Promoting Literacy to Improve Child Development: Reading Model Boosts Efforts

According to new research, improving early literacy can support healthy brain development, strengthen parent-child relationships, and help child clinicians build trust with families.¹

The Reach Out and Read (ROR) intervention began as a simple idea: incorporate children's books into pediatric child care visits. Now, it has helped reshape how clinicians support young children and their families. According to a new article in Pediatrics, the journal of the American Academy of Pediatrics, over its 37-year evolution, ROR has increased understanding of the role reading can play in children's development, caregiver-child relationships, and pediatric care.

“When we started Reach Out and Read, we believed pediatricians could help break the cycle of educational disadvantage by encouraging families to read aloud together. What we did not fully appreciate was how much more a book could do,” said Robert Needlman, MD, Professor Emeritus of Pediatrics at Case Western Reserve University School of Medicine. “We saw the pride and hope parents felt when their children responded to books, and clinicians began having conversations with families they had never had before. We have learned that books do more than build literacy. They strengthen relationships between parents and children and build the trust between families and clinicians that makes this work possible.”

The article, “Literacy Promotion and Child Health: The Role of Reach Out and Read,” brings together perspectives from pediatric researchers, clinicians, parent leaders, and Reach Out and Read co-founder Needlman.¹

Evidence Base

In the first ROR study, which is described as methodologically limited, 79 parents were interviewed. Those who received books were 4 times more likely to name reading aloud among their 3 favorite parenting activities, and the effect was twice as large among families receiving Aid for Families with Dependent Children.^1,2

The ROR research library now lists approximately 70 implementation and outcome studies, and a 2024 American Academy of Pediatrics (AAP) policy statement and technical report review the evidence.^1,3 As the science of early brain development advanced, the program’s focus broadened from toxic stress to early relational health, and the intervention’s starting point moved from 6 months to birth.¹

Program leaders also describe the clinician relationship as a driver of the intervention. Trust may encourage hesitant parents to try reading aloud and may allow parents who have difficulty reading to disclose it and accept referrals to adult literacy classes.

Clinician Modeling

A scoping review found only one-third of ROR manuscripts mentioned clinician modeling, in which the clinician briefly reads aloud with the child. At 3 urban health centers, 84% of parent respondents reported receiving a book and 73% reported receiving anticipatory guidance, while 23% reported clinician modeling.¹

In data from a larger study, modeling was associated with enhanced home literacy environments (β = 0.16; 95% CI, 0.06–0.26). The investigators also observed a dose-response pattern. Receiving 1 component, typically a book alone, was not associated with enhanced home literacy environments, whereas receiving a book plus anticipatory guidance was. The greatest enhancement occurred when both were combined with modeling.¹

In separate focus groups about pediatric care in general, parents and caregivers described productivity pressures in the exam room and warned the parent-clinician relationship could cause harm when it did not respond to family priorities. Their recommendations included having clinicians demonstrate rather than simply instruct.

“One of our responsibilities in pediatric care is helping parents and caregivers understand just how much is happening during those incredibly important early years of life, and the essential role they play in their child’s development,” said Perri Klass, MD, FAAP, the national medical director at Reach Out and Read and article coauthor. “When you give a young child a book, you are investing in that child’s developing brain. When you model reading and talk with families about the power of their voices, you are reinforcing the vital role parents and caregivers play in their child’s development and the strength of the bond they share.”

Training Efforts

The ROR National Center has updated its online training with more videos showing modeling during well-child visits and has developed an accredited Maintenance of Certification program. A pocket-sized booklet offers guidance on introducing the book, modeling shared reading, and incorporating developmental surveillance. In a pilot at 4 Colorado pediatric clinics, 71% of clinicians planned to continue using the booklet and reported modeling increased by 18%.¹

The resident-led ROR Resident Champion Initiative now includes 16 resident champions from 6 training programs. Evaluation and dissemination of its curriculum are under way.

Measuring Relationships

The authors note widely used instruments, including the Press Ganey Outpatient Medical Practice assessment and the Consumer Assessment of Healthcare Providers and Systems survey, were developed outside pediatric primary care and without lived-experience input. To address this gap, 5 parent leaders partnered with researchers to co-design the CONNECT Survey, a measure of the parent/caregiver-clinician relationship, using empathy interviews with caregivers across multiple states and a modified Delphi process.¹

Families consistently prioritized feeling listened to, respected, emotionally safe, included in decision-making, and supported with actionable information. The article describes the survey’s development but does not report psychometric results.

“It showed that our voices were not just being collected but valued as expertise,” said Desarae Smalls, a parent leader on the CONNECT codesign team.¹

Future Directions

The authors identify unreliable funding as a continuing challenge. Although the AAP recognized ROR as essential more than a decade ago, the program still depends on philanthropy for its books and organizational infrastructure. Shrinking well-child visit times and cutbacks to government support present additional barriers. The authors also suggest relational measures may help capture the broader influence of ROR as health care systems prioritize family-centered and value-based care.

More About Reach Out and Read

First developed at Boston City Hospital in 1989, Reach Out and Read was built on the understanding that learning begins long before a child enters a classroom and that pediatricians have a unique opportunity to reach families during the earliest years of development. Today, the program reaches 4.8 million children and families annually through nearly 6,800 clinical sites nationwide, with more than 41,000 pediatricians and other clinicians incorporating developmentally appropriate books, guidance for caregivers and demonstrations of shared reading into routine well-child visits beginning at birth.

With approximately 70 implementation and outcome studies documented in its Early Literacy Research Library and recognition in the American Academy of Pediatrics' 2024 literacy promotion policy statement, Reach Out and Read has a substantial evidence base. The article also identifies the work ahead: strengthening clinician training, ensuring consistent implementation, developing better ways to measure relationships, and securing sustainable funding to make the model available to more families.A new article published in Pediatrics, the journal of the American Academy of Pediatrics, examines 37 years of research behind Reach Out and Read and how a program originally designed to improve early literacy has evolved into an approach that also strengthens parent-child relationships, supports healthy brain development and helps pediatricians build trust with families.

“For too long, we have treated children's health, early learning, and family relationships as separate priorities, when we know they are deeply connected,” said Lynette M. Fraga, PhD, the CEO of Reach Out and Read. “Reach Out and Read gives clinicians a practical way to bring them together during a routine visit. This article shows both how far we have come and why we need to make this kind of care available to every child and family.”

References

1. Needlman R, McFadden T, Jimenez ME, et al. Literacy promotion and child health: the role of Reach Out and Read. 2026;158(6):e2026077966.

2. Needlman R, Fried LE, Morley DS, et al. Clinic-based intervention to promote literacy: a pilot study. Am J Dis Child. 1991;145(8):881-884.

3. Klass P, Miller-Fitzwater A, High PC; Council on Early Childhood. Literacy promotion: an essential component of primary care pediatric practice: policy statement. Pediatrics. 2024;154(6):e2024069090.