsychosocial supports that will allow all children in 2010 to enter kindergarten healthy and ready to learn.

	FOOTNOTES

 
Accepted Aug 2, 2004.

Reprint requests to (M.E.M.) University of Chicago Pritzker School of Medicine, Comer Children’s and LaRabida Children’s Hospitals, 5841 S Maryland Ave, MC0900, Chicago, IL 60637. E-mail: mmsall{at}peds.bsd.uchicago.edu

	REFERENCES

TOP REFERENCES

 

1. Blair WM. 2d Son born to Kennedys; has lung illness. New York Times. August 8, 1963;P1
2. Goals 2000: Educate America Act of 1994. Pub L No. 103-227, 20 USC 5801 et seq
3. Shonkoff JP, Phillips D, eds. From Neurons to Neighborhoods: The Science of Early Child Development. Washington, DC: National Academy Press; 2000
4. Roth J, Figlio DN, Chen Y, et al. Maternal and infant factors associated with excess kindergarten costs. Pediatrics. 2004;114 :720 –728[Abstract/Free Full Text]
5. Msall ME, Tremont MR, Ottenbacher KJ. Functional assessments of preschool children: optimizing developmental and family supports in early intervention. Infants Young Child. 2001;14 :46 –66

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Msall, M. E. Search for Related Content PubMed PubMed Citation Articles by Msall, M. E. Related Collections Office Practice Social Bookmarking                         What's this?