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T. Berry Brazelton, MD Headshot

Books Are Just a Start

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READING TO CHILD
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We applaud the American Academy of Pediatrics' (AAP) new policy statement recommendation that "pediatric providers promote early literacy development for children beginning in infancy" (AAP Policy Statement -- Literacy Promotion: An Essential Component of Primary Care Practice. June 29, 2014). The policy statement carefully embeds reading in the larger project of early literacy development, and in infants' relationships with their parents and other caregivers. We want to highlight here a few critical points of the AAP statement, reported on in the front page New York Times story, "Pediatrics Group to Recommend Reading Aloud to Children from Birth" (June 24, 2014), because books are just a start.

Almost half a century ago, scientific observation of newborns and very young infants led to the conclusion that brain development is not only rapid and extensive at the beginning of life, but that it is highly responsive to the care that parents and others provide. With the subsequent advent of brain imaging technology and its power to convince, these findings finally began to attract the attention of policymakers in the mid-1990s. Yet, we have only begun to take their implications seriously. It still may come as a surprise to some that reading to babies in the first six months of life contributes to their brain development and later academic success.

Although reading can be a powerful force for early brain development, the nature of parent-baby conversations while reading and during other interactions matter at least as much. Even in the first weeks of life, parents and infants are attending to and responding to remarkably subtle features of each other's vocalizations, gestures and facial expressions. These are the interactions that stimulate early brain development. Through these interactions, infants learn to engage with environmental stimulation and protect themselves from it when it is more than they can handle. Babies have short attention spans, are easily distractible and of course may be done reading before even a short, developmentally appropriate story is over. Yet their pleasure in being read to and in pointing to the pictures on the page is its own reward for parents, reinforcing and perpetuating these times for learning together.

Reading can prompt these conversations, but it is just one instance of language-rich social interactions that can start at the beginning of life. These account for much of the difference in processing speed among 15-month-olds and vocabulary size in 4-year-olds. They prepare children's brain for learning and later academic success. It is through these interactions that children develop the executive functions they will need to be school-ready. For example, the ability to focus and prolong attention and the motivation to keep on focusing -- all the way to the next page -- begins on a loving parent's lap. There, a book can spark curiosity and questions even before a child has words to ask them with, and a shared story can lead to a lifelong love of learning.

Still, if parents are to read to their children from the beginning of life, they need more than books. They need time to be with their children and enough protection from overwhelming stress to be able to not simply read at their children, but to converse intimately with them. Paid parental leave, a fair minimum wage securely above the poverty level and family-friendly workplace policies for all working families would certainly help.

Parents also need access to high quality treatment for depression. A very common condition in parents, it can interfere with their brain-building interactions with their infants. Treatment is out of reach for most, even though depression is one of the most treatable of all medical conditions.

Because most parents must work, most infants and young children spend many of their waking hours in the care of others. Infants, toddlers and young children need reading and other language-enriched social interactions all day long -- whenever they are ready, wherever they are cared for. We know what high quality early education and care look like, and we know that they pay off.

Books are a terrific scaffold for getting parents and babies talking with each other. In addition, without even realizing it, when parents read to their babies, they are instilling pre-literacy skills, for example, the understanding that print on a page stands for something, and that the pages of a book progress in a particular sequence. And of course parents' enthusiasm about books and the rewarding reading experiences that parents and babies have together build a foundation for children's excitement about school and learning. But, as every pediatrician knows, books are not enough.

During the first weeks, months and years of life, there are no quick fixes or silver bullets for brain development. Babies' brains are the infrastructure for our nation's future. We need to invest not only in books, but also in babies, their parents and those who care for them while their parents are at work.

Joshua Sparrow, MD
T. Berry Brazelton, MD
Harvard Medical School
Brazelton Touchpoints Center
Division of Developmental Medicine
Boston Children's Hospital
www.brazeltontouchpoints.org