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Reach Out and Read: A Life-Changing Idea

Nearly thirty years ago, an idea came to me that changed my life and my profession. I was a young pediatrician working at Boston City Hospital (now Boston Medical Center), training to be a specialist in child development. The idea was that picture books are important in the lives of children, and can be an important part of what pediatricians have to offer. I took the first part of this idea straight from Jim Trelease’s Read-Aloud Handbook, which I’d happened upon while browsing a local bookstore. The second part I discovered for myself, with the help of colleagues and parents.

One day Kathleen MacLean, who was an early childhood educator in our division, sat down in the middle of the pediatric-clinic waiting room with a canvas bag full of picture books. First one brave child — then another, and another — came over to get a closer look. Pretty soon, all the children who could walk were clustered around her, and most of the others were looking at books with their parents. Some parents were reading aloud to babies who couldn’t have been more than a couple of weeks old.

Another time, Kathleen and I handed a board book to a six-month-old who was sitting in her mother’s lap. The baby held the book in one hand, passed it to the other, watched the pages flip open, banged the book, and patted at the pictures for what seemed like a very long time. The mother was thrilled. “She likes books! She really likes them!” Her face held a mixture of emotions, which I imagined included surprise, pride, hope, and resolve. This response, which I was to see over and over, taught me that picture books could be a lightning rod for a powerful force that emanates from parents’ need to nurture their children not only physically, but intellectually and spiritually, too.

With help from our mentor, pediatrician Barry Zuckerman, Kathleen and I wrote the first Reach Out and Read grant, which allowed us to buy books to give to children as part of well-child care. A few weeks into the project, Ben Siegel, one of the senior pediatricians, pulled me aside to tell me that something new was happening in his primary care clinic. “Parents are talking with me about their babies going to school, then college, then becoming lawyers or doctors.” Picture books appeared to be giving these parents the impulse to talk about their hopes for their children not just to live, but to flourish.

These discoveries made my work life exciting enough, but something even richer awaited me at home. I became a father. I remember very clearly the feeling of surprise that I could love anyone as completely and purely as I loved our new baby. Grace was wide awake from day one, and also pretty fussy and not a great sleeper. So from very early on she and I spent many hours reading together. This became our “thing,” one of our favorite everyday activities. Before she was even two, Grace was an expert bargainer: “Just one more story! Just one more!” By the time I stopped reading aloud with Grace, we’d gone through most of C. S. Lewis, E. B. White, Roald Dahl, and many others. Virginia Hamilton’s The People Could Fly was one of Grace’s favorites; mine was Robert McCloskey’s Time of Wonder. The last book we read together in this way, when she was in high school and increasingly busy with her own reading, was The Complete Sherlock Holmes.

The pleasure I experienced reading aloud with Grace illuminated my work in the clinic. I wanted other parents to find the same rich connection with their children through a shared love of stories and pictures. Sometimes this happened, sometimes it didn’t. One mother told me, in a gesture of solidarity and trust, “Well, you know, Dr. Needlman, reading is okay, but what Charné and I really love to do is sing.” Of course! The magic in reading aloud doesn’t come from the books or the stories; it comes from the joy of exploring and experiencing beauty together. Picture books can open a doorway into a magical space, but it’s just one of many possible portals.

When I teach young pediatricians about reading aloud, I explain the process as a developmental pyramid in which each stage rests on the ones before. The ability to enjoy stories sits on a platform of language and vocabulary; which depend on shared attention; which arises from a foundation of emotional connection. The most basic levels — emotional togetherness and language — are what we look for in babies and their parents when we hand them picture books during their early checkups. When these elements are obvious, we celebrate and nurture them; when not, we look for the spark of connection, feed it, and fan the flames. This is a challenge well worth taking on.

It’s been wonderful, over the past nearly three decades, to watch my little idea grow into something large, beautiful, and powerful. Through the efforts of colleagues — including Barry Zuckerman, Perri Klass, Alan Mendelsohn, Pam High, Judy Newman, Tom DeWitt, and so many others — Reach Out and Read has become an award-winning nonprofit and a national and even international movement. In 1991, Barry and I (along with coauthors Lise E. Fried, Debra S. Morley, and Sunday Taylor) published a study showing that low-income parents exposed to Reach Out and Read were substantially more likely to identify reading aloud as a favorite activity. Pam High and others demonstrated improvements in children’s vocabulary, a robust predictor of school success. Others have examined the effects of our intervention in multicultural contexts; in the wake of natural disasters; as reflected in high-tech brain imaging; in the first weeks of life; and even before birth. We’re learning all the time and still have more to discover. Reading aloud isn’t the answer to the great challenges facing parents and children in our demanding and unforgiving world. But it’s surely part of the answer.

Reach Out and Read in Practice

One of the most enjoyable parts of my job is giving out books to children when they arrive for their checkups. I love seeing their faces light up and seeing how proud parents are when they tell me their children love books. I love that I can use the books not just as a distraction technique or a consolation prize for getting shots, but as a tool for assessing fine motor skills, language development, and attachment. I love that as a pediatrician I am promoting not only good health but also literacy, love of reading, an alternative to screen time, and a positive parent-child interaction.

I am able to enjoy this aspect of my job because of the wonderful program Reach Out and Read, which, for nearly thirty years, has provided brand-new books to pediatric offices to encourage literacy in children from ages six months to five years. I am lucky enough to work in one of the practices that have enthusiastically embraced Reach Out and Read since its inception. I practice in a vibrant low-income community where parents often struggle to feed their families and pay the bills and may not have anything left over for luxuries such as books. We provide each child ten books over these early childhood years and also promote reading aloud, attending preschool, and using the library.

Many parents are surprised that their children’s doctor discusses these topics, but I believe that many pay more attention to reading because I have recommended it. My proof is the decades of children who, when I walk into an exam room, ask, “Did you bring me a book?” and the decades of parents who, rolling their eyes but also very proudly, tell me, “He wants to read that book every night!”

—Diana A. Palmer, MD, MPH
Massachusetts General Hospital
Revere (MA) HealthCare Center Pediatrics

From the May/June 2018 issue of The Horn Book Magazine: Special Issue: Making a Difference. For more on Reach Out and Read, see our 2013 interview with Dr. Needlman.

Robert Needlman About Robert Needlman

Dr. Robert Needlman is co-founder of the literacy development program Reach Out and Read. He is a professor of pediatrics at Case Western Reserve Medical School in Cleveland and the coauthor of Dr. Spock’s Baby and Child Care (Ninth Edition). Visit

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