Closing the Kindergarten Readiness Gap With Direct Literacy Screening in Primary Care

New research suggests direct literacy screening during pediatric well visits can complement traditional developmental surveillance and better support kindergarten readiness.

Pediatricians have long relied on developmental screening tools during well-child visits to monitor whether children are meeting expected milestones prior to starting kindergarten. But new research suggests that these widely used tools may miss an essential piece of school readiness: emergent literacy skills.

A recent study published in Pediatrics, “Comparison of Literacy and Developmental Screening of Preschool-Aged Children During Primary Care,” found that nearly half of preschool-aged children were identified as at-risk or needing additional support when screening for early literacy.

“Our current approach does a good job assessing overall development,” says Sara Bode, MD, a primary care pediatrician and medical director of Nationwide Children’s Hospital’s School Health Services. “But it doesn’t consistently capture whether a child is developing the specific literacy skills they need to be ready to learn to read when kindergarten starts.”

Missed Opportunity in Primary Care

Dr. Bode’s work sits at the intersection of health care and education, with research centered around integrating school readiness measures into primary care. In addition to caring for patients in outpatient practice, she helps lead Nationwide Children’s efforts to support school readiness at the community level.

“That’s where the gap really is,” explains Dr. Bode. “It was incredibly easy to miss early reading challenges because we weren’t measuring them. We saw the opportunity to think about how we can lean into this space and be part of the solution.”

Comparing Screening Approaches

To better understand that gap, the research team compared results from two screening tools used during routine pediatric well visits for children ages 3 and 4:

• The Reading House (TRH), a validated, children’s book-based measure of emergent literacy skills available for use in clinics.
• The Survey of Well-Being of Young Children (SWYC) milestones, a widely used developmental screening tool used in clinics.

The study included 721 children who completed both screenings during well-child visits. The results revealed key differences in the screening tools.

Nearly half (47.02%) of children were flagged as needing additional support by at least one screening tool. Notably, almost one in four children who passed the developmental screening (SWYC) still showed literacy-related risk when assessed with TRH.

“That’s the key takeaway,” Dr. Bode says. “Developmental screening and literacy screening are not the same thing. They measure different skills, and both matter.”

From Screening to Support

A defining feature of the program is that screening does not stop with identification. After administering TRH, Kindergarten Readiness Coordinators work directly with families to create individualized literacy plans, provide hands-on learning materials and connect caregivers to local early childhood resources. These include preschool programs, library-based literacy initiatives and home-based kindergarten readiness programs.

The literacy kits provided to families were developed collaboratively with Columbus City Schools kindergarten teachers and literacy experts to ensure alignment between what children practice at home and what they will see in the classroom.

“We wanted families to have very concrete guidance,” says Dr. Bode. “Parents want to help their child succeed, but it’s hard to know what skills are expected or how to teach them.”

Coordinators also follow up with families after visits to help navigate enrollment processes and ensure connections to services are successful.

Implementation Feasibility

Adding any new element to a pediatric visit raises concerns about time and efficiency. According to Dr. Bode, clinician feedback has been overwhelmingly positive.

“We were very intentional about workflow,” she says. “This was designed to integrate seamlessly into 3- 4-year-old well visits without extending appointment time.”

Literacy screening was conducted by

Because coordinators work alongside providers and clinic staff, the screening process supports, not disrupts, care delivery. Over time, pediatricians and clinic teams have become comfortable reinforcing literacy guidance and distributing resources when coordinators are not present.

“It’s become a practice-wide culture shift,” says Dr. Bode. “Everyone feels like they’re part of the solution.”

Equity Implications

The study also found that race, socioeconomic factors and neighborhood opportunity influenced the likelihood that children would be flagged as at risk — patterns consistent with national disparities in early literacy.

“Families facing economic hardship often have fewer opportunities to access early childhood resources,” explains Dr. Bode. “That’s exactly why health systems need to lean in.”

Nationwide Children’s has prioritized placing Kindergarten Readiness Coordinators in clinics serving communities with higher needs. TRH is also available in English and Spanish, allowing screening and counseling for Spanish-speaking families.

For families who speak other languages, clinics focus on connecting caregivers with community resources even when standardized screening is not feasible.

“Equity doesn’t always look identical. It means meeting families where they are and making sure they have support.” says Dr. Bode.

What Comes Next

Currently, literacy screening is implemented in about half of Nationwide Children’s primary care clinics, with plans to expand systemwide. The initiative grew out of the hospital’s broader Pediatric Vital Signs, which identified kindergarten readiness as a priority for improving long-term outcomes.

Beyond implementation, Dr. Bode and team are tracking long-term outcomes for children who participated in the program, including performance on kindergarten readiness assessments and early academic processes.

“We’re already seeing encouraging early signals,” says Dr. Bode. “Now we want to be sure this intervention truly moves the needle on school success.”

She hopes the findings encourage pediatric practices nationally to view emergency literacy as a distinct and actionable domain on child development.

“This study shows that we don’t need to wait until children fail in school,” says Dr. Bode. “Primary care is a powerful place to identify risk early and to do something about it.”

References:

1. Bode SM, Denny S, Masonheimer A, Irwin MK, Hutton J. Comparison of Literacy and Developmental Screening of Preschool-Aged Children During Primary Care. Pediatrics. 2025;156(5): e2024069941.
2. Bode SM, Denny S, Irwin MK, Hutton J. A primary care-based approach to improving kindergarten readiness. Pediatrics. 2025;155(suppl 1):e2024069159C.

Image Credit: Adobe Stock & Nationwide Children’s