Never Too Early

Q & A with Dr. Pamela High: Should reading be part of a checkup with the pediatrician?

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Not all babies will attend day care or preschool, but sooner or later, just about every kid visits the doctor. So if you have a message you want the parents of all young children to hear, turn to your local pediatrician to deliver it.

That’s the logic behind the recruitment of pediatricians in Hillary Clinton’s Too Small to Fail campaign urging parents to read, talk and sing to their babies from infancy onward. And recently, as the publisher Scholastic donated a half-million books for distribution in pediatricians’ offices nationwide, the Illinois-based American Academy of Pediatrics released its first early literacy policy.

mechanistic explanations

Four-year-old Alona Sharp reads with her mother, Aneisha Newell, in Chicago. (Photo: Kim Palmer)

The organization is asking its 62,000 member doctors nationwide to educate parents about the well-documented benefits of reading on early brain development, as well as the emotional connection reading fosters between children and their caregivers. Pediatricians are also being urged to incorporate reading into office checkups.

The Hechinger Report spoke with Dr. Pamela High, who wrote the policy for the AAP. High directs the division of developmental-behavioral pediatrics at Hasbro Children’s Hospital, the principal teaching hospital of Brown University’s Alpert Medical School in Rhode Island.

Q: What prompted this action?

A: Our science has expanded a great deal in the last 10 or 20 years, so that we realize that it’s not just the genetics that a particular individual is born with, but the environment that makes a big difference in a child’s development over time…Perhaps the most important [environmental factor] is the relationship between parents and children, and ways of promoting those relationships are ones we need to pay more attention to. I really believe that early literacy is one of those ways. One of the reasons reading to children is so powerful is it’s often a one-on-one experience between parents and children where children have your full attention. With high-quality books, it can be a language-enriching experience. It’s also a reassuring, comforting kind of routine for parents and children to spend together that nurtures the relationship that’s so important to the life course.

Q: To what extent are pediatricians already urging parents to read to their children, and how common is it for reading to be a part of routine checkups, as you are recommending?

A: From the perspective of the academy, this is the first time that literacy promotion has been called out as an essential component of primary care. This is not a rewrite of an old policy statement…[While reading has been encouraged previously], this is codifying it in one place and providing the research base to show why it’s so essential. That said …a lot of young pediatricians have been trained in this model [incorporating reading into routine checkups] and feel very comfortable.

Q: Pediatricians already have so much information to cover in visits with low-income families, and they are under pressure to see as many patients as possible to maximize profits, limiting the amount of time they can spend. How will they fit this in?

A: Is [reading during a checkup] going to add more time to the visit? Many people say it adds more joy to the visit, and it gives a vehicle to be able to evaluate early child development with the parent and the child, to see what the child does with the book. Can they point to a picture in the book? Can they identify the colors in the book? Do they know how to turn the pages in a book? How comfortable are they sitting in their parent’s lap? …You want to do your visit in a much more joyous way than just going through a checklist. We recommend that the book be not the candy at the end of the appointment but rather be an essential component of playing with the child and examining the child. It can be part of your developmental assessment, and then it’s not an add-on because you need to look at development anyway. It actually facilitates looking at the child’s development.

Q: How common is it for parents to read to young children in different socioeconomic brackets?

A: Although there is an emphasis on children growing up in disadvantaged situations, the fact of the matter is, when we look at the National Survey of Children’s Health, only 60 percent of children under the age of 5 with [parental] incomes above 400 percent of the poverty level are being read to every day, as compared to about a third of children in families living below the poverty threshold. On average, maybe about half of the children under the age of 5 in our country are being read to daily. There’s a lot of folks who could be advantaged by the message that this is a fun, important, positive way to promote your child’s development and your relationship with your child…For low-income children, giving them a book is immunizing them against illiteracy later on, but the major tool is [connecting with] the parent, the human being that’s there nurturing that child, and the book is a vehicle for doing that.

This interview has been edited for clarity and length.

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