Todd R. Porter, MD, MSPH

 My 3-year-old son, Levi, drowned in June 2018 while we were on a beach vacation with friends. One moment, he was sitting on the couch watching TV. In the next, I was pulling his lifeless body from the bottom of a pool.

Levi had somehow slipped out of a living room filled with children and adults, including myself, my husband, and 5 physician friends. We weren’t drinking, weren’t on our phones, and had finished swimming for the day.

I was the one who glanced over the balcony and found our Levi, my guttural screams bringing a rush of people outside. My husband, a cardiothoracic anesthesiologist, was the first to perform cardiopulmonary resuscitation (CPR) on his only son.

The confusion of “but we weren’t even swimming” and “Levi was just on the couch” hung in the air as we grappled to make sense of the senseless. It happened so quickly. However, despite immediate attention, including advanced resuscitation from multiple physician experts, we lost our Levi.

 At the age of 3, Levi Richard Hughes joined over 400 other children across the United States between ages 1 and 4 years who die annually from unintentional drowning.

 Although it only takes 20 seconds for a child to drown,

 decades of stagnant drowning rates for this vulnerable population.

Levi’s death was not unlike other drownings of children his age. Given his developmental stage of life, he chose to explore his surroundings and met his ultimate fate in the pool, where the majority of drowning fatalities of children ages 1 to 4 years occur1 during moments when the child was not expected to be swimming.

 How did our son drown? How were years of intentional parenting seemingly nullified within seconds?

Levi’s death rests on my husband and myself. There is no denying that we failed to keep him safe. But I have since learned that water safety goes far beyond the assumed foolproof advice of simply “watch your kids while swimming.”

Parents only know what they know. I thought I was doing everything right to keep Levi safe. I have 16 photos of what would be my son’s final day of life; in 14 of them, he is wearing a life jacket. These are time-stamped photos of my precious boy, grinning proudly, secured in his personal flotation device.

I will never stop wishing I had not momentarily turned to clean up dinner or that I had seen Levi slip out the door that night. However, I have come to believe I made another grave mistake that significantly contributed to my son’s death: I encouraged Levi to believe that water was fun. We don’t stand in streets or busy parking lots and eagerly proclaim to our impressionable toddlers, “Come on in—the traffic is fine.” We don’t encourage our kids to play with real guns in an effort to make them “comfortable” around firearms. Yet this is exactly what we do with water, a substance just as deadly as streets, parking lots, and guns.

 For many children, the concept of “water is fun” is introduced in infancy, encouraged by playful splashing in bathtubs. Parents may take their toddlers and preschool-aged children to swimming pools and cheer on their child’s developing comfort in and around the water. Children may even be enrolled in formal swim lessons recommended by family, friends, or a medical provider. These early water engagements have a similar purpose—that children become comfortable in water

—and yet parents are unknowingly increasing their child’s comfort and joy around a substance that kills thousands of children each year without also providing the skills to survive.

 Conventional wisdom has promoted early and gradually increased positive water exposures, followed by swim lessons when a child is ready. “When a child is ready” and the type of swim program are of critical importance and yet unclear.

Currently, the American Academy of Pediatrics (AAP) advises families follow the advice of their child’s pediatrician to determine the appropriate age for formal lessons. Parents may be advised to consider swim lessons after the child’s first birthday, taking into consideration the child’s emotional, physical, and developmental abilities and comfort in the water.

 However, experts only begin to agree that most children are ready for swim lessons by their fourth birthday, which is long after the highest risk age of drowning.

Significant variability in the type of swim programs also exists,

 with experts conveying that not every program will be right for each child.

 Parent-led classes are endorsed for children aged 1 to 4 years to build swim-readiness skills. Simultaneously, parents are advised to consider programs that teach self-rescue skills and encouraged to use life jackets in the pool if the child is considered a weak swimmer.

Figure 1 highlights AAP’s swim lesson messaging according to a child’s age and types of swim programs that, for many parents and pediatricians, can appear confusing and conflicting. This lack of consensus may contribute to the infrequent drowning prevention conversations that are given by pediatricians during well-child visits.

 We agree with the AAP that a broad and coordinated research agenda is needed to address the efficacy of type of swim lesson programs for children aged 1 to 4 years.

The stigma around drowning is the greatest threat to prevention efforts. Clearly our culture’s current approach to drowning prevention is not working. Although advancements in child safety have been seen in other areas, drowning safety has watched from the sidelines (Figure 2). The same water safety tips are casually tossed out each year: Watch your kids while swimming. Install a fence. Buy a life jacket. Wait until children are “ready” to start swim lessons. Learn CPR.

Levi was not swimming. He was wearing khaki shorts and sitting on a couch a moment before he drowned. The beach house had an isolation fence with a self-latching gate. Levi always wore a life jacket when in the pool. We had researched and followed AAP recommendations to wait until the age of 4 years for formal swim lessons. He had 6 physicians by his side within seconds of being pulled from the water. Yet none of these things saved him.

 It is well accepted that drowning prevention involves layers of protection (restricting access to water, supervision, learning to swim, use of lifejackets, CPR) and that enacting all layers achieves the best protection.

 It is also noted that at least 1 layer of protection is breached in 9 out of 10 fatal pool drowning cases.

 One layer of protection that is not often discussed but clearly contributed to Levi’s death was his lack of water competency.

Operationalized concepts of water competency

 have historically included elements such as the ability to float and tread water. However, these 2 elements are not of equal importance because floating requires less energy expenditure than treading water

 and lack of floating ability has been voiced by drowning survivors as a threat to life and reason for rescue.

 Lack of these competencies may help explain the unchanging drowning rates for children ages 1 to 4 years but are rarely a part of drowning prevention conversation for this population.

We must remember that children, not parents, are the true victims of drowning. We owe it to our children to know better and to do better.

We start by looking at success stories in prevention of other premature childhood deaths. For example, as pediatric deaths from motor vehicle crashes rose, we didn’t keep the same approach year after year and hope for the best; instead, we looked beyond the norm and pushed for radical change with the manufacturing and regulation of car seats. Now car seats save thousands of children from preventable injury and death every year.

 To better understand our nation’s current drowning approach as it relates to water competency, we reviewed curricula of 3 popular US swim lesson programs. Programs A and C represent parent-led group lessons typically taught in city recreation centers whereas Program B is a survival swim lesson model taught in public or private pools. Our main objective was to compare these programs’ goals and methodologies for achieved water competency of children aged 6 months to 4 years. The Table summarizes key data elements shared by these programs; results are intended to help caregivers and providers determine which program best meets their child’s water exposure needs.

Review of these programs reveal significant differences in water competency intent and instruction. Although tens of thousands of toddler and preschool-aged children participate in programs A and C, neither of these programs has a goal of water survival at this age. Program B focuses on water survival with significantly more hours dedicated to instructor training and certification as well as a 1:1 instructor-to-child ratio during class. Program B’s methodology also avoids use of flotation aids and teaching of treading water, both of which orient the child in a vertical position thereby inhibiting children’s reliance on their own natural buoyancy.

 After Levi drowned, I heard about swim programs that taught babies how to float. Hundreds of parents reached out to me to share their passionate testimonials of how these swim lessons saved their children. I was admittedly skeptical. However, as I continued to research pediatric drowning, I saw consistent factors: Children who drown usually loved water, they had relied on a flotation device when swimming in pools, and they did not know how to survive if they reached water alone.

My perception of water shifted, and on the exact day that marked 20 months since Levi’s death, we handed over our 8-month-old daughter Willow, Levi’s little sister, to her first Infant Swimming Resource lesson. I watched her take on water and win. She was not just trained to float; she learned to roll her infant body, find the surface, and get air. Even beyond her ability to survive in water, Willow began to develop a lifetime respect for water.

 Although survival swim has existed for decades, it has been less well adopted and accepted within the water safety community. This perspective may be due in part to 1 historical case report of prolonged exposure to water resulting in infant hyponatremia;

 but may also be further perpetuated by the notion that survival swim causes children emotional trauma.

Interestingly, what stands out in our review is survival swim’s rigorous instructor training and private lesson approach. Instructors are trained in methodologies based in behavioral science, sensorimotor learning, schedules of reinforcement, and the building of behavioral chains with the goal of teaching infants and toddlers to learn skills to help them float and find air if met with an unplanned submersion. Although further research is needed to provide evidence on drowning prevention effectiveness comparing differing swim lesson programs, survival swim (program B) currently is the only methodology that aims to teach aquatic survival skills to children aged 12 to 36 months, which are at highest risk age for drowning.

The statistics prove that our national approach to drowning prevention is failing. We cannot continue to only emphasize and rely on environmental barriers to prevent drowning among young children; rather, we must include the critical piece of water competency for children aged 1 to 4 years in the event of an unintended submersion. As stated by Stallman et al, “The causes of drowning should dictate the way we teach swimming, what children should learn.” Yet “an unfortunate number of teachers or schools emphasize that which is popular with parents” and perhaps not what actually saves lives.

It is time to reframe our drowning prevention approach from focusing on enjoyment during early water exposures to prioritizing the sole layer of protection that always accompanies the child—their water competency. We must reconsider how and when we teach infants and young children arguably the most vital aquatic skill they can learn: independent back floating. We must reassess swim programs’ success based on demonstrative acquisition of this aquatic survival skill so that pediatricians can provide parents more clear messaging on the timing and type of formal swim lesson enrollment, especially in this most high-risk age. Pediatricians also need to discuss with parents, starting with when their children are infants, that how children are introduced to water and taught to interact with it are just as important as the skills they are taught in it. Encouraging the young child to jump into your arms in a pool with a flotation device can teach them that it is safe and fun to enter and submerge in water that, absent adult supervision has the ability to quickly kill them.

 Drowning statistics have remained relatively unchanged over decades. Now, we have the power to fix this drowning epidemic. It is time to provide toddlers, our children most at risk of drowning, with the ability to roll, to float, and to survive.

WISQARS (Web-based Injury Statistics Query and Reporting System)|. Centers for Disease Control and Prevention. Updated July 1, 2020. Accessed May 2, 2021. 

https://www.cdc.gov/injury/wisqars/index.html

National Water Safety Program. US Army Corps of Engineers. Accessed May 2, 2021. 

https://www.usace.army.mil/Missions/Civil-Works/Recreation/Water-Safety/videoid/548968/

How to plan for the unexpected: preventing child drownings. US Consumer Product Safety Commission. Accessed May 2, 2021.

Moran K, Stanley T. Parental perceptions of toddler water safety, swimming ability and swimming lessons. 

2006;13(3):139-143. doi:10.1080/17457300500373572

Moran K, Stanley T. Toddler drowning prevention: teaching parents about water safety in conjunction with their child’s in-water lessons. 

2006;13(4):254-256. doi:10.1080/17457300600678201

Global report on drowning: preventing a leading killer. World Health Organization. 2014. 

https://apps.who.int/iris/handle/10665/143893

Swim lessons: when to start & what parents should know. 

. Updated March 15, 2019. Accessed May 2, 2021.

https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Swim-Lessons.aspx

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2019;143(5):e20190850. doi:10.1542/peds.2019-0850

Carr WD. Formal swimming lessons must be defined. 

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Articles

A pediatrician and a mother share sobering lessons learned regarding water safety for children.

How one child’s tragedy is making us reconsider our approach to drowning prevention

Recent articles and position statements have been calling for pediatricians to view literacy as a developmental domain and to participate in screening for future literacy concerns as early as preschool age.

 As a pediatrician, I agree wholeheartedly with one article’s statement that “The development of reading proficiency in childhood is a public health issue.”1 There is robust evidence linking lack of reading proficiency with school failure, negative impact on meaningful employment, increased risk of involvement in the criminal justice and welfare systems, as well as mental health consequences of reduced self-esteem, anxiety, and depression. As pediatricians we should be aware of and attempt to modify all of these negative outcomes by helping to identify risk factors for future reading disabilities and referring our struggling readers for further evaluation and remediation if available.

Yet, is it really that simple? To help answer this question I would like to point out existing barriers that make executing these recent recommendations difficult if not near impossible. My perspective is based on my experiences as a community pediatrician who currently cares for mostly low-income Medicaid patients, many of whom come from non-English speaking households, as well as from my experience being the parent of a now 10-year-old daughter with dyslexia. As a disclaimer, this perspective is based on the educational landscape in the state of Colorado where I live and may not be representative of other educational and health care systems.

The International Dyslexia Association defines dyslexia as “a specific learning disability that is…characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction.”

 Because learning to read requires explicit instruction, identification of such a difficulty in word level reading typically cannot occur until after the child receives formal instruction starting in kindergarten. Yet, as noted in a recent article on dyslexia, “Even after formal instruction begins, it takes some time for individual differences in word reading ability to clearly emerge.”

Perhaps this is the reason why the diagnosis of dyslexia typically does not happen until the struggling reader is in second grade or later when the word level reading gap is well established and negative consequences are already underway.

 This leads to what is called the dyslexia paradox which speaks to the greater effectiveness of word level reading interventions when administered in kindergarten and first grade compared to the later grades when the diagnosis is typically made.

 Early identification therefore is crucial, which is why the authors of these recent articles exhort that I, as a pediatrician, should be screening my pre-k and kindergarten patients, but how?

To date I am unaware of a gold standard for screening preschool and kindergarten aged patients quickly and effectively during an office visit. Recent studies acknowledge that available screenings for this age are not scientifically validated or reliable.

 For this age group a pediatrician is better served to look for risk factors that may consist of family history of reading or spelling problems in the parents as well as history in the child of speech language delay and difficulties in pre-literacy skills of rhyming and learning letter names and sounds (as found in a propagated dyslexia screener by Hugh Catts at 

). Presence of these risk factors should raise concern about future literacy struggles yet do not definitively say that the child has dyslexia. For children aged 6 years and older, screeners such as the Colorado Learning Disabilities Questionnaire (CLDQ)

 have been validated yet still come with the caveat that it would not be “appropriate for clinicians to use the CLDQ in isolation to make categorical diagnostic or treatment decisions regarding a specific individual.”

 Moreover, studies correctly point out the limitations that screeners may face with respect to sensitivity, specificity, and the inherent risk of over identifying early typical readers who just need more time.

My personal experience with the dyslexia paradox comes as a father of a dyslexic child. Our 10-year-old daughter was first pulled out for reading intervention in the first grade. Despite my pediatric training, I was ill-equipped to understand and evaluate what screening and interventions the school was providing her, and I trusted that the school would teach her how to read. By the middle of second grade, after 18 months of intervention without improvement, my pediatrician spidey-sense told me it was time to get her privately tested. She seemed to be on the wait to fail trajectory which occurs when “children at risk for dyslexia have to experience considerable failure before receiving appropriate intervention.”

 Wait to fail also represents a criticism of a failed multi-tiered system of supports (MTSS)10 where a dyslexic child experiences considerable failure because the applied Tier 1, Tier 2, or Tier 3 intervention does not meet their word level reading needs.

The results of my daughter’s private testing revealed what I knew in my gut all along, she has dyslexia. We brought the 13-page evaluation to our school with lists of accommodations and recommended intervention expecting that all would now be fine. It wasn’t. The intervention provided her was ineffective (as it had been prior) and her teachers could not seem to accept that she had dyslexia. Not even an Individualized Education Plan (IEP) could grant us recommended modifications for her.

It was not until I listened to the eye-opening documentaries of Emily Hanford from American Public Media

 that the light bulb went on as to why her school was reacting this way. Many years ago, education abandoned the teaching of phonics for whole language and balanced literacy, which teaches our children to guess at words rather than decode them. What all children need, especially struggling readers, is systematic and explicit phonics that is based on the science of reading. Yet to my dismay, many teacher preparation programs still do not teach the science of reading. In fact, in Colorado, the largest teacher prep program was cited again by the State Board of Education for not teaching the science of reading to teachers in training.

 Perhaps this is why in 2019, state testing showed that only 41% of Colorado third graders were reading at grade level.

 Another likely reason for this failing score is because many Colorado elementary schools are not using reading curriculum approved by the Colorado Department of Education (CDE).

What my dyslexic daughter needed was Structured Literacy, which can be found in the explicit multi-sensory scope and sequence approach of programs such as the Orton-Gillingham (OG) method. This was not available in her classroom, so we paid privately for twice weekly OG tutoring and moved her to a public charter school who used an approved CDE reading curriculum and required all K-3 teachers to be trained in Structured Literacy. The result has been life changing for my daughter’s mental health and reading proficiency.

However, I wish I can say that my low-income pediatric patients who are struggling readers and who are experiencing the behavioral and mental health consequences of school failure have had the same experience. Similar to my daughter’s wait to fail experience, the school may proceed slowly with MTTS that is not evidence based, relying on literacy assessment tools such as iReady

 that do not always provide important data on word level reading and oral reading fluency. One might think that such a response to intervention assessments are the domain of the school. However, a recent medical journal article mentioned that pediatricians should become adept at interpreting and responding to these educational assessments and interventions.1 I believe this is out of the scope of a pediatrician’s practice and to circumvent this, I have relied on professional courtesy of qualified educational neuropsychologists and speech-language pathologists to interpret these for me.

For my patients who do have IEPs for their specific learning disability, their parents are typically not aware of the type of intervention the child receives or whether the school’s reading curriculum is supported by the science of reading. Even in the rare case I have been able to secure grant funding for a private evaluation that confirms dyslexia, the child’s school usually does not have qualified staff trained in Structured Literacy to remediate it. As the child’s pediatrician, there are few if any outside referral options for Structured Literacy reading intervention as not all speech language pathologists have received additional training in Structured Literacy nor do insurance payers typically reimburse reading intervention.

It is heartbreaking for me to see my patients year after year for their well-child exam and not know how to help them overcome all of these system barriers that prevent them from obtaining grade-level reading proficiency. Although privately funded programs like the Promise Project

 would be wonderful to have locally to provide free to low-cost identification and remediation for all children with significant reading deficiencies, parents and pediatricians must continue to advocate at the local and state level for continued educational reforms in teacher preparation programs and science-based reading curricula.

Clinically, pediatricians can attempt to screen their native English-speaking patients aged 6 years and older with literacy concerns with the validated online CLDQ-R screener

 during office visits. Additionally, they can equip parents with tools on how to assess what literacy block curricula the school is using so that they can more effectively advocate for their child’s needs as well as hold the school more accountable for compliance with evidence-based literacy instruction and intervention. One helpful tool is the “Literacy Dialogue Tool for Parents/Caregivers” produced by the Colorado statewide dyslexia parent advocacy group Colorado Kids Identified with Dyslexia in partnership with an educational consulting firm. Links to this tool as well as description of how it can be utilized by parents can be found in the referenced Chalkbeat article by Ann Schimke.

 As best as they are able, pediatricians should also attempt to educate themselves and parents of struggling readers on special education law with respect to the Individuals with Disabilities Education Act and section 1400(D)(1)(A) that defines access to a “free and appropriate education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living.”

 One reputable special education advocacy website is 

It cannot be overemphasized how effective grass roots advocacy and public attention can have on how school districts teach K-3 literacy. Just recently, thanks to successive articles on the discredited curriculum used by Colorado’s second largest school district

 (the district that had failed my daughter), district management recently announced that they will present a new literacy instruction plan to CDE that aligns with the board’s approved programs. Successes like this that push schools and school districts toward teaching the science of reading are within reach of parent and pediatric advocacy groups.

Finally, pediatricians also need to advocate for state legislation that requires insurance payers to cover evaluations as well as remediation for children with dyslexia given the preponderance of medical evidence of its neurobiological origin. Insurance coverage that provides access to early identification and remediation of dyslexia could mitigate the commonly associated physical and mental health consequences of stress, anxiety, depression, and suicide that later on results in great personal and economic costs.

1. Sanfilippo J, Ness M, Petscher Y, Rappaport L, Zuckerman B, Gaab N. Reintroducing Dyslexia: Early Identification and Implications for Pediatric Practice. 

. 2020;146(1). doi:10.1542/peds.2019-3046

2. Klass P, Hutton JS, Dewitt TG. Literacy as a Distinct Developmental Domain in Children.Â 

. 2020;174(5):407. doi:10.1001/jamapediatrics.2020.0059

3. Ness M. Pediatricians Have a Role in Early Screening of Dyslexia. International Dyslexia Association. Published December 13, 2019. Accessed August 15, 2020. 

https://dyslexiaida.org/an-invitation-to-pediatricians-for-early-dyslexia-screeners/

4. Rey-Casserly C, Mcguinn L, Lavin A. School-aged children who are not progressing academically: considerations for pediatricians. 

. 2019;144(4). doi:10.1542/peds.2019-2520

5. International Dyslexia Association. Definition of Dyslexia. Accessed 9/27/20.

https://dyslexiaida.org/definition-of-dyslexia/

6. Catts HW, Hogan TP. Dyslexia: An ounce of prevention is better than a pound of diagnosis and treatment. doi:10.31234/

7. Ozernov-Palchik O, Gaab N. Tackling the 'dyslexia paradox': reading brain and behavior for early markers of developmental dyslexia. 

8. International Dyslexia Association. Dyslexia Screener for School-Age Children. Accessed 9/27/20. 

https://dyslexiaida.org/screening-for-dyslexia/dyslexia-screener-for-school-age-children/

9. Willcutt EG, Boada R, Riddle MW, Chhabildas N, DeFries JC, Pennington BF. Colorado Learning Difficulties Questionnaire: validation of a parent-report screening measure. 

. 2011;23(3):778-791. doi:10.1037/a0023290

10. Multi-Tiered System of Supports (MTSS Accessed August 16, 2020. ). 

https://www.cde.state.co.us/mtss/handouts-mtss-overviewshpgbreakoutsept-2017

11. Hanford E. Why aren't kids being taught to read? | Hard Words | APM Reports. Published June 22, 2020. Accessed August 16, 2020. 

https://www.apmreports.org/episode/2018/09/10/hard-words-why-american-kids-arent-being-taught-to-read

12. Hanford E. How a flawed idea is teaching millions of kids to be poor readers | At a Loss for Words | APM Reports. Published August 14, 2020. Accessed August 16, 2020

https://www.apmreports.org/episode/2019/08/22/whats-wrong-how-schools-teach-reading

13. Hanford E. How American schools fail kids with dyslexia | Hard to Read | APM Reports. Accessed August 16, 2020. 

https://www.apmreports.org/episode/2017/09/11/hard-to-read

14. Hanford E. New salvos in the battles over reading instruction | APM Reports. Accessed August 16, 2020. 

https://www.apmreports.org/episode/2019/12/20/new-people-organizations-reading-instruction

15. Schimke A. Colorado's largest teacher preparation program dinged over reading instruction - again. Chalkbeat Colorado. Published June 10, 2020. Accessed August 16, 2020.

https://co.chalkbeat.org/2020/6/9/21285846/colorados-largest-teacher-preparation-program-dinged-over-reading-instruction-again

16. Colorado Department of Education. 2019 CMAS State Achievement Results. Accessed 9/27/20. 

https://www.cde.state.co.us/assessment/2019_cmas_ela_math_statesummaryachievementresults

17. Schimke A. Colorado wants schools to use reading curriculum supported by science. Here are the ones that made the cut. Chalkbeat Colorado. Published April 24, 2020. Accessed August 16, 2020. 

https://co.chalkbeat.org/2020/4/23/21233583/colorado-wants-schools-to-use-reading-curriculum-backed-by-science-heres-what-made-the-cut

18. Schimke A. Why do so many Colorado students struggle to read? Flawed curriculum is part of the problem. Chalkbeat Colorado. Published March 27, 2020. Accessed August 16, 2020 

https://co.chalkbeat.org/2020/3/27/21231320/why-do-so-many-colorado-students-struggle-to-read-flawed-curriculum-is-part-of-the-problem

19. Assessments That Drive Instruction. Curriculum Associates. Accessed August 16, 2020.

https://www.curriculumassociates.com/products/i-ready/i-ready-assessment

20. Istation Reading. Istation. . Accessed August 16, 2020 

21. Promise Project. Accessed August 16, 2020. 

https://www.promise-project.org/promise2/

22. Schimke A. Colorado parents, here’s what to ask your child’s school about reading instruction. Chalkbeat Colorado. Published October 26, 2020. Accessed November 2, 2020. 

https://co.chalkbeat.org/2020/10/26/21534976/colorado-parents-heres-what-to-ask-your-childs-school-about-reading-instruction

23. US Department of Education. Individuals with Disabilities Education Act. Accessed November 2, 2020. 

https://sites.ed.gov/idea/statute-chapter-33/subchapter-i/1400

24. Schimke A. What do Jeffco schools use to teach reading? District leaders don’t know, and neither does the public. Chalkbeat Colorado. Published September 25, 2020. Accessed November 2, 2020. 

https://co.chalkbeat.org/2020/9/25/21456381/what-do-jeffco-schools-use-to-teach-reading-district-leaders-dont-know-and-neither-does-the-public

25. Schimke A. Many Jeffco schools use discredited curriculum to teach students how to read. Chalkbeat Colorado. Published October 15, 2020. Accessed November 2, 2020. 

https://co.chalkbeat.org/2020/10/15/21517569/many-jeffco-schools-use-discredited-curriculum-to-teach-students-how-to-read

A pediatrician in Colorado attempts to tackle the way literacy is taught so that his daughter—and others—who have dyslexia can get the help they need.

Todd R. Porter, MD, MSPH

Articles

How one child’s tragedy is making us reconsider our approach to drowning prevention

A pediatrician’s role in dyslexia: Where theory meets practice