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Early childhood expulsion: Policy guides pediatricians to assist teachers, programs in discouraging harmful practice

October 30, 2023

Pediatricians have a role to play in preventing expulsions from early education and child care settings, which increasingly are recognized as a problem that reflects societal and health care inequities.

Risk factors for early education expulsion include being male, being Black, having a developmental disability and experiencing trauma/adversity. Implicit biases of child care workers and inappropriate developmental expectations often contribute to high expulsion rates.

Large class sizes, inadequate supports and compensation for teachers/caregivers, and lack of teacher access to mental health consultation regarding the emotional/behavioral concerns of children in their care also play a role.

The consequences of early childhood expulsions can be significant. Dropout rates, poor academic performance and incarceration rates are markedly increased in children who were expelled at an early age. Perhaps most importantly, the underlying causes for behavioral concerns (anxiety, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, developmental problems, etc.) are not addressed, and these children do not get the help they need.

Those are among the conclusions of the updated AAP policy statement Addressing Early Education and Childcare Expulsion. The policy, from the Council on Early Childhood and Committee on Psychosocial Aspects of Child and Family Health, offers recommendations for pediatricians at the practice and community levels, and for those involved in regional and national advocacy. It is available at and will be published in the November issue of Pediatrics.

Impact of pediatricians

Pediatricians and other professionals in the medical home serve an important role in preventing expulsion. They provide information to families about early child brain development and the impact that nurturing relationships and experiences have in promoting resilience. They also model and encourage positive parent-child interactions and discuss appropriate behavior interventions.

Pediatric health care providers also screen for developmental and behavioral problems that put children at risk for preschool expulsion, including adverse childhood events and developmental disabilities.

Pediatricians who point families toward valuable resources can help remediate significant behavioral and developmental concerns. They can discuss features of quality child care programs and encourage family involvement in educational settings. In addition, pediatricians can advocate for quality preschool/child care programs that utilize mental health consultation and employ appropriately trained teachers/child care providers. They also can support community resources that promote safe and stimulating learning/play environments for children (e.g., libraries, playgrounds, museums, etc.).

Educational improvements, community supports

Walter Gilliam, Ph.D., a pioneer in the field and consultant on the policy statement, points out that early childhood teachers need regular access to early childhood mental health consultants. He has stated that child care programs should provide the supports needed to address behavioral concerns or transition children to more appropriate programs.

Dr. Gilliam also suggests student/teacher ratios of no more than 10 to 1, along with additional supports and training for teachers.

Many state and national agencies have recommended clear policies and data collection regarding early childhood suspensions and expulsions.

Additional recommendations in the policy include targeted training of early educators to help them manage child behavior in a positive way, decrease implicit biases, learn the “why” behind problem behaviors and promote social-emotional regulation in young children. Family and child care worker partnerships are critical in this process, as are consultations with child mental health specialists.

Pediatricians play an integral role in these collaborations as they identify at-risk children, provide advice and resources to families, consult with and support quality child care programs, and advocate for community venues that allow children to develop to their full potential.

Dr. Williams is a lead author of the policy statement and a former member of the AAP Council on Early Childhood Executive Committee.


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