Literacy promotion in primary care pediatrics: Can we make a difference?

Background. Reading skills are critical to children's success in school and the increasingly technologic workforce. Children from low-income families are at risk for home environments that fail to promote emergent literacy an d for reading failure. A home environment that encourages learning and pare nts who are involved in their children's education are important factors in school achievement. Objective. To evaluate the effects of a literacy promoting intervention del ivered by pediatric providers as part of well-child care on parent attitude s and behaviors and on child language. Design/Methods. A multicultural group of 205 low-income families with 5- to 11-month-olds were prospectively enrolled, interviewed, and randomized to intervention (n = 106) or control (n = 99) groups. Families in the interven tion group received developmentally appropriate children's books and educat ional materials and advice about sharing books with children, while those i n the control group received no books or materials relevant to literacy. Af ter an average of 3.4 well-child visits in both groups, 153 (75%) were rein terviewed and the children's receptive and expressive vocabulary was tested using a modified version of the MacArthur Communication and Development In ventory (Short Form). Parents were asked if their child understood (recepti ve vocabulary) or said (expressive vocabulary) each of 100 words, half of w hich were in the books given. Families were found to have a Child-Centered Literacy Orientation if they mentioned reading aloud as one of their child' s favorite activities or as one of their own favorite joint activities or i f they usually read together at bedtime. At follow-up toddlers were 18.4 mo nths old on average. Results. Intervention and control groups had similar literacy related chara cteristics at baseline. There was a 40% increase in Child-Centered Literacy Orientation among intervention families compared with 16% among controls. Intervention families read more with their toddlers (4.3 vs 3.8 days/week). Both receptive and expressive vocabulary scores were higher in older inter vention toddlers (18-25 months old; n = 88), but not in younger interventio n toddlers (13-17 months old; n = 62). This significant effect of the inter vention on vocabulary scores in older toddlers was found for both the 50 wo rds in the books and those not in the books. After parent education, foreig n birth and language proficiency, and child age were statistically controll ed, the intervention remained significantly associated with higher language outcomes in older toddlers. However, when reading aloud was added to the m ultivariate analysis, the influence of the intervention was no longer evide nt, suggesting the intervention's effect on child language was mediated thr ough increased shared reading with these toddlers. Conclusion. This simple and inexpensive intervention, delivered as part of well-child care, changed parent attitudes toward the importance of reading with their infants and toddlers. These intervention parents and their child ren read more together and this was associated with enhanced language devel opment in older toddlers in this diverse group of low-income families.