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The case for revolutionizing child care in America


Parents of the world, unite!

OK, so Dana Suskind's call to arms doesn't have quite that revolutionary zeal. But it comes close. In her new book, Parent Nation, Suskind says millions of kids in America are getting left behind during their first three years of life — years that a heap of scientific evidence says are crucial to their brain development. To fix that, she argues, America needs much stronger policies to support parents and caregivers at this early stage. Kindergarten — even pre-K — might well be too late.

"We've got this powerful brain science that is just so clear," Suskind says. "Yet we have a society that is built in absolute diametric opposition to supporting children, supporting families and caregivers in putting this into action."

Suskind's path toward trying to revolutionize child care and education in America began in an operating room. A pediatric surgeon at the University of Chicago, Suskind specializes in implanting cochlear hearing devices in deaf children. This procedure gives kids the chance to hear for the first time in their lives.

Doing this remarkable work, Suskind began to notice a big divergence in her patients' outcomes. After the procedure, some kids learned to talk and understand spoken language with relative ease. Other kids not so much. Kids older than 3 and underprivileged kids consistently fared worse. That bothered Suskind, so she began searching for answers in neuroscience and social science for reasons why.

At the University of Chicago, Suskind audited a course on child development, where she was introduced to a growing body of research that helped explain the disparities she saw. For Suskind, one study, in particular, struck a chord. The study found that — before the age of 4 — kids who grow up in poverty hear a staggering 30 million fewer words than their more affluent peers. The finding resonated with Suskind because she saw this same socioeconomic disparity with her deaf patients — many of whom were born to hearing parents who were not fluent in sign language. That hampered those parents' ability to communicate with their kids. Suskind came to believe that the consequent effects on these kids' brain development could help explain why some of her patients struggled with spoken communication even after receiving the physical means to hear.

It's more than the sheer number of words

About a decade ago, Suskind founded a research initiative and then wrote a bestselling book that each used the term "Thirty Million Words." But in the years since, she's come to feel the slogan puts too much focus on the number of words a child hears while their brain is forming. Really, it's more complex than that. More importantly, she agrees with criticisms of the landmark study that originally found the 30 million-word gap. The study, for example, had only a small sample size (42 families) and subsequent replications found much smaller word gaps. Suskind now shies away from using the 30 million number.

Nonetheless, the general gist of the scientific evidence remains the same, and it's only gotten stronger over the last decade: roughly 85% of the physical brain is formed in the first three years of a child's life. "This is building the foundation for all thinking and learning later on," Suskind says. While the brains of older kids and adults are relatively hard to mold, babies' brains are like silly putty. To use the jargon, the brains of kids under the age of three have much more "neuroplasticity" than older kids and adults. It's why, for example, it's typically much easier for young kids to learn new languages than adults.

Suskind's core message: creating a nurturing, interactive environment for kids aged zero to 3 is vital for their development — and many kids are getting left behind during this critical period. Kindergarten — and even preschool — may be too late for interventions to try and close an opportunity gap that begins to open up at birth. She argues we need to start much earlier.

With her research organization, the TMW Center for Early Learning + Public Health at the University of Chicago, Suskind has developed strategies and curricula to help parents create a more optimal environment to nurture their kids' brains. They've done randomized controlled trials and published research showing that their strategies work.

Beyond individual parents

Since launching the TMW initiative, Suskind has had a big awakening. In working with parents, often from low-income communities, she's come to recognize that there's only so much that focusing on the choices and behaviors of individual parents can do. She beats herself up a bit in her new book, calling her original focus on changing society by simply educating parents "naive." She continues to champion strategies to educate parents on brain science and give them the tools to stimulate their kids' brains. But more important, she now says, is tackling the structural forces in society that are stacked against parents.

"Despite parents wanting the best for their children, it was like barrier after barrier after barrier was being placed in front of them," Suskind says. Some of the parents who participated in the TMW initiative had to work multiple jobs and had less than an hour per day to spend with their child. Some parents got sick, lost their jobs, and their families became homeless. Others were incarcerated, depriving their kids of a two-parent household to raise and provide for them. All lacked social infrastructure to support them, like paid family leave or high-quality child care centers to take care of their kids when they had to work.

In Parent Nation, Suskind calls for new policies and a new culture "that truly values the labor and love of parents and caregivers and puts families, children, and their healthy brain development at the center."

America, she says, is currently failing to do that. The data backs her up.

The average OECD nation spends around $14,000 a year for each toddler's care. America spends only about $500, or about less than 4% of the average. America is literally at the bottom of the list.

One in 4 American mothers returns to work within two weeks of having a baby. America is one of the only six nations in the entire world — and the only rich nation — to not have some form of national paid leave.

Around half of Americans live in "child care deserts" that lack adequate facilities to look after their kids. A study by the National Institute of Child Health and Human Development finds that only 10% of America's child care centers provide high-quality care. "Child care providers are often paid less than dog walkers," Suskind says. Meanwhile, the cost of child care has risen 65% since the 1980s.

Around 11 million American kids — or about 16% of all kids nationwide — live in poverty. Children under 5 are the poorest age group in America.

With institutions like K-12 public education, America already spends billions upon billions to educate the next generation. Suskind argues we should focus more on the critical early years of kids' lives, when interventions can make a big — even the biggest — difference. Numerous studies by top economists find that, when it comes to the bang for the buck from public spending, early childhood programs have far and away the highest returns for society.

Building the "Parent Nation"

Child advocates have been arguing for greater spending on kids for decades. However, for the most part, they've lost again and again. Just this year, the expanded Child Tax Credit — a kind of "Social Security for kids" that reduced child poverty by around 30% — expired. Congress failed to renew it.

[Editor's note: This is an excerpt of Planet Money's newsletter. You can sign up here.]

Despite America's sustained failure to invest in kids, Suskind has found some hope in the history of another demographic group of Americans. Senior citizens, not children, were once the poorest age group in America. In the early 1930s, roughly half of all seniors lived in poverty.

But then, in the mid-20th century, seniors got Social Security, Medicare and a host of other benefits. When the tide turned against the welfare state, and politicians began trying to roll back benefits, Suskind says, a powerful organization protected seniors: the American Association of Retired Persons (AARP).

The AARP is powerful, she says, for multiple reasons. It provides a collective identity to seniors for political action. It helps cement a cohesive voting bloc. And because of its structure, it has tons of resources. The AARP isn't merely a lobbying organization for seniors. It's a business. It offers a range of products that generate revenue. And, with about 38 million members, the organization has a collective buying power that entices Corporate America to offer its members special discounts. These perks incentivize more seniors to become members.

"People often joke that people join the AARP for the travel discounts and the insurance — and they stay for the community and the impact," Suskind says.

Suskind imagines a similar organization for parents, one that entices them to become members with lots of perks, creates a collective identity and a cohesive voting bloc for political action, generates revenue by selling products and services, and then uses its resources for lobbying and campaign contributions to serve parent — and child — interests.

Little kids may not be able to vote or organize, but their parents can.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

Since 2018, Greg Rosalsky has been a writer and reporter at NPR's Planet Money.

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