By: Gail Williams, MD, FAAP & Michael Yogman, MD, FAAP
For very young children,
preschool and child care should be safe, nurturing spaces that support learning and growth. All too often, though, children are forced to leave early education and child care programs when they behave in dangerous or disruptive ways.
Public and private preschool programs serving 3-to-4-year-olds suspend an estimated 50,000 students per year. Another 17,000 are expelled. This means that 250 preschoolers, on average, are forced out of classrooms and child care centers every single day.
When preschoolers hit, kick, scream, use harsh language or refuse to follow adult instructions, other kids don't feel safe. This is why school administrators, teachers and child care professionals often resort to suspending or expelling a child who behaves in aggressive or harmful ways.
Yet studies of young children who
act out in these settings suggest there's more to the story. And there are ways we help. We can address underlying problems to reduce preschool expulsions, along with the sometimes lifelong harms that follow.
Underlying emotional & behavioral health concerns
The more we learn about child development and the effects of
stress and trauma on children, the clearer it is that children don't behave badly by choice. They are often driven by anger, fear and frustration they can't control—and
communication skills that aren't up to the challenge of explaining how they feel.
The American Academy of Pediatrics (AAP) sees preschool and child care as primary sources of healthful learning in a young child's life. And while we support the right of schools and care centers to keep all children safe, we are concerned that:
Preschoolers are dismissed from the classroom
three times as often as elementary-school children.
Preschool classes often have high student-to-teacher ratios which makes it tougher for teachers and aides to cope with challenging behaviors.
Teachers and child care workers often lack resources that could help assess a child's situation and develop alternative plans to suspension or expulsion.
Implicit bias, or hidden beliefs that fuel discrimination against specific groups or individuals, may unfairly influence the decision to expel a child. This compounds the impact of racism and bigotry a child may already face.
In the policy statement, "Addressing Early Education and Child Care Expulsion," the AAP recommends steps to help decrease preschool suspensions and expulsions. Here's what parents and caregivers need to know about the problem and positive changes we hope to see in the years ahead.
What happens to children after preschool expulsion?
While teachers and staff must protect all children in their care, we must also consider what happens after preschool expulsions. Recent studies confirm that:
Once children are expelled, other schools or child care centers may refuse to offer education or counseling services to them. As a result, kids who need even more guidance and support to grow and thrive are cut off from both.
Preschoolers who are expelled are 10 times as likely to drop out of high school as those who stay in class.
Later in life, these students are 10 times more likely to spend time in jail or prison.
We know that preschools and child care centers can play a key role in helping children prepare for success in school and life. That's why we need to consider the reasons for problem behaviors and how to address them.
Understanding the "why" behind a child's negative actions
Any adult who's tried to manage a misbehaving child knows how frustrating the situation can feel. Our tendency is to assume that kids are choosing to act out– but studies of young children reveal a very different picture. For example:
Mental health issues such as anxiety often become apparent in a child's early years. These can fuel aggression, elopement behavior such as running away and outbursts in school settings. Since only 25% of all U.S. children who need mental health support actually receive it, the odds that they will struggle in preschool are high.
Developmental delays and developmental disabilities such as
autism also put children at increased risk for preschool expulsions. Children in these groups may have feeding issues, inadequate restful sleep or lack functional speech and nonverbal communication patterns. These difficulties can stoke a child's anger and frustration, leading to aggressive and harmful behavior in preschool.
Kids living with adversity and trauma are also at greater risk of preschool expulsion than their peers. Sources of trauma that can affect brain development and behavior include:
Physical, sexual or emotional
abuse
Constant criticism or
neglect
Hunger or housing instability
Struggles with money that undermine family life
Violence witnessed at home or in the community
Racism, bigotry or rejection based on things a child can't change
Bullying, whether in person or online
Separation from a parent or guardian due to death, divorce, desertion,
incarceration or any other cause
Compassion in action: supporting our kids (and the adults who care for them)
Understanding why some preschoolers suffer from behavioral problems does not erase our responsibility to help them learn how to do better. Instead of judging and punishing kids who misbehave, preschool educators and child care providers need to offer specific kinds of support. Specifically, preschoolers need:
A safe, stable learning environment
Nurturing relationships with teachers and caregivers
Referrals to mental health services and supports when indicated, including
trauma-informed care
Preschool and child care professionals also need support to do their best for the children in their care. They should have:
Classrooms that are well-stocked and maintained
Reasonable limits on class size and workload
Access to mental health professionals who can assess students and offer strategies
Training in childhood development, along with practical ways to manage behavior and teach kids social emotional regulation skills
Mental health consultation for themselves in order to prevent burnout
Educators and child care teams also need training to overcome ingrained biases that fuel unfair suspensions and expulsions. For example, studies show that many preschool teachers judge Black boys and girls more harshly than their white, Latino or Asian peers.
Sometimes, expulsions result from a teacher's assumption that a child of color is older than their actual age, leading to unfair expectations: "This child should be able to control their actions by now." It's easy to see how views like these can lead to confusion (and ultimately, expulsions that set kids back even further).
A look at the AAP's new policy on preschool expulsions
We believe that preschool suspensions and expulsions do more harm than good. That's why we need to bring preschool and child care professionals together with pediatricians, parents, caregivers and the community to create a more understanding, supportive environment for young children.
Specifically, we recommend that pediatricians and family doctors:
Help families foster positive
parent-child relationships and experiences, based on understanding of how they affect the child's developing brain.
Screen young children for mental health issues that may affect their behavior, and work with families to address the effects of childhood trauma.
Offer and encourage education for parents and other family members that provides insights into the effects of toxic stress on a child's brain development, as well as protective factors which can help buffer stress and build resilience.
Partner with families to create child-focused treatment plans for behavioral issues when they arise.
Encourage families to take an active role in early childhood education. Partner with families of children with developmental delays to develop care plans that bring teachers, child care professionals and others together to support the child's total needs.
Help coordinate care of children with behavioral issues, seeking out and recommending behavioral specialists when appropriate.
Work with families and childcare programs to find supportive approaches that avoid preschool expulsion.
Working together
We also recommend that pediatricians and child health specialists work together at the community and national level to eliminate implicit bias in preschool and child care settings.
Local and federal advocacy can provide much-needed support for preschool and child care providers, who often face high levels of stress. This stress can be amplified by inadequate pay and training (and the sky-high expectations some parents place on them).
Local, state and federal programs that support early childhood educators and provide kids and families with opportunities to build resilience will make a key difference all around.
When we come together to support young children, their preschool years can be a time of robust growth and learning that prepares them for a lifetime of good health and socioemotional wellbeing.
More information
About Dr. Williams
P. Gail Williams, MD, FAAP, is a developmental-behavioral pediatrician in Lousiville, Kentucky. Dr. Williams serves on the American Academy of Pediatrics (AAP) Councils on Early Childhood and Children with Disabilities, and the Section on Developmental and Behavioral Pediatrics. She is co-author of the AAP policy statement, "Addressing Early Education and Child Care Expulsion."
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About Dr. Yogman Michael Yogman, MD, FAAP, recently retired from pediatric practice after 35 years and continues to teach, write and do research as Assistant Professor of Pediatrics at Harvard Medical School. Dr. Yogman is a trustee on the Board of Franciscan Childrens Hospital in Boston, serves on the Leadership Council of the Center on Universal Education at the Brookings Institute, and chairs the Advisory for the Boston Childrens Museum. He is past chair of the Massachusetts AAP Child Mental Health Task Force and the national AAP Committee on Psychosocial Aspects of Child and Family Health. Dr. Yogman has authored AAP policy statements on fathers role with children, perinatal depression, the power of play, trauma, toxic stress and resilience and addressing early childhood behavioral problems including preschool expulsion.
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