School readiness includes the readiness of the individual child, the school' s readiness for children, and the ability of the family and community to support optimal early child development. It is the responsibility of schools to meet the needs of all children at all levels of readiness. Children' s readiness for kindergarten should become an outcome measure for a coordinated system of community-based programs and supports for the healthy development of young children. Our rapidly expanding insights into early brain and child development have revealed that modifiable factors in a child' s early experience can greatly affect that child' s health and learning trajectories. Many children in the United States enter kindergarten with limitations in their social, emotional, cognitive, and physical development that might have been significantly diminished or eliminated through early identification and attention to child and family needs. A strong correlation between socialemotional development and school and life success, combined with alarming rates of preschool expulsion, point toward the urgency of leveraging opportunities to support social-emotional development and address behavioral concerns early. Pediatric primary care providers have access to the youngest children and their families. Pediatricians can promote and use community supports, such as home visiting programs, quality early care and education programs, family support programs and resources, early intervention services, children' s museums, and libraries, which are important for addressing school readiness and are too often underused by populations who can benefit most from them. When these are not available, pediatricians can support the development of such resources. The American Academy of Pediatrics affords pediatricians many opportunities to improve the physical, social-emotional, and educational health of young children, in conjunction with other advocacy groups. This technical report provides an updated version of the previous iteration from the American Academy of Pediatrics published in 2008. EARLY EXPERIENCE MATTERS All of a child's early experiences, whether at home, in child care, or in other preschool settings, are educational. When early experiences are
Background. Amyoplasia is the most commonly seen diagnostic subgroup of children with arthrogryposis. The natural history of these children has not been well described previously. Methods. Review of the medical records of 38 children with amyoplasia enabled us to describe their birth characteristics, therapeutic interventions, and functional outcomes. Results. Eighty-four percent of the children had symmetrical, four-limb involvement, which was similar to the original descriptions of amyoplasia, at birth. There was an average of 5.7 orthopedic procedures per child, and the children had multiple castings and splintings of their limbs and participated in physical and occupational therapy on a regular basis. By the age of 5 years, 85% were ambulatory, most were relatively or completely independent in their activities of daily living, and most were in regular classrooms at the appropriate grade level. Conclusion. Although children with amyoplasia have pronounced musculoskeletal involvement at birth, which requires orthopedic and rehabilitative interventions during their childhood, their functional outcome in both physical and educational areas is excellent.
Of 141 women who finished their pediatric residencies between 1960 and 1987, 84 (60%) completed questionnaires concerning their decisions regarding marriage, pregnancy, child care, and career. Eighty-three percent of the physicians were married, and 77% had natural-born children. The mean age at conception of the first child was 29 years, timing that was based on education or career stage for 51%. When the child was born, 45% of the women were employed, 20% were fellows, 17% were residents, 3% were undergraduate or medical students, and 15% were on leave. Eighty percent found supervisors and peers to be supportive of their pregnancies, but 26% believed they were penalized for their maternity leaves and 24% believed their pregnancies were actively discouraged. The mean leave taken following delivery was 12 weeks; the mean leave time considered ideal was 16 weeks. All women had used some form of day care, and 79% felt generally satisfied with its role in their children's rearing. They did more than 50% of the housework and in-home child care, with the remainder split between spouse and hired help, even though nearly two thirds were working full-time. All subjects with children would become parents again if they had to make the decision again. Eighty-one percent of respondents would go into medicine again; 79% would enter the same specialty. Most found their life-styles challenging but rewarding and, with the benefit of hindsight, would make the same choices again.
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