As a pediatrician practicing in the District, I worry about immigrant children who are not in good preschool or day care programs.

One of my patients, Laura, is typical. She was born in the United States to parents who emigrated from El Salvador three years ago. Her father does construction work during the day and cleans offices at night; her mother works as a nanny. The neighbor who takes care of Laura, 31/2, and several other children puts them in front of the TV all day. The only two words in Spanish that Laura knows are "mommy" and "daddy," although children her age should have about a 500-word vocabulary.

I referred Laura to a specialist who confirmed that she had a "severe expressive delay." I told her parents that their daughter should be enrolled in Head Start, but a month later they told me that all the Head Start programs in the District were full. They can't afford to put their daughter in a private preschool or in better day care.

Their situation isn't unusual for low-income families in the District. Good day care can cost $10,000 a year, which puts it out of reach for most working families. Cost is not the only issue; only a third of the children younger than 5 who live in poverty in the District find a place at Head Start. For thousands of others, space simply isn't available.

In 2004 the District allocated $24,864,991 for Head Start, which served 3,403 children. In the 2003-2004 program year, 79.3 percent of Head Start enrollees identified themselves as black or African American. The second-largest ethnic group, at 18.2 percent, was Hispanic or Latino.

Head Start gives children opportunities for growth and learning that they cannot get from their parents. This is especially true for immigrant parents who also benefit greatly from Head Start's bilingual health and family services.

Without intellectual stimulation, children can suffer developmental delays that can turn into health and learning problems. Many problems faced by poor and immigrant children can be prevented if the children have access to early screenings, health and nutrition services, and language-rich environments.

As a community and as a nation, we must demand that our lawmakers make it a priority to provide children such as Laura with the early childhood services they need to lead healthy, productive lives. Specifically, as Congress works to renew the Head Start program this year, leaders should take into account the changing needs of areas such as the District and expand the program to serve more children and families.

-- Robert Zarr

is chief of pediatrics at Unity Health Care.

rlzarr@yahoo.com