By Jennifer Fernandez
GREENSBORO — At the Cone Health Mom+Baby Combined Care clinic in Greensboro, reading is part of every child wellness check.
At a recent checkup, family medicine physician Kimberly Newton read from “It’s Bath Time” to a 4-month-old patient.
“That’s a donkey. That’s a pig,” she read as the baby grabbed at the pages. “Do you know what sound pigs make? Oink, oink, oink.”
She turned her attention to the adults in the room.
“She’s just absorbing it all. That’s good to see.”
At the end of the visit, the family took the book home to add to their growing library. They’ll get a new book at each wellness checkup until age 5.
The books come from Reach Out and Read, a national program that has been available in North Carolina for 20 years and nationally since 1989.
More than 2,200 providers in the state use the program, which is in almost all 100 counties, according to Amber Pierce, state director for Reach Out and Read North Carolina.
Studies show Reach Out and Read has a “significant effect on parental behavior and attitudes toward reading aloud and that children who participate demonstrate higher language scores,” Pierce said. A June 2023 multi-year study of the program in North Carolina and South Carolina found that caregivers already exposed to Reach Out and Read were more likely to read daily to a child than those who had just joined the program.
Early education advocates say reading is crucial to a child’s development. Yet only 37 percent of parents read to their child, according to the nonprofit Zero to Three, which advocates for evidence-based interventions for infants and toddlers.
Now, the EarlyWell Initiative, a North Carolina effort focused on infant and early childhood mental health, is advocating that the General Assembly provide recurring funding to support Reach Out and Read in North Carolina.
Early literacy
It is during the early years, from birth to age 3, that a child develops in key ways, from learning motor skills to acquiring language. The brain is growing exponentially, absorbing information.
However, not all children receive the same amount of input during this crucial period.
Children from high-income families are more likely to be read to daily than children from low-income families. About 52 percent of U.S. children from birth to age 5 in high-income families are read to daily, according to the most recent National Survey of Children’s Health. By comparison, about 25 percent of children that age from low-income families are read to daily.
More than 1 in 3 U.S. children enter kindergarten lacking the skills needed to learn to read, according to the American Academy of Pediatrics. Those skills include knowing the alphabet or being able to count to 10.
Partnering with pediatricians
The AAP supports literacy promotion as part of child health visits from infancy through at least when the child starts school.
“Reading aloud with young children is one of the most effective ways to expose them to enriched language and to encourage specific early literacy skills needed to promote school readiness,” the AAP said in a policy statement.
In North Carolina, Reach Out and Read works with all the pediatric residency programs in the state and almost all of the family medicine residency programs, Pierce said.
The reading program was part of her residency at UNC School of Medicine, Newton said. Her practice partner was also trained on it during his residency in Boston.
Now it is a standard part of visits at clinics like Newton’s at Cone Health’s Center for Women’s Healthcare and across the state.
Reach Out and Read in NC: Click here to find an interactive map of which pediatric providers in North Carolina participate in Reach Out and Read.
Pierce said Reach Out and Read exists “in a structure and a system that families already navigate,” making it easier to reach them.
Every year the program materials are used and given out at 735,000 well child checkups in the state. That’s a lot of books being given out.
In North Carolina, Reach Out and Read spends a million dollars on books every year, Pierce said.
A bevy of books
Children get books at each well visit, totaling about 20 over the course of the program which stretches through the pre-kindergarten years. However, for that first visit at 1 month, the book — “On the Night You Were Born” — is really geared toward the parents, Newton said.
“I always tell parents you’ll probably read this and if you’re in the right emotional state, you might cry. And that’s OK, because it helps you remember the day your baby was born.”
Books can be ordered in other languages. They can cover specific topics, for example, if a parent is sick, if parents divorce or if a pet dies. They show different races and ethnicities, children who are differently abled and multiple types of family units.
Newton said it’s “super important for children to see themselves in the stories that they read or that are read to them.”
For families who have difficulty reading, just flipping through the book with their child and making up a story works, Pierce said.
“Really, at the end of the day, it’s about sharing the book, sharing the time,” Pierce said. It’s an opportunity to “build those moments together.”
Looking for books for your child?
Here’s information on two N.C. programs:
Reach Out and Read. Free age-appropriate books are distributed by participating pediatric and family medicine providers during child wellness visits. Open to children from birth through age 5. Books can be ordered in other languages.
Dolly Parton’s Imagination Library Free age-appropriate books are mailed to the child’s home every month. Open to children birth through age 5 in areas with a local affiliate program. Some books available in Spanish. Some books available in braille or audio format for visually impaired children.
A typical visit
Doctors can use the book throughout the visit or for just part of it.
With younger children, Newton said she uses the book as a way to assess and share with parents where the child is in reaching developmental milestones. Grabbing and turning pages shows that their hand muscles are working well. A baby leaning forward to see the book indicates that their trunk muscles are working.
“It gives me a way to talk about all the things I’m already looking for, in the context of a book or book sharing,” she said.
With older children, Newton said she can use the book to see where children are in learning letters and numbers.
At the recent visit with the 4-month-old girl, Newton spoke with the child’s mothers about flu and RSV vaccinations and getting the baby to start transitioning from breastfeeding to taking a bottle. Newton suggested going straight to a sippy cup if they had difficulty getting her to transfer to a bottle. She said some children just never take to bottle feeding.
After she examined the little girl, Newton pulled out “It’s Bath Time” and read a little of the book, which included textiles with varied textures on some animals on the pages that children can run their fingers over.
“Books become a whole sensory experience,” Newton explained to the parents as she noted the little girl’s ability to hold herself up on her own and her interest in turning the pages.
“I can tell you guys are sharing books with her,” Newton said.
The parents said they love the program and their daughter likes the books. They have three so far.
Christine Defendorf, a certified medical assistant at the clinic, said she sees how the children and parents react at the visits.
“They know they get the book,” she said. “They get so excited.”
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