Early Childhood Education

Literacy in the Time of Coronavirus

Texas is returning to normalcy as restrictions are being eased from the COVID-19 pandemic. Children are still out of school and it remains to be seen when they will return to the classroom environment. The combination of idle time, travel restrictions, and social distancing practices present a significant challenge to parents with restless children at home – as well as an excellent opportunity to promote reading. Pediatricians should use each well-child visit right now to encourage parents to take time to read with their children.

The Council on Early Childhood found approximately two-thirds of children in the United States fail to develop reading proficiency by third grade.1 Reading proficiency by third grade is an important predictor of high school graduation rates, as those who cannot read by that mark are four times more likely to later drop out of high school.1-2 Early reading deficiencies can lead to a lifetime of economic consequences. The Program for International Assessment of Adult Competencies (PIAAC), in a 2016 survey, suggested roughly 1 in 5 U.S. adults do not have basic literary proficiency.3 Low levels of adult literacy and educational level are associated with less economic opportunity, poor health outcomes, and social dependency.1,4

The promotion of reading skills can start in infancy. Parents can read aloud to infants to encourage language development and model reading behavior.1 As infants age, they begin to mimic their parents by turning the pages of books. With picture books toddlers can make inferences from the images before they can read the words on the page. Gradually and with training they may begin to recognize letters and eventually words. Ideally, pediatricians would like our patients to be familiar with the alphabet and recognize their name prior to starting kindergarten. For older children and teenagers, quarantine can be an opportunity to expand their literary horizons. By reading popular novels, classic literature, or books from high school reading lists, students can improve their literacy.

Many resources are available to help parents promote reading. Reach Out and Read Texas has a partnership with many pediatric clinics to provide children with a book at each visit from 6 months to 5 years; their website (see link below) also includes expected reading milestones by age. The Dallas Public Library has Tumble books available for children grades K-12 (see link below) online and additional books are available with a library card (free with proof of residence). Google Play Books has free children’s books available online which are playable on iOS devices.

Donovan Berens, MD

Works Referenced:

  1. High PC, Klass P, Council on Early Childhood. Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. Pediatrics. 2014 August; vol 134 (2): 404-409
  2. Hernandez D. Double Jeopardy: How Third-Grade Reading Skills and Poverty Influence High School Graduation. Annie E. Casey Foundation. 2011 April. https://files.eric.ed.gov/fulltext/ED518818.pdf Date accessed 5/01/2020
  3. Mamedova S, Pawlowski E. Adult Literacy in the United States. National Center for Education Statistics Data Point, U.S. Department of Education. 2019 July. https://nces.ed.gov/pubs2019/2019179.pdf. Date accessed: 5/02/2020
  4. Torpey E. Education pays. Career Outlook, U.S. Bureau of Labor Statistics. 2019 February. https://www.bls.gov/careeroutlook/2019/data-on-display/education_pays.htm?view_full. Date accessed 5/02/2020.

Additional Resources:




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 http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/23/that-one-time-america-almost-got-universal-child-care/

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.

Why A Strong Start Is Important

All children deserve a fair chance at a bright future, and the greatest window of opportunity to make a positive impact occurs during the years between birth and kindergarten. During this time, children develop very quickly, both physically and mentally.