Kindergarten Readiness Starts Prenatally
Insights from NICHQ President and CEO
During the early years of life, a baby’s brain grows at its most rapid rate, doubling in size in the first year and nearly reaching its full size by age three. And if you think that is rapid growth, imagine that the brain gains a third of its size in the last five weeks of pregnancy!
This period of rapid development—both in terms of size and complexity—lays the foundation for children’s future success at school; it prepares them to read and write, form friendships, and discover their strengths.
Not all children have an equal chance to achieve healthy brain development though. There are large gaps in kindergarten readiness among children living in poverty whose families have less resources, and approximately six out of 10 children across the U.S. start kindergarten not ready to learn. Addressing those disparities means recognizing that, from the earliest moments of life, children’s health and development is entirely dependent on their families. It means seeking solutions that address the health and well-being of both caregiver and child, rather than looking at the two separately.
“Over the past decade, the public and clinical perception about early childhood, specifically birth to 3, has shifted,” says NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP. “It’s been about more than realizing how important healthy early brain development is—it’s been about realizing what we can do to support that health. The shift towards health equity and population health has put a needed focus on two-generation approaches across the early childhood spectrum. NICHQ, our partners and fellow stakeholders are working on efforts across the country to put systems and services in place that better support children and families during those early years.”
These efforts have begun to build a bridge between the 0 to 3 health sector and prekindergarten education sector, breaking down siloes to support families so all children can achieve kindergarten readiness. According to Berns though, helping families get the support they need, when they need it, requires building another vital early childhood bridge.
Connecting to the prenatal space
“We need to start being more explicit that 0 to 3 really means prenatal to 3,” says Berns. “By focusing on children’s early health and development before they are born, those who provide prenatal care and education may identify developmental risk factors, like mom’s health, smoking, intimate partner violence and unhealthy weight. And by recognizing those risk factors before birth, providers can intervene early, connecting the family with the resources and services they need to support their health and the health of their child.”
Similarly, explains Berns, it’s vital to recognize and support early brain growth during prenatal care. Prenatal health professionals can talk with families about environments that foster early socioemotional development. They can discuss the effects of stress on a baby’s developing brain and encourage mothers to talk to their babies, beginning to bond and build the close relationship that will support future socioemotional growth.
“We need to remember that it’s the prenatal space, even earlier than the birth to 3 space, that helps give children the best start on kindergarten readiness,” says Berns.
Shifting this mindset by being more explicit can also help build critical bridges between the prenatal and birth to 3 communities.
“Children and families deserve a holistic continuum of care between pregnancy and pediatrics,” says Berns. “Reinforcing that bridge means ensuring that everyone in the prenatal and obstetric space—nurses and obstetricians working with pregnant and new mothers; neonatologists, physician assistants, and neonatal nurse practitioners; lactation consultants and dieticians; and mental health and social service workers, among others—is prepared to support the hand-off to pediatric care. If everyone is on the same page and involved in that hand-off, fewer families will fall through the cracks.”
Early conversations between families and their pediatric offices are also opportunities to discuss the social determinants of health, such as the family’s housing and cultural values, that will directly affect the child’s development. And those conversations set the stage for a strong and trusting relationship between the child’s pediatric care providers and the family.
Moreover, explains Berns, developing connections with the family’s pediatric office prenatally acknowledges that the child’s health is tied to the mother’s. And this lays the groundwork for pediatric visits to continue to support the health of both, such as by providing maternal depression screenings. When this happens, pediatric visits exemplify two-generation strategies that account for the entire context of a child’s health, including caregiver and family well-being.
“Recently, there have been more conversations about bringing the prenatal and birth to 3 communities together,” says Berns, “but we need to keep having these conversations, breaking down siloes and shifting perspectives. By making these connections even more apparent, we can improve continuity of care from prenatal to 3, which will most benefit vulnerable families and help address inequities in developmental health. This is one of the reasons our portfolio is situated in both spaces—we’re working with our partners across prenatal and birth to 3 to create and support that continuum. Building bridges across this space has the potential to encourage lifelong positive health outcomes for children.”
Find out more about how NICHQ’s working to improve prenatal to 3 health outcomes through initiatives like the National Network of Perinatal Quality Collaboratives, the Collaborative Improvement and Innovation Network to Reduce Infant Mortality, the New York State Maternal and Child Health Collaborative and NICHQ’s full birth-3 portfolio.
As President and CEO of NICHQ, Berns provides strategic direction and leadership of a growing portfolio of initiatives aimed at driving change to improve children’s health. He serves as principal investigator on NICHQ-led multi-million dollar federal projects: the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network and the National Action Partnership to Promote Safe Sleep Improvement and Innovation Network. Berns is a nationally recognized expert in quality improvement science in maternal and child health and has published extensively. He is passionate about the effect of prenatal care on a child’s early development, committed to building the bridge between early childhood health and education, and driven to achieve health equity and find solutions that support all families. Read his full bio.
North Carolina’s Strategy to Address Social Determinants of Health
North Carolina is developing a system that connects individuals with resources to address social, economic and environmental barriers to their health—such as housing, food insecurity, and transportation. By putting funding and policy efforts into addressing social determinants of health, North Carolina is building a system that can improve health outcomes for children and families across the state.
NICHQ Employee Spotlight: Colleen Bernard
In honor or our 20th anniversary, we're sharing insights, memories and goals from the NICHQ team. Here, NICHQ Project Specialist Colleen Bernard shares her proudest moment during her time at NICHQ and her goals for NICHQ's future.
Breastfeeding in 2019: Safe Sleep, Bias, Gender Equitable Norms, and Paid Leave
In honor of National Breastfeeding Month, we’ve taken time with NICHQ Faculty Expert, Lori Feldman-Winter, MD, MPH, an internationally and nationally recognized expert on breastfeeding nutrition, education and policy, to recognize successes and learn about opportunities for improvement. Her frank description of bias and her passion for promoting gender-equitable social norms have inspired us to continue pursuing sustainable improvements.
Successful Strategies Hospitals Can Use to Support Safe Sleep
Hospitals on a national initiative to improve safe sleep came together to share successes and lessons-learned. Here, find their highest-rated strategies and change ideas, all of which reflect early successes in their work. Hospitals seeking to improve safe sleep education can refer to this list as a place to start and guide for gaining quick wins.
Improving Transitions in Care Saves Lives
Advancements in care have helped more children with rare diseases reach adulthood, but health systems and providers have struggled to help children transition to adult care, resulting in high rates of complications and mortality for young adults. These strategies for helping young adults with sickle cell disease transition to adult care can save lives.
“The Act of Making a Referral is Not Enough”
Universal developmental screenings can help identify children at risk for developmental delays and connect them with needed supports. An effective screening process relies on successful referrals though—if there is no follow-up with the referred child, families can never access the supports the child may need, and that child may ultimately fall through the cracks. Here, Dipesh Navsaria, MPH, MSLIS, MD, Associate Professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health provides five steps to build a referral process that works.