PC1093: Child, Parent, and Contextual Determinants of Kindergarten Readiness Among Children with Low Birthweight

Background: Children with low birthweight (LBW; ≤2,500g; 8% US births in 2018) are less likely to be kindergarten ready than those with birthweight >2,500g. In the general pediatric population, special healthcare needs (SHCN) and social disadvantage are negatively associated with kindergarten readiness, while positive parenting practices and community supports are positively associated with kindergarten readiness. This has not been studied in children with LBW. Study

Aims: Among a nationally representative sample of LBW children: 1) Quantify prevalence of kindergarten readiness at ages 3-5; 2) Identify child, family, and community factors associated with increased and decreased odds of kindergarten readiness.

Methods: The National Survey of Children’s Health includes questions to measure school readiness. We included LBW children aged 3-5 years (when parents were asked readiness questions) with complete outcome measure data. We categorized children as “on-track” vs. not in individual domains (early learning skills, physical health/motor development, social-emotional development, self-regulation) and overall (on-track in 4 domains vs. < 4). We calculated prevalence of school readiness in individual domains and overall. We conducted separate logistic regression models for each predictor category (medical factors, social characteristics, community supports, parenting practices), adjusting for survey year, age, and sex as covariates, used backward elimination to remove non-significant (p>0.1) predictors, and created an overall model with variables not eliminated. We calculated the average marginal effect for each predictor.

Results: Among 1421 LBW children in our sample, 487 (34%) were on-track for kindergarten readiness at 3-5 years. Domain-specific readiness ranged from 51% (early learning skills) to 87% (physical health/motor development) (Fig 1). Medical factors (more complex SHCN), social characteristics (lower parental educational attainment, poorer parental mental health, Spanish household language) and receipt of EI or special education services were associated with decreased kindergarten readiness. Childcare outside the home and parenting practices (more frequent household routines, increased family resilience, decreased daily screen time) were associated with increased school readiness.

Conclusion: While prior interventions for this population have focused on medical/developmental care, positive parenting interventions have improved school readiness among low-income children and may have similar effects on the LBW population. Future studies should investigate perceptions and determinants of these behaviors among parents of children with LBW.