Imagine walking into a preschool
where children are learning about
healthy food followed by brushing
their teeth; where children with special health care needs are safely included in activities;
where learning the foundations for reading is balanced
by vigorous play and learning to take turns and share.
Pediatricians strive to deliver the highest quality
medical care to patients but may not think about
the quality of the environment where young children
spend numerous waking hours — their child care setting or preschool. Most children are in out-of-home
care. The staff, activities and environment of that setting influence the crucial early period of their brain
A new AAP policy statement from the Council on
Early Childhood recommends how pediatricians and
policymakers can help ensure that children receive care
in high-quality settings. Quality Early Education and
Child Care From Birth to Kindergarten is available at
https://doi.org/10.1542/peds.2017-1488 and is published in the August issue of Pediatrics.
Research shows that investing in quality preschool
education pays off in preparing children for kindergarten by building healthy living habits, strong executive
functioning and emotional intelligence. Those positive
qualities are increasingly being quantified. The science
of quality improvement (QI) in early childhood education is growing just like the science of QI in health care.
Evidence-informed child care practice standards,
quality rating systems and continuing education for
staff are developing. Quality rating and improvement
systems (QRIS) are a method of QI being implemented
by more than 75% of states and frequently are known
as “star systems.” QRIS systems benefit when they include health components as well as educational components.
While it is known that high-quality child care is good
for kids’ brains, quality sometimes suffers due to inadequate funding, variable regulations and enforcement,
So, what can pediatricians do?
• Ask families about their child care arrangements
and discuss how to judge quality. Resources can
be found at www.childcareaware.org.
• Be a medical home that helps children have care
plans that meet any special health care needs.
• Help navigate any behavioral issues that arise to
avoid preschool expulsion.
• Advocate for safe child care guidelines such as
safe sleep, immunizations and safe medication
• Consider becoming a child care health consultant
and train staff on health issues at a local child care
center. Curricula developed by the Academy are
available at www.aap.org/healthychildcare.
• Help close the gaps between state regulations and
• Advocate for expanded access to high-quality early
• Educate policymakers about the science supporting the long-term benefits of high-quality early
• Become an early childhood champion (ECC). The
Council on Early Childhood and state chapters
support ECCs in their advocacy work. Find out
more at www.aap.org/coec, with related resources
Dr. Donoghue, the lead author of the
policy, is an immediate past member and
former co-chair of the AAP Council on
Early Childhood Executive Committee.