As the professional concerned with monitoring children's growth and development, the pediatric provider is well positioned to contribute to the early detection of children unready for school. Successful early detection requires cooperation and an interchange of information among parents and health and educational personnel. The process of developmental surveillance acknowledges the limitations of screening tests and may be most effective in predicting children's school readiness. Child health supervision services are useful in the promotion of children's optimal school readiness. Research findings support a continued emphasis on developmentally oriented anticipatory guidance while individualizing content to respond to families' needs and encouraging parent-led agendas. Innovations in context worthy of consideration include home visiting, group well-child care, and parent-held child health records. The broad-based societal efforts necessary to promote school readiness and to diminish school failure demand firm and effective pediatric advocacy.