AAP Voices Blog

Walking into a routine well-child visit, I’d rather have a book than a stethoscope.

People are shocked to hear me say this, which I often do. Why would a pediatrician put more value in a book than in a hallowed tool-of-the-trade? What in the world could a book do for that child’s health, and what in the world could a clinician possibly learn using that book?

Of course, I can walk in with both. But my point is that an appropriate book offers so much in a well-child visit to everyone involved: the child, the parent, and the clinician alike.

Building better brains

First, for a child, familiarity with books from an early age (birth — yes, birth!) has numerous benefits. Knowing what a book is and how it works — an object that you open, with pages that you turn in a particular direction (in our culture, anyway) — are important aspects of emergent literacy. Just as important is the gradual recognition by children that printed words convey information. This is not obvious to the infant or toddler, but the preschooler starts to make that connection. This is a key early moment in the evolution of this complex process we call “learning to read.”

Children also learn how to extrapolate from context, completing familiar sentences or formulating working definitions for unfamiliar words that allow them to continue extracting meaning from sentences. Additionally, they develop a sense of routine — of looking forward to sharing a book with a parent or other caregiver, and delighting in that experience of shared language, time, and space.

Enhancing parenting skills

So, what of the parent? A truism we would always do well to remember is that in every pediatric encounter, there are two questions being asked, verbalized or not. One: how is my child doing? Two: how am I doing as a parent?

It’s not enough to simply tell parents how important it is for them to talk, play and read with their child. They need to know what to actually do to be successful in that role, and to feel confident in it. I do this by walking into the room, giving a book directly to the child, saying my greetings, and then commenting on what I see the child doing to start a conversation.

“So, tell me, how often do you have a chance to share books together with your child?” I’ll ask. This neutral, non-leading question lets me encourage and reinforce any amount of reading they describe. Responses like “none” or “my child doesn’t like it” can be be explored. Does the parent have bad associations with reading, or are they interpreting a developmentally-normal short attention span as being a lack of enjoyment in their child?

Book-sharing allows for a parent to effectively engage in some core tasks of parenting (spending time together, nurturing, responsive interactions, teaching, and physical touch, to name a few) through a relatively familiar model. Of course, some parents will do this easily by dint of having had good models around them, while others may need a hand. Regardless, they feel more effective as parents when we use this approach of early literacy promotion.

“Early literacy promotion is an excellent use of my precious time in an exam room. There’s a remarkable body of evidence revealing the tangible effects of early reading, ranging from observational studies of parent-child interaction to MRI scans showing differences in brain activation.”

Reading the signs of healthy child development

Finally, what of the clinician? I began with the provocative statement that I could learn more in a well-child visit using a book than from my stethoscope. I do mean that — most children are well, and the chances that they have an audible cardiac or pulmonary condition that would manifest without any other symptoms are not high. But by walking into an exam room with a book in hand and giving it directly to that child and carefully, intentionally observing what happens, I can learn a great deal.

The toddler who takes the book, goes to their parent, and holds it out in that “read to me” gesture? They’ve told me volumes about their experience with books and their trust that their parent will take them up into their lap and share the book with them — and they want them to do that.

The 4-year-old who holds the book upside-down, backwards, and closed the entire visit, without the curiosity to explore? I’m more concerned about their early literacy skills and how they may fare in preschool and kindergarten.

The five-year-old who jumps off the exam table, runs over, grabs the book from me, turns pages excitedly, and exclaims? I’ve just observed directly gross and fine motor skills, language, vision, and aspects of home environment in mere seconds — all part of the developmental surveillance Bright Futures tells us to do.

Early literacy promotion is an excellent use of my precious time in an exam room. There’s a remarkable body of evidence revealing the tangible effects of early reading, ranging from observational studies of parent-child interaction to MRI scans showing differences in brain activation. Because it’s possible to do so much around early literacy promotion, it is a multifaceted intervention with broad scope and reach.

Embedding books in pediatric practice
Of course, it takes training and practice to promote early literacy in the most clinically sound way. That’s why, in roughly 6,000 clinics through the country, the Reach Out and Read program helps pediatricians use books as primary care tools, offering training and technical assistance to ensure early literacy promotion is done in a manner consistent with the strong evidence base we have. Seventeen scholarly-journal-published, peer-reviewed articles speak to the power of the model—including improved language scores and book sharing in low-income populations.

Other pediatric literacy initiatives include the AAP’s Brush, Book, and Bed program. The academy’s Council on Early Childhood (COEC) Early Literacy Subcommittee has several working groups focused on various aspects of early literacy work, including booklist creation, funding advocacy, research, and more. COEH is also working to revise and update its landmark policy statement on literacy promotion.

Families are often surprised and delighted to discuss shared reading. One parent asked me why her previous doctors had never talked with her about it, because she felt it got to the heart of what she wanted and needed in checkups. Another parent, who was trying to teach his infant daughter letters via YouTube videos, happily accepted my praise of how much he cared about her brain development. He readily followed my advice that book-sharing would be more effective than videos.

By encouraging shared book reading with carefully targeted coaching, modeling, and reinforcement, we can help parents feel that sense of accomplishment, irrespective of their education, background, or socioeconomic status. (I’m a pediatrician…and even I like being told I’m getting it right with my kids.)

Of all the responses I’ve received walking into an exam room with book in hand, asking if the family reads together, this is my favorite: “Yes, because you told us to!”