Ohio AAP Brush, Book, Bed: Book (Early Literacy)
CME Disclaimer I have no personal financial relationships in any commercial interest related to this CME. I do not plan to reference off label/unapproved uses of drugs or devices. James Duffee, MD, MPH james.duffee@wright.edu
Learning Objectives • Promote positive oral health routines with patients beginning at 6 months of age • Understand and implement fluoride varnish procedures • Discuss early literacy with families during pediatric well visits and other encounters • Improve knowledge of appropriate sleep habits and advise patients with sleep related concerns
Early Childhood Literacy Reach Out and Read. www.reachoutandreadnyc.org/programs Literacy Promotion: An Essential Component of Primary Care Pediatric Practice https://pediatrics.aappublications.org/content/pediatrics/early/2014/06/19/peds.2014-1384.full.pdf Reach Out and Read. www.reachoutandreadwa.org/programs
Reach Out and Read Model • At every well-child checkup, doctors and nurse practitioners encourage parents to read aloud to their young children and offer age-appropriate tips and encouragement. • Pediatricians, family physicians, and nurse practitioners give every child 6 months through 5 years of age a new, developmentally-appropriate children’s book to keep. • Clinics create literacy-rich waiting room environments, sometimes with volunteer readers, where parents and children learn about the pleasures and techniques of looking at books together. • Parents who may have difficulty reading are encouraged to invent their own stories to go with picture books and spend time naming objects with their children, rhyming, etc.
Reach Out and Read Programs • Implement the Reach Out and Read • Assign a Medical Consultant and a Program model Coordinator • Ensure all pediatric primary care • Provide or raise funds for books, as needed providers are trained in the Reach to fulfill Annual Book Commitment Out and Read model • Complete and submit bi-annual Reach Out • Ensure ongoing Quality Assurance and Read Progress Reports efforts • Maintain regular contact with • Assure that books are in adequate Coalition/Region (where applicable) and supply, organized appropriately, and National Center, as appropriate delivered at the start of the visit • Assist with federal, state, and local advocacy • Establish and maintain literacy-rich efforts by hosting Legislative Site Visits and environment contacting elected
Reach Out and Read Training Competencies GENERAL guidance • Babies love your voice – sing, talk, and read • Choosing an appropriate book aloud as often as possible. • Giving the book at the start of the visit • Babies enjoy sturdy picture books and books • Providing anticipatory guidance to with rhymes. parents/guardians • Name and point to pictures your baby is looking • Using the book as part of developmental at touching or talking to. surveillance • Act out the story or pictures using your face, hands and voice. • Talk about how your baby is enjoying the book.
• 9 to 12-months may point with one finger to indicate interest in a picture; parents should see this as developmental progress • Babies this age can copy some of the sounds you make, the looks on your face, and the gestures you make. Nine to twelve • You’re teaching your baby that sitting on your months lap and being read to feels good and that books are enjoyable. • It’s okay if your child mouths the book! This is how babies explore and learn about their world.
• 12 to 18 months may turn board book pages, and may insist on turning back again and again to a favorite picture • Babies this age can copy your reactions to the book you are enjoying together. • Ask your child questions she can answer by pointing. Twelve to You can say: “ Where’s the doggie?” “Where’s the happy baby?” or “ Who says meow?” This helps your eighteen baby learn the names of things. • Once babies start to walk, holding them on your lap months can be a struggle. Some children will want to move around during a story. That’s OK. • Read stories every day, but let your child help decide how long you read. • When your child grabs the book, she is showing a healthy drive for independence. This is OK!
Early Childhood Literacy: Reach Out and Read • Parents up to four times as likely to read to their children • Parents more likely to spend time with their children • Children improve both receptive and expressive language resulting in a six-month developmental advance over peers • Children scored higher on school readiness assessments Needlman R, Toker KH, Dreyer BP, Mendelsohn AL. Effectiveness of a primary care Mendelsohn AL, Mogilner LN, Dreyer BP, et al. The impact of a clinic-based literacy intervention to support reading aloud: a multicenter evaluation. Ambul Pediatr . intervention on language development in inner-city preschool children. Pediatrics . 2005;5(4):2009–2015; Sharif I, Rieber S, Ozuah PO. Exposure to Reach Out and Read and 2001;107(1):130–134. vocabulary outcomes in inner city preschoolers. J Natl Med Assoc . 2002;94(3):171–177; and Mendelsohn AL, Mogilner LN, Dreyer BP, et al. The impact of a clinic-based literacy intervention on language development in inner-city preschool children. Pediatrics . 2001;107(1):130–134.
• 127 children studied longitudinally • significant effect of early childhood maternal Caregiver support on hippocampal volume growth Support during • growth trajectory is associated with later pre-school and emotion functioning. Hippocampal Luby et al. Preschool is a sensitive period for the influence of maternal support on the trajectory of hippocampal Development development. PNAS. 2016. www.pnas.org/cgi/doi/10.1073/pnas.1601443113
Five R’s of early literacy • Reading together as a daily fun family activity • Rhyming, playing, talking, singing, and cuddling together throughout the day; • Routines and regular times for meals, play, and sleeping, which help children know what they can expect and what is expected from them; • Rewards for everyday successes, particularly for effort COUNCIL ON EARLY toward worthwhile goals such as helping, realizing that CHILDHOOD praise from those closest to a child is a very potent reward; and • Relationships that are reciprocal, nurturing, purposeful, and enduring, which are the foundation of a healthy early brain and child development
Stress, Hippocampal Development and Maternal Buffering • Cohort followed for 20 years, ecologic in-home assessments • Associations between – parental nurturance and memory development – environmental stimulation and language development • Supports concept of maternal buffering of stress hormone effects on hippocampal development • “Memory is particularly vulnerable to life in low SES settings. One of the specific factors affecting memory is parents’ ability to be responsive and supportive under the stressful circumstances of poverty. “ Farah MJ, et al. Environmental stimulation, parental nurturance and cognitive development in humans. (2008) Developmental Science, 11, 793–801. doi: 10.1111/j.1467-7687.2008.00688.x
SES, Cognitive Ability at Kindergarten • 600 children with cognitive assessments at kindergarten entry from the US Early Childhood Longitudinal Birth Cohort Study • SES divided into quintiles • Average reading and math rankings increased from low 30% to approx 70% across quintiles • Correlated with parental interactions, expectations for achievement and school attendance. Larson et al. Cognitive Ability at Kindergarten Entry and Socioeconomic Status. Pediatrics 2015 www.pediatrics.org/cgi/doi/10.1542/peds.2014-0434
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