American Academy of Pediatrics Urges Steps to Ensure School Readiness for All Children


Too many U.S. children start kindergarten without adequate social-emotional and behavior skills critical to school success, according to an American Academy of Pediatrics (AAP) report in the August 2019 Pediatrics. “School Readiness,” highlights rapidly expanding research that shows how these gaps can be eased or eliminated.

Key to this goal, according to the AAP, is providing developmentally sound and emotionally supportive early life experiences. These play a big role in how well a child learns to handle their feelings, relate to and communicate with others, and enter school ready to learn. Research shows that school success is tied to better social, economic, and health outcomes.

“In their relationships with families, pediatricians can help them establish the kinds of nurturing environments that promote school readiness,” said P. Gail Williams, MD, FAAP, a lead author of the technical report and an executive committee member of the AAP’s Council on Early Childhood.

“It’s not just about pre-academic skills,” Dr. Williams said. “It’s a combination of physical well-being, social emotional abilities, being able to self-regulate, as well aslanguage skills and cognitive skills. And that starts right from birth.”

School readiness is largely determined by the health and well-being of children’s families and neighborhoods, as research increasingly shows. Consistent, developmentally sound and emotionally supportive early experiences help children more readily learn and develop resilience for life.

But while overall school readiness skills of young children have improved in recent years, gaps in achievement based on poverty, race, and early trauma remain.  For example:

  • Fewer than half (48%) of poor children are ready for school at 5 years of age, for example, as compared with 75% of children from moderate- or high-income households.
  • Children who have had two or more key traumatic events known as Adverse Childhood Experiences (ACEs)–such as abuse or neglect, witnessing violence in the home, or being separated from a parent due to death, incarceration or divorce–are 2.67 times more likely to repeat a grade in school than peers without adverse experiences.

Kindergarten screening, rather than a gatekeeping test for age-eligible children to enter school, should be a tool to guide planning, curriculum, and instruction to support developmental and academic achievement for diverse groups of children, according to the AAP.

“Because of societal inequities many children face, an emphasis on kindergarten readiness that only considers the skills of a child isn’t fair,” said Marc Alan Lerner, MD, FAAP, co-author of the report and member of the AAP’s Council on School Health. “Typical development in 4- and 5-year-old children normally varies a lot, so labeling children as not being ready for school at such an early age can isolate them from a more appropriate learning environment. Schools need to be ready to meet the needs of children at all levels of readiness.”

The technical report, which reinforces the 2016 AAP policy statement, “The Pediatrician’s Role in Optimizing School Readiness,” highlights how pediatricians can work with families to promote school readiness, which includes:

  • Helping families incorporate daily activities that strengthen language, cognitive skills and parent-child bonds, such as reading, storytelling, and playing games together.
  • Educating parents about normal child development and behavior and how to address behavior concerns in proactive, skills-building ways using positive discipline techniques.
  • Screening for psychosocial risks such as parental mental illness, substance abuse, family violence, and poverty and connect families with evidence-based community supports that can buffer the effects of “toxic stress” and reduce disparities in school readiness it causes.
  • Using developmental surveillance and screening to identify all children with developmental disabilities such as autism at an early age and connect families with early interventions that can have a positive impact in school readiness.
  • Advocating for expanded access to quality early childhood education to benefits individual children, as well as communities.

“Early experiences and support that occur as early as the womb, and then continuing with the support of loving homes and an absence of trauma, all help to build a brain that is ready to enter school,” Dr. Lerner said.  “By strengthening families, we are helping to encourage the kind of learning we would all like to see happen for all our country’s children.”

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