School readiness for children in the United States

INTRODUCTION — Kindergarten entry, the beginning of a child's formal education, is an important developmental milestone. This topic review will broadly discuss factors that affect a child's ability to learn and will describe aspects of family, school, and community systems that support the child's ability to achieve their maximal educational potential.

The concept of "school readiness" traditionally applies predominantly to children with average or above abilities. Children with below average abilities or who are at risk for not meeting developmental expectations should be enrolled in early childhood programs at the time of diagnosis or identification rather than being considered "not ready" for school. Early childhood programs may foster skill progression and help them to be more successful in academic endeavors and, thus, more likely to achieve better long-term outcomes.

BACKGROUND — Early school success or failure can affect children's well-being, self-esteem, motivation, and subsequent academic achievement [1,2]. Because early learning experiences influence the manner in which children relate to others during the course of their lives [3,4], it is important to try to ensure that children begin school when they are developmentally ready to participate in classroom activities with the greatest likelihood of success [5].

The idea that all children should start school "ready to learn" was part of the Goals 2000: Educate America Act enacted by the United States Congress in 1994 and is the first stated goal of the National Educational Goals Panel which was established in 1990 [6-8]. The idea of "school readiness" has traditionally implied that there is a measurable standard against which a given child's physical, intellectual, and socioemotional functioning can be compared, and that meeting the standard predicts future academic success. Such is not the case. Empiric evidence of such readiness standards does not exist [5], nor is there a consensus among educators about what constitutes readiness [5,9]. (See 'Changes in readiness expectations and curriculum' below.)

Despite the lack of consensus regarding readiness, surveyed kindergarten teachers identified a certain proportion of their students who were not ready to successfully participate in school [10]. Problems identified by the teachers that affected school readiness included deficiencies in language, emotional maturity, general knowledge, social confidence, moral awareness, and physical well-being, in decreasing order of importance.

Virtually every child, regardless of physical or mental disabilities, cultural or ethnic background, or prior exposure to educational activities, is capable of learning and should participate in an educational program [11]. Children with developmental delays or significant psychosocial disadvantage should be offered early intervention, early childhood special education, or Head Start programming before being assessed for kindergarten readiness. According to the American Academy of Pediatrics Committee on School Health and Committee on Early Childhood, Adoption and Dependent Care, "it is the responsibility of schools to meet the needs of all children at all levels of readiness" [12].

CHANGES IN READINESS EXPECTATIONS AND CURRICULUM — Expectations for school readiness in the United States have changed over time with authorization/reauthorization of legislation related to elementary and special education (eg, No Child Left Behind [NCLB] Act, Every Student Succeeds Act). (See "Definitions of specific learning disorder and laws pertaining to learning disorders in the United States", section on 'Every Student Succeeds Act'.)

The main thrust of NCLB was to hold schools more accountable for the performance of students who are struggling or failing [13]. The accountability requirements of NCLB have been associated with changes in teacher beliefs about prekindergarten skills required for success and in the emphasis of various subjects taught during kindergarten, including [14]:

●Increased percentage of teachers who believe that children should know the alphabet before entering kindergarten

●Increased percentage of teachers who believe that children should learn how to read during kindergarten

●Increase in the amount of time spent on reading

●More frequent teaching of more advanced writing skills, such as writing complete sentences, spelling, vocabulary, and composing logical and complete stories

●Less time spent on basic math skills (eg, counting to 100, adding single digits) and more time on more advanced topics (eg, writing equations, thinking about probability)

●Less time spent on science, social studies, music, and art (which are not tested as part of NCLB)

●Decreased time in physical education activities

Despite the increased emphasis on literacy, teachers continue to believe that nonacademic skill domains, such as self-regulation (eg, being able to sit still and pay attention) and social functioning (eg, sharing, taking turns), are the most important skills children need to be successful in kindergarten [15]. (See 'Readiness of the child' below.)

FACTORS RELATED TO A CHILD'S ABILITY TO LEARN — Various sociodemographic factors affect a child's ability to learn and their risk for school problems [12,16,17]. Although it is not the only factor, lack of readiness contributes to early grade retention [18]. Approximately 5 to 10 percent of children repeat kindergarten [19,20], although there is little evidence that retention is effective, and it may be harmful [21].

●Risk factors – Early recognition of risk factors for learning difficulty may permit intervention before school problems emerge [12,17,22-24]. Identification of problems in a school-age child should prompt prevention efforts in preschool-age siblings as needed. (See 'Promotion of school readiness' below.)

Risk factors for learning difficulty include [16,24-31]:

•Adverse childhood experiences, such as:

-Poverty

-Death of a caregiver

-Parent or guardian separated or divorced

-Caregiver mental health problems, including substance misuse

-Exposure to violence in the home or neighborhood

-Being treated or judged unfairly for belonging to a particular group

•Little or no shared reading at home

•Certain medical conditions that are associated with neurocognitive risk, either from the condition itself or through treatments for the condition (eg, very/extremely low birth weight [<1500 g], acute lymphocytic leukemia, cranial-facial anomalies)

•Poor parental health

•Behavioral and socio-emotional problems

•Developmental delay

Exposure to multiple risk factors is associated with decreased attainment of school readiness skills [3,24,32-34]. In a national survey of >15,000 children age three to five years, approximately 30 percent had been exposed to adverse childhood experiences and approximately 10 percent to two or more [24]. Fewer children exposed to ≥3 adverse childhood experiences were on-track for school readiness in all evaluated domains (20 versus nearly 50 percent of children without exposure); the evaluated domains included self-regulation, social-emotional development, physical health, and motor development.

●Protective factors – Protective factors that foster learning ability and resilience include:

•Safe, stable, and nurturing relationships (eg, caregiver responsiveness and supportiveness, particularly in the formative years) [35,36]

•High levels of maternal education (ie, college graduate) [19]

•Development of school-related competencies (see 'Readiness of the child' below), which include [37]:

-Early education experiences (eg, early intervention and quality preschool/Head Start programs) [38-43]

Systematic reviews of randomized and observational studies suggest that early childhood development programs improve intelligence quotient (IQ) and academic achievement test scores, and are associated with decreased grade retention and placement in special education classes [42,44].

-Caregiver involvement in early learning [45-48]

Caregiver resources are available from the Centers for Disease Control and Prevention and Zero to Three.

-Early peer relationships [43,49,50]

-Culturally compatible classroom programs

Research on protective factors is less well developed than that on risk factors but suggests a continuum of protective effects, which are more or less powerful depending upon the combination.

COMPONENTS OF READINESS — The concept of school readiness is multifaceted. The National Education Goals Panel (NEGP) described three essential components [12,51,52]:

●Readiness of the child

●Readiness of the school system

●Family and community supports that contribute to the child's readiness

The recommendations of the NEGP, although endorsed by federal and state governments, have not been fully implemented (particularly those that relate to readiness of schools and community support systems). Nonetheless, there are steps that caregivers and health care providers can take to ensure that their children and patients, respectively, are adequately prepared to enter school "ready to learn." These steps are described below. (See 'Readiness of the child' below and 'Promotion of school readiness' below.)

READINESS OF THE CHILD

Domains of readiness — School readiness is a complex network of development that spans physical, cognitive, social, and community functioning rather than competence in certain foundational academic skills [12]. The scope of the child's readiness includes five interrelated and overlapping domains [32]:

●Physical well-being and motor development

●Social and emotional development

●Child's approach to learning

●Language development

●Cognition and general knowledge

Achievement of proficiency in these domains before kindergarten entry is variable. The differences in achievement are related to early experiences, such as enrollment in quality day care, cultural environments that emphasize varying behaviors and activities, inborn developmental/physical characteristics, and psychosocial risk factors. Even children with seemingly inadequate school readiness skills are capable of acquiring some new skills while in kindergarten. However, children with a solid base of school readiness skills appear to learn more, and to learn more quickly, than children without that foundation [53].

Although proficiency in foundational skills is no longer the focus of school readiness, children with proficiency in rudimentary skills such as counting with one-to-one correspondence, recognizing numbers and letters, and mastering quantitative and relational concepts (eg, bigger than, equal to) are more likely to learn to read and do math earlier and better than children without those skills at kindergarten entry [54].

Physical well-being — The physical well-being of a child can affect their early learning experiences. Children who deviate significantly from normative expectations may need special services or alterations in the school program in order to maximize their learning potential.

The physical well-being and motor development of children varies depending upon their health status, growth, physical abilities and disabilities, and prenatal, perinatal, and postnatal conditions [55]. Although normal physical fitness helps the child to pay attention and participate in social and academic activities, impaired physical or motor development does not prevent the child from entering school. It may, however, affect the child's ability to perform school-related activities and should be considered when making educational programming and service decisions. (See "Children and youth with special health care needs", section on 'School-based services'.)

Examples of conditions that affect physical well-being and, consequently, school program or service planning include:

●Genetic or congenital disorders (eg, Down syndrome) may require remedial instruction or therapy (eg, speech and language therapy, physical therapy, occupational therapy) as adjuncts to the school program.

●Cerebral palsy or delayed gross or fine motor development may require physical therapy and/or occupational therapy in order to improve skills necessary for exploration of the environment, engagement in social activities, and paper-and-pencil tasks [56].

●Vision or hearing impairment must be addressed before entering school, and vision and/or hearing accommodations/supports should be included in the child's educational plan.

●Impaired oral-motor skills may require speech and language therapy to improve ability to participate in academic activities and develop social interaction skills with peers.

●Chronic medical conditions (eg, asthma, sickle cell disease, food allergies [57]) require optimal medical therapy to minimize acute exacerbations that could lead to school absence. Chronic medical conditions may be associated with pain or discomfort that can affect attention and readiness to learn. Medications used to treat chronic conditions may affect cognitive functions. Children with chronic conditions may require a plan to receive medications or urgent medical therapy at school. (See "Seizures and epilepsy in children: Initial treatment and monitoring", section on 'Adverse effects' and "Food allergy in schools and camps" and "Treatment of acute lymphoblastic leukemia/lymphoma in children and adolescents".)

●Poor sleep hygiene may affect school readiness and performance [58]. Among a group of seemingly normal kindergartners (none of whom had been identified as having a sleep disturbance), children with inadequate school readiness who were not going to progress to first grade were more likely to have longer sleep latencies, reduced sleep efficiency, increased nocturnal awakenings, and daytime sleepiness [59]. (See "Assessment of sleep disorders in children".)

At every visit from infancy through the preschool years, pediatric health care providers should be mindful of health conditions that affect the ability of their patients to learn. This includes regular screening for developmental problems, socioemotional and behavioral risk factors, vision and hearing problems, and various medical conditions (eg, lead poisoning, iron deficiency anemia, delayed immunizations, sleep disorders, etc). (See "Screening tests in children and adolescents" and "Standard immunizations for children and adolescents: Overview", section on 'Routine schedule'.)

Social and emotional development — The social and emotional development of the child encompasses their self-concept as well as interpersonal skills. Socioemotional competency also influences cognitive development and pre-academic skills [53,60]. Kindergarten teachers view socio-emotional functioning as more fundamental to school readiness than cognitive/academic skills [61].

●Emotional development is a function of breadth and depth of emotions (eg, joy, anger, sadness, pride, shame, guilt, etc) that have been experienced by the child, the manner in which the emotions are expressed, and whether or not the child manifests sensitivity to and empathy for other people. In an observational study, children who were perceived by peers to be happy also were seen by teachers to be more socially engaged and had better academic skills, whereas children viewed as being angry were less engaged and had lower academic skills [62].

●Social development reflects the child's capacity for forming reciprocal relationships with peers and adults, including the ability to create opportunities for sharing and the ability to consider another person's perspective. A child's ability to interact well with peers predicts kindergarten achievement [63], and peer interactions are one of the most salient predictors of adult adaptation [51,64].

Specific socioemotional competencies include self-regulation and the ability to separate from caregivers, the ability to express emotions in an appropriate manner, positive self-efficacy, awareness of the effect of one's actions on others, comprehension of the perspective of others, and a variety of prosocial behaviors (eg, taking turns, sharing, helping, acceptance of differences, empathy) [51,65]. It is also important to be able to form and maintain relationships with others, which requires the ability to interact cooperatively and respectfully, to recognize the intent of underlying actions, and to offer and seek out support [51]. Some of these skills, including self-regulation, adaptive behavior, interpersonal skills, and attention, can be improved through experience and training in the classroom setting as well as in child care centers and at home (table 1C) [3,23,60,66,67].

Socioemotional functioning is a better predictor of academic performance in early grades than are cognitive abilities or family characteristics [68-71]. Teachers are less likely to recognize cognitive competencies in children who exhibit "undesirable" behavior (eg, verbal and physical aggression, impulsive behavior, lack of cooperation, ignoring or disregarding others, oppositional or defiant behavior) [3]. Such children also have limited opportunities to learn from their peers, since the peers are likely to reject them as friends on account of the undesirable behavior [72].

Surveys of kindergarten and preschool teachers and child care providers indicate that disruptive behavior (eg, arguing, fighting, kicking, hitting, threatening) is common and one of their greatest challenges [73-77]. For some preschoolers, behavioral difficulties may be driven by developmental delays (eg, demands for performance at school exceed their abilities) [29], highlighting the need for universal developmental screening in early childhood. (See "Developmental-behavioral surveillance and screening in primary care".)

Although there is an association between behavioral difficulties and lower school readiness in young children, difficulties with attention and self-regulation appear to be more important than overt aggressiveness [78-80]. Aggression becomes a stronger and unique predictor of academic achievement among older school-aged children [81,82]. Adequate peer interaction skills (eg, cooperation, initiating play) can offset some of the difficulties associated with behavioral problems [83].

Approach to learning — The child's approach to learning refers to the strategies they adopt to acquire, use, and demonstrate skills or knowledge.

Children approach learning through a combination of predispositions and learning styles. "Predispositions" are inborn or instilled at a very early age and refer to such factors as the child's sex, temperament, cultural patterns, and values. "Learning style" refers to the child's method of responding across situations and includes such factors as curiosity, initiative, attention, persistence, reflection, imagination, and reasoning. Young children with symptoms of attention deficit hyperactivity disorder are at increased risk for impaired readiness in approach to learning and may benefit from preschool programs that focus on learning readiness skills and/or caregiver management training [80]. (See "Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis", section on 'Preschool children'.)

Children are most likely to be academically successful when teaching styles match their learning styles, yet standard school curricula often favor one style over others (eg, visual rather than auditory) [51]. Encouraging a particular learning style without considering an individual child's needs or cultural background may put children with alternate learning styles at a disadvantage [51].

Kindergarten teachers describe most students, even the ones most at risk for poor school readiness, as exhibiting positive approaches to classroom learning. That is, even in high-risk groups, the children tend to demonstrate eagerness to master new skills, reasonable attention, and persistence in completing activities [54]. Classroom engagement (eg, working and playing cooperatively, following rules and instructions, listening attentively, working autonomously) has been shown to predict high school outcomes of academic achievement, dropout risk, substance use, and health status [2].

Language development — Language development includes verbal language skills such as listening, speaking, and vocabulary, as well as emerging literacy skills such as sound-symbol association and understanding that stories have a beginning, middle, and end. (See "Emergent literacy including language development".)

Delayed language development is the most common reason identified by kindergarten teachers for lack of readiness among kindergarten students [10]. The timing of language deficits appears to be more important than the persistence of them [84]. The presence of language problems immediately before kindergarten entry (ie, at 4.5 years of age) was highly correlated with decreased school readiness, whereas early language problems that had seemingly resolved did not have an adverse impact on school readiness. Receptive language problems were a stronger predictor of inadequate school readiness than expressive language problems. Caregivers can promote the development of language skills in their children by reading with them daily [85-88], reviewing linguistic concepts, helping them to identify sound patterns, and helping them to understand and retell stories (table 1B). (See "Emergent literacy including language development".)

Children use language not only for basic communication but also to access information in their knowledge stores. Thus, language is crucial for conceptual development and reasoning. Language development is strongly associated with conventional definitions of academic success [51].

Language development is closely interwoven with socioemotional development. The use of language requires agreement about the ways in which words are used and the structure of communication within a group. Most of a child's language development occurs through their interaction with other people, particularly parents and caregivers, who often provide bridges in early communication efforts (eg, asking questions to help clarify the child's expressions).

The way in which children acquire and use language varies between cultural groups; even within a single sociocultural group, the rate of language acquisition varies considerably [51]. In addition, the language of an individual child may vary depending upon the setting. By the time they enter school, children have developed language functions within the background of their home and community environments; thus, a child's language skills are embedded in their cultural background. If that cultural background involves experiences discrepant from typical school experiences, the child may have more difficulty using their language abilities in school. Educators and caregivers should be sensitive to such struggles.

Literacy begins to develop before the child learns how to read; it includes the idea of assigning meaning to symbols, as well as how to listen and remember. Early exposure to books and reading is highly beneficial, although exposure to words can occur in other ways (eg, street signs, television, clothing labels, etc). Simple participation in routine activities contributes to language development. As an example, during make-believe activities, children are exposed to the process of structuring stories by role-playing.

Cognitive development — Cognition and general knowledge involve the recognition that different objects have various characteristics (eg, color, shape, size, number, and spatial relations) and the ability to make comparative distinctions on the basis of those characteristics. It also includes being familiar with conventions of print (in English, reading top to bottom) and understanding sound-symbol associations. Caregivers can promote cognitive and general knowledge skills through various activities at home and in the community (table 1A).

In the past, cognitive ability (ie, intelligence) was the primary, if not sole, indicator of school readiness, and social conventional knowledge (eg, ability to name colors and count) was the predominant area of skill development. Cognitive ability continues to be the domain that is most commonly associated with school readiness, particularly by caregivers [89]. However, the NEGP's view of this domain encompasses all types of knowledge: physical, logico-mathematical, and social-conventional.

●Physical knowledge refers to the recognition that objects have physical properties in an external reality. The properties can be learned through observation and experience. In handling a ball, for example, one learns that it has weight and size and rolls downward when placed on an incline.

●Logico-mathematical knowledge refers to the relationships and associations individuals create in their minds between and among objects: for example, perceiving two objects to be different because of variance in a particular physical property (eg, color, size). Logico-mathematical knowledge is difficult to assess because of its complexity, but understanding relationships is integral to problem solving.

●Social-conventional knowledge refers to school-learned, society-endorsed "facts" that are maintained across generations. For example, use of a Judeo-Christian calendar system, agreeing that the English alphabet consists of 26 letters, and that the color of the daytime sky usually is "blue," whereas the sun is "yellow." Social-conventional knowledge is the type of knowledge on which the assessment of a child's cognitive capabilities is typically focused, even though it has the greatest variation across cultural groups and is the easiest to acquire.

The three types of knowledge are interrelated yet distinct. Children must develop a classification system that discriminates objects before they can "read" the physical properties. They may be able to count by rote to 10, but if they do not understand one-to-one correspondence, they will be unable to say how many blocks are in a stack.

Chronologic age — In order to enroll in kindergarten, children must reach their fifth birthday by a date that is arbitrarily set by the school system, usually the first day of September or October [18].

Empiric evidence supports the enrollment of children in kindergarten at the age-appropriate time. If there is concern about a child's ability to successfully participate in kindergarten, parents, teachers, and health care providers should carefully consider the potential benefit and detriment of proceeding with or delaying enrollment, and if the decision is to proceed with enrollment, they should communicate frequently during the first weeks of school to determine whether special programming or services are necessary [18].

Delayed enrollment — Caregivers and/or teachers may advocate delaying kindergarten enrollment for some children who are deemed to be "unready." This is particularly true of males who have birthdays that are near the cut-off date. This practice assumes that the child needs more time to develop basic cognitive or psychosocial skills.

However, waiting an extra year does not yield any noticeable benefit, particularly if the child remains in the environment where readiness was not fostered. In fact, for attainment of basic academic skills, (eg, sound-symbol awareness, letter and number recognition, counting) the effects of schooling outweigh the effects of age [90]. Children who postpone kindergarten enrollment for one year do not perform any better than children who entered kindergarten at the usual age [91]. Academic performance and social abilities of students who enrolled at five years of age and those who delayed enrollment are similar after first or second grade [92-96].

Moreover, students who are older than classmates are more likely to drop out of school in later grades than their age-appropriate peers [97,98]. The causality of this association has not been established; the high drop-out rate may be related to factors that contributed to delayed enrollment, rather than delayed enrollment itself. Students older than their classroom peers also have more caregiver-reported behavior problems and youth-reported health-risk behaviors (eg, substance use) than their age-appropriate peers [99,100].

Early enrollment — Caregivers also may advocate for early kindergarten enrollment (ie, at age four years) for their children who seem to have more advanced skills than their same-age peers. The ability of such children to successfully participate in kindergarten is comparable to children who entered kindergarten at five years of age if they have above-average intellectual abilities and well-developed socialization skills [101].

However, when controlling for effects of overall intelligence, children who were only slightly older than classmates at kindergarten entry showed modestly greater development across basic academic skills (eg, word decoding, number conceptualization, vocabulary, working memory) in the first few years of school, even though the groups did not differ on rudimentary skills demonstrated in kindergarten [90]. Teacher ratings of academic mastery in second or third grade also favored children who were slightly older at kindergarten entry. Social functioning did not differ between these groups of children during the first few years after kindergarten.

Adverse effects of early enrollment may become evident as the children enter middle and junior high school when physical maturation differences become more obvious. Although early enrollees typically continue to perform comparably in the academic arena, they may lag behind in the physical, and sometimes social, spheres and may be more likely to develop socioemotional difficulties [102-106].

Need for special education — For preschool age children who may need special education services, further assessment can be obtained through the child's local school or the school district's special education center. Under the Individuals with Disabilities Education Act (IDEA), caregivers can obtain free initial assessment and, if deemed eligible, access to services. (See "Developmental-behavioral surveillance and screening in primary care", section on 'Early intervention or special education services'.)

READINESS OF THE SCHOOL — The readiness of the school refers to the educational system's ability to address the needs of young children, regardless of their cognitive abilities. This is a more recent concept than the readiness of the child.

The school system should be prepared to educate kindergarten students who have a range of developmental abilities and skills. School characteristics (eg, teacher-student ratio, availability of multiple levels of instruction and remediation, and the number of children enrolled) can influence how well the various needs of individual students can be met [5].

The National Educational Goals Panel proposed 10 characteristics of schools that are ready to support the learning and development of young children [51]. Such schools:

●Smooth the transition between home and school (eg, by being sensitive to cultural differences and attempting to establish contact with caregivers who are preparing to enroll their children)

●Strive for continuity between early care and education programs and between early education programs and elementary schools

●Help children to learn and make sense of their complex and exciting world (eg, by using high-quality instructional aids with appropriate pacing and by demonstrating that learning occurs in the context of relationships)

●Are committed to the success of every child by being sensitive to individual needs, including poverty, effects of racism, and disability

●Are committed to the success of every teacher and every adult who interacts with children during the school day (eg, by fostering continuing education and skill development); one such intervention might be providing additional training in the education of children who have emotional and behavioral difficulties [3,77,107]

●Introduce or expand approaches that have been shown to raise achievement (eg, by encouraging caregiver involvement and monitoring teaching strategies)

●Alter practices and programs that do not benefit children

●Serve children in communities, ensuring access to available services and supports

●Take responsibility for results (eg, by using assessments to help plan for individual children and to measure accountability in the community)

●Are led by people who have a clear agenda and the authority to make and implement decisions in order to follow through on goals

In addition to the above characteristics, schools must be willing to accommodate the needs of children with chronic medical problems (eg, asthma, food allergies [57], developmental disabilities). (See "Children and youth with special health care needs", section on 'School-based services'.)

COMMUNITY AND FAMILY SUPPORTS — Family and community support for children's readiness is a relatively recent concept. The National Educational Goals Panel (NEGP) states, "Families and communities shape the context in which children grow, framing children's most important early experiences and encounters with their environments" [51]. In accordance with this statement, the NEGP proposed that:

●All children should have access to high-quality and developmentally appropriate preschool programs.

●Children would receive the nutrition, physical activity, and health care they need to develop healthy minds and bodies and to maintain mental alertness.

●Every parent or caregiver would be their child's first teacher and devote time each day to helping their child to learn; caregivers would be provided with the training and support needed to fulfill this role.

Health — The basic health of infants and toddlers sets the stage for ability to function in school environments. As noted above, physical and mental difficulties can impede the acquisition of new skills and information, as well as the successful demonstration of knowledge. Thus, it is important to have interventions at the community level that are aimed at improving early health. Such interventions include:

●Programs that provide monitoring, referral, education, and support

●Immunization initiatives

●Nutritional supplementation programs

●Programs that evaluate and treat oral health problems

●Programs that evaluate and treat mental health problems in parents or caregivers and children

Social — The ability of a child to participate in school activities also is related to their social environment. Providing social supports to families is another way to improve children's ability to participate in school. Examples of such interventions and their anticipated effects include [4,49,108-115]:

●Finding approaches to alleviate poverty can improve nutrition and emotional and/or behavioral problems

●Fostering involvement of all caregivers in divided families reduces the stress of single caregivers and also provides children with multiple models of adult behavior

●Providing parent or caregiver training teaches caregivers how to model appropriate interaction and how to provide boundaries around their children wherein the children have the safety to develop increasing independence

●Providing preschool teachers with explicit training in implementation of evidence-based curricula and teaching practices within the dual focus areas of emergent literacy and social-emotional skills promotes school readiness in both domains, and with the addition of training for caregivers, there are sustained gains even after transition to kindergarten

Provision of family and community support to increase social competence may improve kindergarten readiness and subsequent academic achievement. In a randomized trial, children with disruptive behavior difficulties who participated in the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), an eight-week school readiness parenting program (SRPP) based on parent-child interaction therapy combined with an intensive school readiness program that included social-emotional and self-regulation training, had incrementally greater academic achievement than those who received SRPP alone or SRPP combined with the intensive school readiness program without the social-emotional and self-regulation training [116]; all groups also improved in behavioral regulation. In a subsequent randomized trial, a four-week version of the STP-PreK program and the eight-week version had similar results [117]. Although both groups initially had greater improvement in most domains (eg, behavioral, academic, social-emotional, self-regulation) than a comparison group that was randomly assigned to behavior consultation intervention, overall function was similar in all groups at the end of the year.

Child care/preschool — As the number of single-parent households or households in which all caregivers work increases, more children are cared for outside the home. In addition to providing a safe environment, child care programs should provide enriching and stimulating activities for the children they serve. To meet this goal, they must have appropriate staff-to-child ratios and well-educated and trained staff members. (See 'Factors related to a child's ability to learn' above.)

In addition, the children should receive help in making the transition from child care centers or preschool to the more formal school setting of kindergarten. Communication between staff at the child care or preschool and kindergarten sites helps to facilitate this transition [18,118]. The staff at both sites should communicate with the caregivers to keep them apprised of the child's progress through the transition. Such communication can expedite the implementation of necessary support services if and when such services are necessary.

Literacy — Community- or clinic-based literacy promotion programs support early school success by helping children to develop literacy skills. Early literacy is highly correlated with academic success; children who enter school with the least knowledge of beginning reading skills are at academic risk [119,120]. Children whose caregivers read to them in the preschool years enter kindergarten with better skills than those whose caregivers do not [23,119,121,122]. Exposure to printed material is beneficial, but so is exposure to games and songs that focus on phoneme sound comparisons and rhyming.

The media, particularly television, has an ever-growing influence on the development of young children. Several educational programs foster literacy and psychosocial development [32,123,124]. However, observational data suggest that children learn more efficiently from real interaction with people and things than from situations appearing on a video (television, tablet, etc) [125]. Excessive television viewing limits the time that children spend in other activities that promote learning (eg, reading, playing with peers, coloring, building with blocks, puzzles, etc). Television programming should be closely monitored by caregivers so as to take advantage of the benefits available and to ensure exposure to appropriate models of behavior. (See "Television and media violence", section on 'Family and individual'.)

PROMOTION OF SCHOOL READINESS — School readiness is a multifaceted concept. Steps that caregivers can take toward making sure that all children enter school ready to learn include:

●Ensuring that their child has adequate nutrition and maintains regular sleep habits

●Expanding their preschool-age child's cognitive (table 1A), fine motor, language (table 1B), and psychosocial skills (table 1C) through mindful participation in routine activities of living, as well as structured teaching/learning projects

●Maintaining communication with their child's teachers and personnel in local school districts

The preparation of children for school includes minimization of risk factors for school problems or failure (eg, poverty, low birth weight, developmental delay, behavioral and socio-emotional dysregulation). This includes early identification of problems through screening programs and early intervention when such problems are identified. To this end, pediatric care providers are encouraged to [12]:

●Provide regular health maintenance, including developmental screening for their patients (see "Developmental-behavioral surveillance and screening in primary care", section on 'Approach to screening')

●Refer their patients who are at risk for developmental problems to early intervention programs as soon as such problems are suspected

●Take advantage of Head Start programs in their communities

●Regularly screen their patients for hearing and vision problems

●Promote good nutrition and regular physical activity as part of basic health

●Screen patients for medical or social conditions that affect school performance (eg, lead poisoning, poor nutrition, sleep problems, behavioral and socio-emotional difficulties, poverty, domestic violence, maternal depression)

●Optimize therapy for chronic medical problems so their patients do not miss school for acute exacerbations; communicating with the schools regarding the medical needs of their patients

●Keep their patients' immunizations current

●Encourage caregivers to read to their children and support home-based early education efforts (table 1A-C)

●Communicate with caregivers, day care providers, and teachers, particularly if the child is at risk for school problems

●Advocate for community programs that support children's success in school, which have been shown to have positive cost-benefit outcomes in addition to promoting academic skill attainment

RESOURCES — Resources that may be helpful to caregivers include:

●The Learning to Get Along series of books by Cheri J Meiners – The books cover such topics as working through conflicts, respecting others' property, valuing individual differences, sharing and taking turns, persevering when new activities are difficult, and other social issues. They generally are appropriate for preschool and early elementary school-aged children.

●Parenting the Strong-willed Child: The Clinically Proven Five-Week Program for Parents of Two- to Six-Year-Olds by Rex Forehand and Nicholas Long (2010) – This book provides a good introduction to the function of behaviors and the factors that contribute to them as well as strategies and skills needed to manage behavior problems. It is geared toward preschool and elementary school-aged children.

●The Reader Rabbit program – This is an excellent (and fun) academic instruction program that provides learning activities for reading and math. It is aimed at early and middle childhood ages. The Reader Rabbit program is available through www.reader-rabbit.com, local stores, and online distributors. It may be used at a local library if a home computer is not available.

●The American Academy of Pediatrics website on early literacy, which provides resources for families

SUMMARY

●Components of readiness – The concept of school readiness encompasses preparing children, schools, and communities to maximize the educational experience for all children, regardless of developmental ability or health condition. (See 'Components of readiness' above.)

●Readiness of the child – There are five domains of school readiness for the child:

•Physical well-being and motor development

•Social and emotional development

•The child's approach to learning

•Language development

•Cognition and general knowledge

Children's proficiency in these domains before kindergarten entry varies. (See 'Readiness of the child' above.)

●Chronologic age – Although most children enter kindergarten at or near age five, for typically developing children, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences in academic skill development after the first few years of school. Both deviations from the norm increase the likelihood of psychosocial struggles. (See 'Delayed enrollment' above and 'Early enrollment' above.)

●Readiness of the school – The readiness of the school refers to the educational system's ability to address the needs of the child, regardless of the child's cognitive abilities. The school system should be prepared to educate kindergarten students who have a range of developmental abilities and skills. (See 'Readiness of the school' above.)

●Community and family supports – Community and family supports for school readiness include (see 'Community and family supports' above):

•High-quality preschool programs

•Programs to optimize the child's nutrition, physical activity, and health (eg, supplemental nutrition programs, immunization initiatives)

•Programs that help caregivers to be more effective in their role as their child's first teacher (table 1A-C)