The infant-toddler period is increasingly recognized as crucial for early brain and child development and school readiness.1 Parents can support cognitive, language, and social-emotional development during this period through positive parenting activities, such as reading aloud and playing together. Although parents are inundated with information suggesting that new technology can enhance or even replace books to enhance child development, little is known about whether this is true, especially in early childhood.
In this issue of Pediatrics, Munzer et al2 have sought to narrow the data gap by studying interactions that take place when parents and children engage using electronic children’s books. Ideally, electronic books could increase access to a range of children’s literature through adaptation to ubiquitous digital platforms, such as tablets and electronic readers, and by offering books in multiple languages. They could make developmentally and culturally appropriate reading materials easily accessible at low cost to low-income families in the United States and globally. However, it could also be that tablet-based interfaces are less effective at supporting beneficial interactions than reading print books, especially if features, such as touch activation, are distracting.
One reason books and toys are so important is that they can act as props to support interactions that foster early child development.3,4 Maintaining conversation with an infant or toddler is not easy, and shared book reading supports more verbal interaction than any other activity.5 An example is the back and forth of “dialogic reading,”6,7 in which parents expand on text based on the child’s interests and place the content and narrative of the book in context. Also, reading print books creates an opportunity for a special time not built around any screen or device in a way that supports the parent-child relationship and relational health more broadly.8 Taken together, shared book reading with print books promotes cognitive, language, early literacy, and social-emotional development that strongly support children’s successful transition to school and subsequent learning and achievement.
Can current electronic books function similarly to print books in scaffolding interactions that are critical for early child development and school readiness? To address this question, the authors used an experimental design, in which parents of 37 2- to 3-year-olds were asked to read print books, basic electronic books, and electronic books with enhanced features in randomized order. Analyses revealed increased beneficial interactions with print books, including more dialogic reading, text reading, and child engagement in content, compared with either type of electronic book and evidence of barriers to positive interactions (indicated by distracting comments related to the book format and struggles over tablet possession), especially for electronic books with enhanced features.
Importantly, the design employed for this study was strong because it enabled comparison of parent-child interactions within dyads, potentially eliminating effects of confounding variables and supporting causal inference even with a relatively small number of study participants. These findings are consistent with limited previous studies of electronic-book enhancements in older preschool children, which also suggest that these features do not enhance supportive interactions and may work against them. The findings are also consistent with previous studies of screen time in young children, which suggest screen time interferes with verbal interactions and parent-child play9 as well as reduces capacity for verbal and spatial learning (eg, “transfer deficit”).10 Because electronic books, unlike print books, can be “activated” by the child alone, there is a risk that solitary play with a device will replace the supportive interactions that are so important for scaffolding and early development.
This study provides evidence that electronic books as they presently exist are unlikely to result in benefits over print books for young children and are instead likely to result in barriers to interactions that are proven to be critically important for school readiness. These findings have implications for parents as they consider the reading choices they make for their children and also for clinical practice and public health policy. Regarding clinical practice, pediatricians and other child-health professionals have new data to support recommendations regarding the use of print children’s books and avoiding electronics and gadgetry.3,4 Regarding health policy, findings provide support for pediatric primary care programs, such as Reach Out and Read,11 the Video Interaction Project,8 and HealthySteps,12 that can help prevent disparities in early development and school readiness through promotion of reading aloud with children’s books.
There may well be a place for electronic books. Additional research is needed to understand ways to take advantage of potential benefits of this technology while still emphasizing the importance of parent-child interactions. In the meantime, pediatricians should help parents understand that enhancements often found in electronic books will not help child development as much as enhancements provided by parental interaction.
Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.
FUNDING: No external funding.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2018-2012.
POTENTIAL CONFLICT OF INTEREST: Dr Klass is the national medical director of Reach Out and Read (no financial compensation). Dr Mendelsohn is the principal investigator of studies of Reach Out and Read and the Video Interaction Project (no financial compensation).
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.