The next chapter for infant health

The baby was eleven months old when her mother brought her to my clinic. She had a small flat spot on the back of her head from sleeping in one position, a noticeable tilt to her neck, and a delayed crawl. Her mother apologized for waiting so long. She hadn’t known what she was looking at.

I see this exact scenario play out often: a parent arriving at month nine, ten, or eleven with a child whose developmental concern could have been spotted and addressed at month three. In a decade of practicing pediatric physical therapy in Arkansas, I have watched some version of it hundreds of times. The difference between catching this condition at three months and catching it at nine is the difference between a few weeks of guided exercise at home and a much longer course of intervention. For a child with significant motor delay, the difference can be lifelong.

I’m writing this because Arkansas is in the middle of the most ambitious maternal-child health build this state has ever attempted, and the next chapter of that work is the one most likely to be missed.

Consider what has already been put in motion. The Healthy Moms, Healthy Babies Act has committed $45 million a year to maternal health. UAMS received $40 million in February for maternal and infant mortality work. The Rural Health Transformation Program is moving $209 million through the THRIVE initiative for telehealth, AI-enabled care coordination, and remote patient monitoring.

The Governor’s Strategic Committee for Maternal Health convened more than a hundred stakeholders, and its recommendations are landing in budgets and statute. Centene, Heartland Forward, Excel by Eight, the UAMS Institute for Community Health Innovation, and dozens of community organizations are doing the unglamorous work of building infrastructure that did not exist three years ago.

This is the right investment. I’ve spent ten years inside the system this work is trying to fix. The political will, the funding, and the convening capacity are unprecedented.

But maternal health investment ends, by design, at the postpartum window. Most of the developmental concerns that surface in the first two years of a child’s life (torticollis, gross motor delays, plagiocephaly, feeding difficulties, early signs of cerebral palsy) first emerge in the months after that window closes. In rural Arkansas, where 35 of our 75 counties are maternal care deserts and where pediatric specialists are concentrated in three or four cities, that is exactly where families fall through the cracks.

We have built the plan to keep our mothers alive. We have not yet built the plan to make sure their babies thrive.

The cost of missing this window is not abstract. A child with untreated torticollis becomes a six-year-old with postural issues, a ten-year-old in occupational therapy, a teenager with chronic pain. A toddler with an unaddressed motor delay falls behind in kindergarten. A baby with feeding difficulty becomes a family in crisis. Every condition I treat is more expensive, more painful, and harder to remediate the longer it goes unaddressed.

The opposite is also true. Catch a baby’s developmental concern at three months, and most of the time you resolve it with a parent, a phone, and a few minutes a day of guided exercise. Arkansas’s investment in the first chapter of life pays exponentially over the next eighteen years, but only if the screening, the education, and the referral pathways exist.

Arkansas is positioned to lead the country on this. Representative Aaron Pilkington is already a fellow in the national Prenatal-to-Three Innovation Fellowship. Heartland Forward’s new Maternal and Child Health Center for Policy and Practice is actively identifying scalable models. Excel by Eight has the convening infrastructure. The Strategic Committee for Maternal Health has the recommendations framework. The Rural Health Transformation Program has the funding mechanism. What we need is the same coordination and execution that has made the maternal health build possible, applied to the first 1,000 days as a single continuous arc.

Three concrete steps would move this forward. First, the next Rural Health Transformation Program tranche should designate a portion for early childhood developmental health: screening, referral, and remote monitoring for the postpartum-to-toddler window. The infrastructure being built for maternal care can serve this population with marginal additional investment. Second, Arkansas’s Medicaid program should expand reimbursement for developmental screening and early intervention delivered through telehealth and community health workers. The state has already done this for maternal care. The same model works for infant developmental care. Third, the next legislative session should commission a companion framework to Healthy Moms, Healthy Babies that extends the policy architecture into early childhood.

The baby in my clinic, the one whose mother apologized, did well. Her mother was committed, the diagnosis was straightforward, and the timeline for recovery, while longer than it would have been at three months, was workable. Most of the families I see have that outcome. But “workable” is not what Arkansas should be aiming for. The goal is a state in which no family arrives apologizing because no family had to figure it out alone.

We have the plan to keep our mothers and babies alive. The next chapter is the one that makes sure they thrive.

Editor’s note: Dr. Allison Young is a board-certified pediatric clinical specialist and an associate professor in a doctor of physical therapy program. With a decade of clinical practice in Arkansas, she is the founder and CEO of NurtureWell, an AI-powered developmental screening platform for families in the first 1,000 days, based in Fort Smith. The opinions expressed are those of the author.