[Takeaway for Cambodias:] To put it another way, we don’t invest nearly enough in helping children in the first few years of life as their brains are developing.

When Even the Starting Line Is Out of Reach

International New York Times Sunday Review | FEB. 22, 2014

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Johnny Weethee, 3, has trouble speaking. His mom, Truffles, said his hearing problems weren’t discovered until he was 18 months old. Audrey Hall/Show of Force

Nicholas Kristof

POINT PLEASANT, W.Va. — JOHNNY WEETHEE, a beautiful and beaming child who at the age of 3 still struggles to speak, encapsulates the shortcomings of our approach to poverty.

As an infant, Johnny was deaf but no one noticed or got him the timely medical care he needed to restore his hearing. He lives in a trailer here in the hills of rural Appalachia with a mom who loves him and tries to support him but is also juggling bills, frozen pipes and a broken car that she can’t afford to fix.

“We weren’t aware of his hearing problems,” said his mother, Truffles Weethee. It was Save the Children, the aid group, that discovered Johnny’s deafness in a screening when he was 18 months old. That led to medical treatment that restored most of his hearing, but after such a long period of deafness in infancy, it’s unclear if he will fully recover his ability to communicate.

Johnny is a happy, friendly child, and it’s infuriating that lapses in infancy may hold him back for the rest of his life — but that’s often how disadvantage works.

One reason American antipoverty efforts over the last half-century haven’t been more effective is that they mostly treat symptoms, not causes. To put it another way, we don’t invest nearly enough in helping children in the first few years of life as their brains are developing. If we miss that window, then adult interventions like higher minimum wages can never be fully effective.

Almost one-fifth of children here in West Virginia are born with drugs or alcohol in their systems, one study found. Those kids may never reach their potential as a result.

What would make a difference? We need an integrated set of early interventions, starting with family planning to help women and girls avoid unwanted pregnancy (four out of five births to teenagers are unplanned or unwanted). We need outreach efforts to help pregnant women curb use of drugs, alcohol and tobacco, as well as free at-home help for new moms who want to breast-feed.

Let’s push for home visitation programs that encourage parents to speak to children and read to them; many low-income homes don’t have a single kid’s book. We also need initiatives to reduce exposure to lead and other toxins. Finally, how about screenings for problems like hearing and visual impairment — all followed by a good prekindergarten.

Rigorous evidence suggests that these kinds of interventions save money because the costs of failure are so great. Yet most kids don’t get such help.

Johnny’s deafness may have been congenital. But there are also preventable causes of hearing loss. Most low-income moms here would like to breast-feed, but only one-third do so — partly because there is no free help available when they run into troubles, according to Tonya Bonecutter, a local Save the Children caseworker. Research suggests that formula-fed babies are 70 percent more likely to get ear infections, and that’s a special concern for low-income families with only haphazard access to medical care.

Dr. Irwin Redlener, a Columbia University professor who is president of the Children’s Health Fund, notes that untreated ear infections can lead to deafness. This comes on top of a well-known finding that low-income children hear 30 million fewer words by the age of 3 than the children of professionals.

“Poor kids are already at a disadvantage,” Dr. Redlener said. “Add chronic, untreated ear infections and you have extreme risk of insufficient language development — inevitably leading to increased rates of learning challenges and school failure.”

Dr. Redlener says that all young children should have a primary care physician who screens them for eight barriers to learning: vision problems, hearing deficits, undertreated asthma, anemia, dental pain, hunger, lead exposure and behavioral problems.

Poverty isn’t just a lack of money, but sometimes a complex web of challenges that keep children from ever reaching the starting line. One home I visited was a trailer jammed with eight people, and some nights it has double that. None of the adults has a job, and most are former drug addicts or alcoholics whose addictions began when they were children. Two are convicted felons, which makes job-hunting difficult. Several dropped out of school. Only one can drive.

They have lofty dreams for their children, but those kids face struggles that middle-class children don’t. Breaking the cycle of poverty means helping those kids get a solid start.

Johnny’s fortunes were transformed by the screening, and now that he can hear again he’s trying to speak. I watched him attend his first day of preschool. Johnny dashed around the classroom, giddily playing with toys and books, trying to repeat words. He beamed.

Let’s broaden the conversation about opportunity, to build not just safety nets for those who stumble but also to help all American kids achieve lift-off.