Pediatricians a link between children, programs that boost school readiness
P. GailWilliams, M.D., FAAP
AAP Technical Report
School readiness once was thought to be solely the function of the child and family
with focus primarily on pre-academic skills. We now recognize that schools and communities
also are responsible for school readiness, and that a child’s experiences from birth
impact the social, emotional, physical and cognitive development needed for school
School readiness encompasses not only the child’s general knowledge and cognition,
but also physical well-being, language skills, social-emotional development and approaches
to learning. Schools must be ready to meet the needs of each child, and communities
must take responsibility to ensure safe environments, access to health care and adequate
housing. Poverty and adverse childhood experiences increase toxic stress and likelihood
for school failure. Building resilience through nurturing relationships and positive
experiences should be the goal of everyone working with young children.
The Academy has updated the 2008 technical report School Readiness, outlining the role of primary care practices in supporting healthy development of
young children so they are ready to learn. The report, from the Council on Early Childhood
and Council on School Health, is available at https://doi.org/10.1542/peds.2019-1766 and will be published in the August issue of Pediatrics.
School readiness testing previously was used to exclude age-eligible children from
kindergarten. While there is significant variability in states’ use of readiness testing,
it has been recognized that restricting kindergarten entry based on testing is inappropriate.
However, readiness testing may be helpful to support children’s academic achievement
and educational programming.
A literature review suggests that children may be more prepared to enter school than
earlier in this century. This likely is related to the increased availability of preschool
programs. Enrollment of 4-year-olds in state-funded preschool programs doubled from
2001 to 2016, with nearly 33% of these children being served. Despite this increase,
there continue to be major gaps in readiness based on socioeconomic factors and ethnicity.
Pediatricians have a significant role to play in school readiness. They have longstanding
relationships with children and families that are established early and grow over
time. As such, pediatricians address not only physical health and preventive care
but also screen for psychosocial stressors such as maternal depression, which may
interfere with the establishment of positive parent-child relationships.
Pediatricians also screen for developmental and emotional/behavioral problems, which
can hinder school readiness and put children at increased risk for school failure
and preschool expulsion. Early identification allows referral to appropriate interventions
that can improve outcomes.
Pediatricians also model appropriate caregiver-child interactions and provide resources
and advice on positive parenting strategies and appropriate disciplinary approaches.
They promote early literacy opportunities and encourage book-sharing and utilization
of public libraries. In addition, pediatricians can share information about quality
preschool and child care programs and encourage families to become involved in their
In many instances, pediatricians are at the forefront of advocating for access to
health care, home visitation, preschool mental health consultation, early literacy
funding, quality early childhood programs and child care subsidies. In multiple ways,
pediatricians are an integral link between children and their families to school and
community programs that promote school readiness.
Dr. Williams, a lead author of the technical report, is a member of the AAP Council
on Early Childhood Executive Committee.