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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 207

Promoting Early Literacy

Terry Kind, MD, MPH, FAAP
Department of Community and Ambulatory Pediatrics
Children’s National Medical Center
Washington, DC 20010

To the Editor.—

As a pediatrician who brought Reach Out and Read (ROR) to a community health center in one of the most underserved areas of Washington, DC, I read with great interest the recent article by Klass¹ in which she describes literacy promotion by pediatricians who practice "pediatrics by the book." I fully agree with Dr Klass that promoting early literacy at the well-child visit not only seems like a good idea, but also is increasingly supported by evidence, especially among high-risk inner-city children.^2–4

Although this evidence suggests that the provision of anticipatory guidance and new developmentally appropriate books at well-child visits positively affects language development, could it also be a tool in increasing compliance with well-child visits? An important stipulation of the ROR model is that the books are provided at the well-child visits only, at each physical examination from 6 months to 5 years. That includes a new book at 6, 9, 12, 15, and 18 months and 2, 3, 4, and 5 years. Infants and children come to the health center for sick visits and walk-ins as well, but they do not obtain a book at these visits. This stipulation is, in part, based on funding limitations, but also is grounded in the premise that books and age-appropriate tips should be provided within the context of anticipatory guidance.

Noncompliance with appointment-keeping for health supervision (well-child care) visits is an important problem,⁵ and 1 review concluded that the average rate of compliance with appointments was only 58%.⁶ Although the determinants of appointment keeping are multifactorial, could the linking of the well-child care visit with a book enhance compliance with keeping these health supervision visit appointments?

REFERENCES

1. Klass P. Pediatrics by the book: pediatricians and literacy promotion. Pediatrics.2002; 110 :989 –995[Free Full Text]
2. High PC, LaGasse L, Becker S, Ahlgren I, Gardner A. Literacy promotion in primary care pediatrics: can we make a difference? Pediatrics.2000; 105(suppl) :927 –934[Abstract/Free Full Text]
3. Mendelsohn AL, Mogliner LN, Dreyer BP, et al. The impact of a clinic-based literacy intervention on language development in inner-city preschool children. Pediatrics.2001; 1007 :130 –134
4. Sharif I, Reiber S, Ozuah PO. Exposure to Reach Out and Read and vocabulary outcomes in inner city preschoolers. J Natl Med Assoc.2002; 94 :171 –177[Medline]
5. Ross LV, Friman PC, Christophersen ER. An appointment-keeping improvement package for outpatient pediatrics: systematic replication and component analysis. J Appl Behav Anal.1993; 26 :461 –467[Medline]
6. Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB. An overview of interventions to improve compliance with appointment keeping for medical services. JAMA.1992; 267 :1813 –1817[Abstract/Free Full Text]

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Perri Klass, MD
Department of Pediatrics
Boston University School of Medicine
Boston, MA

I thank Dr Kind both for the effort and dedication involved in bringing Reach Out and Read (ROR) to children who need it, and also for raising this important question of whether providing books and discussing reading at primary care visits may improve parental compliance. There are some as-yet unpublished data from a large, multisite study to suggest that implementation of ROR programs may be associated with improved attendance at health supervision visits, and the issue deserves additional study as part of efforts to improve appointment-keeping and thereby improve immunization rates and other indicators of child health and primary care. As Dr Kind points out, compliance with appointments is multifactorial, and issues may vary from one clinic population to the next; looking at the question in detail may help us understand the role that ROR can play in bringing parents and children back for well-child care.

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PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kind, T. Articles by Klass, P. Search for Related Content PubMed PubMed Citation Articles by Kind, T. Articles by Klass, P. Social Bookmarking                         What's this?