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Improving School Readiness - By Dr. Tayloe

Posted: 08/01/2014



Improving School Readiness: Translating the AAP Strategic Plan into Practice

Promoting Early Literacy: Making Well Baby Care More Fun


by David T. Tayloe Jr., M.D., FAAP

A 2013 report from the Annie Casey Foundation showed that 60%-82% of fourth-graders are not reading proficiently. Furthermore, research shows that if children are not reading at grade level in the third grade, they are at high risk of dropping out of school before they graduate from high school.


It is time for us grassroots community pediatricians to make a concerted effort to promote early literacy development in our patients.


A new AAP policy statement recommends that pediatricians encourage parents to read to their children from birth ( The Academy also has partnered with the Clinton Global Initiative, Scholastic Inc., and Reach Out and Read to promote early literacy and vocabulary development.


At Goldsboro Pediatrics in North Carolina, we are engaged in a project to improve the school readiness of at-risk preschool children so that more of them will be able to read proficiently by the time they reach third grade.


We are the only pediatric practice in our county, so almost all of the children who enter kindergarten are our patients. Our schools admit that about the same number of children enter kindergarten without the skills necessary to learn to read as are unable to read proficiently in third grade. The schools are encouraging us, the pediatricians, to do whatever we can to empower parents of at-risk children to prepare them better to become good readers during the kindergarten to third grade timeframe.


Our project embodies the priorities of the AAP Agenda for Children: 1) Poverty and Child Health; 2) Epigenetics; 3) Early Brain and Child Development; and, 4) Children, Adolescents and Media. If pediatricians are to improve the school readiness of preschool children, they must consider these four topics going forward.


In our practice, more than 18,000 children are eligible for Medicaid. So, we have to consider poverty as a factor in the school readiness challenges of our families. We must partner with organizations (Head Start, Smart Start, public health department, churches, etc.) that come into regular contact with the families of our at-risk patients. Our Medicaid care coordination staff have to work hard to ensure at-risk children show up for well-child care, since we must utilize the 16 well-child visits from the birth to 8-year-old timeframe to implement our school readiness project.


Epigenetics encompasses functionally relevant changes to the genome that do not involve a change in the nucleotide sequence. Epigenetic events occur in at-risk children based on the level of stress in their environment. Families in poverty have more stress than those of middle class means, and their children are more likely to have adverse childhood experiences. We must be able to link these at-risk families with the health and human services they need to address the sources of stress in their families.


The Academy’s focus on early brain and child development is all about achieving optimal child outcomes. There probably is not a worse outcome than school dropout for our children. So, the main focus of our project is improving early brain and child development so that our patients will achieve better overall outcomes.


We have been participating in Reach Out and Read for the last 10 years. While school administrators cannot show that the school readiness of K-3 children has improved during this last decade, there is an evidence base within Reach Out and Read to show that the program does improve school readiness. However, it is obvious that our at-risk preschool children need more verbal stimulation in their home environments if they are to become good readers by third grade.


The language skills of kindergartners are determined in part by the number of words babies hear caregivers say in the first two years of life. Some children hear their parents say 10 times as many words as do other children. It is obvious that many caregivers of preschool children are consumed by technology (e.g., smartphones, iPads, laptops, videogame boxes, HD TVs). Technology is diminishing the face-to-face conversation that needs to occur between caregivers and preschool children.

As an older community pediatrician, I have totally changed the way I conduct well-baby visits, now emphasizing the importance of parents spending as much time as possible talking with their babies face-to-face with televisions and other screens turned off. Since I have become passionate about this issue, I find that I enjoy the well-baby checkups more than I did when I rushed through a litany of nutrition, safety, development, dental and vaccine information.


In conclusion, our practice is working to promote a straightforward agenda to empower the parents of at-risk children in our community to maximize, from the moment of birth, the time they spend engaged in face-to-face talking with their children. This project is rooted in the AAP Agenda for Children. We are collaborating with other organizations throughout the community to promote this agenda. We will work with our public schools to measure the school readiness of our K-3 students to determine if our efforts are successful.


Dr. Tayloe is senior partner/founder of Goldsboro Pediatrics, medical director for Reach Out and Read of N.C., and AAP past president (2008-’09).

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