A-Waiting Opportunity

Dr. Dina LieserDr. Dina Lieser is Co-Director of Docs for Tots and Director of Community Pediatrics and Ambulatory Pediatrics at Nassau University Medical Center.



As a pediatrician at a safety-net hospital serving some of Nassau County’s most vulnerable families, some days I am inspired. On others, I am haunted by the missed opportunities that occur on a daily, systemic basis. Walking past our clinic waiting room I see Juliana, who has been sitting restlessly for the past 30 minutes, her mom on her phone. As we are in a clinic serving a low-income population in a community that boasts a 41% high school graduation rate, I know Juliana’s odds for poor school readiness and the cascade of life events that follow.

And yet there are so many of these moments, these precious moments that could be so much better spent. I can’t help but feel shorted by my medical education, which spoke little about a pediatrician’s role in our nation’s economy and education system. The pediatric venue is the only service system that sees our youngest children and parents with near universality and regularity  in the earliest years (14 recommended visits through age 4). With all we know about early brain development, shouldn’t every moment spent in pediatric care be the concern of everybody- school superintendent, business owner, tax payer, teacher and law enforcement alike?

What happens in well-child and prenatal care should be on the front-line of investments in children. Parents spend long waits- both in the waiting room and the exam room- that are prime time for interventions. Yet this trusted setting is so often ignored in discussions and investments in the early childhood and educational systems. We are missing opportunities to promote lifelong health and success through simple, scalable approaches around

  • Positive parenting and social emotional development
  • Early screenings, referrals, and connections to evidence-based community resources
  • Promotion of early literacy
  • Getting to the roots of of both poverty and inequalities in health and education

Reach Out and Read, the literacy intervention designed for implementation in doctor’s offices, is a key example of how the primary care venue can be leveraged for lasting child outcomes. Dipesh Navasaria MPH, MSLIS, MD and Amy Shriver, MD, long-time leaders and champions of utilizing the primary care venue, have just released “The Elephant In The Clinic: Early Literacy And Family Well-Being.” It is a brilliant description of the depth and impact of Reach Out and Read, organized around the theme of ‘the blind men and the elephant’.  Advocating for bringing such programs to well-child care: the place where we greet our youngest and their families, is a practical and scalable opportunity that will have great returns. Let’s stop missing opportunities every day to welcome our babies with ready and open arms.

Share this brief and start the dialogue in your communities and states!

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Investing in quality early learning programs is the most efficient way to affect school and life success and to reduce social expenditures later.

James Heckman, economist, Nobel laureate