Early Literacy Promotion in the Neonatal Intensive Care Unit

Evidence Supporting Shared Reading for Developmental Promotion in the Neonatal Intensive Care Unit (NICU) 

Infants cared for in the NICU are at higher risk for developmental delays as a result of their prematurity or medical complexity. Shared reading is a promising strategy known for providing multiple benefits for infants and their families that has been successfully extended to the NICU environment.The American Academy of Pediatrics recommends shared reading beginning at birth, including in the NICU.

Infants born preterm do not receive the typical in utero sound exposure of children born full term. During NICU hospitalizations, which can last for months, infants are exposed to a variety of sound stimuli, but there is a relative paucity of infant-directed, meaningful language exposure. Adult language exposure is critical for early speech and language development and may be facilitated through shared reading. By fostering positive parent-child interactions, shared reading supports early relational health. Shared reading can also improve parent engagement in the NICU, which is often a stressful and unpredictable place for families. It provides a tangible tool for parent-child interaction and supports parent-infant attachment and bonding. Shared reading allows parents an active role in the NICU and gives families a sense of normalcy and control. Families who read with their babies in the NICU are more likely to establish home reading routines after discharge which supports neurodevelopment among this vulnerable population.  

Tips for Engaging Parents in Shared Reading in the NICU 

• Talk with parents about how talking, singing, and sharing their joy of reading promotes their baby’s development and facilitates parent-infant interaction and bonding.
• Support parents in learning their baby’s cues which show when the baby is ready for interaction or in need of rest.
• Show parents how to position their baby and the book. If their baby needs to remain in an isolette, but can tolerate having a porthole open, show them how they can still read/talk/sing to their baby. Let parents know that it is more important for the baby to hear their voice, than to see the book. 
• Encourage parents to read whatever they like to their baby, and in whatever language is most comfortable for them. The most important thing is that they are talking to their baby. They can tell stories, read, talk, sing. Babies love hearing their voices. 
• Reassure parents that they don’t need to read the words on the page, they can tell stories from the pictures. 
• Encourage parents to establish a daily reading routine. This is a great habit they can begin in the NICU and continue at home.  

Considerations for book selection 

• Allow parents to choose from a variety of books or materials. 
• As possible, provide books in the family’s preferred language. 
• Many infants, due to prematurity or medical complexity, are not yet ready to interact directly with the books. Listening to the cadence, rhythm, and emotion communicated by the caregiver’s voice is the most important thing. 
• Offering a variety of books helps to build the infant’s library for later and may also be used by older children in the house. 
• As possible, provide developmentally appropriate books for infants as they grow and heal.