Patient Presentation
A 12-month-old male came to clinic with his mother for a health maintenance examination. When the pediatrician walked into the room, the infant was trying to give his mother a book, but she did not notice as she was playing a game on her cellphone. She stopped the game appropriately and did not use it again during the visit. The mother said she was only concerned that he didn’t talk as much as she thought he should. He had 3 words and made a dog sound. He would appropriately point and would try to follow 1-step commands. The past medical history showed a normal hearing test as an infant. The pertinent physical exam showed a healthy male with growth parameters in the 10-25%. His physical examination was normal.
The diagnosis of a normal infant was made. During the examination, the pediatrician noted that he would say many different sounds and would turn-take when interacted with. She also noted that he tried to bring a book to his mother on two other occasions and she did not react to him. The pediatrician offered, “He seems to be on track for talking. He says several words, and the other things he is saying and you don’t understand will become words. He takes turns saying things just like we are doing now too. A couple of things you can do is to talk with him alot. Talk all the time about what you are doing like, “We’re walking down the hallway. Now we are stopping at the check out counter.” It seems funny but it really helps. Another important thing you can do is to read with him. I noticed that he seems really interested in books and has tried to bring you several during our visit. Do you read with him?” The mother answered, “I don’t read with him because I thought he was too little. He also doesn’t sit still very long so I didn’t thing he could do it. I tell him stories and sing with him.” The pediatrician said, “That’s great that you tell stories and sing. That’s great for his language. He’s never too young to read with though. Even a few minutes a day can really be a nice time to spend together and he will learn about books and stories. I forgot to bring a book for him, so let me get it and I’ll show you a few ways you can use the book with him.”
Discussion
Positive parenting has been shown to improve the overall health and well-being of children. Positive parenting includes:
- Respecting the individuality of the child and the adult in the relationship – accept the child for their strengths and weaknesses, encourage children to take risks, encourage their confidence in themselves
- Respecting that the individuals are part of a family and community – help children understand that they cannot have everything their way, that other people and the world they live in must be considered too.
Even in a resource poor environment, data shows that positive parenting can help ameliorate the effects of poverty in children. - Working together – doing things together – reading, coloring, singing, cleaning up and household tasks, etc. Family meals are great ways to spend time together. For more information Click here.
- Respecting others creativity and individuality – thank children for their actions as one would another adult, allowing children to do things by themselves even if it isn’t the way the parent would do it, allow them to fail and support them in the failure
- Positive communication – listening more than talking, be encouraging, appreciating when the person may not be able to find the words well, model respectful discussions and show children how to disagree in a respectful way. Hold emotions in check and say “I’m sorry” when one doesn’t do this as well.
Say “Please” and “Thank you,” be honest but positive - Setting limits – every child (and adult) wants to know what the rules are – be clear about them. For more information about discipline Click here.
Learning Point
Reading is one positive parent activity that parents and children can do together. It is usually a happy activity, time-limited and low cost. Adults can help children learn about reading and literacy from the day they are born. It takes a little time each (or most) days and is a great time to spend together. For specific ideas about how to read to your young child Click here.
- Read with your child every day
- 20 minutes daily is recommended. The 20 minutes doesn’t have to be at one time. You can split it up over the day. Especially if your child is young as they only have a short attention span.
- Some days this may seem too long, but even 1 book read together is a special time together. It can help both parent and child be calmer, closer and enjoy the experience.
- Even when your children can read, spend time reading to them or with them. It continues to be a nice time to spend together and you can share and discuss the stories.
- Have a book box
- Have a box to put books in your child can easily use. Your child can read to himself and choose books to read with you. They also know where the books go when it is time to clean up.
- Having a blanket, mat or towel next to the books encourages your child to sit and read in a cozy place.
- Get your child a library card
- Most libraries encourage children, even babies, to have their own library card.
- Picking their own books and having their own card is special for children.
- What should children read?
- In general – EVERYTHING. Children should learn about fiction, non-fiction and reference books even at young ages. They should learn about all book types. Importantly, books should have appropriate content for your child’s age. Books are usually grouped by section based on age such as:
- Board books: Newborn to age 3
- Picture books: Ages 3-8
- Coloring and activity books: Ages 3-8
- Novelty books: Ages 3 and up but this depends on the content
- Early, leveled readers: Ages 5-9 (these usually have the level listed on the cover or inside of book)
- First chapter books: Ages 6-9 or 7-10
- Middle-grade books: Ages 8-12
- Young adult book: Ages 12 and up or 14 and up
- In general – EVERYTHING. Children should learn about fiction, non-fiction and reference books even at young ages. They should learn about all book types. Importantly, books should have appropriate content for your child’s age. Books are usually grouped by section based on age such as:
- Not sure the book’s content is right for your child?
- Read the book (or sections of it) and see what you think.
- A children’s librarian can also help.
- Booklists can be found at any library. They usually are for different ages, or categories such as holiday books or biographies. Winners of children’s book awards are good places to start too.
The Association of Library Service to Children notable book lists can be found here.- Caldecott Medal for most distinguished picture books Click here.
- Newberry Medal for contributions to American literature for children Click here.
- Coretta Scott King Book Awards for outstanding African American children’s authors and illustrators Click here.
- Pura Belpre Award for outstanding Latino/Latina children’s author and illustrators Click here.
- Geisel Award for most distinguished American book for beginning readers. Click here.
- Other book award winner lists can be found at the Association for Library Service to Children Click here.
- Librarians can help you
- Librarians are specially trained to help children and parents find information and choose appropriate books.
- They can help with choosing books that:
- Match the child’s reading skills
- Match the child’s interests
- Find books similar to one the child already likes
- Help dual language learners who may have different reading skills in each language
- Find foreign language books
- Help gifted children who may have advanced reading skills but still need age-appropriate content
- Help encourage slower readers to enjoy reading and improve their reading skills
- I’m not a good reader myself so how can I help my child?
- It’s okay if you are not a good reader. Parents cannot be perfect. You can still read to your child whatever books you are comfortable with. It is about encouraging your child.
- Modeling something you are also not as good at is also important for your child to see. They learn to keep trying even when it may be hard to do.
- Maybe you can take some classes to improve your reading. These are often available free or low-cost at your local schools, community center, churches, and community colleges.
- What about audiobooks or eReaders?
- These also are fine as part of reading regular paper books. Listening to audiobooks can bring different stories to life while traveling in a car for example. You can discuss the book together.
- Using an eReader with your child can also be another way to share books together.
- Special opportunities
- Bookmobile – some communities have books in a van or bus that will move around the community and distribute books.
- Children’s reading programs in parks, recreation centers or other places.
- Summer reading programs – these encourage children, teens and adults to read during the summer time by offering small incentive items for reading activities. For example, children would read 5 books, use their library card, attend a library program and then would receive a free ice cream cone donated by a local business.
- Free Little Library – There are many communities that have “Free Little Libraries” where books are free to take and use. Small houses (like a birdhouse) are placed around the community. People donate books to the little libraries and the books are free to read and share. Click here.
Questions for Further Discussion
1. What other ways can early literacy be promoted in the office setting?
2. What are signs of a language disorder?
3. When should a child be referred for a language or learning disorder?
Related Cases
- Disease: Early Literacy | Child Development | Learning Disorders
- Symptom/Presentation:
Health Maintenance and Disease Prevention
- Specialty: General Pediatrics | School
- Age: Toddler
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Child Development and Learning Disorders.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Brody GH, Gray JC, Yu T, et.al. Protective Prevention Effects on the Association of Poverty With Brain Development. JAMA Pediatr. 2017 Jan 1;171(1):46-52.
Association for Library Service to Children. Available from the Internet at http://www.ala.org/alsc/ (cited 5/22/17).
Reach Out and Read. Available from the Internet at http://www.reachoutandread.org (cited 5/22/17).
Author
Donna M. D”Alessandro, MD
Professor of Pediatrics, University of Iowa
Pediatric Education 