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Policy outlines importance of quality child care, pediatricians’ role :

July 31, 2017

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 development.

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 and will be 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.

Addressing barriers

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, and difficulties related to staff retention and education.

Child care staff have among the lowest salaries, and child care centers have difficulty paying more due to slim margins. High staff turnover disrupts the emotional bonds children create with their caregivers and makes it difficult to build a knowledgeable workforce.

Regulation and inspection are one way to ensure healthier environments for young children such as ensuring babies are put to sleep on their backs and toddlers are not being served large quantities of sugar-sweetened beverages. However, there are no national regulations for child care settings, and state regulations and enforcement vary widely.

So, what can pediatricians do?


  • Ask families about their child care arrangements and discuss how to judge quality. Resources can be found at
  • 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 administration.
  • 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
  • Help close the gaps between state regulations and best practice.
  • Advocate for expanded access to high-quality early childhood education.
  • Educate policymakers about the science supporting the long-term benefits of high-quality early childhood education.
  • Become an early childhood champion (ECC). The Council on Early Childhood and state chapters support  ECCs in their advocacy work. Find out more at, with related resources at

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.

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