School Readiness by Presence of Congenital Heart Condition Among U.S. Preschool-Aged Children Without Diagnosed Developmental Conditions, National Survey of Children's Health 2022-2023.

Given the heart-brain relationship, children with congenital heart conditions (CHC) may experience poor academic outcomes, even if not diagnosed with developmental conditions. Among children without diagnosed developmental conditions, this study evaluates the "healthy and ready to learn" (HRL) metric by CHC status and identifies associated factors. Using 2022-2023 National Survey of Children's Health (NSCH) data, we compared HRL among 3-5-year-olds with no known genetic, intellectual, or developmental disabilities by CHC status using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). HRL was defined using an established algorithm with 5 domains (Early Learning skills, Social-Emotional Development, Self-Regulation, Motor Development, Health) and scored as "needs support," "emerging," or "on track," aligning with developmental expectations. Among children with CHC, we further identified associated characteristics. Of 19,094 included children, 408 (1.9%) had CHC. Compared to children without heart conditions, fewer children with CHC were "on track" for HRL overall (CHC = 62.4%; no HC = 70.4%) and for each HRL domain (CHC range: 64.3%-83.9%; no HC range: 71.9%-92.5%), though most aPR 95% CIs included 1. Among children with CHC, characteristics associated with not being "on track" in some domains were: ≥3 h of screen time on most weekdays, having special healthcare needs, access to fewer neighborhood amenities, experiencing ≥ 1 adverse childhood event, or caregivers with less than a high school education (aPRs range: 0.58-0.79). Less than two-thirds of children with CHC were HRL. Families of preschoolers with CHC may benefit from intervention efforts and resources to improve school readiness.