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As pediatricians in Chicago, one of America’s most diverse cities, we see children of many races, ethnicities, and socioeconomic backgrounds. Pediatricians treat all the usual ailments such as ear infections, asthma, strep throat, and the like. But we are also trying to address another one — the developmental gap — that often goes unnoticed.

A child’s intellectual development, sometimes called cognitive development, starts at the very beginning of his or her life. As our colleague Sandra Waxman has shown, something as simple as listening to a parent or other caregiver talk positively affects intellectual development. Some children have vibrant verbal connections with adults; others don’t.

In a landmark study of language development, University of Kansas researchers followed 42 families over a two-and-a-half -year period. During that time, the average child in a professional family heard 45 million words, while the average child in a lower-income family heard only 13 million words. This set the stage for differences in language and cognitive development starting as early as 3 years of age. This is the developmental gap.


According to the American Academy of Pediatrics, almost half of young children in the United States live in poverty or near poverty. Growing up poor can dramatically influence the physical development of children’s brains, which affects their overall developmental and learning trajectories.

Using national data from more than 12,000 families, one of us (Reshma Shah), and colleagues showed last year that parents’ economic status contributes to the development gap. Income-related differences in parenting practices stem largely from variations in negative life experiences, parenting stress, and money to pay for educational materials and experiences.


This year, the American Academy of Pediatrics called upon pediatricians to help guide and support all parents, but especially those who are economically disadvantaged, as their children grow.

Discussing strategies to promote positive parenting practices during an already filled 15-minute office visit where a pediatrician must also address a child’s health, growth, safety, and parental concerns isn’t always easy. Even so, a pediatrician’s office can be a perfect place to help parents improve their child’s early development and readiness for school.

Here are some simple practices that we and other pediatricians discuss with parents that don’t cost any money and that fit smoothly into daily routines:

  • Talk with your child as much as possible.
  • Read books together.
  • Share mealtimes without the presence of television or portable media devices.
  • Use the grocery store to help your child learn about colors and categories.
  • Make travel time to school, church, doctors’ appointments, and the like opportunities to practice conversations.

There are no hard and fast rules to make these strategies appropriate for children with a wide range of learning styles, including those with autism spectrum disorders and developmental delays.

We start by understanding parents’ concerns about their child and what they want for them. Then we tailor recommendations for each family. These sometimes involve problem-solving to find ways they can spend more time with their child. It may also involve connecting them with outside resources, which can be very difficult in times of economic scarcity.

Innovative programs such as the Thirty Million Words Initiative, led by Dana Suskind at the University of Chicago, offer ways for parents from all backgrounds to help their children’s brains develop. Thirty million is the gap between 45 million words and 13 million words seen in the University of Kansas study mentioned earlier. This initiative helps parents become their children’s “first and most important teachers” in building language and cognitive development.

We need to rethink and simplify ways that even the most economically stretched families can better support their children’s development and close the developmental and educational gap. Even with limited resources, parental involvement and empowerment make a huge difference in their child’s life — we see it happen every day.

Sarah C. Bauer, MD, is a developmental pediatrician at the Ann & Robert H. Lurie Children’s Hospital of Chicago, assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, and a fellow in The OpEd Project’s Public Voices program. Reshma Shah, MD, is a developmental pediatrician at the University of Illinois at Chicago and assistant professor of pediatrics at the University of Illinois College of Medicine.