Child Care

Giving our patients a HEAD START!

Head Start began in 1965 with the aim to provide children from low income families with skills to be ready for and to succeed in kindergarten and in life. It now serves nearly 1 million children from birth to age 5 years with comprehensive early learning services in classrooms, home-based programs and family child care partners. Pediatricians should promote Head Start in patient visits and through advocacy efforts at local, state and federal levels. (more…)

Regulating the Quality and Availability of Our Children’s Pre-Kindergarten

Texas House Bill 4 introduced this session seeks to regulate the quality of pre-kindergarten programs that eligible Texas children receive. The measure includes a provision to authorize state payment up to $1,500 per child to the schools to ensure the programs are effective. It requires that teachers be certified or have at least eight years of experience and that the student:teacher ratio be no more than 18:1. It also requires reporting of data to the state to regulate quality and track outcomes in these existing pre-kindergarten programs. Programs must also have a curriculum and a family engagement plan to maintain “high levels of family involvement and positive family attitudes toward education”. It does not expand enrollment, nor would it increase from the current half-day model.

Current opposition to the bill is reminiscent of 1971 and the failure to establish universal childcare for all American children. At that time, the Comprehensive Child Development Act had passed both houses of Congress. Before being signed into law, it was vetoed by President Nixon. Various repudiated the legislation as the “Sovietization” of American children. Opponents argued that the law took the rights of child-rearing away from parents and placed them with the government. They characterized the act as an attempt to indoctrinate American children, and further stated that children should stay at home with their mothers. This same argument is being revived today by some opponents of House Bill 4. Other opponents are rejecting this bill because they believe more could be done by expanding pre-kindergarten enrollment to allow every child to participate. Others withhold support claiming a lack of evidence to support early childhood education as effective.

With many more women fully employed now, childcare and early childhood education is a clear necessity for most families. High quality early educational programs have demonstrated substantial effects on social and cognitive outcomes for children. Some studies also show a reduction in crime and arrests of the participants in their later adult years. Two aspects which are crucial for a program to be effective are limitation of class size and the amount of individualized attention that each child receives.  House Bill 4 lacks content to address those aspects, and it does not include a requirement to expand pre-kindergarten programs from half-day to full-day

As of May 7, 2015, House Bill 4 has been approved by both the House and Senate in Texas. When this bill is signed into law by Governor Abbot, we will have taken a step to help some Texas children reach their full potential. I encourage my colleagues to continue to advocate for all of our children. Universal early childhood education will benefit Texas families. Continue to raise awareness for this need by writing your state legislators to expand pre-kindergarten programs to give every Texas child the opportunity to benefit.

Stephanie Bousquet, MD


Badger, E. (2014, June 23). That one time America almost got universal child care. Retrieved May 5, 2015, from

Barnett, W. (2011). Effectiveness of Early Educational Intervention. Science, 975-978.

The Raising of America: Early Childhood and the Future of our Nation [Motion picture]. California Newseel with Vital Pictures.

Help support the ACE Kids Act to promote the medical home concept for medically complex children on Medicaid

The Advancing Care for Exceptional Kids (ACE) Act was first introduced in the House in June 2014 by Joe Barton (R-Texas) and Kathy Castor (D-Fla) to improve care for children with complex medical needs on Medicaid. Recently, it has been introduced to the Senate on January 29th, 2015 and re-introduced in the House on January 27th, 2015 with bipartisan support. These children have multiple diagnoses and often require multiple specialists which is why we need to support this legislation so that they can have a place to call their medical home.


Help Update Nutritious Meal Pattern Requirements for Young Children

A proposed federal rule accepting comments until April 15, 2015 proposes changes to meal pattern requirements for young children served by the Child and Adult Care Food Program (CACFP) to better align with updated nutrition guidelines. Several proposed revisions would extend to affect the National School Lunch Program, School Breakfast Program, and Special Milk Program to be more consistent across all Child Nutrition programs, as well as move toward more nutritious meals for children in day care.  (more…)

Please support the extension of Medicaid and CHIP funding

Medicaid and CHIP are essential to children’s healthcare in the United States. It is critical that we continue to fund both of these programs to ensure that our nation’s children continue to receive well child care from their primary care provider.  Well child care includes routine visits for vaccinations, ongoing surveillance visits for chronic health conditions, or yearly “check-ups.” (more…)

Exceptional Kids Require Exceptional Care

Right now there are roughly 3 million children in the U.S. with complex medical conditions. Two-thirds of these children rely on Medicaid to access. These children represent 6% of kids accessing medicare but account for 40% of Medicaid costs for kids. This population is growing as medical advances allow kids with previously fatal diseases or conditions to live and thrive into adulthood. (more…)

Child Immigration Crisis: Access to Health Care

Recently there has been a surge in the number of immigrant children crossing illegally into the United States through the southern border. This crisis provides us with the opportunity to take a closer look at immigration reform policy and how current legislation is creating more gaps in access to health care for immigrants. (more…)

Reforming Foster Care in Texas

In the wake of the tragic news that 2 Texas children drowned at Lake Georgetown earlier this month while in the care of their foster family, Texans Care for Children, an organization focused on public policies impacting children, has renewed its call for reform within the Foster Care system and Child Protective Services (CPS). In addition to advocating for higher standards in the foster family screening and training process, improvements in the role CPS plays within the system remains a core issue for the safety of these vulnerable children. (more…)

Health Needs for Children in Foster Care

Foster care children often have difficulties finding a consistent medical home. The children see different health professionals when their placement changes, which can be frequent. Health care providers then face difficulties to provide effective treatment with lack of follow up or inadequate knowledge of the child’s past course. (more…)

Childcare and Developmental Fund

All of us have had the opportunity to work with patients and parents who depend on having quality daycare available during the day in order to be able to work and provide for their families. The child care and developmental fund was established in 1998 in order to help these families, as well as to provide standards for the quality of care that children receive in these facilities. In 2014, this fund is up to be reauthorized with some important additions. The senate has passed the legislation and it is now in the house for approval. (more…)