NEW YORK - Many children are about to start school for the first time, but doctors say the key to successful learning may be found long before children enter a classroom.

In the first years of life, according to pediatricians, children's brains develop at a remarkable rate, and developmental problems often are detectable well before a child reaches school age. Dr. Dina Lieser, co-director of Docs for Tots and director of community pediatrics at Nassau Community Medical Center, said it's something that should be part of regular health care.

"Every single child should have a developmental screen done at nine months of age, at 18 months of age, and at 24 or 30 months of age," she said.

According to Zero to Three, the National Center for Infants, Toddlers and Families' website, about one out of every seven children in the United States experiences a developmental or behavioral problem before age 18. But a national survey by the Child and Adolescent Health Measurement Initiative showed that from 2011 to 2012, almost 80 percent of New York children ages 1 to 5 years, had not had a developmental screening in the past 12 months.

For example, Lieser said, language problems are noticeable in infancy and early childhood, and should be dealt with as soon as possible.

"Our capacity to make a difference becomes much more labor-intensive the older children get," she said, "as well as much less potentially effective."

Advocates also cite a strong correlation between poverty and developmental disabilities, but children in low-income families and those without health insurance are less likely to get early screening.

Lieser, who chairs the American Academy of Pediatrics' National Council on Early Childhood, said early screening and intervention are key for successful school years and beyond.

"Those years of development truly set the foundation for their lifelong development, school success, life success and health," she said.

Lieser added that about 20 percent of developmental disabilities may not be detected in a single screening, so parents are encouraged to make them part of every well-child visit to the pediatrician.


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Buy-in on Montana's first state-funded early literacy program has been lower than expected in its first year of operation and a school administrator group plans to offer training to help increase the numbers.

State lawmakers in this year's session added math literacy to a 2023 reading literacy program for K-3 students, which is voluntary for both students and schools.

Rob Watson, executive director of the group School Administrators of Montana, said the most successful early literacy programs are aligned with their associated upper grade levels.

"Everything down to how the curriculum aligns, how the assessments align, how you identify which kids need extra help," Watson outlined. "The strategies have to be aligned in grades pre-K all the way through 3."

Watson applied for a grant to help train elementary school principals about alignment, which he thinks could increase use of the programs. Participation varies widely by region, which he noted is likely related to the availability of accredited teachers. According to his research, nearly 70% of districts in north central Montana have launched the program, compared to only 5% in northeast Montana.

Watson pointed out fewer than half of Montana's school-age kids are reading at or above their grade level, according to Zero to Five Montana.

"That's a big predictor for a lot of different things later on in life with regard to progression in middle school and high school, dropout rates, graduation rates," Watson outlined. "All that stuff is connected to students' ability to read."

He estimated fewer than 2,000 4-year-olds participated last year, of about 11,000 kids that age.


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CORRECTION: The name of the spokesperson from the Center for Law and Social Policy is Suzanne Wikle. She had been incorrectly identified as Suzanne Michael. (2:57 p.m. MDT, May 6, 2025)

Potential Medicaid cuts could have a negative impact on early childhood education professionals in Arkansas.

A report from the Georgetown University Center for Children and Families shows 31% of the state's child-care workers are covered by Medicaid.

Nicole Carey, education policy director with Arkansas Advocates for Children and Families, said having health-care coverage impacts the overall well-being of the educator.

"Which then plays into their relationship with the kids they're serving, and their longevity in the profession," said Carey. "And it has this ripple effect if they lose their health coverage, then maybe they aren't getting the services they need, and then they can't be as present at work."

Arkansas has expanded Medicaid coverage. It's one of 13 states nationwide that covers more than one-third of the child-care workforce through Medicaid.

Congress is considering cuts to Medicaid and other federal programs, which some say will eliminate federal waste.

The report shows many child-care centers are operated by small businesses owners who cannot afford to offer their employees health coverage.

Carey said Medicaid is needed to provide coverage to these essential workers.

"It will be your hourly workers, which could be the people in the classroom," said Carey, "it could be nutrition, it could be front desk."

Suzanne Wikle, associate director for state health policy and advocacy with the Center for Law and Social Policy, said most proposals for streamlining Medicaid includes shifting costs to the states, which means many Americans could lose health coverage.

"State budgets cannot just absorb that," said Wikle. "So, states will have to raise additional revenue through other ways, or cut, or do both, most likely, and because most states have to balance their budgets, these decisions will come quickly, and they will be very, very difficult."



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Child care is expensive and in high demand but groups in Montana are taking creative approaches to help.

Child care services in Montana currently meet about half the state's need, and full-time child care can cost more than college tuition, according to Montana Advocates for Children. Experts said solutions are unique to communities.

Jennifer Pfau, executive director of the Central Montana Childcare Alliance, helped launch the group in 2022, which offers startup grants and support for businesses, schools, churches and others to start child care centers. She said the pandemic made visible the "workforce behind the workforce."

"It's shifting the focus to helping people realize that child care is essential community infrastructure," Pfau explained. "And then working together to help address the needs in your community."

The group has helped open 15 new child care centers and expand capacity by nearly 200 slots with American Rescue Plan Act funding, which Pfau noted has since run out. She called finding more "challenging."

As school enrollment decreases, some empty classrooms are being remodeled for child care. That worked for Pfau and for the group Missoula Child Care Advantage, which also created a business membership, offering in-network child care for employees of local businesses and schools.

Sally Henkel, Missoula Child Care Advantage coordinator for the United Way of Missoula County, said fees go toward a "shared services model" to stabilize the child care sector by reducing administrative costs.

"Once that can be alleviated, the hope is that providers can really reinvest that time and energy into mentoring staff, maybe paying them a little bit better," Henkel outlined. "And also offer higher quality child care and have a little bit less burnout as well."

At the Montana Capitol, House Bill 360, scheduled for a hearing in the Human Services Committee this week, would establish a child care workforce recruitment and retention support payment program.


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