NEW YORK - Many children are about to start school for the first time, but doctors say the key to successful learning may be found long before children enter a classroom.

In the first years of life, according to pediatricians, children's brains develop at a remarkable rate, and developmental problems often are detectable well before a child reaches school age. Dr. Dina Lieser, co-director of Docs for Tots and director of community pediatrics at Nassau Community Medical Center, said it's something that should be part of regular health care.

"Every single child should have a developmental screen done at nine months of age, at 18 months of age, and at 24 or 30 months of age," she said.

According to Zero to Three, the National Center for Infants, Toddlers and Families' website, about one out of every seven children in the United States experiences a developmental or behavioral problem before age 18. But a national survey by the Child and Adolescent Health Measurement Initiative showed that from 2011 to 2012, almost 80 percent of New York children ages 1 to 5 years, had not had a developmental screening in the past 12 months.

For example, Lieser said, language problems are noticeable in infancy and early childhood, and should be dealt with as soon as possible.

"Our capacity to make a difference becomes much more labor-intensive the older children get," she said, "as well as much less potentially effective."

Advocates also cite a strong correlation between poverty and developmental disabilities, but children in low-income families and those without health insurance are less likely to get early screening.

Lieser, who chairs the American Academy of Pediatrics' National Council on Early Childhood, said early screening and intervention are key for successful school years and beyond.

"Those years of development truly set the foundation for their lifelong development, school success, life success and health," she said.

Lieser added that about 20 percent of developmental disabilities may not be detected in a single screening, so parents are encouraged to make them part of every well-child visit to the pediatrician.


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CORRECTION: The name of the spokesperson from the Center for Law and Social Policy is Suzanne Wikle. She had been incorrectly identified as Suzanne Michael. (2:57 p.m. MDT, May 6, 2025)

Potential Medicaid cuts could have a negative impact on early childhood education professionals in Arkansas.

A report from the Georgetown University Center for Children and Families shows 31% of the state's child-care workers are covered by Medicaid.

Nicole Carey, education policy director with Arkansas Advocates for Children and Families, said having health-care coverage impacts the overall well-being of the educator.

"Which then plays into their relationship with the kids they're serving, and their longevity in the profession," said Carey. "And it has this ripple effect if they lose their health coverage, then maybe they aren't getting the services they need, and then they can't be as present at work."

Arkansas has expanded Medicaid coverage. It's one of 13 states nationwide that covers more than one-third of the child-care workforce through Medicaid.

Congress is considering cuts to Medicaid and other federal programs, which some say will eliminate federal waste.

The report shows many child-care centers are operated by small businesses owners who cannot afford to offer their employees health coverage.

Carey said Medicaid is needed to provide coverage to these essential workers.

"It will be your hourly workers, which could be the people in the classroom," said Carey, "it could be nutrition, it could be front desk."

Suzanne Wikle, associate director for state health policy and advocacy with the Center for Law and Social Policy, said most proposals for streamlining Medicaid includes shifting costs to the states, which means many Americans could lose health coverage.

"State budgets cannot just absorb that," said Wikle. "So, states will have to raise additional revenue through other ways, or cut, or do both, most likely, and because most states have to balance their budgets, these decisions will come quickly, and they will be very, very difficult."



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Child care is expensive and in high demand but groups in Montana are taking creative approaches to help.

Child care services in Montana currently meet about half the state's need, and full-time child care can cost more than college tuition, according to Montana Advocates for Children. Experts said solutions are unique to communities.

Jennifer Pfau, executive director of the Central Montana Childcare Alliance, helped launch the group in 2022, which offers startup grants and support for businesses, schools, churches and others to start child care centers. She said the pandemic made visible the "workforce behind the workforce."

"It's shifting the focus to helping people realize that child care is essential community infrastructure," Pfau explained. "And then working together to help address the needs in your community."

The group has helped open 15 new child care centers and expand capacity by nearly 200 slots with American Rescue Plan Act funding, which Pfau noted has since run out. She called finding more "challenging."

As school enrollment decreases, some empty classrooms are being remodeled for child care. That worked for Pfau and for the group Missoula Child Care Advantage, which also created a business membership, offering in-network child care for employees of local businesses and schools.

Sally Henkel, Missoula Child Care Advantage coordinator for the United Way of Missoula County, said fees go toward a "shared services model" to stabilize the child care sector by reducing administrative costs.

"Once that can be alleviated, the hope is that providers can really reinvest that time and energy into mentoring staff, maybe paying them a little bit better," Henkel outlined. "And also offer higher quality child care and have a little bit less burnout as well."

At the Montana Capitol, House Bill 360, scheduled for a hearing in the Human Services Committee this week, would establish a child care workforce recruitment and retention support payment program.


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Alabama is part of a national program aimed at diversifying early childhood education.

The Enriching Public Pre-K Through Inclusion of Family Child Care initiative gives the state ways to explore how family child care homes can be part of its public pre-K system.

Erin Harmeyer, assistant research professor in the National Institute of Early Education Research at Rutgers University, said family child care providers play a crucial role in filling gaps in access, especially in rural areas where they can be a better cultural and linguistic match for families compared to traditional child care centers.

"Home-based child care providers are often doing things like offering care during nontraditional hours, nights or evenings or weekends," Harmeyer explained. "They offer this really kind of familiar and flexible and personal option for families that makes them very preferred for many."

The initiative comes as demand for pre-K programs is rising. Nationwide, state-funded preschool enrollment hit record levels last year, with 35% of 4-year-olds and 7% of 3-year-olds participating in one recent school year.

Harmeyer noted Alabama was chosen for the program because it already meets her institute's 10 quality benchmark standards, including having well-qualified lead teachers, small class sizes and robust professional development requirements. She added integrating family child care homes into the system builds on this strong foundation and can offer more opportunities to support children's development.

"We know that a large body of research does show the positive impacts of preschool, in both the short and the long term for children," Harmeyer emphasized.

Alabama is one of four participants in the initiative, alongside Nevada, Michigan, and the city of Durham, North Carolina.


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