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Birthweight is a prominent health condition that matters for early childhood development. Despite research depicting an enduring association with health and educational outcomes years and even decades later (Conley and Bennett 2000), there has been surprisingly little attention placed on understanding why a child’s weight at birth would set such an important developmental trajectory. for a child. Using the Early Childhood Longitudinal Birth Cohort–2001, we analyze a sample of almost 7,000 nationally representative live births in the United States to (1) establish the association between birthweight and school readiness and (2) assess to what degree this relationship can be explained by more proximate measures of a child’s health at birth. We find that an array of medical risks at birth and a measure of days children spend in the hospital explain nearly all of the associations between birthweight and school readiness. This turns scholars and practitioners towards the proximate mechanisms for why child developmental delays are associated with weight at birth. In other words, birthweight may be better conceptualized as a proxy rather than a mechanism. This would suggest more directed research and intervention on decreasing medical risk at birth and the amount of days children spend in the hospital.