Shared Reading Should Start in Infancy, AAP Says

ORLANDO — The American Academy of Pediatrics (AAP) recommended that pediatricians encourage parents and caregivers to read aloud with their children beginning in infancy, according to an updated statement on literacy promotion, the first since 2014.

Pre-publication releases of the policy statement and an accompanying technical report that touted the benefits of shared reading were unveiled during the AAP annual meeting. The statement recommends continuing the practice through at least kindergarten.

“The research shows this is anticipatory guidance that parents and caregivers want,” Perri Klass, MD, of New York University’s Grossman School of Medicine, said during the meeting. “Thank you for opening your incredibly busy clinical practices to include even more, and doing it all because you know children, and you know families, and you know that supporting parents can help shape children’s whole life trajectories, and you know how important it is to help them write their own good stories.”

The recommendations, which are similar to those from the previous update, include encouraging all parents and caregivers to read aloud with their young kids using “engaging and interactive styles.” The statement also recommends that parents begin reading aloud in the newborn period, even in the neonatal intensive care unit, when possible.

Pediatricians should also develop skills to discuss strategies with parents and caregivers to offer meaningful engagement with books. They should also provide high quality and developmentally and linguistically appropriate books at visits, especially for low-income families who would otherwise not have access to them.

It also recommends supporting the existing AAP recommendation of limited screen use in early childhood, and placing an emphasis on print books for young kids “because digital books do not foster equivalent parent-child interactions.”

Identifying parents and caregivers with low literacy skills was also recommended, and tailoring guidance in these situations to focus on “language-rich interactive activities that do not require reading print but may include conversations about colors, numbers, shapes, characters, or actions depicted,” as well as supporting parents and caregivers who want to improve their literacy skills.

Messages should be reinforced with posters and other materials for parents about interactive reading, public libraries, and book distribution programs, and books with diverse characters, cultures, and themes should be promoted.

Finally, the recommendations encouraged reading aloud even in virtual appointments during which books are not readily available, and partnering with other child advocates on national messaging and policies that support shared reading.

“Relationships between shared reading exposure and brain structure and function have been demonstrated across early childhood, and even in utero,” they said in the accompanying technical report, which detailed evidence for the benefits of shared reading.

Evidence also supported encouraging print books rather than screens, as “too much exposure to screens (even when the content is meant to be ‘educational’) can replace important positive interactions and routines, including shared reading activities, with possible negative effects on subsequent emergent literacy and social-emotional development,” the report stated.

The National Center for Learning Disabilities has pointed to pediatricians as being key resources for recognizing early signs of reading difficulties through screening and interactions with families during visits, the report noted.

In addition to recommendations for pediatricians, the policy statement also included a number of recommendations for policymakers, including funding children’s books, pediatrician time, and reading program support by public and private insurance programs and hospital systems to allow these interventions at all health supervision visits from birth through kindergarten “as an evidence-based and ‘value-added service.'”

Other recommendations included advocating for early literacy promotion as an essential part of primary care “so that it is taught in residency training and evaluated as an element of competency-based pediatric medical education,” as well as funding research on the effects of early literacy promotion on child health and education outcomes, among others.

“Reading and books in children’s lives can help shift the balance toward language,” Perry said, “toward positive interactions, toward lap time and physical contact, toward words and rhymes and pictures and stories, toward moments of security and learning and language in the arms of those who love a child most.”

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