Elsevier

Academic Pediatrics

Volume 11, Issue 1, January–February 2011, Pages 11-17
Academic Pediatrics

Perspective
Books and Reading: Evidence-Based Standard of Care Whose Time Has Come

https://doi.org/10.1016/j.acap.2010.09.007Get rights and content

Abstract

Reach Out and Read (ROR) is the only systematically evaluated clinical activity to promote child development in primary care used throughout the United States. The ROR intervention is straightforward: clinicians provide advice about the benefits of reading aloud, as well as directly giving books to high-risk children and parents to take home at each pediatric visit of children aged 6 months to 5 years. ROR builds upon a significant evidence base of the value of reading aloud to young children. The studies evaluating ROR from different sites from subjects from different racial backgrounds and numerous outcome measures are consistently positive. From its initial single site at Boston City Hospital in 1989, to over 4600 clinical sites in 2010, over 30 000 clinicians distributed over 6.2 million books a year to 3.9 million children across the United States. The future efforts for ROR include integrating mental health competencies found in American Academy of Pediatrics guidelines as part of residency and clinician training into the ROR paradigm, quality improvement to ensure fidelity to the intervention, and expanded pediatric clinician involvement in local early childhood/school readiness community efforts. Finally, the most important future goal is the adoption of giving advice about reading aloud and giving developmentally appropriate books to high-risk families as best practice by official bodies.

Section snippets

Infant Brain Readiness

A child’s every day experience, including being read to, shapes early brain development and behavior. Language development, which is the core of early literacy, depends on this sensory and perceptual development, with the discrimination of speech sounds during infancy serving as a base for later language and learning. Brains of newborn infants are sensitive to all language, especially in the first 6 months. It is well documented that newborns and even fetuses know their own mothers voice:

The Birth of an Intervention: Development and Implementation of ROR

In 1989, a clinic-based literacy promotion model with 3 components was developed by pediatricians Barry Zuckerman and Robert Needlman and early childhood educators Jean Nigro, Kathleen MacLean, and Kathleen Fitzgerald-Rice at Boston City Hospital (now Boston Medical Center). From the beginning, 2 key components—providing advice about the benefits of reading aloud to young children and giving a book to the child, both done by the pediatric clinician as part of well-child care—remain unchanged. A

Best Practice in Pediatrics: Adequacy of Evidence

The preponderance of information suggests to us that promoting reading aloud and giving books to high-risk parents meets criteria for evidence-based medicine, as it is broadly defined: integrating individual clinical expertise and the best external evidence.68 In the case of ROR, the best external evidence is consistent and generated from different independent investigators who used different outcomes and diverse populations, including masking to assess language and home environment. In

Conclusion

ROR is recommended in Bright Futures but not designated as best practice for child health providers, even though ROR is widely practiced and is 1 of 3 evidence-based health promotion strategies (the others are vaccination and selective injury prevention). This raises the question of what it takes for an innovation to rise to a level of evidence-based care that is supported by the appropriate professional bodies. ROR is supported by positive evidence, acceptance by physicians and parents, and

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      ROR is notable among pediatric primary care innovations for the scale it has achieved and the evidence it has accumulated. ROR's rapid uptake over its 30-year history reflects how it responds to a clear need to support child development that resonates with practitioners across the US.19 During this time, several studies have documented ROR's effectiveness, building strong practice-based evidence for this innovation.20-23

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