American Academy of Pediatrics Details Alternatives to Preschool Expulsions and Emphasizes Need to Address Deeper Health Concerns

Children expelled from preschool are ten times as likely to drop out of high school and more likely to face incarceration.

When a child is expelled from a preschool or early learning program they may be struggling with an underlying emotional or behavioral concern that, if not addressed, may lead to lifelong negative consequences.

That is one reason why the American Academy of Pediatrics urges pediatricians, early learning professionals and communities to provide alternatives to expulsion in an updated policy statement, “Addressing Early Education and Expulsion,” published in the November 2023 Pediatrics (published online Monday, Oct. 30).

“All children need and deserve safe, stable and nurturing places to learn how to interact with others,” said P. Gail Williams, MD, FAAP, an author of the statement, written by the Council on Early Childhood and Committee on Psychosocial Aspects of Child and Family Health.

“When preschoolers hit, kick, scream, use harsh language or refuse to follow adult instructions, their peers 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 that we as pediatricians and caregivers can help.”

Children who are Black, male, have developmental delays or have experienced trauma are at higher risk of being expelled from early education programs. The statement suggests that addressing implicit bias and providing child mental health consultation to providers can prevent expulsion.

In 2014, the Office of Civil Rights reported that 6% of school districts with preschool programs reported suspending at least one child from public preschool. Estimates of numbers outside the state-funded system were even higher, with national estimates approaching 12/1,000 or more than 300 000 preschoolers per year.

One 2016 report found Black preschoolers 3.6 times more likely to be expelled than white preschoolers and males were 4.5 times more likely to be expelled than females. Preschool children with disabilities were 14.5 times more likely to be expelled, and 4-year-olds were twice as likely as 3-year-olds to be expelled, according to the report cited in the policy statement.

The federal Head Start program has much lower levels of expulsion, due largely to rule changes in 2015 that severely limit suspensions, prohibit expulsions and require programs to engage a mental health consultant.

“Pediatricians already promote school readiness in discussions with families, which can help to avoid preschool expulsion,” said Michael Yogman, MD, FAAP, an author of the policy statement. “We know the importance of developing positive child-adult relationships and experiences, and how they affect the child’s developing brain. They can encourage enjoyable parent and child activities such as reading and playing together which can buffer stress.

“Preschool teachers need to recognize that problematic behaviors are a symptom and need to understand the underlying emotions that might need remediation,” Dr. Yogman said. “Pediatricians can use care  coordinators and integrated behavioral health providers (as part of the medical home )  to work with the family when children are at risk for expulsion. As part of an expanded health consultant role, pediatricians  can work  with child care providers  and early child mental health resources to find more supportive and therapeutic alternatives to  expulsion.”

The AAP also recommends:

• Preschools and daycare facilities should develop clear policies on suspension and expulsion with subsequent tracking of data and the goal of eventually eliminating these practices.
• Teachers and providers should be trained on how to manage behavior, recognize implicit bias, and promote social emotional regulation in preschoolers.
• Early childhood teachers benefit from supports, such as improved working conditions, lower student teacher ratios, appropriate compensation,  and access to mental health consultation.
• Families and early educators should partner to develop alternatives to preschool expulsion by accessing appropriate resources.
• Recommendations specific to pediatricians are also provided in the report, including the need to  collaborate and consult with early education programs and families on social emotional development and managing negative behaviors.

The report also offers recommendations for pediatricians at the practice level, the community level and regional and national level.

“The stakes are high for these children and for our society,” Dr. Williams said. “We know that children expelled from preschool are ten times as likely to drop out of high school, experience academic failure and grade retention, have negative attitudes toward school, and are more likely to face incarceration. All of us can advocate for safe and nurturing communities and quality child care and early education programs to support families. Mental and behavioral health consultation plays a crucial role in helping vulnerable children develop to their full potential.”

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.