“There’s a good amount of research looking at associations between the neighborhood environment and various health outcomes,” says Julia G. Carter, lead author on the study, , published in JAMA Obstetrics and Gynecology. “When I was reviewing the literature, I saw a lack of research on the mother’s subjective experience, which is what our study looks at.”

Because individuals who live in the same community can encounter the same environment in radically different ways, Carter says the research team from Northwestern University’s Feinberg School of Medicine wanted to go beyond the data about exposure to crime and other adverse conditions to look at how the mother’s view of her personal safety affected her and her infant’s well-being.

The researchers took their data from the (PRAMS), a project of the Centers for Disease Control and Prevention (CDC) which, along with state, territorial and local health departments, collects targeted, population-based attitudes on maternal attitudes and experiences surrounding pregnancy. The survey asked set questions of respondents in the participating 46 U.S. states, territories, District of Columbia and New York City, which creates data on 81 percent of all live births in the U.S. Individual states have the option of selecting additional questions to deepen their understanding of their own populations.

For their study, the Northwestern researchers analyzed responses PRAMS had gathered from 2016 to 2020 from the states that had asked respondents how they perceived their neighborhood safety.

Eight states — Illinois, Louisiana, Minnesota, Missouri, Pennsylvania, Rhode Island, Virginia and WisconsinĚý — asked respondents, “During the 12 months before your new baby was born, how often did you feel unsafe in the neighborhood where you lived?” Answers were then categorized as always or often unsafe, sometimes unsafe, rarely unsafe and never unsafe. To assess interpersonal physical and emotional abuse, one item asked whether respondents had been pushed, hit, slapped or physically hurt by another individual in the 12 months before they got pregnant. After 1829 exclusions, 29 987 respondents were included in the Northwestern study. Most of the respondents (78 percent) reported that they never felt unsafe. At the other end of the scale, 3 percent said they always or often felt unsafe.

The researchers then analyzed respondents’ birth outcomes including low birth weight, self-reported depression during pregnancy or postpartum, attending more than eight prenatal care visits, attending a postpartum visit, and breastfeeding for at least eight weeks.

After controlling for maternal age, race and ethnicity, and other sociodemographic factors to test the independent significance of perceived neighborhood safety, the researchers found that, compared with respondents who never felt unsafe in their neighborhoods, those reporting that they always or often felt unsafe had nearly 25 percent higher odds of having a low birthweight baby and 100 percent higher odds of perinatal depressive symptoms. The group that felt unsafe had 10 percent lower odds of attending more than eight prenatal care visits.

Although the Northwestern researchers’ cross-sectional study didn’t assess the factors that could determine why a pregnant person might choose not to seek prenatal care, their study cited an in-depth Canadian published in the BMC Journal of Pregnancy and Childbirth that analyzed the motivators associated with inadequate prenatal care among eight inner-city Winnipeg, Manitoba, neighborhoods. Researchers from the University of Manitoba found that, although the women in their study lived in the same group of disadvantaged neighborhoods, psychosocial, attitudinal, economic and structural barriers and a variety of motivators, separated those women who received adequate prenatal care from those who did not. The study highlights the diversity among inner-city women with respect to their experiences with prenatal care and their perceptions of factors that help or hinder them in accessing this care.

Psychosocial issues that increased the mothers’ likelihood of not receiving adequate care included feeling stressed, having family problems, being depressed and worrying that child welfare officials might take the baby. Being abused by their husband or boyfriend also prevented several of the women from obtaining adequate prenatal care. Structural barriers included not knowing where to get prenatal care or having a long wait to get an appointment. Problems with transportation or child care were mentioned by nearly half the women who didn’t receive adequate prenatal care.

The good news, Carter says, is that these factors have policy implications, which means they can be addressed. Solutions are more likely to be found in such initiatives as providing access to social workers who can help with scheduling and follow up, providing mental health resources, or addressing systemic issues such as the lack of bus stops near clinics.

A reverse image of the neighborhood perception study can be found in the paper, “,” published in the International Journal of Environmental Research and Public Health, which looks at the relationship between favorable social and environmental neighborhood conditions and perinatal outcomes.

Researchers from the University of Albany looked at nearly 300 mother-infant pairs in small cities, suburban regions and rural areas in upstate New York. The neighborhoods were analyzed according to the (COI), a multidimensional indicator of a neighborhood’s favorable social, environmental and educational community attributes. The study, the first to analyze the COI in association with pregnancy health and birth size, demonstrated that positive neighborhood attributes cumulatively contributed to healthy pregnancies and favorable birth outcomes.

While the idea that better neighborhoods make for better health may seem like a foregone conclusion, the contrast among the studies underscores an important point. The factors that give one neighborhood a high COI score and make other neighborhoods a source of fear and concern for mother and child, are all malleable and subject to change.

In their neighborhood perception paper, the Northwestern researchers point out that social and economic interventions that combat neighborhood and domestic violence may be more beneficial in reducing adverse pregnancy outcomes than biomedical interventions. Reducing expensive, often counterproductive police crime-prevention initiatives and mass incarceration in favor of resources that strengthen low-income communities may go further to create a sense of safety not only for pregnant people, but for the entire community.

“The main question,” Carter says, “is what are we going to do about it? That is outside the scope of our study, but assessing the situation is the first step in having this conversation. There are still a lot of steps to make improvements and develop solutions.

“With these social determinants of maternal health, the truth is, there’s no quick fix. But to have the data and the commitment to collectively do something about it makes a big difference.”

Further Reading

ĚýChildren from neighborhoods perceived as unsafe by parents engaged in one less day per week in physical activity. Children from neighborhoods perceived as unsafe were less likely to use recreational facilities compared with children from neighborhoods perceived as safe, and children from less affluent families across rural and urban areas had half the odds of using recreational facilities compared with children from the wealthiest families living in urban areas.

Neighborhoods can be a potential source of psychosocial stressors associated with childhood asthma. Parents who perceive their neighborhoods as sometimes or never safe reported asthma at higher rates than those living in neighborhoods parents perceived to be always safe.

Babies born to mothers on Medicaid died at almost twice the rate of babies born to mothers with private health insurance.

That may read like an indictment of the federal Medicaid program, but it isn’t. Rather, it’s a reflection of the program’s limitations, the complicated circumstances of mothers experiencing poverty, and sometimes a simple matter of geography.

“Medicaid is fantastic and undoubtedly has improved outcomes for mothers and babies. But even though it’s beneficial, it isn’t as good as private insurance,” says Dr. Colm P. Travers, neonatologist and assistant professor of pediatrics for the University of Alabama at Birmingham School of Medicine. “Babies don’t get to choose who their parents are, how much money their parents make or what they do for a living. The baby shouldn’t suffer because of their parents’ socioeconomic status.”

Travers led a recent study on how insurance status relates to infant outcomes in the U.S. The study, “,” was published in the October 2023 issue of JAMA Network Open. The study used data from the birth and infant death records database of the Centers for Disease Control and Prevention (CDC) from 2017 to 2020. Researchers analyzed data of more than 13 million infants; 54% born to mothers with private insurance and 46% to mothers with Medicaid. The study found that those with private insurance had a significantly lower risk of infant mortality — almost half the rate of mothers with Medicaid — as well as a lower risk of low birth weight, vaginal breech delivery and preterm birth. They were more likely to receive prenatal care in the first trimester compared with those with Medicaid.

Prenatal care is foundational for positive outcomes because the first trimester is such a crucial time for both mother and baby, says the study’s first author, Desalyn Johnson, a soon-to-be MD from the University of Alabama at Birmingham.

“From a biological standpoint for the fetus, that first trimester is when organogenesis occurs,” Johnson says. “The other two trimesters see more growth of the body, but the first trimester is when the heart, the lungs — all the organs — are formed. It’s also a time for recognizing the mother’s baseline risk factors that might put a pregnancy at risk, such as high blood pressure or diabetes. You really want mothers to have access to prenatal care at that critical time.”

Presumed Eligible

Because the prenatal period is so crucial, many states provide presumptive eligibility for low-income mothers, meaning that they can start prenatal care as early as possible in their pregnancy. General guidelines for Medicaid eligibility are set by the federal government, but each state sets up their own requirements for eligibility, which differ from state to state. In states that don’t allow presumptive eligibility, the process for approval can send applicants through an administrative tangle that takes weeks and involves multiple steps to navigate the bureaucracy — at a time when the clock is ticking for both mother and fetus.

“One of the big differences we found in infant outcomes was that the Medicaid population had delayed or inadequate prenatal care, possibly because of the process they have to go through before they can even get an appointment for their first prenatal visit. That can mean by the time they get approved, they’re delayed in their prenatal care, or they haven’t received adequate care in those first months. They’re already behind,” she says.

Sometimes whether an expectant mother can receive adequate care boils down to whether she can get to it, Johnson adds.

“Here in Alabama, a lot of our population is very rural,” she says. “Some must travel great distances to receive healthcare. When you’re trying to access Medicaid services, it adds to the barrier when you have to go to this county clerk or that building to fill out paperwork and then back and forth. It can be difficult.

“A lot of times, researchers look at urban health, which is very important, but we also need to consider this rural aspect, especially in the Southeast.”

Nowhere to Go

Once a pregnant person does get signed up for Medicaid, there is no guarantee that they will be able to find a health professional to care for them or their babies. According to a research letter published in JAMA Network Open, “,” in 2020, the number of general pediatricians in the entire U.S. was 56,800. Only 2,900 of these doctors worked in rural counties; 86 worked in completely rural counties, which the defines as a county with open countryside, fewer than 500 people per square mile and no towns with more than 2,500 population. Nationwide, 1,391 counties had no pediatrician; 1,156 of these were rural counties; 331 counties had neither general pediatricians nor family medicine physicians (FMPs).

The March of Dimes’ 2022 report, “,” finds that about 36% of all U.S. counties have no maternity care, whether obstetric providers, certified nurse midwives, or hospitals or birth centers offering obstetric care — a number that appears to be growing. Maternity care deserts are associated with a lack of adequate prenatal care during pregnancy, treatment of pregnancy complications and an increased risk of maternal death. More than 2.2 million U.S. women of childbearing age 15 to 44 live in maternity care deserts.

Among all highly industrialized countries, the March of Dimes report states, the U.S. is considered one of the most dangerous developed nations in the world in which to give birth.

, counties with neither general pediatricians nor FMPs were more likely to have higher percentage of non-Hispanic Black children, higher child uninsured rates, higher child poverty levels and fewer children enrolled in K-12. The issue of health professional deserts is so pervasive now in the U.S. it even gets its own acronym, HPSA (health professional shortage areas).

This shortage helps explain — though not entirely — why babies, especially post-neonatal intensive care unit (NICU) babies, born under Medicaid don’t receive the same level of postnatal care, such as oxygen monitors and ventilators, as babies born to privately insured mothers. The babies born on Medicaid also face increased risk of dying from trauma, accidents, and — a serious neonatal illness most common in premature babies, especially NICU babies who don’t get human milk.

Lifesaving Alternatives

These negative outcomes don’t have to be assumed for mothers living in poverty, the researchers say. Multiple studies have shown that expanding Medicaid prenatal care can dramatically improve things for both mothers and babies. For example, found that expanding Medicaid to cover prenatal care for undocumented immigrant women in Oregon was associated with more prenatal care visits and improved care, a reduction in the number of babies born with extremely low birth weight, and lower infant mortality rate. Additionally, the mothers’ access to prenatal care was associated with an increased number of well child visits and increased rates of recommended screening and vaccines during the child’s first year.

A study of Medicaid-sponsored provided strong evidence that the program improves the lives and health of mothers and babies. A team of nurses, social workers and other specialists work with the pregnant person’s doctor and local providers to care for mother and child throughout pregnancy and the child’s first year, including a well-regarded . The study found that enrollment in the program significantly reduced the odds of babies dying within their first year.

Ruling Out Race

Aware of important racial disparities in infant outcomes in the U.S., researchers adjusted their health insurance study for race, so the results reflected the difference between mothers on Medicaid and mothers with private insurance, not race-based differences.

“Race is largely a social construct,” Travers says. “Increasingly, medical and genomic studies are showing that there is little basis for race-based medicine in the U.S. In this study, we adjusted for the effect of race in our analysis, not to eliminate race, but to try to take it out of the equation. We purposely looked at insurance and adjusted for race so that we could get at the question of socioeconomic status and insurance specifically.”

For example, a recent from the National Institute of Child Health and Human Development found that newborns of Black patients had the worst perinatal outcomes. But once the study adjusted for insurance status, the difference was no longer significant.

The researchers also adjusted for sex of the newborn, maternal pregnancy risk factors, education level and tobacco use to analyze the differences between the two groups. The difference boiled down to who had the better health care. In other words, infant mortality outcomes are not fully explained by those external factors but are associated with the mother’s socioeconomic status, and access to insurance and adequate health care. Populations that are entirely self-pay, such as undocumented immigrants, may have even poorer outcomes than Medicaid patients —a subject for future study, the researchers say.

The results reflected in these studies don’t point to Medicaid’s failure but to the work remaining to be done to ensure that pregnant women of all socioeconomic circumstances receive the timely, adequate care they and their babies need.

“The draw of pediatrics for us as doctors is that when we’re working with children, we can lay the foundation for them to have healthy and successful lives,” Johnson says. “But if you don’t lay that foundation in the dawn of life, it can have repercussions for their entire lifespan. Ěý“We’ve now documented that, yes, these findings are what we expected. The next steps now are to decide how we as physicians, as policymakers, can address these issues and improve the outcomes for these babies.”

Further Reading

: In 2020, 42% of all births in the U.S. were covered by Medicaid. About one in nine women of childbearing age (11.6%) in the U.S. was uninsured. About one in 18 children younger than 19 was uninsured.

An interactive map showing which of the states have adopted Medicaid expansion coverage for nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and the 10 states that have not done so.

A key to halting that malign ascendency could be found very close to home, especially Latinx homes, recent research from the University of Washington’s Institute for Learning and Brain Sciences (I-LABS) indicates. “,” published in the Journal of Latinx Psychology, found that Latinx children living with grandparents at home were more likely to exhibit prosocial, other-oriented behavior than children without grandparents in the home. The findings, the authors write, have broader implications for our understanding of culture, socialization and prosociality.

Prosociality refers to behaviors that accommodate or benefit others, voluntary actions such as sharing, comforting, helping and cooperating. In short, the cornerstones of a workable society. For research scientist Dr. Rodolfo Cortes Barragan, the study’s lead author, investigating children’s prosocial behavior is more than an academic exercise, its real-world applications matter to the kind of society we have now and in the future. Barragan’s research seeks to identify the key ingredients for positive outcomes in human development and society.

“Prosociality is key to everyday human civilization,” Barragan says. “Civic society may start with simple actions with children but over the long term, that gets us to a well-functioning society.

“It’s an important goal for scientists to be able to inform the dialogue about how we can have a better, more civilized, courteous society. I’ve been interested in that reality and that’s what drives me to conduct research that’s broadly relevant to everyday social interactions.”

Though prosocial behaviors vary by culture, numerous social theorists have held that Latinx culture is especially adept in this domain. According to previous research cited in this study, Latinx individuals generally prefer to engage and work in settings that emphasize personal harmony and seek to engage in positive conversations and interactions with new people. Latinx people’s graciousness, gregariousness and hospitality are legendary, and those qualities generally begin at home. A series of I-LABS experiments with 19-month-old infants showed that Latinx infants shared more objects of personal value with strangers than non-Latinx white infants, indicating that the enculturation of prosociality may start at “surprisingly early ages,” the researchers wrote.

A solid body of research has looked at children’s prosocial learning from their parents, but little has been done to examine the connection between grandparents and young children’s prosociality, including Latinx grandparents. What is known about Latinx grandparents is their connection to cultural values such as ˛őžąłžąč˛šłŮĂ­˛š, or relational harmony; familismo, an emphasis on supporting and nurturing all members of a family; and respeto, deference and respect toward others, all of which are likely to be emphasized in their interactions with grandchildren. These prosocial behaviors can have a significant effect on children in an academic setting, and previous research has shown that Latinx children with grandparents at home do better academically and emotionally than kids without grandparents at home.

To test the idea that Latinx grandparents’ presence in their grandchildren’s homes puts them in a prime position to influence prosocial values, the researchers conducted their study in Los Angeles County, which has the largest Latinx population of any U.S. county. The children in L.A. County are often children and grandchildren of immigrants, or immigrants themselves, and a pilot study found that approximately 50 percent of the young Latinx children in the region’s parks lived with grandparents at home. The researchers focused on 4- and 5-year-olds because at these ages children are less influenced by the formal education system and are considered old enough to engage in verbal interactions with researchers.

The pilot study took place in 2019 and ground to a halt along with most other public life when the pandemic hit in early 2020. By the time the study started again once vaccinations became available, researchers observed that the percentage of live-in grandparents had been reduced to about 33 percent — likely reflecting the fact that COVID-19 had hit the older U.S. population hardest. A national analysis found that Latinx children had nearly twice the risk of experiencing a grandparent’s death during the pandemic compared to non-Latinx white children.

Still, the researchers were able to carry out their study with 250 young Latinx children and their families, which Barragan says is the largest — “almost unheard of” — sample of children of this population on a behavioral test. They conducted the study in public parks because they wanted to take it out of the constrained environment of the behavior lab and into the community. Testing sessions were conducted in the mid-to late-afternoon when the parks had many families with young children and a recreational atmosphere prevailed. On some days, the parks were hosting COVID-19 vaccination drives.

For the study, young children were invited to play a “sticker game” on a preprinted sheet of paper divided into two sides. One side gave the child the choice of getting a small smiley-face sticker for themselves, and another child represented by a silhouette would also get a sticker. The other side gave the child the choice to take a sticker for themselves only, with the other child getting none. The study indicated that children with a grandparent in the home were almost twice as likely to make the prosocial choice of giving another sticker to the other child as were the children without a grandparent at home.

The researchers theorize that the grandparents may be transmitting these prosocial behaviors by verbally encouraging helpfulness and communicating the complex web of Latinx social values during mealtimes, while taking walks with the children and through daily interactions with others. The grandparents’ own behavior and the “imitative abilities of young children” may also serve to model these prosocial attitudes and behaviors. The precise ways in which this occurs, and if there’s any difference between the influence of grandmothers in the home versus grandfathers remain questions for future studies, Barragan says.

“We’re going to need more research on some of these questions because one limitation of our studies is that we had to be quick because of COVID and weren’t able to get as much information as we would have liked,” he says.

The researchers write that the current findings underscore the desirability of examining the grandparent-grandchild prosociability link in other groups beyond the Latinx community, such as African American families, and in Native American and Asian American communities, all of which have strong but distinct familial values and frequent involvement of grandparents in childrearing.

“Even though this study was focused on a particular population, it’s really important to extrapolate (to our larger society),” Barragan says. “This study teaches us about the importance of how grandparenting can be important in a culture that’s perhaps more traditional than contemporary mainstream American culture. It teaches us about different ways of being and the diversity of our community.

“And it teaches us that by looking into different communities, we can learn about human psychology in ways that inform our approach. It’s about being open to new ideas and new ways of seeing things.”

Child-related tax credits are typically modest in size, but the studies found that for low-income families, receiving this boost sooner rather than a year later can have all sorts of benefits: persistent higher family income, fewer dealings with the child welfare system, improved academic performance and increased earnings for children turned adults. The research is part of an emerging understanding of the first few months of a child’s life as a pivotal window for boosting low-income families and possibly children’s social mobility, a period where even relatively small cash transfers might be “changing something fundamental about family structure and well-being that has long-lasting consequences,” said Katherine Rittenhouse, an economist at the University of Texas at Austin and an author of one of the studies, in a 2023 interview.

Economists have long regarded family income during a child’s early years as a kind of Magic 8 Ball, the time when economic deprivation can predict a host of disparities that threaten to endure or deepen with time. But few studies have been able to pinpoint why: Is it simply money that makes the difference? Or is it something more murky, like differences in parenting, or neighborhood environments and schools?

For families with babies, tax data offers an elegant way to isolate the impact of receiving extra cash during a child’s first year of life. That’s because infants born in, say, December of 2023 can be claimed on this year’s taxes, providing parents with extra income through tax credits this year. But for babies born just a few days or weeks later in early 2024, parents must wait a full year to receive child-related tax credits. This creates a natural experiment that allows researchers to compare the impact of extra cash on families and children who are similar in all ways except one: some received child-related tax credits when their babies were a few months old, and some waited until their children were at least 15-months-old to receive the money.

In one such study published in 2020 in the reputable , researchers scoured federal tax data spanning four decades along with state-level education data to determine that low-income families who received the tax credit during their first babies’ first year, as opposed to later, had higher family earnings which persisted. Andrew Barr, a professor of economics at Texas A & M and an author of the study, said this suggests that something about receiving the credit during a child’s first year of life supports parental employment. (The study focused on low-income parents with first-born babies.)

The effects of extra cash during infancy were even more pronounced for the children. Children whose families received the child-related tax credits sooner went on to have higher reading and math scores, and lower suspension rates and higher graduation in school. Possibly as a result of those academic gains, the researchers speculated, their earnings were found to be 1 to 2 percent higher as young adults, and continued to increase as they aged.

The authors concluded that the tax credits not only paid for themselves through increased tax income, but delivered more bang for the buck than even the famed Perry Preschool Project of the 1960s, which was also found to boost participants’ future earnings, but cost far more per participant while serving a very small number of children.

In a different study using similar methodology, Rittenhouse of the University of Texas at Austin used California birth records to determine that for low-income families with first born children, tax credits received during a child’s first year appeared to prevent child welfare involvement, which is strongly linked to poverty. , Rittenhouse estimated that for low-income families, receiving a one-time cash transfer of $1,000 during the first few months of a firstborn’s life as opposed to a year later led to four percent less involvement with child protective services during the first three years of life and six percent fewer days spent in foster care. The effects endured until at least age 8, which is the last year studied. “Increasing payments to families during the first year of a child’s life may pay for itself in terms of reduced long-term maltreatment costs,” Rittenhouse wrote.

In both studies, the average tax credits amounted to less than $1,500, which researchers said likely made little difference to families’ lifetime earnings. But they did make up a sizable percentage of a family’s yearly income — roughly 10 percent in one study — which economists believe is key to their effectiveness.

After all, the months following the birth of a first child comprise a uniquely vulnerable, influential time of transition for families, one when “stress is high, expenses are increasing, and working is physically difficult or impossible for new mothers,” as Barr and his co-authors explained in the study.

Because of this intensity, the first year of life is also a time when a lot can and often does go very wrong. The Survey of Household Economics and Decision-Making identified a child’s first year as a time when parents reported being financially worse off and denied credit. The first year of life is also the age when a person in the U.S. is most likely to experience homelessness and also to enter foster care.

The chronic stress stemming from adverse events like these may be especially harmful during a child’s early years, when a child’s brain grows most rapidly and consistent, positive relationships with caretakers are particularly important to healthy development.

Even a little more cash during this tenuous time of transition may go an unusually long way to protecting financially strapped families from derailing, potentially devastating events like eviction or unemployment, which can snowball. “It’s when an extra few thousand dollars can have a big effect,” said Rittenhouse.

Take reliable transportation — something many depend on to work. One study found that more than 40 percent of families who received the earned income tax credit for low-income families have a major car repair within six months of filing taxes. For some, that extra cash from the tax credit could be the difference between having a way to get to work, or not. “Having what might seem a modest financial buffer might be enough to allow [parents] to repair their car, and maintain connections to the workforce, and keep things going in a way that results in better outcomes for them as a family and then the child as well,” said Barr. “This one-time transfer kind of allows you to somehow keep your job, or get a job or do better at your job.”

Recognizing the pivotal nature of a baby’s first year, other developed countries invest in infants by providing paid family leave for parents to bond with babies and by funding child care. For decades the Finnish government has sent expectant families filled with toys, clothes and even a mattress that transforms the cardboard box it arrives in into a crib.Ěý

Here in the United States, where we have none of this, a handful of pilot projects have been trying to make the case for no-strings-attached cash to new mothers. Since January, all mothers in Flint, Michigan can receive $1,500 while pregnant, plus $500 a month for the first year of their baby’s life. Meanwhile, researchers conducting , in New York City, and Baby’s First Years are studying the impact of cash on new mothers and their children. Baby’s First Years is particularly interested in measuring child .

Projects such as these are often small and, for the time being, focused on potential short-term effects of cash transfers. By contrast, the tax studies offer compelling, large-scale, long-term evidence that investing in infants pays off big. “We now have strong evidence that providing income or welfare supports during early childhood improves the outcomes for kids throughout their life course,” said Rittenhouse.

A answers both questions with a yes, at least when it comes to low-income and disadvantaged children.

The out of Tulsa, Oklahoma is a randomized control trial in which half the children of low-income parents were randomly assigned to attend a high-quality Educare program as infants and half were not. What it found is that from kindergarten through third grade, children who had gone to Educare as infants and toddlers had higher academic outcomes by the end of third grade than those who didn’t. They had better letter and word identification, vocabularies, oral comprehension and math scores. The study found mixed results when it came to executive functioning—by one measure the children who went to Educare scored higher, but by another there was no difference. There were no differences between the two groups in social-emotional skills.

“There are very few longitudinal studies tracking children from their infant and toddler years to middle school years,” said Diane Horm, the George Kaiser Family Foundation Endowed Chair in Early Childhood Education at the University of Oklahoma, one of the authors of the study and the evaluator for Educare Tulsa. “Our study is one of the few that does that.” By doing so, it has proven two different things: that investing in children’s educational environments is important starting as early as infancy, not just when they reach typical preschool age; and that doing so will reap rewards long after they get older.

“As a society it’s great for us to be focused on expanding preschool, but earlier is better,” Horm said. “Our study shows that if we want to change the educational direction of children growing up at disadvantage, we need to start early, earlier than preschool.”

Educare is network of 25 schools serving children from birth to age five across the country. Begun with a single school in Chicago in 2000, it has since spread and focuses on the first three years of a child’s life. In offering what Educare Tulsa Executive Director Cindy Decker calls “full day, high-quality, holistic education,” it has four core features: high-quality teaching practices, an emphasis on ongoing professional development, intensive family services and the use of data to continuously improve the program. It complies with Head Start and Early Head Start standards and then goes above and beyond them.

Lead teachers in each classroom are required to have a bachelor’s degree in early childhood education or a related field. Each classroom has three teachers, and they stick to Head Start mandated ratios: eight infants maximum for three teachers, 17 three-year-olds for three teachers, and 20 four-year-olds per three teachers. The staff is offered ongoing professional development, including a coach for every teacher and a supervisor for every family advocate. They’re encouraged to meet and reflect on problems they’re facing, coming up with solutions and “empowering staff to really think through things and problem solve as a team,” Decker said.

Every program partners with a local evaluator that collects and shares data on the school for “continuous improvement,” Decker said. “While we feel we know what matters, we also know that learning never stops.”

For parents, the programs are free and full-day, year-round. Educare also offers what Decker calls “intensive family engagement.” When children first enroll, family support workers interview families to assess their needs. For those with immediate needs such as hunger, domestic violence or the threat of eviction, the school will connect them to resources in the community that can help. Families that are more stable are encouraged to become advocates, possibly even traveling to Washington, D.C. to lobby Congress for more child care funding. The program’s family support workers have lower caseloads than in regular Head Start programs.

Educare is thus a far higher-quality option than what many children in the U.S. experience. of four-year-olds attended preschool in the 2021-2022 school year and less than 7 percent of three-year-olds did, and not all of those programs will offer the same kind of quality that Educare strives for. In 2006, of child care centers met all quality standards.

The control group in the Tulsa study, or the children who weren’t assigned to attend Educare, often ended up with a patchwork of care. The most common arrangement was for their parents to leave them with a family member or friend. Five went to a public preschool program, five attended Head Start, five went to a formal child care provider and one had a babysitter. But they had “often multiple combinations of those things,” Horm said.

When Horm first started following the children in each group, her study was part of a larger research project on the Educare system that began in 2010 and spanned four different programs. Those studies looked at how children fared of Educare and again . Both found positive impacts for the children who attended the program: after a year they had better auditory and expressive language skills, while parents reported fewer behavior problems and had better interactions with their children. After three years, the children who had been in Educare had better auditory language and early math skills and fewer behavior problems as reported by parents.

“These initial positive results propelled us to continue the study in Tulsa,” Horm said. She wanted to keep following the children after they left Educare to see whether these effects would last once they entered the public school system. With some funding from the George Kaiser Family Foundation, they were able to keep going while other sites ended their tracking.

The results of this latest study have limitations in terms of their application. For one, Educare offers a much higher quality setting than many preschool settings. To replicate the results, policymakers would have to ensure the same level of quality.

But for Horm, what it proves is that, at the very least, the country should be fully funding Early Head Start and Head Start programs to reach all eligible children. The study shows “the power of starting with high-quality infant/toddler programs, which as a society we have invested in least,” Horm said. As of 2020, the funding for Head Start was only enough to serve of children living in poverty, and for Early Head Start it was enough to serve a mere 10 percent. More funding would also have to be added to make these programs more closely resemble Educare—ensuring they operate for a full day, year-round, with well trained teachers and caseworkers who can give parents the attention they need. It’s “a reach that our society could do if we chose to do it,” she said.

Another limitation is that the study only looks at low-income children, as Educare follows Head Start parameters and is only open to families living below the poverty line. The results can’t necessarily, then, be applied to universal preschool programs that are offered to students of all backgrounds, such as what’s been implemented in New York City, Boston and Washington, D.C. But Horm pointed to other studies that make a case that her results could potentially apply to higher income children, too. For example, found a positive relationship between higher quality care from the ages birth to four and a half years, and better academic achievement at age 15 for an economically diverse group of children. Another, which looked at Boston’s program, found that universal, public preschool reduced behavior issues in elementary and middle school, increased high school graduation rates, and boosted college attendance.

Prior to the Bill de Blasio administration (2014-2021), free pre-K in New York City was a patchwork of means-tested, half-day programs that served just under 20,000 4-year-olds. In his first year in office, Mayor de Blasio delivered on a campaign promise to create an expansive universal pre-K program. By the time of de Blasio’s exit, his administration had created an immensely popular program that served 90,000 children, transformed New York City’s early childhood education infrastructure and was on track to add another 30,000 seats for three-year-olds.

But in the fall of 2022, current Mayor Eric Adams announced a preliminary budget that reallocated $568 million away from universal pre-K and halted the expansion of 3K For All.ĚýSo, where did things go wrong? Senior Adams administration officials have argued that mismanagement under de Blasio has resulted in the uneven distribution of seats, including the “opening tens of thousands of seats where there isn’t family need and failing to open seats where the need exists.” Nathaniel Styer, press secretary for the New York City Department of Education, claims that a has resulted in a large number of open slots in low-income, immigrant neighborhoods of the city like Highbridge in the Bronx, and few open seats in wealthy communities.

For my graduate capstone thesis at the Department of Urban Policy and Planning at Hunter College, I sought to understand why some of New York City’s most economically vulnerable residents are not making use of what should be an economic lifeline: free child care. I conducted research interviews with participants in four key stakeholder groups: parents, child care providers, former staff within the Division of Early Childhood Education, and policy experts.ĚýMy research aimed to unpack the “demand mismatch” theory and answer two questions:

1. Is there an unmet need for universal pre-K in low-income communities that is not captured by the way the Adams administration measures demand?
2. Are there barriers to information, access and enrollment that may be contributing to underutilization?

Here are my findings.

Finding: Universal pre-K may not have enough flexibility to match the diverse needs and preferences of New York City families.Ěý

Many parents need child care before or after the traditional school day, on nights and weekends, and over the summer. In fact, of children in the United States have at least one parent who works non-traditional hours. The vast majority of New York City’s universal pre-K programs, however, are offered on a school-day/school-year calendar (6 hours and 20 minutes per day; 180 days per year) and only some community-based providers offer extended day and year programs primarily for families who meet Child Care Development Block Grant or Head Start eligibility criteria. found just 15% of 4-year-olds enrolled in universal pre-K received full-day, year round care and in some low-income communities less than 10% of pre-K seats were full-day, year-round.

Interviews confirmed that so few options for extended care may contribute to low utilization rates in low-income communities.ĚýElliot Haspel, author and expert on child and family policy, explained that “family needs for child care do not exist on a school-year, school-day basis. Often disproportionately, we know that lower income parents and parents of color tend to be those who are working shift jobs, and a high proportion of them are working non-traditional hours… So, the lack of flexibility can certainly be a barrier.”

A former staffer within the Division of Early Childhood Education, who requested anonymity in order to speak with me candidly, told me not being able to offer early or after-school hours was one of the biggest hurdles reported by principals. They also described the lack of extended hours as a “misalignment with what is being offered and what is needed in the community.”

For some parents, inflexible operation times can leave universal pre-K entirely out of reach. One mother, whose daughter is enrolled in a community-based center in Red Hook, said start times for some pre-K centers conflicted with the ferry schedule. Choosing to send their child to one of those programs would mean she or her spouse would be late to work every day, and therefore they did not apply.Ěý

Finding: There may be demand for home-based family child care, but that need is not reflected in the composition of universal pre-K.

Enrolling in universal pre-K programs at district schools or formal child care centers may work for some families, but other families prefer different options. A argues that due to a “lack of multilingual staff, rigid schedules, and limited programming that is culturally and linguistically responsive, formal child care centers historically have not fully met the needs of immigrant communities, and particularly low-income immigrant communities.”

Julie Kashen, senior fellow and director for Women’s Economic Justice at the Century Foundation, said Ěýthat home-based family child care is an option , especially those who are looking for a cultural or linguistic match and/or who require extended or nontraditional hours of care. These program options, however, are not offered for pre-K and are very much awith typically only a few hundred family child care seats.

A former DOE staffer, who requested anonymity, expressed that home-based family child care providers “are not technically excluded, but the way that the system is constructed ends up resulting in it being really difficult for them to be able to participate.”ĚýHe explained that New York City’s complex contracting process for its universal pre-K programs can shut family child care providers out, and thus, an arrangement that attracts low-income, immigrant communities remains out of reach.

Finding: Sustained outreach is necessary to engage low-income and immigrant communities, and scaling back the outreach initiatives could contribute to low utilization rates.Ěý

The de Blasio administration focused heavily on outreach to reach families who may not typically have a high level of engagement with government agencies. There were borough- and neighborhood-specific outreach teams equipped with materials like palm cards and flyers available in all DOE languages, and there was on-the-ground support, including canvassing, days of action at shelters and events at libraries to bolster enrollment. Coordinated outreach and partnership with trusted community members has among “hard to reach” low-income and immigrant communities.

My interviews with former DOE staffers, however, revealed that the Division of Early Childhood Education under Adams has been plagued by understaffing and has significantly scaled back outreach initiatives. The Division of Early Childhood Education is across all divisions at City agencies. Members of the neighborhood and borough-specific teams have reportedly been and there is more focus on automated forms of outreach like , which are not nearly as effective in engaging low-income families, especially those who may have had previous negative experiences interacting with government agencies or who are undocumented.

After months of negotiation and just a few weeks after my capstone was published, the New York City Council voted to that restores universal pre-K funding and supports efforts to convert 1,800 3K seats from school-day/school-year seats to extended day/extended year seats. The final budget is a huge sigh of relief for early childhood education advocates who feared Adams’ proposed cuts, but the future of universal pre-K remains uncertain.

My research only begins to scratch the surface of this issue, but it does suggest that demand for universal pre-K is more complex than a simple measurement of seats vs. students. As the Adams administration continues to make staffing, strategic and budgeting decisions about universal pre-K, it should not assume that open seats means that there is no demand.

Instead of strategizing ways to reduce the size and scope of universal pre-K, it should invest in resources to help parents navigate the complicated enrollment process and ensure low-income communities can enroll in programs that fit their needs.

Working with organizations like to increase the number of licensed home-based family child care providers who participate in the program, reengaging the outreach teams and strengthening partnerships with on-the-ground trusted community organizations, and offering more extended day, full-year programming options could improve utilization rates in low-income communities.

At a December 2022 press conference, Mayor Adams stated “A true universal program prioritizes and serves every child, every day, in partnership with families and reflects the needs of the community.” It is up to the Adams administration to continue the legacy of universal pre-K and ensure that it is truly universal.

Children in their early years are not only uniquely susceptible to the effects of climate change, but they are also the key to solving its challenge, he says.

Capita envisions a future in which children and their families can realize their full potential in a “just, peaceful, prosperous society on a healthier, cleaner and safer planet.” In pursuit of that objective, Capita has released the first in a series of papers that will explore how young children, families and communities can flourish in this time of climate transition. Capita commissioned the paper, “,” to support the Capita/Aspen  Early Years Climate Action Task Force members in thinking about the most promising approaches to accomplish that goal. The task force will publish its first U.S. Early Years Climate Action Plan later this year.

The paper’s key messages are:

• In the face of climate change, focusing on our youngest children and families is an important avenue for ensuring an equitable, sustainable future for all.
• Aligning early years and climate change policies, practices and financing protects those most vulnerable to the impacts of climate change and drives action on adaptation, mitigation and reducing loss and damage.
• The are the best framework for aligning action on climate change with action on the needs of young children.

Presently, children are barely in the picture in the global campaign to address climate disruption, though according to the World Health Organization (WHO), young children’s developing bodies and brains bear the brunt of impacts from the fossil fuel consumption that’s driving climate change.  According to the journal Pediatrics, 88% of the illnesses, injuries and deaths due to climate change occur to children, particularly those living in poor and under-served areas. Look at any devastation related to climate change, and it lands on small children and the most vulnerable communities first and hardest.

“That’s a life-altering statistic,” Waters says. “On the basis of that information alone, we have to completely reimagine our public health, health care and all the other systems of support for children in the face of climate change. How do we create environments, ecologies that enable flourishing, despite all the negative changes in our environment that are going to happen because of climate disruption?”

The redeeming news is that supporting young children and their families is a powerful tool to address both the short-term threats and long-term challenges of climate disruption, Waters says. Meeting the needs of young children and their families today can create the foundation for resilient communities going forward. Doing so ťĺ´Çąđ˛ő˛Ô’t require reinventing the wheel, though it may require reallocating some resources.

A Path to Action

Climate financing is essential to implementing the quantum leap for humanity needed to successfully navigate the cascading effects of climate disruption; it also is one arena in which the failure to take young children into account is most blatant. According to a paper on climate change by the Children’s Environmental Rights Initiative — comprising UNICEF, Save the Children and Plan International and funded by Capita — an showed that children are being dramatically neglected in climate funding commitments globally. Just 2.4% of climate finance from multilateral climate funds — a cumulative $1.2 billion — can be said to support projects incorporating child-responsive activities.

The change if such child awareness were embedded in climate financing mechanisms would be comprehensive — everything from strengthening our early care and education system to be more resilient in the face of climate impacts, to altering infrastructure to offer more shade.

“I want to be very clear that we are not asking the early care and education sector to solve climate change,” Waters says. “Climate disruption demands that we take a different lens, a different frame, to all our work.

“Climate change is not an issue as much as it is a context,” he says. “So, we must reimagine all our systems and infrastructure across society for this context — as we did with Covid, which showed us that it’s doable. At the end of the day, government is the largest mechanism by which we tackle massive issues in our society. I’m unapologetic about the idea that the place where you can drive the biggest change over the long haul to deal with massive societal problems is government. It’s where we do big things together.”

Reimagining Everything

What that new context might look like is as varied as communities themselves.

“Take cities as an example,” he says. “Cities are already making investments in resilience, to adapt to the effects of climate change today. Cities are setting up cooling centers to support people who don’t have air conditioning. Are those child-friendly? Are there places to play? Are there places for parents to nurse their babies?

“That’s one low-cost adaptation a city can make. Shade equity is another. Do the areas where our lowest-income, most vulnerable children live have adequate shade? Generally, not. But they could have. And we can clearly propose that, yes, this is good for everyone – not just our youngest. Let’s focus our efforts — whether shade-equity or similar solutions — in those areas first. Let’s prioritize those things.”

Promoting the well-being of children in the face of climate disruption would involve strengthening communities and relationships, as well as providing parents and other caregivers with the knowledge and resources to support their children in a climate-related event.

“How do we strengthen our early care and education system to be more resilient in the face of climate impacts?” Waters says. “To withstand heat waves, to withstand bad air-quality days and so forth.

“Our pediatric health care system is generally not attuned to providing anticipatory guidance to parents when there is a forecast of an extreme heat wave. That’s the type of investment in an early-warning system that needs to be made so parents and other caregivers have the tools they need to protect the health of their children.

“If you take a child health and well-being lens to climate change, you’ll see that A.) All the systems that support children and families have a great deal they could be doing now with appropriate investment to support healthy development, and B.) All the other institutions that exist and are focused on resilience and adaptation could be taking much more robust child-sensitive and child-responsive lens to their work.”

This paper encourages the U.S. to take a leadership role in addressing climate change and making the lives of young children a priority in that effort. As the country with the largest historical and per capita greenhouse gas on earth, it is critical that the U.S. advocates for and supports efforts to mitigate climate disruption. The group urges the U.S. to make financial contributions appropriate to the scope of the challenge, as well as bring forth the nation’s best minds and best efforts to addressing the many issues involved.

“The United States needs to be leading the world with investment, with putting children and families the world over first,” Waters says. “We’ve contributed to this problem but we’re also one of the most innovative, creative, forward-leaning countries in the world, particularly when it comes to new ideas and new technologies.

“It’s an opportunity for us to do what Americans do best and have done historically, from the New Deal to NASA. This is a moonshot opportunity for America.”

RESOURCES

• (Children’s Environmental Rights Initiative)
• (Capita)

A yawning gap exists between what we say about children and what we do for them. The reasons for this disconnect are complicated, but much of it has to do with how children exist — or simply don’t exist — in the imagination of the public and policymakers. Philosopher René Descartes’s first principle, “I think, therefore I am,” pretty much says it all. How we think about our world gives us our reality. As a nation, the way we think about children — or don’t consider them at all — is failing our kids.

Fortunately, as stacks of behavioral and brain research have shown, we aren’t stuck with the attitudes and values we’ve inherited: As both individuals and a society, we can change our minds. We can change the lens, reframe the issues and give childhood — particularly early childhood, in our case — the value it deserves.

A study published in the February 2023 issue of the journal set out to explore how the early childhood sector could increase its prominence in the thinking of both the public and policymakers. The three-year project took place in Australia, but according to lead author Dr. Nathaniel Kendall-Taylor, based on conducted in the U.S. in partnership with the nonprofit , the societies are sufficiently similar that the findings offer worthwhile insights for advocacy messaging in the U.S., with some notable differences.

The project, Story to Change Culture on Early Childhood in Australia, built on efforts led by Harvard University’s and Canada’s to use the science of framing to identify the cultural models that shape how members of the Australian public think — their mindsets — about early childhood.

An expert in psychological anthropology and communications science, Kendall-Taylor heads the Washington, D.C.-based , a think tank that applies social science methods to study how people understand social issues and help organizations craft practical ways of communicating solutions with their audiences. To “make sense” of social problems, people rely on mental shortcuts — some of which are more helpful than others. If advocates communicate in a way that cues the unhelpful ways of thinking, their ideas are much more likely to be dismissed or to evoke equally unhelpful responses. Ěý

For example, a frame that early care and education (ECE) workers are underpaid professionals caring for our nation’s most precious resource is significantly more powerful than the frame that they are long-suffering, low-wage heroes.

The Australian study interviewed early childhood experts in fields including psychology, education, public health and neuroscience (referred to in the research as “the sector”) about their thoughts on the most important early childhood concepts for members of the public to understand, and key policies they saw as most important for supporting young children and their families.

Researchers then asked questions of members of the public across a broad spectrum of society, all designed to elicit stories and ideas about early childhood. After analyzing their responses, the scientists developed a set of frames to test with the public, ultimately interviewing more than 7,000 participants to develop a set of evidence-based framing recommendations to address the gaps in understanding that showed up between those in the early childhood sector and members of the public.

One of the greatest takeaways of this and other studies on framing is for communicators to recognize that they are not the audience for their messages, as evidenced in the gaps in understanding the study observed. To break through to policymakers and the public, advocates must work to understand the other’s frames and reality. Otherwise, any attempts at telling the story of early childhood will either bounce off or fall on unhearing ears.

An example of this might be seen in the fact that several of the Australian findings emphasized the value of early childhood resources and policies to support children’s health and well-being.

“One of the more interesting findings from the Australian research is that when we tested different issue frames, such as ‘Is early childhood learning about joy?’ we found that by far health was the most effective issue frame.

“I suspect that health ťĺ´Çąđ˛ő˛Ô’t have the same collectivizing effect in the U.S. as it does in Australia because there’s a more socialized medical system and much more of an understanding of the social drivers of health — of public responsibility for health.”

So, trying to communicate the early childhood story in the U.S. through the frame of supporting children’s health is unlikely to move the needle as far. Here, the value that typically has worked best is focusing on future progress and social prosperity — the idea that we need to invest in kids now for the collective good going forward. A caveat, however, is that the early childhood field has focused more on later — the idea that you invest X amount now and get a return on your investment later. Recently there’s been some backlash against this view because it seems to devalue children for who they are now and send the message that they only matter for what they’ll be contributing when they’re wage-earning adults.

One of the study’s recommendations was for the early childhood narrative to highlight the idea that supporting early childhood development leads to good outcomes for children, families and society now, as well as setting the stage for good outcomes in the future.

The idea of who’s responsible for a child’s development in the early years had some overlap between the two countries, with the public in both believing it’s primarily the adults in children’s lives who are responsible for how they turn out rather than seeing the systemic factors that shape development. In general, Kendall-Taylor says, people assume that individual choices rather than social systems shape their lives and outcomes and therefore, the government shouldn’t overstep. Americans take it a step farther.

“One thing that’s amazing about research that we’ve done in the U.S. is the degree to which Americans will hold kids — even very young kids — responsible for their own outcomes,” Kendall-Taylor says.

Given that degree of rugged individualism, it may seem contradictory that fairness — at least fairness among places — is an effective frame in both countries.

“That’s a big thing that came out of the Australia project. Pointing out that stress and adversity are unevenly distributed across the population, and fairness between places is the value that worked. It’s sometimes called the zip code argument — the idea that where a kid is born shouldn’t determine their life chances generalizes to the U.S. as well. The call to action needs to be to make people feel efficacious about being able to do something about it and cement a sense of collective responsibility for doing so.”

In considering using the fairness frame to tell the early childhood story, Kendall-Taylor cautions advocates to consider emphasizing that every child should receive the resources that meet their needs. The idea of giving “everything to everybody” was viewed as wildly unrealistic and untenable. And only giving to those with the most needs reinforced the idea that “those people” were taking resources they didn’t deserve and set up the zero-sum mentality of “more for them means less for me.” But saying, “We’re interested in making sure everyone’s doing well and that means supporting different kids in different ways,” is, he says, “the magic combination.”

For those who have been in the early childhood space for even a little while, discouragement and frustration are often just around the corner. Kendall-Taylor has been studying framing and early childhood for more than 20 years and he offers something that might help the advocates themselves do a bit of reframing.

“I don’t think people (in the U.S.) see kids as a public responsibility yet,” he says. “But there is a sense that the decisions we make as a society affect kids in a way that wasn’t the case 20 years ago. If you look at 25 years ago, when budgets got tight, it was always the kids’ issues that got cut. The younger the kids, the more their issues got cut.

“Now, that just isn’t the case. If you’re a candidate or a decision maker, part of what you’re doing has to be acknowledging the importance of early childhood.”

“We know that physical activity is a foundation for children’s health,” says Dr. Andrew Koepp, a researcher with the University of Texas Department of Human Development and Family Sciences. “Physical activity promotes bone, muscle and heart health. Most medical organizations recommend that children ages 3 to 5 be involved in some non-sedentary activity for about three hours throughout the day.

“At the same time, we know with climate change we’re expecting more hot days and that will impact children’s activity levels.”

Koepp led a study to help determine just how great that impact might be — the first study of its kind on preschoolers.

“We knew there had been some studies on adults and older children about how heat impacts their physical activity outside,” he says, “but we weren’t finding any studies that were specific for preschoolers. That’s important because young children are a sensitive group — much more vulnerable to the heat than adults because their bodies are not as efficient at releasing heat.”

The paper, “,” was published in the May 2023 issue of the Journal of the American Medical Association Pediatrics. The study took place over two weeks in April 2022 with 47 children aged 3 to 6 attending the university-based laboratory preschool in Austin, Texas. The playground is partially shaded, and researchers monitored air temperature and relative humidity data hourly. The preschoolers, a mix of male and female, Asian, Hispanic, White and “other race or ethnicity,” were outfitted with a hip-worn device like a very precise junior Fitbit to measure their physical activity. The ambient temperatures during their outdoor play ranged from 72 to 95 degrees Fahrenheit.

On days with higher temperatures, the children engaged in more sedentary behavior and less moderate-to-vigorous physical activity. On days when the ambient temperature was in the lower range, the children ran around, climbed, or played games 27 percent of the time. When the temps reached into the 90s, the children were only active 21 percent of the time.

Though the study is a small one, the researchers are repeating the experiment at different times of the year at other preschools in the Austin area to further develop the data. The results are important for several reasons, Koepp says, not least because they show the difference having shaded playgrounds can make.

In led by one of Koepp’s co-authors, Dr. Kevin Lanza of the Michael and Susan Dell Center for Healthy Living at The University of Texas Health Science Center, researchers noted as much as a 10-degree difference between the shaded and unshaded parts of playgrounds. On a 90 degree day, this is the difference between “extreme caution” and “danger” levels for risk of heat illness, according to the .

“This underscores that the built environment can have a really big impact on the temperature in the city,” Koepp says. In Koepp’s and Lanza’s studies, preschoolers had the option (which they exercised) of heading for the shade, situating themselves under big trees when it was really hot. For millions of U.S. children, that is not an option.

According to , a map of tree cover in the U.S. is often a map of income and race. Due to decades of discriminatory policies such as redlining, trees, with their capacity to clean and cool the air, are often sparse in neighborhoods with people of color and low-income families. Low-income and socially marginalized populations are also more at risk because they have less access to climate-controlled housing.

In urban heat islands created by extensive concrete and pavement with few trees and green spaces, daytime temperatures can be as much as 7 degrees higher than temperatures in outlying areas. In cities where the humidity is high, vegetation reduced, with buildings denser and the population greater, temperatures can climb even higher — up to a scorching 20 or more degrees hotter in the urban core of some of the largest cities in the U.S.

Heat Hits Some Kids Harder

The children in Koepp’s study had other advantages besides trees on their playground.

“The group of kids who participated in our study came from relatively affluent families in the area,” he said. “The center has a lot of green outdoor space and the children in the sample were healthy. They had BMIs that were in the normal range, and none had asthma.

“It’s remarkable that we see this pattern of findings of the children being less active on hot days among these totally healthy kids. Children who are heavier are going to heat up faster, and we may see stronger findings in children with other health concerns.”

Children with asthma, which disproportionately , are especially sensitive to heat, which can trigger an attack and irritate already narrowed airways. Though preschool children are unlikely to develop Type 2 diabetes, children as young as 10 are now being diagnosed with the disease, which puts them at particular risk from the heat. , complications related to diabetes can make it tougher for the body to cool itself, leading to heat exhaustion and heat stroke.

Heat may be one of the major human-rights issues of the coming decades. According to Frederica Perera in “Children’s Health and the Peril of Climate Change,” without rapid global action to reduce global emissions, children born in 2020 will experience two to seven times more extreme heatwaves on average in their lifetimes than people born in 1960.

While we can’t immediately turn around the forces driving climate change we can work to mitigate as much heat in children’s environments as possible. In addition to planting trees, schools, communities and urban planners can take other steps to relieve the heat, particularly for the youngest and most vulnerable residents.

Koepp and his co-researchers suggest that something as simple as providing water tables, sprinklers and hoses can help children stay cooler. Misters and fans can help, as can sending the children out to play during the coolest times of the day.

Koepp says their hope is that the research they’re doing into how heat affects small children, and the difference sufficient shade can make will be of use not only to schools but also to public health officials, urban planners and others looking to design children’s spaces.

“Climate change is happening,” he says. “And we have to learn to live with it.” That ťĺ´Çąđ˛ő˛Ô’t mean that children will have to live indoors, he says, but it will take diligence and thoughtful planning to make certain they can safely get the exercise they need to grow up strong and healthy.

To some, strengthening a system created to address child abuse and neglect might sound like a reasonable response to restrictive abortion laws. After all, poverty fuels most child welfare involvement, and for many new parents, bringing home a new baby is a financially precarious moment. Even back in the before-Dobbs days of 2022, who are in poverty or low-income. In places with abortion bans, that proportion is likely to grow, as it is low-income women who most often lack the money, time and child care to head out-of-state for abortions.

But to many, the idea of preparing for forced births by activating a system empowered to forcibly remove children from parents judged as unfit sounds “dystopic.” “This is a coerced family,” said Erin Miles Cloud, co-director of the nonprofit and a former family defense attorney. “And then you want to create a condition where the child and parent in the coerced family only gets support if the family is disrupted and separated and the child is put with people who are deemed to be better.”

Thankfully, a host of recent studies by economists point to a far less extreme and more cost-effective way to protect children from maltreatment and foster care: give low-income parents material supports. “Even a small amount of resources either in terms of food or in terms of cash are the difference between being able to provide adequate care for your kid or not,” said Donna Ginther, an economics professor at the University of Kansas.Ěý

Ginther is co-author of two recent studies suggesting that strengthening social safety nets reduces child maltreatment and child welfare involvement. In one, published in , Ginther and her co-authors found that states which made it harder for families to access TANF cash assistance—such as restricting the amount of time a family can receive it, or requiring mothers to return to work before their child turns one—saw a marked rise in both the number of substantiated reports of child maltreatment and the number of children removed from homes and placed in foster care.

If all states had instead made it easier for families to access TANF during the 12 years studied, more than 29,000 fewer children would have entered foster care, the researchers estimate. Considering that at the time of the study, foster care for one child in Kansas cost five times more than the monthly TANF payments for a family of three, that would have added up to huge savings for states. “And that’s not counting the potential negative impact of a child being in foster care,” said Ginther.

In another study also , Ginther along with Michelle Johnson-Motomaya of Ohio State University and other co-authors determined that making it easier for families to access SNAP, the program formerly known as food stamps, also reduced a state’s child welfare caseloads; every 5 percent increase in the number of families receiving SNAP reduces a state’s child protective and foster care caseloads between 8 to 14 percent, they estimate. “If a state is more generous with SNAP benefits, that protects kids from entering foster care,” said Ginther.

Such findings are part of demonstrating that material supports given to parents help to keep families intact. at the University of Chicago details the many different forms of assistance that have been linked to lowered child welfare involvement: a higher minimum wage, no-strings-attached cash assistance, lower gas costs, access to subsidized child care, housing help.

Researchers and family advocates say the reason is simple: such supports reduce economic hardship, which makes it easier to parent. About 85 percent of families investigated for child welfare have incomes below 200 percent of the federal poverty line, according to the Chapin Hall report. While poverty is not supposed to be a cause for states to remove a child from home, conditions such as not having money to pay for child care can impact a child’s safety and make a family more likely to be investigated for child maltreatment.

“If you don’t have a home and you’re bumping back and forth between different shelters, that makes it difficult to get to school,” said Miles Cloud. “If you don’t have food, then your kid is hungry, so you’re trapped for the conditions to care for your kid, not your ability to care.”

About one in every three children in the U.S. become part of a child protective investigation at some point in their lives; for Black children, that number rises to more than half. Though most child welfare investigations do not result in a maltreatment finding, they do add strain and stress to already vulnerable families. Some research suggests that in low-income neighborhoods saturated with child welfare cases, parents can be reluctant to seek help for their children for fear of triggering an investigation. This is part of why Miles Cloud and other proponents for abolishing child welfare systems have long called for increases in no-strings-attached material supports for families such as cash assistance and free child care.Ěý

Many of the states embracing abortion bans are notorious for their. Some even that could provide cash assistance to parents into child welfare programs, instead. Miles Cloud said that state child welfare systems, meanwhile, are more likely to offer supports focused on changing behaviors, such as parenting classes or substance abuse treatment, rather than material help, “creating this idea that child welfare involvement is about character flaws and not about money.”

If states want to protect children born due to abortion bans, Ginther said the research is clear on what to do: help parents financially. “If we provided support to the mother and father of that unplanned child, the child would be better off, and that means having a robust social safety net.”

For the Head family, the pandemic flipped their traditional responsibilities in a lasting way. released this month by researchers Richard Petts and Dan Carlson looked into relationships like the Heads and found that lasting change in traditional family setups was more likely when the woman worked in some capacity and the man had a remote-work arrangement. Fathers’ child care and household support is vital for mother’s labor force attachment. If a mom wants to stay in the labor force, a dad’s support isn’t just a nice-to-have, it’s essential.

Petts and Carlson surveyed more than 4,500 parents about their work-life responsibilities during the pandemic and found that though a father’s remote work was a greater indicator for a more equitable division of labor, a mother’s job flexibility was not. A mother being able to have flexible work meant that she was more easily able to attend to the child care and housework needs as they arose. Petts and Carlson cautioned that simply increasing workplace flexibility can be a double-edged sword toward creating more gender equality at home. If men weren’t willing to take on more of the work at home, then women with the more “flexible” jobs wound up doing double duty.

But even those jobs that offered flexible, remote work as an option during the early stages of the pandemic were often concentrated in high-income occupations. Workers in lower-income jobs had fewer remote and flexibility options, and this has continued even as other structural supports, like schools and child care, have returned.

As part of their findings at “The Future of Gender Equality in a Post-Pandemic Society,” an event hosted by the Better Life Lab at New America, Petts and Carlson found that both fathers and mothers increased their at-home child care and housework responsibilities during the early stages of pandemic. But as domestic supports returned — such as schools and child care facilities reopening — fathers began to reduce their child care and housework. For the mothers who stayed attached to the labor force during the pandemic, the division of labor at home became more equal, and in most cases, has stayed that way since. Like Melissa Head, who worked throughout the pandemic as a nurse, the changes they have made to their child care arrangements have lasted — especially since Richard’s role is now permanently remote.

This wasn’t everyone’s reality. For Brittany Wiliams, a single mother, lack of child care remained one of the top obstacles in her return to work. Williams worked as a home health aide in Seattle, work she said had gone largely unnoticed until the pandemic, when “people realized we were the essential workers.” She wanted to keep going to work, but without child care for her son she had no option but to stay home with him. She considered bringing him along, but worried about the risk of COVID exposure — both for her child and for her clients. Too many missed shifts meant she had to quit her job. Williams had been working to get off public assistance before the pandemic, and she may have been able to achieve that had she found a tenable child care situation. Though Williams is optimistic for the future, this setback has largely erased many of her pre-pandemic economic gains. As a single mother, she feels she works twice as hard to maintain a level of stability for her family.

So what does gender equality look like going forward?

There’s no quick fix, and lasting change involves a shift from trying to solve this on an individual and single-family level, and look at the infrastructure support that will allow more families to achieve a manageable stasis. These include a lot of the priorities the Better Life Lab champions: access to affordable, reliable, quality child care; paid family leave; societal recognition and compensation for ongoing caregiving responsibilities; and creating meaningful work boundaries and advancements systems that allow for upward mobility for everyone, regardless of caregiving opportunities.

The symposium included a panel discussion, moderated by Better Life Lab’s Vicki Shabo and included First Shift’s Sophia Mitchell, The Century Foundation’s Julie Kashen, and Main Street Alliance’s Chanda Causer. The fact that our federal policies need to better reflect the families we currently have: two working parents, mothers as breadwinners, nontraditional family arrangements, caregiving for aging parents, and more — came up multiple times. Cash infusions to families under the American Rescue Plan Child Care Stabilization Program, made a significant difference — serving more than 220,000 child care providers and affecting as many as 9.6 million children—but even those will sunset this year.

The symposium shifted to an afternoon of engagement with colleagues in academia, reviewing forthcoming research on gender, families and work. Child care remains a primary focus, as does the lack of funds that are being spent to build up a child care infrastructure, and to compensate caregivers — including those who do work similar to Brittany Williams — accordingly.

“When the federal government invests in the care agenda, it matters: people get paid better and people get the care they need,” said Kashen, one of the panelists. “The American Rescue Plan Act was not only a one-time pandemic emergency action, but looking at the results, it provides important lessons learned. The cliff is approaching — child care stabilization funds need to be spent by September of this year. This is why we need the stories of why this works.”

Myelin is the fatty insulation that protects axons, the transmission lines of the nervous system that shoot information-bearing electrical impulses to various parts of the body (which is a much-abbreviated explanation of a fantastically complex process). Myelin helps these electrical impulses to travel efficiently along the axon. This is critical for effectively transmitting information throughout the brain with exquisitely precise timing.

Babies are born with brains full of axons located right where they need to be for various functions, such as hearing, seeing and movement. White-matter pathways associated with language are also present at birth, but their myelin continues to develop for many years after birth. By examining myelin development, scientists have discovered that these neural connections don’t simply grow, they are cultivated by their environments.

Parental input has been considered a key environmental factor for infants’ language development, as shown by a wealth of behavioral research. But few studies have looked at how parents’ verbal interactions with babies affect the physical development of their brains. Given the critical growth in children’s language-related activities in their first two years of life, a better understanding of what’s going on in their brains at this time is badly needed.

Thanks to a long-term intervention study of infant language-learning, researchers at the University of Washington’sĚýĚý(I-LABS) have a trove of -device home recordings of child vocalizations and parent-child verbal interactions taken at regular intervals throughout babies’ first 24 months.

For their recent study on the effect of language experience on white-matter development, researchers invited all the families back to the lab for an MRI session when the children were around 2 years old. The MRIs imaged the white matter in the toddlers’ dorsal language system, a brain network that is tied to expressive language development and long-term language ability. They found that the frequency of parents’ verbal interactions with their infants, specifically conversational turns, uniquely predicted myelin density in this system.

“Conversational turns” are the back and forth between adult and child that can occur even before the child has actual words, a call and response that speaks “connection” in every utterance. In their study described in a published March 1 in The Journal of Neuroscience, researchers found that parent-infant conversational turns link to white-matter growth (myelination) at age 2 and suggest that early interactive language experiences uniquely contribute to brain development associated with long-term verbal and cognitive ability. The more back and forth between babies and parents, the greater the growth of the brain in areas critical to language ability and sensory-motor integration that affect the child’s ability to learn language and build vocabulary. These effects carry through early childhood and predict cognitive and linguistic ability into adolescence.

In other words, conversational turns are a very big deal, and MRIs show it.

Not Words Alone

I-LABS researcher Dr. Elizabeth Huber, the paper’s first author, says the studies establish that the growth in white matter isn’t related simply to the amount of language a child is exposed to — the number of words that wash over a child — but the amount of high-quality verbal interaction they have with the adults in their lives. The effects of these interactions were apparent as early as six months, when the child is not yet speaking but vocalizes (“babbling”) and the parent vocalizes back.

“Conversational experience as early as 6 months is predicting what the brain looks like at age 2 years,” Huber says. “It was striking to me how early and potentially long-lasting these effects are.”

It is impossible to overestimate the importance of those early years. White-matter pathways develop at their most dramatic rate during these years, though they continue to develop through adolescence. Language exposure during this window has been linked not only to vocabulary building but to multiple aspects of children’s cognitive development. Being exposed to conversational contingency — meaning interactions that acknowledge each other’s presence and take note of what’s happening in their shared physical environment (Do you see that kitty? How does a kitty go?) — encourages shared and sustained attention. If the adult is focusing on something and draws the child’s attention to it, the child is then able to focus on that thing distinct from everything else in the environment. Maybe not for long, but conversational contingency builds the muscle.

Conversational turns have been shown to stimulate more and higher-quality vocalizations from infants, including making sounds that are more consistent with the speech sounds and patterns of the adults around them (phonology). If you keep sharing conversational turns with your child in your Deep South accent, it’s a fair bet that their baby talk will have a drawl.

Through this conversational give and take, babies learn to listen and adjust their vocalizations in response to another person, a critical ability in all human interactions.

So Much More to Learn

Huber stresses that this research really has just begun. The current study was limited to native English speakers and families without known risk factors such as lower social economic status or a family history of dyslexia. The sample size was relatively small, and future work will look at larger and more diverse samples, including a larger control group of families that didn’t take part in an enriched language intervention.

“Right now, we’re really excited about the idea of adding brain scans with 6-month-old, or even younger, infants,” Huber says. “Can we already see these effects (on white matter) at a much younger age? Or is there something special about what’s happening in the brain around 2 years, as toddlers are starting to really use language to communicate in a more sophisticated way? Are there incremental changes in the white matter that connect to what an infant is currently experiencing, or do environmental effects show up at certain points in development more strongly than others? What we see right now is that conversational turns in infancy predict white-matter density in the 2-year-old, but that raises a lot of follow-up questions.”

Another area that’s ripe for research, Huber says, is looking at the effects of environmental factors such as poverty or trauma, which can interrupt the brain’s development, and potential ways to mitigate that interruption. The human brain is incredibly flexible, she says, and if there is some kind of a deficiency, researchers wonder if there are ways that deficiency can be mitigated.

It’s important to avoid thinking that all is lost if a child isn’t exposed to rich conversational interactions in their earliest years, Huber says. People working two jobs and giving their all to keep a roof over their heads and food on the table might not have as much time as they’d like to spend with their children.

“The rich early experience seems to be really important,” she says. “There are moments in development where we’re particularly sensitive to certain aspects of our environments, and where it’s easier to learn certain skills. So, for example, it’s harder to master a second language if you didn’t hear it or have some exposure as a very young child. I studied Spanish for years in college, but I speak it with a heavy Kansas accent, and I have to stop and search for words.

“At the same time, it isn’t as simple as saying, ‘If you have this amount or type of interaction at this exact age, you will excel in learning language, and otherwise you won’t.’ Children learn in different ways, and there is still lots of flexibility to learn and adapt, even later in life.

“Ultimately though,” Huber adds, “it’s exciting to me to think that we are starting to understand more about what matters for different aspects language development. If we can help parents and children so that a given child is coming into school on strong footing, that can make a difference for a child’s whole life going forward.”

The tension between 3K-for-All’s ambitious goal and its political and economic realities underscores a central question facing every fledgling public preschool program: Should the program be “universal” — available to all — or “targeted” to the families who need it most?

in the peer-reviewed empirical microeconomics-focused Journal of Human Resources has a ready answer: Preschool programs reserved for poor children aren’t nearly as effective as universal ones.

Elizabeth Cascio, the study’s author and an economist at Dartmouth College, was once among the many who suspected that targeted preschool programs offered the most learning bang for the buck. In 2013, Cascio and the economist Diane Schanzenbach of Oklahoma and Georgia’s preschool programs which found that the universal programs had a significant, positive impact for disadvantaged children. It did not have an impact for children from higher-income families, who would have otherwise likely been enrolled in private preschool paid for by their parents. For those families, the free program acted mostly as a cash transfer, said Cascio. “In the conclusion, we were really tempted to say, why don’t we just do this in a targeted way, because you can get the same results with lower costs?” she remembered.

But there was one big, potential caveat to that recommendation: Targeted preschool programs made the most financial sense unless — for some reason — the wildly positive results for children from lower-income families depended on the programs being open to families of all economic strata.

To test whether that was the case, Cascio used survey data from the national Early Childhood Longitudinal Study to compare test scores of thousands of 4-year-olds in more than 30 states, some which offered targeted state preschool programs, others universal, yet others none. Across the board, poor children in states where preschool programs also welcomed children from other economic backgrounds showed far better reading test score gains when they became eligible for and enrolled in public preschool than children in states with programs targeted to disadvantaged children. This held true even when Cascio adjusted for factors such as class size, spending per pupil, teacher training and education in the state programs, as well as children’s alternate care arrangements. Effects on math scores were also higher for disadvantaged children in states with universal programs, though not high enough to be deemed significant.

With such pronounced, positive effects in universal programs, Cascio determined that the universal programs were also more cost effective. Universal programs “cost more overall” because they serve more children, said Cascio, but their return “is more per dollar spent.”

The key takeaway? To reap the greatest positive benefits for children from low-income families, explained Cascio in a phone interview, “you have to pay for the kids who aren’t disadvantaged.”

The study was not able to determine why, exactly, the universal programs worked so much better, but Cascio and other researchers have offered possible explanations. Universal preschool programs may be operated or designed in ways that focus more on kindergarten readiness, leading to higher test scores, said Cascio in a phone interview.

Alternately, higher income families generally have not only more social capital, but sometimes a heightened sense of entitlement, which could prompt them to hold programs more accountable, leading to higher quality. “Maybe higher income parents feel more like their voices will be heard and are sort of more empowered to make their opinions known and have the privilege to do it,” said Cascio.

Or it may be that mixing children from different economic backgrounds–even if only slightly different–is key. Economic integration has been found to be beneficial for older children’s learning, but there is scant research on economic integration among young children, largely due to a lack of opportunity to study it. Because most early education is private, programs typically segregate by what parents can afford. But research has been able to establish that higher skill sets in preschoolers strongly correlate with higher income families. And in preschool, kids learn as much, if not more, from playing and interacting with each other as they do from teachers — what researchers call “the peer effect.” It goes to reason, then, that in economically mixed classrooms, the skills of more economically privileged children can influence other kids, potentially leading to the higher test scores. In other words, paying for those kids’ presence might be what makes universal programs so effective.

Whatever the reason, the finding that universal programs are both more impactful and cost efficient than targeted programs flies in the face of decades of policy assumptions and decisions in the U.S. Historically, most government funding for early education has targeted economically disadvantaged families, with the idea being that affluent families already pay for preschool.ĚýAs the historian Elizabeth Rose details in her book The Promise of Preschool, ever since President Richard Nixon vetoed a national plan for universal child care in 1971, Americans grew used to the idea that preschool should be paid for privately. This led to “stronger political support for using public dollars for low-income childrenĚýwho clearly ‘need’ it than for building a bigger and more expensive system,” wrote Rose.

This, in turn, helped to cement economic segregation during the early years, which some researchers believe has only fueled the achievement gap between children from low- and higher income families — a gap which arises long before children step foot in kindergarten. “It is exciting to think that a [universal preschool program] could address that,” said Cascio.

Universal programs also have other benefits–in many places, they’ve increased mothers’ participation in the workforce and generated significant tax revenue. But in the absence of federal funding, state and city leaders continue to face tough choices as they struggle to foot the bill for truly universal programs.

Cascio’s research should tip the scales, the economist Diane Schanzenbach said back in 2017, when Cascio revealed the study’s early findings in a working paper. Given the research, Schanzenbach , “I think this means we have to support universal pre-k programs, and the large price tags that go along with them.”

To achieve its goals, the state is enlisting the support of Oregon State University. As the state’s public, land-grant institution of higher education, OSU is committed to serving the people of Oregon. , the Early Learning System Initiative at OSU, is a vital new partner in the enterprise.

Megan McClelland, director of the , says discussions about ELSI began in 2020 when (then part of the Department of Education) requested a coaching framework for early learning professional development.

As McClelland and her colleagues planned, iterated and conducted interviews with stakeholder groups, more funding became available from a variety of sources totaling $14.4 million, and ELSI has branched out into other ways of improving the state’s workforce and system as a whole. In the midst of this metamorphosis, the division that sparked the initiative is undergoing a change of its own, becoming the .

“It feels like we’ve been in charge of a startup for the last two years,” says McClelland.

Professional development remains at the heart of ELSI. This includes Practice-Based Coaching, which, according to Patricia A. Snyder of the University of Florida’s , needs to be “cohesive and sustained over time rather than episodic, one-shot training. The content… should focus on explicit curricula, interventions, or sets of practices rather than general teaching methods such as lesson planning or instructional grouping methods.”

Bridget Hatfield, associate professor at OSU’s College of Public Health & Human Sciences, helped to develop a mentor coaching framework to support the state’s existing network of early childhood coaches. She partners with a quartet of ELSI mentor-coaches, who fan across the state to work with about 120 coaches (about 20 of whom are employed by ) — who then partner directly with the state’s early education workforce. “This framework means there’s someone those educators can have reflective conversations with, whether it’s about how to be more intentional about using data or about their professional development.”

Hatfield, who started her career as an educator with a child care center in southern Indiana before undertaking graduate and postgraduate studies, adds that improving teaching practices is just one aspect of the mentor-coaches’ work, along with values such as equity and anti-racism. The National Association for the Education of Young Children (NAEYC) and Elena Aguilar’s have been especially helpful for the mentor-coaches’ leadership journey. “The educators benefit the most,” she says, “when the coaches feel equipped and empowered.”

ELSI is also engaging with statewide partners, gathering and reporting data to inform and improve policy, and elevating the voices of parents and caregivers. This work includes developing communities of practice with coaches around the state, partnering with other statewide centers at Portland State University and Western Oregon University and analyzing statewide data to provide recommendations for increasing the quality of early childhood education in Oregon.

“Child care is incredibly local,” says Megan Pratt, OSU professor of practice. Child care solutions differ across communities. Some prefer mixed-age home-based programs, while others are looking for preschool center programs.

“Like a lot of other states,” continues Pratt, who worked as a child care provider before earning her doctorate. “Oregon is trying to figure out how to move from fragmentation toward a more cohesive system that works better for families and the workforce.” For example, a better system will help ensure that federal relief dollars — as well as state money from Oregon’s program and pilot — flow to formal and informal providers more quickly and efficiently.

ELSI has engaged to provide business coaching to help connect the dots. The nonprofit organization delivers trainings and technical support to early child care centers and home-based providers.Ěý “We offer tools to help these businesses become sustainable,” explains Kari Stattelman, a business development consultant with First Children’s Finance. “That could be marketing, finance or record keeping. Some of them benefit by pooling resources through a shared services network. Others need help selecting and implementing a child care management system.”

Thanks to the , everyone in Oregon’s early education workforce is getting two $500 checks with no strings attached. Of course, the other half of successfully connecting providers and checks is ensuring that providers know about these opportunities and have the capacity to apply. First Children’s Finance helps providers overcome linguistic and other challenges that might prevent them from securing funds for which they are eligible.

To build the capacity of providers and the strength of the overall landscape, ELSI will incorporate additional strategies over time. “Design is never done,” McClelland states. “It’s a continual process, and we’re just beginning, but we’re already having an impact.”

Researchers examined inequalities in children’s access and participation in extracurricular activities by looking at 401 kindergarten students across 31 classrooms in Ohio’s sixth-largest school district, which spans urban, rural and suburban neighborhoods. Most of the students in that district were English-speaking, with half of the students receiving free and reduced lunch. Researchers analyzed participation in five extracurricular activities: tutoring, sports, religious activities, artistic lessons and organizations such as Scouts.

“There’s quite a bit of research looking at the positive benefits for adolescents who participate in extracurricular activities,” said Arianna Black, a third-year Ph.D. student at Ohio State and one of the study’s co-authors. “We found that young children are participating at about the same rate as adolescents, but we know comparatively very little about who participates in terms of young children and what benefits might be associated when young children participate in extracurricular activities.”

The study revealed that race, gender, income and the mother’s education emerged as determining factors for extracurricular participation. Among those demographic factors, race and the mother’s education showed the strongest links to participation. The results point to a continued and troubling gap in opportunities that has persisted in recent years; white children were 2.5 times more likely to participate in athletics compared to their peers.

Other findings:

• Racial minority students and those from disadvantaged backgrounds who don’t participate in extracurriculars at a young age could miss out on opportunities later in life that could help them succeed academically, according to Elise Allen, a graduate student in Ohio State’s educational studies program and a co-author on the study.
• Students whose mothers held higher levels of education were also twice as likely to play after-school sports.
• 47% of children whose mothers held a high school degree or less, participated in sports compared to 74% whose mothers received a bachelor’s degree and 96% who held a graduate or professional degree.

Those numbers reflected a similar association with participation across the range of extracurriculars. Children whose mothers held a graduate or professional degree had the highest levels of participation in each extracurricular, with the exception of religious activities.ĚýBlack noted that they only used mothers, not fathers, as a variable in the study. The questionnaire, which was available in both English and Spanish, asked caretakers to respond to questions about their demographics, home environment, language status and extracurricular participation.

“What we find is that in general, mothers tend to be the people filling out these types of surveys,” she said. “Particularly with the Early Learning Ohio survey…So it might be a byproduct of that sort of larger trend when it comes to giving surveys.”

While researchers also probed whether there was a link between participation in extracurricular activities and growth in vocabulary development, they found no increase. Previous studies have indicated a link, albeit small, between social interactions and vocabulary skills. Research has also shown that poverty negatively impacts a child’s language development. Ohio State researchers noted that those previous studies used a larger sample of 10,000 children and that their own study may have needed a larger sample size to find a relationship between extracurricular activities and vocabulary outcomes.

“There might need to be a more nuanced measure of extracurricular activities that captures critical variation in activity and participation,” Black said. “Things like frequency of intensity, how long they’ve been participating, things like that would probably give us more information in terms of how extracurricular activity participation is related to some of those academic outcomes, such as expressive vocabulary.”

The study also dug into how the children’s gender affected their participation in extracurricular activities. The research indicated that girls were at least 2.5 times as likely as boys to participate in certain activities, particularly organizations and lessons.

“It was interesting to see some of these gender gaps,” Black said. “Our study doesn’t look at why any of these gaps are occurring. So, I think that’s a really interesting area for future research.”

Researchers recommended that programs designed to provide more opportunities for disadvantaged children should pay close attention to the demographic factors that still determine extracurricular participation. Those programs could even the playing field for children by subsidizing activities and providing compensation for low-income families. The study pointed to Tennessee, which has set aside grant funding for after-school activities and prioritizes serving low-income students and those with disabilities. School districts also could increase access and participation by advertising activities and sign-up information during kindergarten enrollment.

These disparities have rightly led to calls to improve health care to non-English speaking families, from individuals and communities, as well as from the National Institutes of Health and the National Academy of Medicine. However, research undergirds any progress in health care: If it isn’t accurately representing the population, progress is impeded or skewed, and voices are silenced, deepening health care inequity. In this arena, U.S. pediatric research is woefully lacking.

A new review of more than 5,000 pediatric research articles found that only 9 percent included non-English speaking participants. The study, , published in October 2022 in JAMA Pediatrics, screened all original investigation articles published in JAMA Pediatrics, Pediatrics and The Journal of Pediatrics from January 2012 to November 2021. Of the 5,008 articles that met the study’s criteria, only 469 included participants who didn’t speak English. It is one of the first studies to describe the inclusion — or lack thereof — of non-English speaking participants in pediatric research.

According to the study’s senior author, Dr. Maya I. Ragavan of UPMC Children’s Hospital of Pittsburgh, an assistant professor of pediatrics at the University of Pittsburgh, she intended the study to be a call to action.

“The data states a problem,” Ragavan says, “but that’s just the first step in a multi-step process toward equity. It’s only the beginning of addressing health equity. We hypothesized that these numbers would be very low, but you don’t really know until you do the analysis. We wanted to write this paper as a call to action.

“Addressing health equity has to happen in a multi-level way,” she says. “At an individual level, the most important part of this is that it’s the responsibility of researchers and research institutions to make research more equitable to non-English speaking communities. It isn’t the responsibility of the participants to somehow inform themselves better. That’s our responsibility. We need to become trustworthy; we need to do better science. So, at a researcher level, it’s important to start with advocacy and awareness on this topic.”

Ragavan stresses that including non-English speakers in the research ťĺ´Çąđ˛ő˛Ô’t mean just popping in a few participants who don’t speak English. Researchers need training via conferences, webinars and on-the-ground learning to build a workforce of researchers who know how to do the culturally and linguistically informed work to include non-English speakers, and to train the next generation of researchers.

Change must happen at the institutional level as well, she says. Budgetary constraints are always a barrier, and funding agencies—which, along with academic journals, serve as de facto gatekeepers on what science is viewed as having merit—can make a difference by committing to language equity and supporting that research financially.

Doing the work well is expensive, Ragavan says, and isn’t just a matter of hiring a few translators. Many English words don’t translate into other languages—and vice versa. Being able to move beyond a basic vocabulary into the cultural nuances and experiences of participants is essential to fully hear from them, and fully hearing from them is essential to fully providing the health care they require.

To foster this research, Ragavan says, funders could build in bonuses or supplemental grants for those who are doing the work, and require researchers to specify their plans for including non-English speakers in their studies.

“One of the biggest ways those of us who are involved in this conversation would like to change research is to think about how we can co-create the research with the community,” she says. “Co-creating science with community partners and people with experience ensures that their voices are brought in with the conception of studies. We don’t just want to ask people from the communities to help us recruit participants for the studies, but to bring them in at the beginning of studies and make sure their voices are represented. How can we leverage their experience and make sure we compensate them for their time and their work?”

The Deep Dive

A team of researchers worked together on the study for more than a year, led by University of Pittsburgh medical student Annie Chen, who Ragavan praised for her “amazing job” of organizing the project’s minutiae and coordinating the team. In a rigorous process, the team divided up and read 8,142 articles before winnowing them to the 5,008 studies that met the criteria. Then the researchers combed through those studies to assess how frequently non-English speaking families were included in pediatric research, how rates of inclusion had changed over time, what languages were included, and methodological details about oral and written communication with non-English speaking participants.

With roughly 42 million Spanish speakers in the U.S., it’s unsurprising that Spanish was the most common non-English language found in the research. However, the percentage of people in the U.S. who speak a language other than English or Spanish is increasing, underscoring the necessity of expanding inclusion of other languages. (For example, the U.S. Census reports that 3.5 million U.S. residents speak Cantonese or Mandarin as their first language.)

The result of doing the work to address inclusion and diversity matters not only in deepening researchers’ understanding of the participants they study, but ultimately in providing health care to the entire U.S. population.

The important piece once research becomes more inclusive, Ragavan says, is to sort out how to share that information with the communities involved. We must get the research off the shelves and into the hands of those who want and need it.

“In academia, the standard is the academic paper, which is behind paywalls and not generally accessible. So now, we need to discover how we can thoughtfully share our results back with those communities—through infographics, social media posts or maybe videos.

“It’s important to get the word out,” she says. “Language equity and health equity can’t be an afterthought.”

In an experiment that’s the first of its kind in the world, I-LABS, in collaboration with Japanese and Taiwanese brain scientists, conducted a study of the neural connection between mothers and their 5-year-old children using dual MEG brain-imaging devices. , or magnetoencephalography, is a safe, silent, precise technique for investigating human brain activity.ĚýThe ultra-high-tech device allows brain activity to be measured millisecond-by-millisecond and maps down to the millimeter where in the brain that activity is produced.

Previous research by I-LABS scientists has shown that verbal turn-taking and imitation are essential in young children’s language learning and social development, and that their language learning happens only via social interaction with other people. But how parents and children coordinate their brain activity during these social interactions has been an intriguing mystery. With the development of a dual-MEG setup, it has become possible to observe those interactions in real time right where they’re happening in the brains of mother-child pairs.

“Humans are social creatures, and we evolved to learn from one another,” says Dr. Patricia Kuhl, I-LABS’ co-director, who holds the Bezos Family Foundation Endowed Chair in Early Childhood Learning. “So now the big question is how our brains do that, how they exchange information and learn and feed off each other. Understanding that is complicated from the experimental standpoint.”

In the article “,” published this summer in the journal Cerebral Cortex, lead author Jo-Fu Lotus Lin, a researcher from National Tsing Hua University in Taiwan with an appointment at Japan’s Kanazawa University, details the history of testing two interactive individuals simultaneously. During the last 15 years or so, simultaneous recordings of brain activity have been observed using less precise measuring techniques. The advent of MEG has made it possible to precisely pinpoint the regions of the brain that light up during interpersonal interactions. (Until recently, the MEG lab in Japan has been the only one in the world with two MEG machines; I-LABS has now become the only lab in the world with two MEG machines, one of which is a “wearable” MEG machine, which Kuhl says will open whole new worlds of social neuroscience research.)

For the dual-MEG mother-child study, Kuhl says, each pair of mothers and their 5-year-olds lay next to each other in their respective MEG machines. The mothers then read a phrase and the child imitated the intonation and words of that phrase. As a control, mother and child listened passively to pure tones.

“With the MEG machines, we’re able to see what’s happening in the mother’s brain and the child’s brain during the social interaction,” Kuhl says, “and what we see is neurons firing in areas of the brain related to attention and learning at the same rate in mother and child. The neurons are doing a dance together at the same rhythm at the same time in the same places in these two brains.”

It was a moment of amazement for the researchers, Kuhl says.

Although the study was admittedly “pretty cool,” Kuhl says the research is just getting started. Now that I-LABS has the wearable MEG as well as the traditional one, the plan is to study parents and 5 ½ month-old babies. Fathers will be part of the study for the first time, she says, and researchers will measure the social interaction of mom with the baby and then dad and baby when they are interacting face-to-face.

Another exciting layer to the experiment will be to test the parents’ natural levels of oxytocin before and after the social interaction to see if adults who have more oxytocin have more neural synchrony with their child. Oxytocin has sometimes been called the “love hormone” because of the role it plays in social bonding.

The wearable MEG will allow the parent to interact with the baby in more normal face-to-face interaction. The parent will engage with the child and then turn away to engage with someone outside the child’s periphery to see what happens to that neural synchrony when the parent’s attention temporarily turns in a different direction.

What the study won’t do is have the parents completely ignore the baby and focus entirely on their cellphones. The researchers had considered doing such a study but stopped it before it really got under way.

“Right before the pandemic, we were setting one up with the mom moving her attention completely from the baby to focus entirely on the cellphone,” Kuhl says. “It upset the babies so much we said, ‘Nope. Can’t run that experiment.’ The one we’re setting up now — where the mother rotates to another person — happens all the time in the real world and the baby will try to get her attention back. The phone thing really tended to upset the babies.”

One of the long-term goals of the newest research is to see whether the social connection represented by neural synchrony predicts other positive outcomes in a child’s life, such as mother-infant attachment.

“I think we’ll see that it affects the learning of language,” Kuhl says. “I think we’ll see that social interaction is the seat of language—which is a fairly radical view. I think social interaction is the instigator, and connections between adults and infants precede and predict rapid language learning because language is so necessarily social. What comes first is this attraction between parent and child, this intense attention being paid where the baby is glued to their faces and voices and that input changes their brain.”

In the dual-MEG study, Japanese researchers had the mothers and their 5-year-olds playing an imitation game, in which the mother would change the pitch of her voice and the child would try to mimic it. The role of neural synchrony prompted by imitation is an important one in human evolution, Kuhl says, and the tangible evidence of that dance is thrilling.

“That initial connection is how babies know that they’re one of us, that they have bodies like us and that they belong,” she says. “If you raise your finger and the baby imitates that or open your mouth and the baby does that back to you, that’s the baby relating to members of the group and saying, ‘I’m like you.’ That’s a very critical connection.”

Our society has given short shrift to social needs and the degree to which social interaction influences learning. Kuhl’s hope is that the research she and others are doing on brain synchrony will help put to rest the idea that social connection is “just soft and fuzzy.”

“It’s not just playing. It’s not being nice or just giving hugs,” she says. “Social connection is a conduit for knowledge — all of our cognitive, linguistic and social development, all our cultural institutions come through the social brain.

“There’s so much more to know — about that neural synchrony in other relationships, for instance. If you have a teacher relating to a group of students and for some there’s that ‘Aha!’ moment where they say, ‘Oh, I get it. Chemistry works like this…,’ maybe that’s the same sort of synchrony. Maybe it’s quite common—maybe between husband and wife or two students working on a project together.

“With the new MEG technology, this is a field of work that’s only going to grow,” Kuhl says. “We’re just beginning to chip away at the magic that might be happening when we’re in face to face contact.”

According to the (CDC), nearly 13% of preschool children in the U.S. and 21% of 6- to 11-year-olds are classified as overweight or obese. Note: The CDC defines children’s weight status differently from adult Body Mass Index (BMI) categories. Because children’s body composition varies as they age and varies between boys and girls, the BMI levels in children and teens are expressed relative to other children of the same age and sex. Ěýplace underweight as less than the 5^thĚýpercentile of children of the same age and sex; healthy weight from the 5^thĚýto less than the 85^th percentile; overweight as 85^thĚýto less than the 95^thĚýpercentile; and obese as 95^thĚýpercentile or greater.

The (NIH) describes childhood obesity as the most challenging public health issue in the 21^st century, and is associated with increased morbidity and premature death. Children who are obese in childhood tend to stay obese into adulthood and face increased risk for diabetes, asthma, cardiac problems and issues such as low self-esteem and anxiety. The NIH paper, “” by James A. Levine, states that obesity-associated chronic disease accounts for 70% of U.S. health costs. The paper further states that halting the U.S. obesity epidemic and lessening its health costs “may require that the U.S. addresses poverty itself.”

Multiple environmental factors influence childhood obesity, but living in a low-income family and in environments and communities that don’t support healthful diets or physical exercise are two of the most substantial risk factors, according to the . Though the CDC recommends children eat healthy food and stay physically active, many children — especially those living in very low-income homes — don’t have ready access to either nutritious food or a place to play freely. According to the NIH, roughly 6% of the people in the U.S. live in a food desert, defined as a geographic area that lacks sufficient access to grocery stores. Economic and racial disparities persist across the U.S., with about 30% more non-white residents facing limited access to retail food outlets than their white counterparts.

Dahlin says early childhood programs can provide an important pathway to launch children on healthier trajectories. Program standards for most early childhood programs require that the children receive some information on nutrition and physical education, though how this information translates into daily interactions can vary from one program to another. Information alone won’t make much of a dent in the complex issue of childhood obesity; Dahlin says a web of approaches is required.

“You can’t just tell families, ‘Eat healthier things,’ if you aren’t addressing the systemic components that affect their health,” she says. “How accessible is food? Can families get there? Is it affordable? Do the children have access to play areas where they can run around, play and be children?”

“Food deserts are in low-economic status neighborhoods without grocery stores or even transportation. Sometimes families are working multiple jobs, so their work schedules make it extremely difficult to get to any type of store with fresh fruits and vegetables. They might have one child in child care and another in school, and they have to take a bus to get each of them. These people are incredibly busy and just trying to access food is challenging and time intensive.”

To solve these challenges, it may not be necessary to reinvent the wheel.

Enter Head Start. Authorized in 1965, Head Start is the longest running publicly funded early learning program in the U.S. It not only provides child care, but it also connects low-income families with the services they need to support their child’s development. Guided by the that was introduced in 2011, Head Start has fostered positive parent-child relationships, community connections and viewed parents as leaders and advocates.

“Head Start provides food when children are attending, and they connect families to resources to support food security outside program hours,” Dahlin says. “That’s essential for learning. Look at — if a child is hungry, they aren’t learning. The program also connects children with primary care providers, dental care and immunizations — all these things that promote good health.”

Head Start collects BMI () information on children in the program within 45 days of entry and uses the information to monitor the well-being of children whose BMI percentiles are in the underweight, overweight or obese range. The NIH considers BMI an economical method to assess body fat indirectly, though the measure has come under scrutiny in recent years because it was developed in the 1800s as part of a quest to determine an average weight for “the average (white, European) man.” The tool is often inaccurate in determining health in women and people of color and has been the source of medical discrimination and weight stigma.

“There has been a lot of understandable push back on using BMI as the metric for health, but we felt that BMI, collected by the programs, could serve as a useful proxy for understanding the effects of Head Start’s contribution to children’s nutrition and physical activity,” Dahlin says. “In the program, children develop food vocabulary and a knowledge base to understand the impact of nutrition and different foods on health. They learn where food comes from. They have consistent access to food, which is a really important takeaway. So, moving away from that one-size-fits-all BMI metric, it’s important that future research take more of a look at what it would mean for children to develop healthy behaviors and to look at that behavior change over time.”

For their study, Dahlin and Reich looked at administrative data from a large urban Head Start program in the Southwest that comprised 26 Head Start centers. Their sample was restricted to 1,120 children with at least two reports of BMI at the 85^th percentile or higher, at points at least 90 days apart. All the children identified as Latine (the researchers prefer the term Latine), their parents spoke Spanish as their primary language and nearly all families reported incomes that fell under the federal poverty level.

What the researchers found was that children in the sample saw a reduction in their BMI over the program year and children with a BMI in the severely obese range experienced a greater, statistically significant, reduction than children who entered the program as overweight or obese. Entry to Head Start at 3 years old predicted a greater reduction in BMI for each month the child was in the program than for children who started later. Having a sibling in the program and receiving a child care subsidy also predicted lower BMI per month.

As is often the case with research, the study created questions that beg more research.

“I think as we transition away from BMI as the measure, we want to consider other ways to measure these health outcomes,” Dahlin says. “We need a lot more qualitative work to understand folks’ experiences and how they interact with food. What are their experiences with some of these food security programs? How do we foster behaviors like positive relationships with food and what systems do we need to set up to make sure folks have access to and an ability to get affordable, healthy food regardless of where they live or how much money they make?

“The bottom line is that the Head Start program is an existing, comprehensive program that is already well set up and well-suited to make a difference in our country’s child health and overweight and obesity issues.”

In his January 1964 State of the Union address, President Lyndon B. Johnson declared an“unconditional war on poverty” in response to new research on the effects of poverty in the U.S. He then placed Kennedy administration stalwart Sargent Shriver in the lead to assemble a panel of experts to develop a comprehensive child development program — and Head Start was born.

The program began as an eight-week demonstration project aimed at helping break the cycle of poverty. It provided preschool children from very low-income families throughout the U.S. with resources to meet their social, emotional, health, nutritional and educational needs. Baked into the program’s design was the insistence that it be culturally responsive to the communities it served, and that families and communities would be invested in its success. The program offered supports for healthy child development that included nutrition, medical and dental screenings, vaccinations and referrals to other social services. The poverty was acute: Some of the children coming into the program had never seen a book; between 9 and 17% of the families reported having no running water in their homes.

The program quickly grew to include full-time, full-year services offering a diverse set of program options with more than 36 million children participating over the years. Head Start currently serves more than 1 million children and their families in all 50 states, the District of Columbia, Puerto Rico and U.S. territories, as well as American Indian, Alaska Native, and migrant and seasonal communities.

Decades of research have shown short- and long-term successes for Head Start children; notably, fewer teen pregnancies, improved educational attainment and employment, and less criminal involvement. Until now though, no studies have tracked these effects into the second generation—a true test of whether poverty’s cycle was interrupted rather than just somewhat improved. Thanks to some deep, number-nerd detective work by economists Drs. Andrew Barr and Chloe Gibbs, the first large-scale intergenerational study of Head Start’s effects has been published in the Journal of Political Economy.

Although it seems that following up on a massive program like Head Start would be a policy no-brainer — who ťĺ´Çąđ˛ő˛Ô’t want data on their program’s effectiveness, especially if it has been successful — getting information for the second-generation study was a daunting undertaking. Barr and Gibbs’ paper, “Breaking the Cycle? Intergenerational Effects of an Anti-Poverty Program in Early Education,” took eight years and multiple rounds of improvements and revisions before its publication this year. Gibbs, an economist at Notre Dame who studies early childhood education, says that during that period “he has had three children and I’ve had two. So, the paper is older than our kids.”

The statistical kismet that enabled the project goes a long way to explaining why such a longitudinal study is only now being done. The study required the passage of decades — as the early Head Start children grew to adulthood and their children did the same — and statistics that could be verified along that timeline. The first kids in Head Start were in the program in the late 1960s. Their records were housed in the National Archives and Records Administration (NARA), where Barr and Gibbs drilled down for data on the availability of the program during its early years.

The two economists’ concept was that this Head Start data could be linked to another massive data set: the National Longitudinal Survey of Youth-1979 Cohort (NLSY79), a project of the U.S. Bureau of Labor Statistics that followed the lives of more than 12,000 American young people aged 14-22 when first interviewed in 1979. The secret sauce that made the second-generation study possible was the NLSY79 Children and Young Adult cohort, a second longitudinal project that followed the biological children of women in the NLSY79. By matching the NARA data with the NLSY79, Barr and Gibbs were able to compare such measures as teen parenthood, education, employment, and income between the women who had Head Start available as children and those who didn’t. They then could look at similar outcomes in the children of the Head Start mothers compared with the second generation from mothers who lacked access to the program.

The appendix for the study alone was 122 pages of supplemental figures and tables, and small-print notes on the figures and tables. If the thought of making sense of those three data sets in relation to each other ťĺ´Çąđ˛ő˛Ô’t make you a little woozy, you may not have grasped the complexity — or you may be an economist.

“Well, I do like numbers,” Barr, an economist at Texas A&M, says with a laugh. Ěý“I’m motivated by trying to figure out how to help people better and it’s important to use evidence and careful thinking to answer that question.”

“There have been a handful of studies in Scandinavian countries where they’ve set up data infrastructures that track individuals over decades, so they’ve been able to link some of the intergenerational effects of early childhood programs. But in the U.S., the data infrastructure makes it difficult to look at these kinds of intergenerational questions.”

One of the study’s findings that Barr initially found surprising was the degree to which the intergenerational effects held. It would be predictable that large effects on the first generation of Head Start kids might begin to diminish in their children’s generation, but that didn’t prove to be the case. The results held within the same statistical neighborhood as the first generation, pointing to an observable disruption in the conditions of poverty.

Although the authors are careful to note that small sample sizes and measurement issues Ěýmake precise numbers difficult to pinpoint, the study found decreases in teen parenthood in the second generation by roughly 8 percentage points and a reduction in criminal engagement by about 13 percentage points, with increases in high school graduation by 11 percentage points and college enrollment by 10 percentage points, corresponding to an estimated increase in wages through age 50 of between 6 and 11%.

Though many of the first Head Start generation now have grandchildren and some may have great grandchildren, the longitudinal data sets don’t exist to track results into the third and fourth generations. But just as a sailboat adjusting its direction by one degree can ultimately alter its destination by hundreds of miles, putting in early, effective course corrections for a generation of Head Start kids may prove to exponentially improve the lives of their heirs.

“The emphasis, the vision for the Head Start program was to do precisely what we document in this paper,” Gibbs says. “By breaking the cycle of poverty, the vision was to move the first generation substantially enough that their children were on better footing to have successful lives, to flourish.

“It’s so rare to be able to answer the question, ‘Did this program do the precise thing it was set up to do?’ But here, we’re able to say that the second generation has that better foundation to move through life with better outcomes.”

The implication is not simply that the Head Start program of yore created lifelong changes for the participants and their offspring, but that resource-rich programs that provide what families and children in their earliest years need can have a lasting difference into subsequent generations. Poverty is a condition, not an immutable fact, and with proper resources, smart implementation and buckets of political will, its debilitating cycle can be broken.

But the information is critical. A large body of research shows that the more parents know about typical child development and effective parenting, the better they interact with their children and provide them with stimulating environments. Parents with a better understanding of what to expect as their babies develop feel less stressed, more effective, and better about themselves and their infants.

By contrast, parents who don’t know what to expect are often impatient and intolerant of the baby’s actions, misinterpreting normal child development as bratty or malicious behavior, increasing the possibility that the child could be mistreated. Parental impatience and intolerance also directly affect infant attachment, which can lead to harsh, inconsistent, disengaged parenting and the cycle of issues that can arise from that.

Reich, a professor in the School of Education at the University of California-Irvine, researches the factors that influence parenting behavior and how those influences affect children’s development. While working on her doctorate at Vanderbilt University, she and a fellow in developmental pediatrics, Dr. Kim Worley, along with their advisor, Len Bickman, began looking at how the process of delivering parental education might be improved.

In 1994, the American Academy of Pediatrics created the — well-structured, evidence-based parent-education material intended to be delivered across 31 age-based visits. The guidance has been updated and revised over the years, most recently this year, to help health care professionals spread the word on child health and behavior to parents and caregivers. The information is there but getting it into the hands of parents is rarely as simple as it ought to be.

“Theoretically, well-child checkups should be a good time to educate parents about injury prevention, typical development and optimal parenting practice,” Reich says. “But there’s a lot of evidence that if physicians can spend any time covering parent education it tends to be a minute or less, and maybe covering three topics. When parents are interviewed later, even if the physician covered a lot of material, they don’t remember much of it.”

Sometimes the doctor’s office will give parents handouts based on the Bright Futures Guidelines, but often their literacy level is too high for many families. As the two researchers discussed alternative methods of spreading the word, they hit upon the idea of embedding the information in baby books — not books about babies a lá Drs. Spock and Brazelton — but books for babies. The books are written at a first-grade level, have pictures to supplement the text and will be read multiple times.

“If you’ve had a child, you know that you read the same books over and over and over,” Reich says. “We thought we could capitalize on this repetition.”

For the initial Baby Books Project (there are two so far), Reich and her colleagues at Vanderbilt created a three-group randomized study to compare the impact of educational books with noneducational books or no books at all. The researchers created a series of professionally illustrated board books targeted to different stages in babies’ development, with content addressing why babies might be behaving in a particular way, which parents might interpret as misbehavior, and how hitting won’t correct the behavior. The text also discussed tantrums and the value of praise, distraction and redirection when dealing with baby’s meltdown. The noneducational books feature the same illustrations, but without the informational approach. Both sets of books contained images of ethnically diverse families and were written in short, catchy, rhyming stanzas.

The books featured messages on the inside of each cover about self-care for the moms with such topics as managing stress, eating well and what to do when they’re feeling overwhelmed. The first project followed 145 low-income, first-time, predominately African American mothers in the southern US, from their last trimester of pregnancy until their child was 18 months old. In Baby Books 1, all books were delivered in person during home-based data-collecting visits.

Baby Books 2, which Reich developed in partnership with Dr. Natasha Cabrera at the University of Maryland, replicates and expands on the first project by including first-time mothers and fathers, and targeting co-parenting. Families in the study are low- to moderate income in Washington, D.C. and Southern California, and are racially and ethnically mixed. The books were written in both English and Spanish and the project was divided into four parts: families receiving books for mothers, books for fathers, books for both mothers and fathers, and noneducational books.

Thanks to a grant from the National Institutes of Health, the second study, which had been derailed by COVID-19 because researchers could no longer go to subjects’ homes, was expanded to 46 months and the books were mailed to families rather than requiring in-person visits. The results are now being evaluated but early analysis indicates many of the same positive results as Baby Books 1.

Based on assessments at all stages of data collection for Baby Books 1, mothers in the group receiving educational books increased their knowledge of child development and positive parenting practices, showed reduced support for spanking, increased efficacy and read more often to their children.

Children of the mothers receiving the educational books had fewer preventable injuries compared with the other groups. An analysis of medical chart audits of doctor office, emergency room visits and hospitalizations found that the impact of preventing injuries such as burns, cuts, falls and dropping showed that the educational book resulted in an overall estimated cost savings of $14,194 compared to the noneducational book group and $128,954 compared to the no-book group.

“The economist who did the analysis tried to calibrate the cost considering that when a child is injured, they have to be taken to the doctor and the parent has to miss work. There are costs around preventable injuries beyond the injury itself, and if the injury is significant, that can change the family’s quality of life.

“As we were hoping, the families did change some of their safety practices in the home,” Reich says. “If the action was putting away choke hazards or removing plastic bags or keeping dangerous things away from the kids, the moms changed those behaviors — mainly the practices that didn’t cost them money. If it meant installing smoke detectors or using baby gates, we didn’t see any changes because our families were very low income.”

The women’s feelings of stress and depression were measured at regular intervals throughout the project. At baseline — the women’s third trimester of pregnancy — the scores for depression hovered just below the criteria of clinical depression for all the women. Though those symptoms gradually decreased for all in the children’s first 18 months, the intervention group became less depressed faster than women in the comparison and control groups.

Where the needle didn’t move, Reich says, was the mothers’ practices around food. The first books included a lot of information about nutrition and breastfeeding.

“We had zero impact on any of that. The parents did better on demonstrating their knowledge, but they didn’t change their feeding practices whatsoever. That’s a common finding — food practices in families are a really hard thing to change. So, in the second baby books, we took all of that out because it was space in the books that wasn’t having an impact on behavior, so we moved in other information.

“We’ll see how that goes,” she says. “My hope is that with each study we’ll figure out what pieces are really amenable to change, and which aren’t and then really target those that are will have utility.”

Though the books are not available for distribution, the researchers hope that they eventually might be able to partner with a publisher to make the books widely available, for instance in Reach Out & Read programs in pediatric clinics or offered during Women, Infants and Children clinic visits. The books could also be made available through public libraries, preschools or bookstores.

“Maybe it could become like the TOMS shoes model where if someone buys a book, the publisher gives a free book away,” Reich says. “It’s such a low-cost, easy-to-disseminate, easy-to-implement intervention, I would love to see it expand.”  ​​​