Children living in low-income households are at increased risk for poor health. Factors contributing to this disparity include less access to timely medical care and increased risk of accidents and illness. These same children also exhibit disproportionately poor developmental outcomes, possibly because of a lack of opportunity for stimulating interactions and experiences in their homes, such as reading, playing, having a daily schedule, and eating meals with the family. Since such risk factors are linked to poverty and early life experiences, there is much overlap of children’s health and developmental morbidity.
In response to the finding that health and developmental problems frequently co-occur, especially among children from low-income families, a number of public programs—most notably Head Start, Early Head Start, and Medicaid—were structured to promote comprehensive, multidisciplinary interventions and collaborative care.
In the larger policy arena, the child outcome of greatest current interest is school readiness, as the public has come to accept that the first five years of life are critical to a child’s lifelong development. Federal legislation, action by governors, and a variety of other efforts have emerged to ensure that children are ready for school. A three-year initiative of seventeen states reached consensus on a limited number of indicators of children’s readiness for school in five domains: (1) physical well-being and motor development; (2) social and emotional development; (3) approaches to learning; (4) language development; and (5) cognition and general knowledge. Underlying these domains is the central belief that families need to be supported and strengthened, since child development is directly linked to how well the family functions.

These domains are familiar to pediatricians who monitor and promote children’s development, including their physical well-being and social and emotional development, through the provision of well-child care. Developmental services—such as developmental surveillance and screening, parent education and counseling, referral to needed services, and care coordination—are core preventive child health care services that are specified in both American Academy of Pediatrics (AAP) policy statements and clinical guidelines. Most pediatricians see themselves as responsible for identifying and addressing developmental problems and are well positioned to do so. Surveys of pediatricians reveal their belief that they should be responsible for identifying a variety of emotional and behavioral problems among children, and first among their goals in child health supervision is "to ensure normal development of children." They report routinely discussing preventive care topics such as nutrition, physical and cognitive development, substance use, exercise, and safety with parents of their patients.

Despite opinions to the contrary, the impact of a large number of the components of pediatric preventive care has been demonstrated. The U.S. Preventive Services Task Force has supported the provision of immunizations, oral fluoride supplementation, vision screening, and blood screening for elevated lead levels and a number of congenital metabolic disorders. A review of developmental services by researchers at the University of California, Los Angeles (UCLA), found evidence of the efficacy of the following developmental services: (1) structured inquiry into parents’ concerns about development and behavior; (2) questionnaires to identify psychosocial risk factors children’s environment that could impair their development; (3) parental education to increase sensitive and responsive parenting of infants; (4) parental education on infant temperament and how to manage challenging infants; and (5) parental education about healthy sleep habits, sleep problems, excessive infant crying, effective discipline, and book sharing to promote language development. The Healthy Steps for Young Children intervention, a controlled, randomized trial of structured, developmentally oriented well-child care, resulted in major improvements in the provision of recommended services, parents’ approaches to discipline, and practice staff’s responding to signs of parental depression.

Source: Medicaid: Health Promotion and Disease Prevention for School Readiness March 6, 2007 | Volume 80 Authors:Edward L. Schor, M.D., Melinda K. Abrams, M.S., Katherine Shea