Mia bounces into your exam room for her well-child visit and asks if you have a book for her. You offer the 4-year-old a choice of books, and she picks one about a girl who looks like her and shows the pictures to her 2-year-old brother. Their mother tells you Mia takes pride in her library at home, started with the books provided by the clinic, loves their bedtime reading and plays school with her brother. Mia answers your questions about the pictures and even points out some letters. Your developmental assessment is well underway, though your visit is just starting. You also have a good sense of the family’s relationships.
When the AAP policy statement Literacy Promotion: An Essential Component of Primary Care Pediatric Practice came out in 2014, it was big news. “Pediatrics Group to Recommend Reading Aloud to Children from Birth,” ran the headline in The New York Times.
Since the policy’s publication, a large and growing body of evidence has supported the power of literacy promotion in pediatric primary care and the critical role shared reading plays in fostering child development. The policy statement has been revised and an accompanying technical report written to incorporate this research, which also shows literacy promotion supports early relationships by promoting positive, joyful and language-rich adult-child interactions.
The policy statement and technical report, from the Council on Early Childhood, are available at https://doi.org/10.1542/peds.2024-069090 and https://doi.org/10.1542/peds.2024-069091 and will be published in the December issue of Pediatrics.
Research findings
Over the past decade, research has looked at shared reading in the context of early relational health and found it to be a positive parenting strategy that strengthens the safe, stable and nurturing relationships young children need to thrive. Indeed, the AAP policy on relational health recommends Reach Out and Read (ROR) as a universal primary prevention strategy to support these relationships.
The updated policy statement and technical report trace the many ways that reading with young children enhances their development. For example, engaging with books and listening to stories promotes early development of spoken language, vocabulary and emergent literacy skills.
The technical report details neurologic research, including brain imaging, that has teased out details of the complex brain circuitry that enables fluent reading and comprehension.
The statements review the evidence that literacy promotion in pediatric primary care is effective, when provided with fidelity to the ROR model. ROR includes provision of developmentally appropriate anticipatory guidance and developmentally and culturally appropriate and diverse children’s books in a family’s preferred language. Families who receive the intervention report reading aloud more frequently and more positive attitudes toward books and reading than those who don’t take part. Young children receiving the intervention show language gains.
Recent research suggests it is particularly important for pediatricians to model reading in the exam room. Studies also have begun to examine how literacy promotion can strengthen families’ attachment to the medical home and enhance pediatricians’ satisfaction and joy in their practice.
Equity issues, funding strategies
The statements emphasize equity and access. School struggles and school failure can perpetuate cycles of poverty and social marginalization. Children growing up in economically disadvantaged families and who are members of minoritized groups are at increased risk of reading difficulties in school. It is essential for primary care to support their parents and caregivers with strengths-based literacy promotion strategies and high-quality and culturally diverse books.
The policy statement strongly recommends advocacy for public funding for pediatric literacy promotion. The technical report includes information on successful public funding strategies at the city, county, state and federal levels, and literacy promotion partnerships and collaborations that can link primary care to other platforms. It also describes enhancements to the ROR model.
Key recommendations
The policy statement includes the following recommendations for how pediatricians and pediatric advanced care providers can promote literacy development at health supervision visits from the newborn period at least through kindergarten.
- Encourage all parents/caregivers to read aloud with their young children with engaging and interactive styles that enrich early relationships, enhancing social-emotional development, supporting resiliency and building brain circuits.
- Support parents to initiate reading together starting in the newborn period, including, when possible, in the neonatal intensive care unit.
- Model techniques that use books to prompt reciprocal, responsive, positive experiences.
- Provide high-quality, developmentally and linguistically appropriate, and culturally diverse books at health supervision visits for all young children, especially those from low-income families.
- Emphasize the value of books that represent diverse cultures, characters and themes for all children.
- Partner with other child advocates to influence national messaging and policies to promote reading aloud starting in infancy as an important component of positive parenting.
The policy also recommends that policymakers at the federal, state, local and institutional/corporate levels support early literacy promotion as an essential component of pediatric primary care by funding children’s books, pediatrician time and program support to provide this intervention at pediatric health supervision visits for all children.
Session on early literacy at National Conference
Perri Klass, M.D., FAAP, and Claudia Aristy will present a plenary session titled “Turning Pages Together: How Pediatricians Rewrote the Book on Early Literacy” on Sept. 29 at the AAP National Conference & Exhibition. The plenary also will be livestreamed. Conference registrants can view recordings through Jan. 31. For details, visit https://aapexperience24.eventscribe.net. To register for the conference, visit https://aapexperience.org/conference-registration/.
Dr. Klass is a lead author of the policy statement and technical report. Anna Miller-Fitzwater, M.D., M.P.H., FAAP, and Pamela C. High, M.D., M.S., FAAP, lead authors of the policy statement, contributed to this article.
