Factors that contribute to developmental vulnerability were examined in a 4-year follow-up of 31 children who, as infants, had participated in an investigation of the relationship between recurrent otitis media and developmental status. The children in this inner-city sample experienced significant decline in their language and developmental status regardless of their history with otitis media. Findings support a threshold model of risk, suggesting that otitis media does not necessarily pose an additional stress to the language and cognitive development of low-income, inner-city children. In keeping with theoretical models by Vygotsky and Rutter, maternal cognitive growth fostering facilitated children's language development by serving as a compensatory factor, counteracting the potential impact of recurrent otitis media.