Literacy promotion (LP) is an essential component of primary care. This study explored different LP strategies in 2 cohorts of children aged 6 months to 6 years coming for routine care. In cohort 1 (N = 24), LP consisted mainly of advice. In cohort 2 (C2, N = 21), LP prioritized observing parent-child dyads reading aloud and giving feedback. Parents were interviewed 1 to 2 weeks later. LP took longer in C2 (138 ± 66 seconds vs 73 ± 50, P < .001), and parents were more likely to recall having learned about reading aloud (48% vs 8%, P < .001), even after controlling for time spent. More parents in C2 reported uncertainty about their reading aloud skills (73% vs 22%, P < .002) and a desire to learn more about reading aloud (100% vs 17%, P < .001). Observation and feedback may make LP more memorable to parents and is more likely to motivate parents to improve their skills in this area.