The University of Arkansas Medical Sciences Department of Pediatrics at Arkansas Children's Hospital participated in a national research project from 1984-89 that focused on low birthweight premature babies. Results of the research revealed significantly higher IQ scores in children receiving intervention. In 1989, the KIDS FIRST program was developed to continue that model of care.Located in 12 sites throughout Arkansas, KIDS FIRST serves approximately 550 medically at risk children age six weeks to four years. In 1996, nutrition was added to the comprehensive list of services provided. Approximately 50% of children enrolled require medical nutrition therapy. Nutrition services include screening, assessment, development of treatment plans, participation in staff training and parent conferences, therapeutic menu writing, monitoring food safety and sanitation, and coordination of care with physicians, nurses and other health professionals. A system of billing and reimbursement for medical nutrition therapy was established.The KIDS FIRST program with the addition of nutrition services shows substantive promise of decreasing further delay and developmental disability in children medically at risk.