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Among children without diagnosed developmental conditions, this study evaluates the \u201chealthy and ready to learn\u201d (HRL) metric by CHC status and identifies associated factors. Using 2022\u20132023 National Survey of Children\u2019s 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 \u201cneeds support,\u201d \u201cemerging,\u201d or \u201con track,\u201d 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 \u201con track\u201d for HRL overall (CHC\u2009=\u200962.4%; no HC\u2009=\u200970.4%) and for each HRL domain (CHC range: 64.3%\u201383.9%; no HC range: 71.9%\u201392.5%), though most aPR 95% CIs included 1. Among children with CHC, characteristics associated with not being \u201con track\u201d in some domains were: \u22653\u00a0h of screen time on most weekdays, having special healthcare needs, access to fewer neighborhood amenities, experiencing\u2009\u2265\u20091 adverse childhood event, or caregivers with less than a high school education (aPRs range: 0.58\u20130.79). 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.<\/jats:p>","DOI":"10.1007\/s00246-026-04251-x","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:53:05Z","timestamp":1777985585000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["School Readiness by Presence of Congenital Heart Condition Among U.S. Preschool-Aged Children Without Diagnosed Developmental Conditions, National Survey of Children\u2019s Health 2022\u20132023"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6470-5830","authenticated-orcid":false,"given":"Justina A.","family":"Omari","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5312-7596","authenticated-orcid":false,"given":"Emily O.","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5721-7468","authenticated-orcid":false,"given":"Helena J.","family":"Hutchins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2243-8367","authenticated-orcid":false,"given":"Matthew E.","family":"Oster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3063-1781","authenticated-orcid":false,"given":"Karrie F.","family":"Downing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"issue":"2","key":"4251_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1161\/circulationaha.115.019307","volume":"134","author":"SM Gilboa","year":"2016","unstructured":"Gilboa SM, Devine OJ, Kucik JE, Oster ME, Riehle-Colarusso T, Nembhard WN, Xu P, Correa A, Jenkins K, Marelli AJ (2016) Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010. 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