One Book, PRN

Thomas Robey -- Do you remember your favorite childhood book? Was it a chapter book that you read on your own? Or the picture book you insisted a parent read to you every night? Perhaps, like me, it was the Si-Sz volume of the 1984 World Book Encyclopedia? If you have fond memories of books, you probably grew up in a book-rich environment. Consider this tidbit: in middle-income neighborhoods, the ratio of books per child is 13 to 1; in low-income neighborhoods, the ratio is 1 age-appropriate book for every 300 children. And it turns out the only behavioral measure correlating significantly with reading scores is the number of books in the home.

What does this all have to do with being a medical student? I learned from an insightful pediatrician that the top five ways to prepare kids for long, productive and meaningful lives are: love them, keep them safe, feed them well, keep them healthy, and teach them to read. You may think that pediatricians focus only on the “keep them healthy” task, but after a couple dozen well-child checks, the third-year student will be able to ask parents about family life, smoke detectors, car seats, diet, and developmental milestones as readily as checking on the immunizations, recent illnesses and vital signs. Is encouraging reading habits on your list? Parents who were not read to as children may not realize the value of reading to their own kids. As a result, children from low-income families enter school at a disadvantage. Adults who were read to as children tend to assume all children are read to. What category do you think most doctors fall into?

Last fall, I had the pleasure of spending half of my pediatrics clerkship at the Odessa Brown Children’s Clinic, an outpatient clinic associated with Seattle’s Children’s Hospital. Apart from the opportunity to learn pediatrics from an enthusiastic team of docs and nurse practitioners, I was privileged to help care for kids from widely varied social, economic and racial backgrounds. I learned first-hand about sickle-cell disease, asthma and juvenile obesity, along with colds, rashes and ear infections. It was the problem of illiteracy that surprised me. When money is tight, books are a luxury. Fortunately kid’s health care isn’t yet a benefit for the rich. Thanks to the State Children’s Health Insurance Program (by the way, the Federal bill that’s the backbone for SCHIP has been vetoed twice this year), most kids from poor families are eligible for free or inexpensive health care. Our society values kids’ health. (Insert toothpaste commercial voice here: “Studies show that ten out of ten pediatricians want their patients to succeed in life.”) This is where health and literacy converge. Why not give a book to every child at every doctor’s visit?

This is not a new idea. A national organization called Reach Out and Read provides funding to give kids who are six months to five years old a new age-appropriate book at every well-child visit. Some clinics raise funds to expand the age range and number of books given per year. Taking kids back to the book pharmacy to select their reward was a favorite part of the patient encounter for me. Thousands of Seattle children have Odessa Brown libraries in their homes where previously there wouldn’t have been a book in sight. By providing books to a population of kids who may not otherwise have exposure to reading, doctors can do as much for kids' futures as giving shots and antibiotics. If you end up in pediatrics, consider prescribing one book, PRN ad lib for all of your patients.

(Federal legislation to help sponsor programs like Reach Out and Read is included in HR 4449 and S 1895. Check out the legislation and let your representatives know if you support it. Special thanks to Hillary Chisholm who directed me to much of the data presented in this post. Statistics collected from studies were presented in the Handbook of Early Literacy Research, Vol. 2, edited by Susan Neuman and David Dickinson.)