Serious Disparities Remain in How Well Young Children Are Prepared for School, Report Shows

New York city, September 8, 2004—Are young children getting the social, developmental, and health care support they need to be ready for school? For too many, the answer is no, says a new Commonwealth Fund/Child Trends chartbook on how young children are faring in America based on a number of key developmental indicators. Despite progress, the report shows that many American children remain at a serious disadvantage because they have problems with physical, social, emotional, and intellectual development that go unrecognized or untreated, creating barriers to achieving their full potential. Children from families with low incomes, low parent education levels, and children from minority households are at even greater disadvantage, says the report released today: Early Child Development in Social Context: A Chartbook. "It's clear that we deliver children to school on a very uneven playing field, and there is much more we can do to help all children be prepared to learn. Pediatricians can make a big difference, for example, just by asking parents how much television their children watch, and by encouraging parents to read regularly to even very young children," says report co-author Michael Weitzman, MD, executive director of the American Academy of Pediatrics' Center for Child Health Research. "We all pay for failure to address these issues early on," he says. "Pediatricians and other health practitioners who have regular contact with children and families are in the best position to identify developmental problems at early, more treatable stages," says Commonwealth Fund Assistant Vice President Ed Schor, MD. "Efforts such as having child health care providers routinely screen young children for developmental problems and improving communication between those providers and others in the community who serve young children and their families are important steps toward ensuring that children get the best start in life." The report reviews more than 30 indicators of development and health for children up to age six, along with social factors in the family and neighborhood that affect their readiness for school. The comprehensive overview relies on original and existing research to present how young children are faring on:

• Indicators of intellectual development, such as reading and math proficiency;
• Indicators of socio-emotional development, such as behavioral self control;
• The link between good health practices and social, emotional and intellectual development of young children; and
• The effects of family function and parental health on how young children grow and develop.

The report's lead authors, Dr. Weitzman and Brett Brown, Ph.D., Director of Social Indicators Research at Child Trends, a nonprofit research center dedicated to improving the lives of children, say their analysis shows there remain sizable gaps in average levels of intellectual development that need to be bridged if a child is to succeed in school. The report shows that when it comes to reading and math proficiency as well as expressive language, minority students and children whose parents are less educated do not start out on equal footing with other children. For example:

• Only 38 percent of kindergarten children whose mothers lack a high school degree are proficient at recognizing letters--a basic stepping stone to reading--compared with 86 percent of kindergarteners whose mothers have graduated from college.
• Minority kindergarteners are much less likely than non-Hispanic white children to use complex sentence structures at an intermediate or proficient level--20-21 percent for non-Hispanic blacks and Hispanics, compared with 41 percent for non-Hispanic whites.
• Only about one-third of kindergarteners whose mothers had less than a high school education could count beyond 10 and perform sequencing patterns appropriate to their age, compared with 79 percent of kindergarteners whose mothers had a bachelor's degree or higher.

"These gaps should be raising alarms," says Dr. Brown of Child Trends. "Early reading proficiency is strongly related to future reading ability and academic achievement. Reading deficits at an early age have been found to widen over the elementary school years, and for many kids these deficits persist throughout school and into adulthood." To address these gaps, the authors say pediatricians should integrate more developmental assessments into their well-child examinations. For example, they can more aggressively disseminate information to parents about the benefits of early literacy, including encouraging parents to begin reading to children during the first year of life. And they should be asking parents a checklist of questions to assess a five-year olds' math proficiency. The chartbook also shows how family functioning and parental health relate to disparities in intellectual and social development at an early age. For example:

• While more than one-half of all children under age three are read to every day by their parents, one in five are read to less than three times a week. Children who live in homes where English isn't spoken face particular problems. Only 15 percent of Hispanic children in Spanish-speaking households are read to every day.

Citing a national program called "Reach Out and Read," the authors say that studies have shown that children with health care providers who discuss with parents the importance of reading to their young children are more likely to be read to every day. In addition, not all parents seem to have gotten the message about the downsides of too much television for young children. According to the chartbook:

• About one-third of children through age 3, and 43 percent of children between the ages of four and six have a television in their bedroom.

The authors say practitioners can measure children's media consumption during well-child visits, during which time they can educate parents on the effects that too much television viewing have on children's health and development. The authors say parents need to provide more structure to children, including instituting regular bedtimes and mealtimes as well as regulating the type and amount of television their young children watch. Other highlights of how children are doing from the report:

• Kindergarteners whose parents are depressed are more likely than other kindergarteners to exhibit socio-emotional problems. Kindergarteners living in families below the federal poverty threshold are much more likely than other kindergarteners to have depressed parents. Non-Hispanic black kindergarteners are more likely than other kindergarteners to have parents at risk for depression.
• While nearly one-half of insured children between ages two and five have seen a dentist in the last year, just over one quarter (27 percent) of those without health insurance have had regular dental checkups.
• One-quarter of children with health insurance have not had a vision screen prior to entering kindergarten, while one-third of children without health insurance have not had that essential screening.

The report is the latest in a series of chartbooks on children's health in the United States. As children are starting off or heading back to school, it is a reminder to all health professionals of the significant role they can play in identifying developmental problems at an early stage, and working with parents, schools, and community services to address them. In April 2004, the Commonwealth Fund also released Quality of Health Care for Children and Adolescents: A Chartbook.