Child, Parent, and Contextual Correlates of School Readiness Among Children with Low Birth Weight.

Objectives: Among US children with low birth weight (LBW): (1) Determine prevalence of school readiness (being "healthy and ready to learn"); (2) Examine associations between school readiness and medical factors (special healthcare needs, birth weight), sociodemographic characteristics (child race/ethnicity, household income, parental education, household language), community supports (early intervention/special education, outside childcare, medical home, neighborhood amenities), parent factors (mental health, emotional support, family resilience), and parenting practices (bedtime, mealtime, storytelling routines; daily screentime).

Methods: We studied 1421 children 3-5 years with birth weight <2500g from the 2016-19 National Survey of Children's Health. We calculated prevalence of school readiness overall and in individual domains (early learning skills, physical health/motor development, social emotional development, self-regulation). We investigated associations between predictors and school readiness with logistic regression.

Results: Thirty percent of children with LBW were on-track for school readiness. Domain-specific readiness ranged from 45% in early learning skills to 87% in physical health/motor development. More complex special healthcare needs (average marginal effect -17%, 95%CI -30%, -9%), parental education high school or less (AME -16%, 95%CI -15%, -4%), and early intervention/special education (AME -14%, 95%CI -26%, -5%) were negatively associated with school readiness. Parental emotional support (AME 12%, 95%CI 0.9%, 24%) and less than one hour daily screentime (AME 16%, 95%CI 6%, 29%) were positively associated with school readiness.

Conclusions: Less than one-third of US children with LBW were on-track for school readiness. Future work should focus on improving school readiness, a key predictor of long-term educational, health, and economic outcomes, among this population.