The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported family-centered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive family-centered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.

The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices. It was conducted in an inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents. There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness. Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p<0.05). Physician's rating of parental receptiveness was also higher in the treatment group than in the control group (p<0.05). Two years after enrollment, mother-child pairs who received guidance and a book were two times more likely to report enjoyment in reading together than the controls who received guidance but no book. We conclude that anticipatory guidance that included early literacy development and distribution of books at WCV resulted in increased family literacy orientation, parental receptiveness, and perception of physician helpfulness.

ABSTRACT. Objective. To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning.Design. Survey of mothers of infants 4 months of age from November 1993 to March 1994 with follow-up survey of selected birth hospitals.Setting. A private practice (PP) serving predominantly white middle-and upper-income children and a pediatric clinic (CY) serving inner-city predominantly African-American low-income children in Louisville, Kentucky.Patients. Fifty infants from each practice site. Outcome Measure. The sleep instructions given and practiced, and other risk factors for sudden infant death syndrome (SIDS).Results. Nonprone sleeping instructions were received by 72% of the PP and only 48% of the CY parents, with 72% of the PP and 54% of the CY following the nonprone recommendations. Infants were more likely to be in smoking households (60% vs 12%) from the CY practice than the PP practice.Conclusions. Our study showed that, despite having a higher prevalence of SIDS risk factors, there was a greater delay in discontinuing prone positioning instructions in the hospital serving the CY infants. The evidence suggests that this population is as likely as the PP group to follow medical advice given. Pediatrics 1997;99(5). URL: http://www.pediatrics.org/cgi/content/full/99/5/e12; infant sleep position, SIDS, sleep instruction.ABBREVIATIONS. SIDS, sudden infant death syndrome; AAP, American Academy of Pediatrics; CY, Children and Youth Project; PP, private practice.The sleep position of infants was most often viewed in the past as a trivial aspect of infant care. It has recently received serious attention because of the reported association of the prone sleeping position with sudden infant death syndrome (SIDS). In the United States in the early 1990s, the prone position was most commonly used when placing an infant down for sleep. 1 However, as early as 1985, 2 the prone position has been challenged as "unsafe." In subsequent foreign studies, sleep position was implicated as a risk factor for SIDS. [3][4][5][6][7][8] Publicity that discouraged the prone sleeping position in Australia, the Netherlands, New Zealand, and Great Britain was associated with a decrease in the incidence of SIDS ranging from 20% to Ͼ50%. 4,9 -16 The evidence of these reports was so persuasive that in 1992 the American Academy of Pediatrics (AAP) recommended the use of either the supine or the lateral position for placing healthy infants down to sleep. 1 Two years after such a recommendation, the AAP Task Force on Infant Positioning and SIDS noted that "although pediatricians have heard the recommendations, many children's physicians and allied health care workers are not actively recommending nonprone sleeping for their patients." 17 In addition to the prone position, several studies have reported the association of SIDS with infant hyperthermia, 18 -23 swaddling, 23 and suffocation....