A Prescription for Literacy

Each year standardized tests reveal that thousands of Massachusetts schoolchildren can’t read at basic levels and each year educators are pressed for solutions. But a Boston-based, national literacy program suggests the best place to look for solutions may not be in the classroom but in the doctor’s office.

Reach Out and Read, created 10 years ago at Boston City Hospital (now Boston Medical Center), trains pediatricians to view early literacy as a vital part of every child’s health. At each check-up from six months to five years, volunteers read to children in the waiting room, doctors encourage parents to read to their kids, and they give each child a book to take home. By kindergarten, each child has a library of at least 10 books.

Reading aloud to young children is the single most important factor in preparing them to learn to read, according to research, but fewer than half of American parents read to their infants and toddlers regularly.

Dr. Perri Klass, the program’s medical director, started expanding Reach Out and Read beyond Massachusetts in 1993. Today there are 492 sites in 47 states. About 5,000 pediatricians have been trained and 830,000 children–most from low-income families–are served annually.

Klass admits her interest is at least a bit selfish. An award-winning writer, she is the author of five books, including the 1990 novel Other Women’s Children, and dozens of short stories and articles. She often jokes that she wants to guarantee herself a future audience. But she has also seen the dramatic impact of books on her own three children–and on the kids at Dorchester House, the neighborhood health center where she is a staff pediatrician.

CommonWealth caught up with Klass at Boston Medical Center to learn more. Here are edited excerpts of our conversation.

What can a six-month-old, or any very young child, learn from a book besides its taste?

Of course you can learn how the book tastes, and chewing on books is fine. That’s why we use the board books. But then in addition…you’re on your parent’s lap…. The child learns this is associated with good times, with being safe, with warmth, with my mommy paying attention to me, with her voice. And very quickly the repetition becomes important because children love repetition. You go through the same books over and over. And you’re learning what we call the book-handling skills. Say from six months to a year, you go from a baby who doesn’t care whether the book is upside-down or right-side-up to a baby who will deliberately turn the book right-side-up because he wants the pictures right-side-up….

And by one-and-a-half, they’ll ask to be read to. They don’t necessarily have any words, but they’ll go choose the book they want and give it to you. And then they start…filling in words, and they start to correct you if you get anything wrong. They build on these literacy skills, which leads you eventually to the point where your two-and-a-half-year-old is reading to you and knows exactly which words go on which page. This has nothing to do with recognizing letters or interpreting the text, but it’s about an incredibly strong attachment to the books and the stories, and it’s about language and repetition. But it’s also about the beginning of that feeling of, I like these books, they bring me pleasure, they bring me information.

Why is early literacy something pediatricians should concern themselves with when there are so many important medical issues to monitor at each check-up?

First of all, logistically, we have the kids. We see them over and over during these years–six months, nine months, 12 months, 15 months–because of all those important medical issues and immunizations. For many parents, the only person that they talk to regularly about child development, the only person with training that they’re seeing, is the pediatrician.

But the other side of it is that if you’re thinking about what makes a healthy child, it isn’t just preventing diseases…. The pediatrician who’s busy giving the kid all his immunizations but has never looked into the question of whether or not he’s learning speech, that pediatrician is not doing a good job. That’s not a healthy, happy child. Early literacy as a contributor to school success is part of children growing up healthy, children able to do what they’re supposed to do…. This is a way of trying to look at it preventively. Instead of just treating the disasters, what can we do so that in general our patients are a little more likely to get to school and succeed and be happy?

Research shows that children have trouble learning to read if they’re not exposed to books early. Are there also longer-term issues in terms of how children fare in school later on?

Let me not exaggerate what you can say. What is true is that not reading in school, not reading at grade level, is a real risk factor for general school failure. Especially after the fourth grade, almost all school success just really depends on reading success. You have to be able to get information out of a printed text. So what that does mean is that kids who come to school and don’t learn to read on time, if the school can’t give them the extra help they need, if there’s nobody to help them catch up, those kids a few years down the line are going to be the ones at risk for school failure. And those are the kids who are at risk for truancy and absenteeism and dropping out, but also for early pregnancy and sub-stance abuse and for juvenile delinquency…. I don’t want to say, you don’t read to a young child, the child ends up in jail. But I do want to say that there [can be] a sort of cascade of events.

How do you persuade reluctant parents to read regularly to their children?

I think there’s an issue with parents who don’t read well, who don’t have good associations with reading, aren’t comfortable with reading. And it brings up all kinds of anxieties and worries and that’s a really hard thing…. If you get a feeling the parent really can’t read comfortably, you have to have a place to send them [for help]. And we look for some books with very few words on the page, or even with no words on the page, just pictures. And we talk in training about [how] you don’t have to use the word “read,” you can say to parents, “Look at the book together, at the pictures together, tell a story together.” But I think the hope is really that parents are seeing from the beginning that this is important and they will start thinking, “Should I be doing adult literacy or family literacy?” We’re looking to collaborate with national family literacy organizations so those referrals can get made as effectively as possible.

What makes you so passionate about this cause?

Meet the Author
Little children are really smart; they can do all this stuff we can’t do, like learn whole languages and pick up all these things without being formally taught. It’s very sad if their lives don’t offer them enough to take advantage of these unbelievable years with the remarkable brain….When you talk to elementary school teachers or Head Start teachers or day care workers, one of the things they say over and over is you can tell immediately on Day One who’s been read to and who hasn’t…. And it seems so sad to me that by five or by six you can already be behind that way. It’s not teaching them to read. It’s that by that age they should really want to read. By that age they should feel that reading is the secret code and if I can crack it then I’ll be able to get into all these stories myself and the world will make sense.

I can’t imagine growing up without the various kinds of pleasures and excitement that you get from a book…. I don’t think anyone should have to grow up without that…. And the thing about children is… if you get the right books in there, you have to tell them to stop. That’s the fun part-“Put that book down while you’re talking to me! Put that book down while you’re putting on your shoes!”…. If you end up with a child who is truly hooked, then you just have to make sure the books keep coming and stand out of the way.