School readiness among urban children with asthma.

BACKGROUND: Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated. OBJECTIVE: To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma. METHODS: A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes. RESULTS: Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8). CONCLUSIONS: Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.     

Educational readiness

The early identification of children not yet ready to begin the formal task of classroom learning has been increasingly emphasized by educators, psychologists, pediatricians and parents. The pediatrician, as the professional concerned with monitoring children's growth and development, is uniquely suited to participate in the identification of such children. Effective participation requires recognition of the various factors influencing educational readiness, as well as the manner in which they fit together into a whole greater than the sum of its parts. Possible pediatric roles include screening children for educational readiness, as well as clinical problem-solving when issues or concerns arise.     

School readiness and CNS maturity: relation to psychophysical and psychosocial development and to early school achievement.

In randomly selected schools 113 girls and 102 boys were subjected to a School Readiness (SR) test and to a Complex Reaction Time (CRT) measurement at the age of 7. Their psychophysical development, social adjustment and school achievement were assessed by teachers and by means of self-ratings during the first 3 school years. The developmental outcome of the children seemed principally related to CNS-maturity as measured by CRT, and not to the SR test scores. A CNS-dysfunction, indicated by slow CRT, seemed to be an essential handicap during the early school years, impairing particularly the boys' language and motor development and their school achievement and causing feelings of inferiority. This handicap, which is mainly a developmental delay, should thus be taken into consideration when assessing school maturity. Early detection of this handicap might enable us to take preventive measures with regard to these children.     

School readiness among children with behavior problems at entrance into kindergarten: results from a US national study

The impact of behavior problems on kindergarten readiness is not known. Our objective was to estimate the association between behavior problems and kindergarten readiness on a US national sample. In the US educational system, kindergarten is a natural point of entry into formal schooling at age 5 because fewer than half of the children enter kindergarten with prior formal preschool education. Parents of 1,200 children who were scheduled to enter kindergarten for the first time and were members of the Harris Interactive online national panel were surveyed. We defined behavior problems as an affirmative response to the question, “Has your child ever had behavior problems?” We validated this against attention deficit hyperactivity disorder diagnosis, scores on a reliable socioemotional scale, and child’s receipt of early intervention services. We used linear, tobit, and logistic regression analyses to estimate the association between having behavior problems and scores in reliable scales of motor, play, speech and language, and school skills and an overall kindergarten readiness indicator. The sample included 176 children with behavior problems for a national prevalence of 14% (confidence interval, 11.5–17.5). Children with behavior problems were more likely to be male and live in households with lower income and parental education. We found that children with behavior problems entered kindergarten with lower speech and language, motor, play, and school skills, even after controlling for demographics and region. Delays were 0.6–1 SD below scores of comparable children without behavior problems. Parents of children with behavior problems were 5.2 times more likely to report their child was not ready for kindergarten. Childhood behavior problems are associated with substantial delays in motor, language, play, school, and socioemotional skills before entrance into kindergarten. Early screening and intervention is recommended.     

Kindergarten readiness after extreme prematurity.

OBJECTIVE--To assess kindergarten readiness among survivors of extreme prematurity and to identify predictors of special education requirements. DESIGN--Historic cohort design. SETTING--Regionalized tertiary pediatric center. PARTICIPANTS--One hundred forty-nine (97%) of 153 children who were alive at follow-up (mean +/- SD age, 52.7 +/- 9.9 months). SELECTION PROCEDURES--Study cohort included infants (gestation, 23 to 28 weeks), born between 1983 and 1986 (N = 194), who were alive at follow-up (N = 153, 79% survival). INTERVENTIONS--None. MEASUREMENTS AND RESULTS--Standardized neurodevelopmental and psychometric evaluations were administered by a multidisciplinary team that was blinded to the neonatal course. Thirty-one children (21%) had major neurodevelopmental impairments. By using the McCarthy Scales of Children's Abilities for children free of major impairments, 61 (63%) had one or more minor neurodevelopmental impairments noted. Half of the surviving children were thought to require special education resources at kindergarten entry. Multivariate logistic regression identified three significant predictors of special education: low socio-economic status, nonwhite race, and male gender. CONCLUSIONS--Social and demographic variables were associated with minor neurodevelopmental impairments and special education requirements among extremely premature children. Continued developmental follow-up and targeted interventions to reduce the risk of educational underachievement appear to be warranted.     

Low birth weight and school readiness

In the United States black women have for decades been twice as likely as white women to give birth to babies of low birth weight who are at elevated risk for developmental disabilities. Does the black-white disparity in low birth weight contribute to the racial disparity in readiness? The author summarizes the cognitive and behavioral problems that beset many low birth weight children and notes that not only are the problems greatest for the smallest babies, but black babies are two to three times as likely as whites to be very small. Nevertheless, the racial disparities in low birth weight cannot explain much of the aggregate gap in readiness because the most serious birth weight-related disabilities affect a very small share of children. The author estimates that low birth weight explains at most 3-4 percent of the racial gap in IQ scores. The author applauds the post-1980 expansions of Medicaid for increasing rates of prenatal care use among poor pregnant women but stresses that standard prenatal medical care cannot improve aggregate birth outcomes substantially. Smoking cessation and nutrition are two prenatal interventions that show promise. Several early intervention programs have been shown to improve cognitive skills of low birth weight children. But even the most promising programs can narrow the readiness gap only a little because their benefits are greatest for heavier low birth weight children and because low birth weight explains only a small share of the gap. The author stresses the importance of reducing rates of low birth weight generally and of extending to all children who need them the interventions that have improved cognitive outcomes among low birth weight children. But because black infants are more likely to be born at the lowest birth weights, preventing low birth weight--when researchers learn how to--is likely to be more effective than early intervention in narrowing birth weight-related racial gaps in school readiness.     

Health disparities and gaps in school readiness

The author documents pervasive racial disparities in the health of American children and analyzes how and how much those disparities contribute to racial gaps in school readiness. She explores a broad sample of health problems common to U.S. children, such as attention deficit hyperactivity disorder, asthma, and lead poisoning, as well as maternal health problems and health-related behaviors that affect children's behavioral and cognitive readiness for school. If a health problem is to affect the readiness gap, it must affect many children, it must be linked to academic performance or behavior problems, and it must show a racial disparity either in its prevalence or in its effects. The author focuses not only on the black-white gap in health status but also on the poor-nonpoor gap because black children tend to be poorer than white children. The health conditions Currie considers seriously impair cognitive skills and behavior in individual children. But most explain little of the overall racial gap in school readiness. Still, the cumulative effect of health differentials summed over all conditions is significant. Currie's rough calculation is that racial differences in health conditions and in maternal health and behaviors together may account for as much as a quarter of the racial gap in school readiness. Currie scrutinizes several policy steps to lessen racial and socioeconomic disparities in children's health and to begin to close the readiness gap. Increasing poor children's eligibility for Medicaid and state child health insurance is unlikely to be effective because most poor children are already eligible for public insurance. The problem is that many are not enrolled. Even increasing enrollment may not work: socioeconomic disparities in health persist in Canada and the United Kingdom despite universal public health insurance. The author finds more promise in strengthening early childhood programs with a built-in health component, like Head Start; family-based services and home visiting programs; and WIC, the federal nutrition program for women, infants, and small children. In all three, trained staff can help parents get ongoing care for their children.     

Oral feeding readiness in the neonatal intensive care unit

Oral feeding is a complex sensorimotor process that is influenced by many variables, making the introduction and management of oral feeding a challenge for many health care providers. Feeding practice guided by tradition or a trial-and-error approach may be inconsistent and has the potential to delay the progression of oral feeding skills. Oral feeding initiation and management should be based on careful, individualized assessment of the NICU infant and requires an understanding of neonatal physiology and neurodevelopment. The purpose of this article is to help the health care provider with this complex process by (a) defining oral feeding readiness, (b) describing the importance of oral feeding in the NICU and the physiology of feeding, and (c) providing a review of the literature regarding the transition from gavage to oral feeding in the NICU.     

Employers' readiness for the mother-friendly workplace: an elicitation study

Currently over half of mothers of infants under 1-year-old are in the workforce in the United States. These women face challenges to continue breastfeeding when they return to work 3 to 6 months post-partum. This study explored the perspectives of employers on mother-friendly environments to assess their readiness to provide breastfeeding accommodation using the elicitation under the theory of planned behaviour. Researchers conducted phone/in-person interviews with a convenient sample of 20 human resource managers from companies that had 500 or more employees in the New York metropolitan area in 2009. Content analyses identified the common concepts that represent underlying beliefs of the constructs of the theory. The demography of the participants is 40% male and 80% White, with mean ages of 34.3±8.5 years. 'Happy employees' and 'high retention rate and improved loyalty' were the most frequently mentioned (95%) benefits to the company (behavioural beliefs). Supporters of a mother-friendly environment (normative beliefs) in the workplace included 'mothers and expectant mothers (70%)', and 'managers supervising women and new mothers (55%)'. Most frequently mentioned company drawbacks (control beliefs) were 'not cost effective (65%)' and 'time consuming (65%)', followed by 'perception of special favours for some (50%)'. Workplace breastfeeding promotion efforts can be successful by reinforcing positive beliefs and addressing the challenges associated with implementation of breastfeeding accommodation through education and other incentives such as recognition of model companies and tax breaks. The identified beliefs provide a basis for the development of a quantitative instrument to study workplace breastfeeding support further.     

Neuroscience perspectives on disparities in school readiness and cognitive achievement

This article allows readers to look at racial and ethnic disparities in school readiness from a neuroscience perspective. Although researchers have traditionally measured gaps in school readiness using broad achievement tests, they can now assess readiness in terms of more specific brain-based cognitive functions. Three neurocognitive systems--cognitive control, learning and memory, and reading--are essential for success in school. Thanks to recent advances in brain imaging, it is now possible to examine these three systems, each located in specific areas of the brain, by observing them in action as children engage in particular tasks. Socioeconomic status--already linked with how well children do on skills tests generally--is particularly closely linked with how well they perform on tasks involving these crucial neurocognitive systems. Moreover, children's life experiences can influence their neurocognitive development and lead to functional and anatomical changes in their brains. Noting that chronic stress or abuse in childhood can impair development of the brain region involved in learning and memory, the authors show how the extreme stress of being placed in an orphanage leads to abnormal brain development and decreased cognitive functioning. More optimistically, the authors explain that children's brains remain plastic and capable of growth and development. Targeted educational interventions thus have the promise of improving both brain function and behavior. Several such interventions, for example, both raise children's scores in tests of reading and increase activity in the brain regions most closely linked with reading. The brain regions most crucial for school readiness may prove quite responsive to effective therapeutic interventions-even making it possible to tailor particular interventions for individual children. The authors look ahead to the day when effective educational interventions can begin to close racial and socioeconomic gaps in readiness and achievement.     

College readiness for all: the challenge for urban high schools

Melissa Roderick, Jenny Nagaoka, and Vanessa Coca focus on the importance of improving college access and readiness for low-income and minority students in urban high schools. They stress the aspirations-attainment gap: although the college aspirations of all U.S. high school students, regardless of race, ethnicity, and family income, have increased dramatically over the past several decades, significant disparities remain in college readiness and enrollment. The authors emphasize the need for researchers and policy makers to be explicit about precisely which sets of knowledge and skills shape college access and performance and about how best to measure those skills. They identify four essential sets of skills: content knowledge and basic skills; core academic skills; non-cognitive, or behavioral, skills; and "college knowledge," the ability to effectively search for and apply to college. High schools, they say, must stress all four. The authors also examine different ways of assessing college readiness. The three most commonly recognized indicators used by colleges, they say, are coursework required for college admission, achievement test scores, and grade point averages. Student performance on all of these indicators of readiness reveals significant racial and ethnic disparities. To turn college aspirations into college attainment, high schools and teachers need clear indicators of college readiness and clear performance standards for those indicators. These standards, say the authors, must be set at the performance level necessary for high school students to have a high probability of gaining access to four-year colleges. The standards must allow schools and districts to assess where their students currently stand and to measure their progress. The standards must also give clear guidance about what students need to do to improve. College readiness indicators can be developed based on existing data and testing systems. But districts and states will require new data systems that provide information on the college outcomes of their graduates and link their performance during high school with their college outcomes.     

Patient web-resource interest and internet readiness in pediatric inflammatory bowel disease

OBJECTIVE: The internet has been touted as a cost-effective method of providing valuable patient education and support resources. However, little is known of the level of internet interest in or access to web-based resources of most chronically ill populations generally, and pediatric populations in particular. Web-based patient resources could be especially applicable to the pediatric inflammatory bowel disease (IBD) population given the potential appeal of an anonymous forum for this group. METHODS: Tertiary-care clinic patients aged 8-18 years and diagnosed with IBD were surveyed by mail. chi and/or analysis of variance were used to compare demographic data from nonresponders and responders and for subgroup analyses. RESULTS: Of 162 eligible patients, 63 (38.9%) completed the survey. Responders did not differ significantly from nonresponders by age, sex, or distribution of disease. Overall, 98.4% of those surveyed had internet access, with 61.9% having access at school. Ninety-five percent had used the internet, while 91% expressed interest in visiting a pediatric IBD website for general IBD information (83%), for support (73%), to pose questions (78%) or read (73%) or respond (60%) to questions, or to chat with others (46%). Despite expressed interest, far fewer had ever used the internet as an IBD information (52.4%) or support (9.5%) resource. Similarly, although 15.8% anticipated visiting a pediatric IBD site weekly, only 1.5% had done so in the week of the survey. CONCLUSIONS: Reported levels of interest in web-based patient resources are high among pediatric IBD patients, yet use may be infrequent.