Reading aloud to children: the
E Duursma,1M Augustyn,2B Zuckerman2
Promoting healthy child development lies
at the heart of paediatric practice, yet a
major challenge facing the field is applying
evidence based standards. However, the
evidence is clear as regards reading aloud to
reading aloud to young children promotes
the development of language and other
emergent literacy skills,1–4which in turn
help children prepare for school.3 5
READING ALOUD AND CHILDREN’S
EMERGENT LITERACY AND LANGUAGE
Reading aloud to children or shared book-
reading has been linked to young chil-
dren’s emergent literacy ability, which
can be defined as the skills or knowledge
that children develop before learning the
more conventional skills of reading and
writing6–8which affect children’s later
success in reading.9
During shared bookreading, children
learn to recognise letters, understand that
print represents the spoken word, and
learn how to hold a book, turn the page
and start at the beginning.10–12Shared
bookreading is also associated with learn-
ing print concepts11and exposing children
to the written language register, which is
different from spoken language,13as well
as story structures (eg, stories have a
beginning, middle and end) and literacy
conventions such as syntax and grammar
which are essential for understanding
texts.14These emergent literacy skills are
important for later success in reading.2 15
PHONOLOGICAL AWARENESS AND
Phonological awareness (the ability to
manipulate the sounds of spoken lan-
guage1 16–18) is another important prere-
quisite for learning to read. To read
words, children need to know the rules
for translating print into meaningful
sounds.8 16For example, preschoolers’ sen-
sitivity to alliteration and rhyme at age 4–
5 contributed to progress in reading and
spelling at age 6–7.19Children’s knowl-
edge of nursery rhymes at age 3–4 is
related to detecting alliteration and rhyme
at ages 4–7.20Many parents naturally
promote awareness of sound patterns by
emphasising rhyming words and patterns
when reading to a child.21When children
do well at detecting and manipulating
syllables, rhymes and phonemes, they
tend to learn more quickly to read.15 19 22
Children acquire sensitivity to different
sounds in a specific order, although stages
tend to overlap.23Children can learn about
phonemes or sounds more or less infor-
mally by learning to name letters and by
recognising which phoneme is critical in
the name.24Many alphabet books, for
example, contain the letter name accom-
panied by pictures of objects whose names
begin with the critical sound, such as D,
for example a dog, deer or doctor. When
parents stress the initial sounds in these
words while reading with their children,
they are teaching awareness of initial
phonemes or shared phonemes across
words.24 25Since children who have diffi-
culty with phonological awareness can
might help to prevent these difficulties
by exposing children to a wide variety of
become aware of the relationship between
letters and sounds.
In addition to being aware of sounds,
children also need to recognise the role
that alphabet letters play and that letters
have different sounds. It is easier to learn
these letter–sound relationships once chil-
dren know at least some alphabet letters
and are able to recognise words that start
with the same phoneme.27While shared
bookreading promotes children’s alphabet
knowledge,10most parents focus on the
meaning of the story and not the print.28
Also, while knowing the names of letters
is not itself related to reading ability, it is
knowing the sound of letters (eg, the letter
‘b’ sounds like ‘ba’) that is important.
There are important differences in letter
knowledge between children from middle
class and lower class families. Four-year-old
children from middle class families knew
an average of 54% of the letter names and
5-year-old children knew 85% of the
letters.29However, 4- and 5-year-old chil-
dren from low-income families who enter
programs such as Head Start know on
average four letters and learn an additional
five while enrolled in the program.24 30
Alphabet and counting books for young
children promote greater focus on the
READING ALOUD AND LANGUAGE
Studies demonstrate a relationship be-
tween oral language skills such as vocabu-
lary, syntactic (the way in which ling-
uistic elements such as words are combined
to form sentences) and semantic (focus on
the meaning of words or sentences) pro-
cesses, and narrative discourse processes
such as memory, storytelling and compre-
hension,9and reading ability.31All of these
contribute to word recognition and reading
Children’s oral language skills can be
stimulated by parent–child literacy activ-
itiessuch as shared
Children learn the meaning of new words
their parents.35Reading aloud familiarises
children with the language found in
growth.37 38Books contain many words,
especially the more sophisticated words
that children are unlikely to encounter
Children’s books contain 50% more rare
words than prime-time television or even
college students’ conversations.40Shared
bookreading can stimulate more verbal
interaction between child and parent, and
therefore children’s language development
is likely to profit more from reading aloud
than from toy play or other adult–child
interactions.12 41In addition to new voca-
bulary, children are exposed to the more
complex language adults use interacting
with children around a book.11 42 43
knowledge and understanding of spoken
language tend to have less trouble with
reading.6 31Large social class differences
have been reported in children’s exposure
to oral language and their vocabularies.
Hart and Risley reported that at age 3,
children in professional families heard an
average of 2153 words per hour, while
children in working class families heard
1251 words per hour and children in
welfare families heard only 616 words
per hour.44This led to enormous differ-
ences in children’s vocabularies. At age 3,
1Reach Out and Read National Center, Boston, MA,
USA;2Department of Pediatrics, Boston University
School of Medicine, Boston, MA, USA
Correspondence to: Barry Zuckerman, Department of
Pediatrics, Boston University School of Medicine, One
Boston Medical Center Place, Dowling 3 South, Boston,
MA 02118, USA; firstname.lastname@example.org
554 Arch Dis Child July 2008 Vol 93 No 7
on 23 June 2008
children in professional families had an
observed cumulative vocabulary of 1100
words, while children in working class
families had an observed vocabulary of
750 words and those in welfare families of
just above 500 words. In professional
families, parents not only talked more
but also used more different words and
provided a greater richness of nouns,
modifiers and verbs. Parents spent a lot
of time and effort asking their children
questions, affirming and expanding their
responses and encouraging their children
to listen and notice how words relate and
refer in order to prepare their children for
a culture focusing on ‘‘symbols and
analytic problem solving’’ (see Hart and
Risley,44p 133). On the other hand,
parents on welfare spent less time talking
while they more frequently initiated
topics and used more imperatives and
prohibitions. These parents were more
concerned with established customs such
as obedience, politeness and conformity.
Working-class families showed a mixture
of the two cultures using imperatives and
prohibitives while using rich language to
label, relate and discuss objects.44
Shared bookreading provides children
with opportunities to learn vocabulary
from books as well as the use of decon-
texualised language (the use of language
to communicate new information to
those who have little experience with
the context of the information).45 46Since
this task involves cognitive and linguistic
demands, it tends to be more challenging
The positive effects of
having been read to from an early age
continue to be observable in the elemen-
tary school years.3 12The age at which
parents begin reading to their children is
correlated with children’s language devel-
opment; children who are read to from an
early age tend to have higher scores on
language measures later on.47 48
READING ALOUD AS A SHARED
An added dimension of reading aloud is
that it involves parents and other impor-
tant adults to the child in a focused
interaction. Early parent–child relation-
ships influence children’s engagement in
literacy activities. Mothers with securely
attached children tend to more frequently
provide a rich and interactive way of
reading to their children than mothers of
Children not only acquire knowledge
about narratives but also learn about their
own personal narrative when sharing a
book with an adult, something that is
Bookreading can play an important role
in wake and sleep patterns by making
bookreading part of bedtime routines.
Sharing books with children can also help
them learn about peer relationships, cop-
ing strategies, building self-esteem and
general world knowledge.
Reading aloud likely promotes joint
attention, which has many potential
benefits related to reading,52such as
enhancing receptive language by asking
children to point, touch or show during
bookreading or expressive language by
asking children questions about the text.5
FACTORS INFLUENCING QUANTITY AND
STYLE OF SHARED BOOKREADING
Similar to child health problems, certain
‘‘risk’’ factors such as socioeconomic
status, race/ethnicity and parental educa-
tion can affect children’s development of
emergent literacy and oral language skills.
Statistics (NCES), for example, found
that children in families with incomes
below the poverty threshold are less likely
to show signs of emergent literacy skills
such as pretending to read and write.53A
total of 28% of children aged 3–5 years
who were not living in poverty were able
to recognise all the letters of the alphabet,
while only 10% of children living in
poverty were able to do so. In addition,
45% of children not living in poverty
showed three or more signs of emerging
literacy, while only 19% of children living
in poverty did so.53
Associated with these lower levels of
emergent literacy skills is less exposure to
bookreading and print. Children from low-
income families often participate less fre-
quently in shared bookreading than chil-
dren from higher socioeconomic groups.54 55
on Child and Family Statistics, 64% of
families whose incomes were at or above
the poverty level read to their preschoolers
below the poverty level.56
Children in low-income families often
have less access to printed materials in the
home,54which likely impairs children’s
early language and literacy development
and later reading achievement.48The 2007
Nation’s Report Card on reading showed
that children from low-income families
had lower reading scores in grade 4 and
grade 8 than their peers from middle class
families.57When children are poor readers
at the end of first grade the probability
that they will remain poor readers by the
end of fourth grade has been reported to
be as high as 0.88.58
The National Research Council’s
Committee on the Prevention of Reading
Difficulties in Young Children stated that
most reading difficulties can be prevented
by ensuring that all children, in particular
those at risk for reading difficulties, have
access to early childhood environments
that promote language and literacy devel-
opment and encourage those skills needed
to learn to read.3It is essential to start
promoting those skills needed to prepare
for school early on by, for example, having
parents read to their children.3
Low-income parents often have lower
levels of education. The link between
maternal education and frequency of
shared bookreading is well documented.
Mothers with higher levels of education
are more likely to read frequently to their
children than mothers with lower levels
of education.59 60In addition to social
economic status (SES) which is based on
family income, education and occupation,
other factors such as race/ethnicity and
language spoken at home play a role in
parental bookreading practices. Hispanic
non-English speaking mothers are less
likely to read to their children compared
to white, African-American or Hispanic
English-speaking mothers.61 62
QUALITY OR STYLE OF SHARED
It is important for parents to keep
children’s personal interests and motives
in mind when trying to get children
interested in books.63 64When children’s
encounters with literacy are pleasant,
they are more likely to develop a positive
disposition towards reading frequently
and broadly.63Children who experience
shared reading from an early age tend to
be more interested in reading at age 4 and
5 than children who receive shared book-
reading when they are older.63
It is not only the reading itself that is
and children have during shared bookread-
ing, as well as the emotional quality of the
interactions and the discussions related to
print are even more important.65It is not
to encourage children to learn from being
read to. When parents are supportive when
interacting with their children around
The style of reading, more than the
frequency, impacts children’s early lan-
guage and literacy development.67White
middle class parents tend to use a more
interactive style when reading to their
children. Working class non-white par-
ents, on the other hand, tend to focus
Arch Dis Child July 2008 Vol 93 No 7555
on 23 June 2008
more on labelling and describing pictures
during bookreading.68 69These differences
in reading styles can impact children’s
development of language and literacy-
Two parental styles of reading were
identified as having beneficial effects on
child vocabulary and print skills: the
oriented style. A describer style focuses on
describing the pictures during reading and a
performance-oriented style focuses on dis-
cussing the meaning of the story after
completion.70Children with initial lower
levels of vocabulary profited more from the
describer style, while children with higher
initial vocabulary levels profited most from
the performance-oriented style.70
Whitehurst et al developed an interven-
tion program called dialogic reading to
ment.38 71Adults are taught specific tech-
niques that can be used during shared
bookreading. These techniques focus on
asking questions, providing feedback and
letting the child become the narrator of
the story.38 71Children whose parents
received training in dialogic reading had
significantly better expressive language
skills, used longer and more utterances,
and had lower frequency of single words
than children whose parents did not use
9 months after the training.38
One of the most powerful pieces of
shared reading is what happens in the
pauses between pages and after the book
is closed. The use of ‘‘decontextualised’’ or
non-immediate talk and active engage-
ment has proven to be particularly bene-
ficial for children’s
enhancement.70 72–74Non-immediate talk
is talk that goes beyond the information
in the text or the illustrations, for
example, to make connections to the
child’s past experiences or to the real
world (eg, ‘‘you like ice cream’’), or to
offer explanations (eg, ‘‘he cried because
he was sad’’), including explanations of
word meanings (eg, ‘‘a piglet is a baby
pig’’). Mothers’ use of non-immediate talk
while reading to their preschoolers was
related to children’s later performance on
measures of vocabulary, story comprehen-
sion, definitions and emergent literacy.73
Engaging in book discussions that include
non-immediate talk gives children the
opportunity to understand and use the
more sophisticated words required to
make predictions, to describe the internal
states of the characters and to evaluate
the story.73It also provides the opportu-
nity for children to learn to talk about
their own feelings. Children’s early lan-
guage and literacy development benefits
more from actively engaging the child
during shared bookreading than by simply
reading the text.70 75
A CHALLENGE FOR PAEDIATRIC
What are the implications of the impor-
tance of parents reading aloud to their
children’s development for child health
clinicians? ‘‘Reach Out and Read (ROR)’’,
founded at Boston City Hospital in 1989,
promotes early childhood development by
promoting reading aloud. In response to
reading to their children, ROR was created
to involve child health clinicians by having
to parents about the importance of reading
aloud as part of well child care. In an early
study among inner city parents receiving
ROR, researchers found that parents who
had been given a children’s book during a
previous visit were four times more likely
to report looking at books with their
children or that looking at books was a
favourite activity.76Among Spanish-speak-
ing immigrant families, those who had
been exposed to ROR reported a doubling
in the rate of frequent book sharing,
defined as reading aloud 3 or more days
per week.77In the largest study to date of
this program, in a national sample (multi-
site evidence from 19 clinical sites in 10
states) of parents of children age 6–
72 months, implementation of ROR pro-
grams was associated with increased par-
ental support for reading aloud.78Most
importantly, two studies show increased
language development.79 80
Health practitioners who do not have
access to ROR can help families by asking
them about bookreading in the family, and
of sharing a book with their child. In
addition, they can demonstrate ways of
reading that are particularly beneficial to
young children (eg, connecting the book
with thechild’s world,making predictions).
Reading aloud to young children, particu-
larly in an engaging manner, promotes
emergent literacy and language develop-
between child and parent. In addition it
can promote a love for reading which is
even more important than improving
specific literacy skills.81When parents
hold positive attitudes towards reading,
they are more likely to create opportu-
nities for their children that promote
positive attitudes towards literacy82and
they can help children develop solid
language and literacy skills. When parents
share books with children, they also can
promote children’s understanding of the
world, their social skills and their ability
to learning coping strategies. When this
message is supported by child health
professionals during well child care and
parents are given the tool, in this case a
book, to be successful, the impact can be
even greater. This effect may be more
important among high risk children in
low income families, who have parents
with little education, belong to a minority
group and do not speak English since they
are less likely to be exposed to frequent
and interactive shared reading.
Competing interests: All authors are paid consultants
to Reach Out and Read.
Accepted 25 February 2008
Published Online First 13 May 2008
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