Reach Out and Read

A prescription for a lifetime of language development

By Karen Haslund, M.D.

Reach Out and Read is a national program promoting early literacy by bringing new books and advice about the importance of reading aloud into the physician’s examining room. It is based on a research model showing a connection between increased frequency of sharing books with infants and young children and enhanced language development. Now more than 24,000 primary medical care providers nationwide distribute 3.2 million new books each year. Since 1989, doctors and nurses have been prescribing books and reading aloud at each well-child visit from age 6 months to 5 years with a special emphasis on children living in poverty. Risk factors such as single parenthood, young parental age, poverty and low parental literacy place children at particular risk for school failure. Early childhood intervention programs help but are expensive and limited in availability.

The Reach Out and Read program works by helping parents become their children’s first and best teachers, providing them with the skills and tools — or books — to use in reading aloud. As a part of well-child care, physicians provide families with an understanding of why reading to children in the first years of language development is so important. By as young as 2 years of age, children who have been read to regularly show a six-month advancement in language acquisition over children who have not received the reading intervention.

Family physicians are particularly suited to use Reach Out and Read as an intervention with high-risk families. They may practice in areas where it is difficult for families to obtain books and with patients who have limited reading skills. The American Medical Association has recognized low adult literacy as a prime predictor of inadequate medical care. Family physicians may follow the child from the mother’s pregnancy forward throughout the child’s life and have already gained the family’s trust. Frequently physicians are the only professionals that high-risk families encounter on a regular and ongoing basis in the critical first three years of language development.

Reach Out and Read is collaboration between physicians and the larger community. Many people assist in raising awareness, national corporations donate books, volunteers read to children in waiting areas modeling how to read to a young child and show parents that sharing books is a pleasurable activity for children.

Reading aloud helps families build a solid foundation of enriched family life as well as advancing language development. Studies show that when children have been in a Reach Out and Read program, parents were four to 10 times more likely to report sharing books with their children and more likely to report reading aloud as one of the children’s favorite activities. Children love books because they love their parents and enjoy the positive attention they receive when sharing a book together.

For the physician in the exam room, a book can also be an assessment tool helping the physician gather information quickly and share child development, parenting and safety tips. Offer a board book with three or four stiff pages to a six-month old sitting in a parent’s lap. The baby will squeal, whack the pages with an outstretched hand and promptly put the book into his or her mouth. Some parents, not understanding, may become upset that the infant is either hitting or destroying property. The physician can then channel the discussion to the baby’s increasing awareness and participation in the world.

The baby is excited and wants to show the adult the interesting thing he has just discovered. With his limited arm and hand control he tries to communicate by pounding on the book. Chewing on books — or anything — is the way an infant explores his world. Physicians can point out that pounding and mouthing is normal and appropriate at this age. They can also remind families that babies explore everything and lead naturally into anticipatory guidance about childproofing the environment and maintaining vigilant watch for small objects while still providing many stimulating things to examine. Anticipatory guidance flows quickly and naturally from such an interaction and may be better received by the family.

Toddlers, usually cautious or frightened in the office, can be enticed by the physician taking a moment to share and discuss the pictures in a book. This is an opportunity to talk about bedtime rituals, substituting a story for a bottle, the importance of routines in a child’s life — as well as that toddlers like control and want to choose and hold the book and will likely only sit still for two or three pages. Toddlers like routine. As their language skills improve, they like to hear the same story over and over and over. It is normal to read the same book four or five times daily for weeks on end. Offer the book upside down to see if they can turn it around, open it up and pretend to read. Fine motor control can be evaluated by watching page turning. By 18 months most toddlers can turn one or two board book pages at a time. By two years of age they should start to fill in words of familiar books if they have been read to regularly. They may insist upon every single word of familiar books and correct the parent if a word is wrong or missing.

Many families are amazed that it is so important to talk to and describe the world to an infant who cannot talk back. Parents’ reading levels may be low but that does not hinder their ability to deeply enrich their child’s language. Some families believe that watching educational programs on TV will help their infants and young children learn. The sad fact is that TV cannot speak back and is negatively correlated with language acquisition and school success. The basis of language development is the need and response cycle of human interaction with a consistent caregiver.

Parents are delighted to be their children’s first teachers. They are eager to help their children. With the physician’s guidance and the proper tools, brand new age-appropriate books chosen just for them, struggling parents can provide a bright future for their children.

The glow of delight in the children’s eyes and the pride on the parents’ faces as they realize that they are the first and most influential teachers makes this one of the most important and fun parts of well-child care.

Karen Haslund, M.D., practices and teaches ambulatory pediatrics at the Austin Medical Education Program. She can be reached at khaslund@seton.org. For more information about Reach Out and Read, contact Susan M. Cooler, Ph.D., director of Texas Reach Out and Read, at susan.m.cooley@uth.tme.edu, or visit www.reachoutandread.org.