In 1989, while one of us (B.Z.) was director of the Division of Developmental and Behavioral Pediatrics at Boston City Hospital (now Boston Medical Center) and the other (R.N.) was a fellow, we began thinking about the role of books in the school readiness of vulnerable young children. Four years earlier, the National Institute of Education had dubbed reading aloud "the single most important activity for building the knowledge required for eventual success in reading." 1 But no pediatric textbook mentioned reading aloud, nor did the early editions of Bright Futures.Reach Out and Read (ROR) began with the idea that doctors have a special opportunity to encourage reading aloud in families that are facing the dual challenges of poverty and limited literacy. 2 We recognized the indivisibility of health and education. A recent National Academy of Medicine report highlights the point, showing that the duration of education is a better predictor of health and long life than either cigarette smoking or obesity. 3 Shifting forward 30 years, ROR, supported by more than 6000 clinics and practices and backed up by numerous peer-reviewed studies, 4-19 now reaches ∼25% of low-income children. A policy statement by the American Academy of Pediatrics has identified literacy promotion as an essential component of primary care. 20 And yet, the misconception that ROR is a "book giveaway program" persists, as does the notion that literacy promotion is simply a matter of informing parents about the importance of reading aloud. In this commentary, we aim to correct these errors by grounding the practice of literacy promotion in the science of child development in order to support efficacy and policy.
READING ALOUD VERSUS BOOK SHARINGMany parents, and some professionals, think that reading aloud means a parent pronounces words written in a book while a child quietly listens. That may be true for school-aged children (although active child participation enhances learning at every age), 21 but with infants and toddlers, what we are really talking about is an enjoyable, language-and affect-rich interaction that involves a book and sometimes the words on