Highlights
- •Describe the role of pediatric providers in literacy and promotion of Language Nutrition.
- •Understand the influence of Language Nutrition on a child's future education and health outcomes.
- •Develop skills to teach parents why and how to engage in language-rich interactions and to provide Language Nutrition to their children.
Abstract
Language Nutrition, a term created to describe language exposure that is rich in quality and quantity and delivered in the context of social interactions, is crucial for a child's development and is strongly associated with his/her future literacy, academic achievement, and health. However, significant differences in children's early language environments contribute to disparities in their educational and health trajectories. Interventions, including book distribution programs, coaching parents to enrich their child's language environment, and public awareness campaigns, have all been shown to positively influence a child's access to language-rich interactions. Incorporating Language Nutrition coaching and literacy promotion into pediatrics is a promising platform for building the capacity of parents to provide language exposure to their children. By teaching parents both how and why to treat their child as a conversational partner and by modeling such interactions, pediatric health care providers can help parents set their children on a pathway toward literacy, educational success, and health.
Key Words
Objectives
- 1.Describe the role of pediatric providers in literacy and promotion of Language Nutrition.
- 2.Understand the influence of Language Nutrition on a childs future education and health outcomes.
- 3.Develop skills to teach parents why and how to engage in language-rich interactions and to provide Language Nutrition to their children.
Shonkoff and Phillips, 2000
). Language enables a child to communicate and interact with others, which encourages both social and cognitive development and is a prerequisite of school readiness and literacy (Dickinson and Porche, 2011
, Forget-Dubois et al., 2009
, Hart and Risley, 1995
, Rowe et al., 2012
, Weisleder and Fernald, 2013
). Neural networks for language acquisition are fully formed before birth; babies are able to perceive and react to sound as early as at 24 weeks gestation and begin to learn language in utero by 35 weeks gestation, suggesting that newborn infants' brains are primed to learn language (Kisilevsky et al., 2009
, Perani et al., 2011
). In fact, growth in synapses responsible for language learning peaks at 6 months of age (Shonkoff and Phillips, 2000
). This synaptic growth is influenced by auditory stimuli in the child's early language environment (Hoff and Naigles, 2002
, Shonkoff and Phillips, 2000
). Given this robust neuroplasticity, early childhood is a time of both significant vulnerability and immense opportunity for establishing the foundational neural circuitry necessary for higher learning (Shonkoff and Phillips, 2000
).Language Nutrition
Early exposure to language-rich interactions between adults and children forms the basis of Language Nutrition, a term created to describe the use of language sufficiently rich in engagement, quality, quantity, and context that it nourishes the child neurologically, socially, and linguistically (
Head Zauche et al., 2016
, Weldon, 2014
). Just as a child needs an adequate amount of nutritious food for physical growth, so too does a child need language for his or her brain development (Weldon, 2014
). Evidence indicates that both the quantity and quality of words spoken to a child in the first 3 years of life predict a child's language and emerging literacy skills more strongly than socioeconomic status, parent level of education, and race/ethnicity (Dickinson and Porche, 2011
, Hart and Risley, 1995
, Hoff, 2003
, Hoff, 2013
, Hurtado et al., 2008
, Huttenlocher et al., 2010
, Rowe, 2012
, Weisleder and Fernald, 2013
). A higher number of words spoken to a child contributes to increased vocabulary development, enhanced language and speech processing, and improved literacy outcomes (Hoff and Naigles, 2002
, Hurtado et al., 2008
, Huttenlocher et al., 1991
, Weisleder and Fernald, 2013
, Zimmerman et al., 2009
). Remarkably, the quantity of words spoken to a child has been shown to mediate the relationship between social risk factors, such as low socioeconomic status and low levels of parent education, and language outcomes (Burchinal et al., 2008
).Greater reciprocity in speech, or conversational turns, also promotes language outcomes and may even be more influential than the quantity of words (
Ambrose et al., 2014
, Kuhl, 2007
, Zimmerman et al., 2009
). A conversational turn is defined as back-and-forth communication, or adult speech followed by a child's vocalization within 5 seconds or vice versa. Conversational turns invite children into the conversation regardless of whether they are able to communicate verbally or through nonverbal signals and provide children with the opportunity to build their communication skills in the context of an engaged social relationship (Kuhl, 2007
, Zimmerman et al., 2009
). The importance of social engagement through conversational turns is highlighted by studies showing that media exposure and overheard speech not directed toward the child offer no support for a child's early lexical development (Ambrose et al., 2014
, Christakis et al., 2009
, Mendelsohn et al., 2010
, Weisleder and Fernald, 2013
). This research suggests that the words a child hears need to be directed at the child for them to have developmental benefits. As a result, language-rich interactions with an engaged caregiver provide children with an environment that is conducive to language learning.There are a number of programs across the United States that have begun to incorporate Language Nutrition as a concept into pediatric health care. Language Nutrition coaching can be executed in different programs, by different pediatric providers, and in a variety of settings with the same goal of improving rich parent/adult–child interaction.
Thirty Million–Word Gap
Variations in the language environments of young children have been well documented (
Greenwood et al., 2011
, Hart and Risley, 1995
, Hoff, 2003
). Socioeconomic status has been shown to be a key determinant of the language input parents provide for their children (Hart and Risley, 1995
, Hoff, 2003
, Hoff, 2013
, Rowe, 2008
). Although all families communicate with their children, children who live in low-income families generally are more likely to hear shorter sentences and phrases and are less likely to hear words of encouragement and prompts that encourage the child's participation in the conversation (Fernald et al., 2013
, Hart and Risley, 1995
, Hoff, 2003
). In addition to the quality of the language input, the quantity of words spoken to a child has substantial differences across socioeconomic groups (Fernald et al., 2013
, Hart and Risley, 1995
, Hoff, 2003
). In a renowned study by Hart and Risley, children growing up in low-income families were found to hear 600 words per hour, whereas children growing up in middle- to high-income families heard 2,000 words per hour (Hart and Risley, 1995
). Over the course of the first 3 years of life, this accumulates into a thirty million–word gap between children of low socioeconomic status and those of higher socioeconomic status (Hart and Risley, 1995
). Inequalities in language and cognitive development by socioeconomic status are present as early as 9 months old, and gaps in vocabulary skills rapidly widen throughout early childhood (Fernald et al., 2013
, Halle et al., 2009
). As a result, low-income children arrive in kindergarten with exposure to only about one third of the words heard by their more affluent peers. This disparity in language exposure contributes to gaps in vocabulary, school readiness, and long-term academic achievement. It is important to note, however, that socioeconomic status does not by itself create these disparities, but rather differences in average language exposure between socioeconomic groups.Third Grade Literacy
The word gap and disparities in early vocabulary have significant implications for a child's future literacy and educational trajectory. A child's vocabulary at the age of 3 years has been found to be the single strongest predictor of a child's ability to read proficiently by third grade (
Dickinson and Porche, 2011
, Hart and Risley, 1995
, The Campaign for Grade Level Reading, 2014
). Third grade marks a time when children are expected to shift from “learning to read” to “reading to learn” (Fiester and Smith, 2010
, The Campaign for Grade Level Reading, 2014
). Eighty-five percent or more of the fourth grade curriculum in the United States is delivered through textbooks, smart boards, computers, and worksheets (Fielding et al., 2007
). As concepts in all subject areas start to increase in complexity, their verbal descriptions become more complex and are not comprehensible to children who are not able to read proficiently (Fielding et al., 2007
, Fiester and Smith, 2010
). As a result, children who are not able to read on grade level by the end of third grade fall further behind in school (U.S. Department of Education, 1999
, Fiester and Smith, 2010
, The Campaign for Grade Level Reading, 2014
). In 2015, 64% of fourth graders in the United States did not meet the standards for proficient grade-level reading (National Center for Education Statistics, 2015
). This low literacy rate has enormous educational, health, and economic implications, not only for the individual children but also for the nation (Fiester and Smith, 2010
, National Center for Health Statistics, 2012
, Robert Wood Johnson Foundation, 2009
, Sum et al., 2009
).This progressing gap in academic achievement between children who can read and children who cannot read at grade level by the end of third grade is highlighted through a disparity in educational attainment for these children. Children who meet the standards for third grade literacy are 4 times more likely to reach high school graduation than those who are not as literate (
Fernandez, 2012
, Fiester and Smith, 2010
, The Campaign for Grade Level Reading, 2014
).Relationship Between Education and Health
Better education leads to healthier lives. Research points to significant associations between educational attainment and individual health outcomes (
Fiester and Smith, 2010
, National Center for Health Statistics, 2012
). High school graduates have a higher life expectancy and are less likely to engage in risky behaviors, have a chronic disease, receive welfare assistance, or be unemployed, victims of violence, perpetrators of crimes, or incarcerated (Fiester and Smith, 2010
, Robert Wood Johnson Foundation, 2009
, National Center for Health Statistics, 2012
, Sum et al., 2009
). They also are more likely to engage in health-promoting activities such as exercise, follow screening guidelines, and be compliant with medication use (Fiester and Smith, 2010
, Robert Wood Johnson Foundation, 2009
, National Center for Health Statistics, 2012
, Sum et al., 2009
). Promoting literacy has been identified not only as an education priority but also a public health imperative by government and public health officials at both the national and state levels (Johnson and Shelton, 2014
, Kanne, 2014
, Office of the Governor, 2015
, U.S. Department of Education, 1999
).Purpose
The importance of talking to babies, reading to young children, and using everyday words as opportunities to enhance early language learning has been gaining national prominence. Although all families communicate and interact with their babies, there is substantial variation in children's early language environments. Parent knowledge of child development and the importance of language exposure greatly affects the quality of a child's language environment and opportunities for learning (
Rowe, 2008
). Parents of infants and young children are uniquely poised to be their child's first and best teachers given the time they spend with their child and the influence of parenting on a child's health and development. Therefore, parents are key targets for education and skill building around language.The purpose of this article is to review key components of language-rich interactions and examine existing or previously developed interventions that focus on improving the language and literacy skills of 0- to 3-year-old children. This two-fold purpose will lead to a discussion of how pediatric health care providers can integrate Language Nutrition coaching into their daily practice to help support families in optimizing their child's future health and educational trajectory.
Review of the Literature
PubMed and Web of Science were searched for peer-reviewed studies published between 1990 and 2015 in the English language using the key terms parent or caregiver, infant or child, intervention, talk or read, and language or literacy. Studies were selected if they discussed or evaluated parent-based interventions for improving the language or literacy of 0- to 3-year-children. A total of 57 articles met search criteria.
The Basis of Language Nutrition
Quantity of Words
Many studies have documented the effects of the quantity of child-directed speech on a child's cognitive, language, and academic outcomes (
Head Zauche et al., 2016
, Hurtado et al., 2008
, Rowe, 2008
, Rowe, 2012
, Weisleder and Fernald, 2013
, Zimmerman et al., 2009
). Research has shown that the quantity of speech directed at children even as young as 32 weeks' corrected gestational age has resulted in neurocognitive benefits (Caskey et al., 2014
). Greater quantity of speech directed at a young child may result in improved language and academic outcomes by providing children with more opportunities to interpret language and be exposed to a greater variety of grammatical combinations and diversity of words and may help children develop skills necessary to learn language, such as word segmentation and language processing.Words can be delivered in a variety of different ways in multiple different contexts. Parents and caregivers can narrate their daily activities, point out various objects in their environment, ask their baby questions about how he/she is feeling, and share books, nursery rhymes, and songs. All of these activities are ways in which parents or caregivers increase the quantity of words in their child's early language environment and thus enrich their learning potential (
Glascoe and Leew, 2010
, Rodriguez et al., 2009
, Topping et al., 2013
).Power of Interactions
Social relationships drive the need for an understanding of language and is an essential component of language learning. Language is the basis by which individuals are able to communicate with others and thus, language learning does not occur passively. Extensive research has shown the profound influence of social engagement for an infant's language development, and theories of social learning have emphasized the importance of social interaction for language learning (
Brofenbrenner, 2005
, Kuhl, 2007
, Tomasello, 2003
, Vygotsky, 1978
). Children who establish greater joint attention and follow the gaze of an adult develop a larger and more complex vocabulary in the first year of life than children who do not track eye movements (Brooks and Meltzoff, 2008
). It is possible that contingent and reciprocal social behaviors, such as establishing joint attention, provides additional information to infants that help to scaffold their language development, including the provision of additional cues for communication intentions. Additionally, social interactions may help facilitate language learning through increased attention to the language being delivered; infant attention has been shown to be greater with a live person than a person via television or recordings (Kuhl et al., 2003
).There are no scientific data to suggest that television, educational videos, or music recordings have the same positive, measurable impact on early childhood brain development as language from an interaction between an adult and child (
Weisleder and Fernald, 2013
). Infants have been found to learn language from adults in the context of an engaged adult–child interaction but not when the same information was delivered via a television (Conboy et al., 2015
). Although certain educational toys, recordings, and videos may provide learning enrichment for preschool-aged children, there are no data to support the claim that these educational materials have beneficial effects on infants and toddlers. In fact, evidence suggests the contrary, in that media may actually adversely affect the language development of infants and toddlers by limiting opportunities for parental language input and child speech (Christakis et al., 2009
, Zimmerman et al., 2009
). Thus, the back-and-forth communication exchanges between adult and baby is an essential component of language and brain development.Parentese
Parentese, or infant-directed speech, is a style of communication that is used across various cultures and languages to talk with infants and young children (
Grieser and Kuhl, 1988
). It uses actual words and sentences as opposed to “baby talk,” which simply mimics the sounds made by babies. It is characterized by varied intonation and prosody, elongated vowel and consonant sounds, repetition, and exaggerated gestures and facial expressions (Grieser and Kuhl, 1988
).Research has shown that parentese helps facilitate language acquisition (
Saint-Georges et al., 2013
, Song et al., 2010
). Slow speech and vowel hyperarticulation may help a young child pick out words from sentences, and varying pitch at the ends of sentences may provide clues as to the boundaries of sentences and words (Saint-Georges et al., 2013
, Song et al., 2010
). Parentese may facilitate quicker word segmentation and thus contribute to faster speech processing (Saint-Georges et al., 2013
). In addition, parentese is associated with positive affect, praise, playing, teaching, and comforting a child, and thus may influence language acquisition through a social mechanism (Saint-Georges et al., 2013
).Home Language
Home language refers to an individual's first language, or the language in which an individual is most fluent in. A growing number of children in the United States live in homes where a language other than English is spoken (
National Center for Education Statistics, 2016
). Language exposure is most beneficial in the language the parent or caregiver is most comfortable speaking. Speaking in a nonfluent language generally leads to simpler and grammatically incorrect phrases and thus, the amount of language the child hears is significantly reduced (Paradis et al., 2011
). Learning one language well lays a foundation for learning another language (Espinosa, 2014
). An extensive body of research has highlighted the many benefits of learning more than one language, including executive function and academic achievement, and no scientific evidence indicates that learning two languages significantly delays a child's acquisition of the second language (Bialystok, 2001
, Espinosa, 2014
, Head et al., 2015
). By reinforcing the primacy of the home language, children will be exposed to more complex ideas, abstract thoughts, expanded vocabulary, which are all crucial for children to development important cognitive and language skills necessary for educational success (Paradis et al., 2011
).Interventions
Efforts to promote early language exposure and improve children's language development have focused on training parents to read, talk, and interact more frequently with their child in a way that maximizes the developmental benefits of these shared experiences. Previously developed or existing interventions generally fell into at least one of five categories: (a) a book distribution program with anticipatory guidance for shared-book reading, (b) teaching dialogic reading techniques, (c) coaching parents to talk more with their child, (d) training parents to be responsive to their child's focus of attention and communication initiations, or (e) public awareness campaigns. Such programs are appropriate for enhancing literacy and language development, because evidence suggests that aspects of parent–child interactions associated with a child's language development include (a) amount of parent-child interaction, (b) amount and quality of linguistic input, (c) responsiveness of child's communication, and (d) the use of language-learning support strategies, such as book-reading (
Hart and Risley, 1995
, Roberts and Kaiser, 2011
, Rowe, 2012
, Weisleder and Fernald, 2013
, Zimmerman et al., 2009
). Most articles reported positive changes in parental behaviors, including frequency of shared book-reading and parent–child interactions, greater attention to child's communication, and encouragement of the child's participation in conversations and book reading (Glanemann et al., 2013
, Girolametto et al., 1994
, Knoche et al., 2010
, Landry et al., 2008
, Roberts and Kaiser, 2012
). These changes were accompanied by improvements in children's receptive or expressive language skills (Arnold et al., 1994
, Landry et al., 2012
, Mendelsohn et al., 2005
, Sheridan et al., 2011
, Tannock et al., 1992
, Whaley et al., 2011
). Furthermore, knowledge about child development increased as a result of these interventions (Suskind et al., 2016
). A few interventions that have a strong evidence base or are implemented through pediatric providers are highlighted in this article as exemplars. A more complete list and description of these interventions can be found in the Table.TableIntervention descriptions
| Intervention | Description |
|---|---|
| Dialogic Reading | Trains parents to use interactive reading techniques during book reading that follow the child's interest and invites the child to participate in story-telling by
|
| Enhanced Milieu Teaching | Facilitates children's language use in everyday contexts by following a teach–model–coach review approach consisting of 28 1-hour sessions with the parent and child. |
| Getting Ready | Early childhood professionals in the Head Start program promote parent–child interaction and language-developing behavior during home visits by
|
| Muenster Parent Program | Delivers information to parents through lectures, video demonstration, and feedback from trainers during six group sessions and two individual sessions, which build skills to
|
| Pequeños y Valiosos | National public action campaign targeted for the Hispanic population that encourages talking, reading, and singing to young children through radio and network programming and social media http://www.univisioncontigo.com/en/education/early-childhood/ |
| Play and Learning Strategy | Over a series of 10 visits, using video demonstrations and by videotaping the mother interacting with her child and providing feedback, mothers are coached to
|
| Providence Talks | Initiative in Providence, RI that involves having families with children younger than 2 years conduct home recordings using LENA technology and receive coaching and feedback on collected data biweekly by a home visitor. www.providencetalks.org |
| Reach Out and Read | Incorporates literacy promotion into pediatric primary care well checks for children 6 through 60 months old by
|
| Talk With Me Baby | Statewide initiative in Georgia to integrate coaching about language-rich interactions as a core competency of nurses and WIC nutritionists www.talkwithmebaby.org |
| Thirty Million Words Initiative | Delivers eight educational computer-based modules through 1-hour home visits with a trained coach, strengthening the ability of parent language to build a child's brain and narrow the achievement gap. Parent–child interactions are recorded during home visits for feedback purposes. Additionally, LENA technology is used by the coach to provide feedback, allowing parents to set goals and recognize progress. www.thirtymillionwords.org |
| Too Small to Fail: Talking is Teaching | Public awareness campaign that
|
| Video Interaction Project | Incorporates one-on-one sessions with a child development specialist into low-income pediatric primary care visits for children 2 weeks through 36 months in which
|
Note. LENA, Language Environmental Analysis; WIC, Women, Infants, and Children.
Factors that have contributed to the successful implementation and dissemination of interventions include the simplicity of the messaging; well-defined and straightforward mission and tasks; the support of the intervention within the pediatric profession; communicating about the intervention though published articles, media, continuing education courses; and the generation of data showing its effectiveness.
All of the interventions discussed here use the concept of Language Nutrition. The goal for all of the programs is to enrich the language interactions that young children have with their caregivers. All of the programs reach their goals through Language Nutrition in various settings and with different pediatric providers and educators reaching the families. Although there are multiple ways in which parent-based interventions can be designed and delivered to parents, incorporating literacy and language promotion into pediatric primary health care represents a promising platform for the delivery of parent-based interventions for young children.
Pequeños y Valiosos (Young and Valuable)
Pequeños y Valiosos is a national public action campaign that aims to help optimize learning in everyday moments for Hispanic children under the age of 5 years by targeting parents/caregivers and broader Hispanic community (
Univision Communications, 2016
). Through a partnership with Univision, the leading media company serving the Hispanic population, and Too Small to Fail, a public awareness and action initiative of the Clinton Foundation that mobilizes communities to improve the health and well-being of young children, Pequeños y Valiosos delivers information to the Hispanic population across Univision platforms, radio and network programming, social media, and local community outreach to encourage talking, reading, and singing to children (Univision Communications, 2016
).Reach Out and Read
Reach Out and Read is a program that was started in 1989 to address low literacy skills by incorporating literacy promotion in pediatric primary care well-child visits for children 6 through 60 months old (
Needlman et al., 1991
). Reach Out and Read includes the following three components, which are each aimed at supporting and encouraging shared reading between parents and young children: pediatric health care providers (a) provide anticipatory guidance to parents about shared reading and (b) distribute a culturally and developmentally appropriate book to the child at each well-child visit; (c) volunteers in waiting rooms of primary care clinics model reading with children and/or books are available for children to read in the waiting rooms (Needlman et al., 1991
, Zuckerman and Khandekar, 2010
).Reach Out and Read has developed into a nationwide early literacy intervention. With endorsements by the American Academy of Pediatrics, Reach Out and Read has been adopted by over 5,000 hospitals and health clinics throughout the United States, reaching 32% of children below the poverty level, and has been adapted in over a dozen countries (
Zuckerman and Khandekar, 2010
). The success of this intervention is rooted in its simplicity and in support and dissemination at a grass-roots level through physician champions (Zuckerman, 2009
).Increased frequency of shared reading and improvements in child language development have been documented by studies evaluating Reach Out and Read (
Needlman et al., 2005
; Zuckerman and Khandekar, 2010
). The anticipatory guidance component of Reach and Read was associated with the greatest increase in shared reading, which highlights the importance and influence of the education provided by health care providers on parental behavior concerning literacy-promoting activities (Sharif et al., 2002
).Several other book distribution programs modeled on Reach Out and Read have been developed and successfully implemented in health care settings, such as the neonatal intensive care unit; at discharge from the well-baby nursery; and in the Women, Infants, and Children clinics (
Lariviere and Rennick, 2011
, Moore and Wade, 2003
, Veldhuijzen van Zanten et al., 2012
, Whaley et al., 2011
).Talk With Me Baby
Talk With Me Baby (TWMB) is a statewide initiative in Georgia to dramatically transform the understanding, will, and skill of all parents and caregivers to become conversational partners with their babies and children (). This cross-sector coalition is integrating coaching about language-rich interactions as a core competency of two key large-scale workforces of trusted professionals that already serve most parents and babies—nurses and Women, Infants, and Children clinic nutritionists, who see 99% and 50% of all new and expectant parents in Georgia, respectively. TWMB has created a continuing education program to teach nurses how to coach parents on the provision of language-rich interactions and to encourage nurses to model language-rich interactions in their own interactions with infants and children (). TWMB has also developed resources for parents to use to encourage conversations with their young child, including a smartphone app called “Let's Talk!” and videos showing how parents can incorporate talking and interacting with their baby into their daily life. TWMB has partnered with Scholastic to produce books for children that emphasize the importance of language-rich interactions for a young child's literacy and language development. Currently, evaluation studies are being conducted to evaluate the efficacy of this initiative in both outpatient and inpatient settings.
Thirty Million Words Initiative
The Thirty Million Words (TMW) Initiative is a program designed to strengthen the ability of parent language to build a child's brain and narrow the achievement gap. This initiative is delivered at the individual, community, and population level through individual coaching, social media, and a public awareness campaign in Chicago, Illinois.
The TMW project involves eight educational, computer-based modules delivered by a trained coach for 1 hour at weekly home visits (
Suskind et al., 2016
). These educational modules emphasize using language-enhancing strategies with daily activities and everyday contexts and provide information about child language development (Suskind et al., 2016
). A simple message, called the “3 T's”, is emphasized to parents: “talk more, tune in, and take turns” (Suskind et al., 2016
). At the home visit, videos of the parent interacting with the child are recorded to enable the coach to review the interaction with and provide feedback to the parent (Suskind et al., 2016
). In addition, the coach uses Language Environmental Analysis digital language processors, which act as “word pedometers,” in which the number of words, conversational turns, and child vocalizations in a child's language environment are recorded (Gilkerson and Richards, 2009
). Parents receive feedback about each of the recordings by looking at reports generated by Language Environmental Analysis, which offers a mechanism for parents to set goals and recognize their progress and instills a sense of competency in facilitating their child's development (Suskind et al., 2016
).A randomized controlled trial of TMW showed that parental knowledge about language learning and predictors of school success dramatically improved after the intervention and was sustained 4 months after the study (
Suskind et al., 2016
). The intervention also resulted in an increase in adult word count, conversational turns, and child vocalizations (Suskind et al., 2016
).Implications for Practice
The American Academy of Pediatrics issued its first policy statement addressing early child literacy in 2014, which established early literacy promotion, beginning in infancy, as an essential component of pediatric practice (
High and Klass, 2014
). This policy recommends that pediatric health providers receive training about literacy promotion and that they provide anticipatory guidance about early literacy promotion and how parents can provide opportunities for their child to learn (High and Klass, 2014
).The workforce of pediatric nurses and nurse practitioners is well positioned to build the capacity of parents to interact with their infants and young children in a way that promotes language learning, given many scheduled touchpoints: the frequency and near universality of these visits allow for an intervention, or educational and health messages, to be delivered and reinforced on a regular basis by capitalizing on an already existing infrastructure. Pediatric nurses and providers are uniquely qualified to deliver messages regarding the importance of shared book reading, talking with a child, and engaging social parent–child interactions given that part of pediatric well-child visits includes assessment of developmental milestones, as well as parent education and anticipatory guidance on health and development.
Pediatric health care providers can incorporate language promotion practices into everyday tasks in early childhood checkups, sick visits, or hospital stays. Coaching should include both the “why” and the “how” to engage in language-rich interactions and the demonstration of such an interaction. Strategies such as motivational interviewing and the teach-back method can help providers assess parents' understanding and will to engage in language-rich interactions with their child.
Teaching “Why”
As part of anticipatory guidance at well-child visits, pediatric health care providers discuss development and developmental expectations and assess whether the young child is meeting their developmental milestones. The American Academy of Pediatrics recommends that providers ask about shared book reading and television exposure, which could be a way to lead into discussing Language Nutrition (
Hagan et al., 2008
).As mentioned, all parents and caregivers interact and communicate with their infant or young child, but disparities exist in the amount and quality of these interactions. Merely asking parents or caregivers whether they read or talk with their baby and saying that it is important that they do so will not convey the importance of Language Nutrition for their baby's future health and academic success. Research has shown that when parents understand the implications of their actions and understand child development, their behavior changes (
Suskind et al., 2016
). Examples of messages to tell parents “why” can be found in Box 1.Box 1
Teaching why
- •You have the ability to be your baby's first and best teacher simply by talking and interacting with him or her.
- •Talking with your baby builds your baby's brain.
- •Even if your baby is not able to talk yet, your baby is actively learning the words you speak.
- •Your baby is able to recognize your voice and is capable of learning language even before birth.
- •It is easier for your baby to learn at an early age because the brain is growing more rapidly in the first 3 years of life than at any other time.
- •The more words you speak to your baby, the more words he or she will know, which will help him or her do better in school.
- •Doing better in school leads to better health, a higher chance of graduating from high school/college, and a lower chance of imprisonment.
- •Talking with your baby is a great way to build an emotional bond.
- •By talking with your baby, you are teaching your baby how to engage socially with other people.
- •The single strongest action you can take to increase your child's educational opportunities is to talk with your baby.
Teaching “How”
In addition to understanding the importance of Language Nutrition for a child's health and educational trajectory, families need to be equipped with tools to implement practices into their daily lives. A powerful way to teach “how” is through modeling Language Nutrition with infants and children. Greet the baby or young child when entering the room and narrate the examination to the child. Direct questions and comments to the infant—realizing that parents will supply the answers. Directing the conversation to the baby provides families with an example to follow and reinforces the importance of Language Nutrition.
Pediatric health care providers should tell families to make the baby their conversational partner as often as they can. As they go throughout their day, they can narrate what they are doing and point out objects in the environment as a way to introduce new words. Families should pay attention to the baby or young child's social and verbal communication, whether it be the child looking at something, pointing to something, babbling, or using actual words. Responding to the child's communication, even if it is nonverbal, and asking the child questions facilitates reciprocity and, thus, language learning in a social context. Reading children's story books and singing songs on a daily basis will help establish daily practices of literacy promotion. Additionally, families should be encouraged to speak using parentese and the home language. Messages to share with families about “how” can be found in Box 2.
Box 2
Teaching how
- •Talk with your baby every day and as much as you can.
- •Narrate daily activities to your baby, such as changing diapers, feeding, or bathing. Describe to your baby what you are feeling and doing.
- •Respond to your baby's lead. Tune in to what your baby looks at and the expressions and babbles your baby makes.
- •Ask your baby questions and encourage your baby to answer with facial expressions, gestures, coos, babbles, and words. This back-and-forth communication helps them learn.
- •Talk to your baby in a sing-song voice. This type of talking helps your baby learn words.
- •Use actual words when you talk with your baby.
- •Repeat words and phrases.
- •Praise your child when he or she communicates.
- •Talk with your baby in the language you are most comfortable using, because you will help your baby learn best by speaking in the language you know most.
- •Use gestures to communicate with your baby.
- •Introduce new vocabulary through singing, reading, and telling stories.
- •Avoid use of TV or music recordings for language development. TV and recordings do not help babies learn new words.
- •You do not need fancy toys, books, or to even know how to read to talk to your baby. You just need your words. Talk is cheap!
- •Encourage others who spend time with your baby to talk with your baby.
Many of the established interventions highlighted in this article have Web sites that provide additional information and resources, including handouts, educational curricula, and early literacy milestone checklists and videos for health care providers and/or parents. Web sites of the interventions are listed in the Table.
Conclusion
The ability to provide Language Nutrition is crucial for shaping the social, learning, and health outcomes of young children (
Head Zauche et al., 2016
). All parents and caregivers are capable of being their baby's first and best teacher; all parents know how to talk and can talk, either verbally or through sign language. Toys and books are not necessary for a family to be successful in influencing their child's chances for academic success. Consistent with evidence, the single most important action a parent can take to positively influence their child's future health and educational trajectory is to talk with their children (). By sharing these messages with families, pediatric health care providers can build the capacity of families to talk with their children in a way that promotes their linguistic, cognitive, and social development. Thus, pediatric providers have the potential to leverage dramatic results for children's academic and health outcomes and be partners in the efforts to close the nation's educational achievement gap.References
- Linguistic input, electronic media, and communication outcomes of toddlers with hearing loss.Ear and Hearing. 2014; 35: 139-147
- Accelerating language development through picture book reading–replication and extension to a videotape training format.Journal of Educational Psychology. 1994; 86: 235-243
- Bilingualism in development: Language, literacy, and cognition.Cambridge University Press, Cambridge, UK2001
- Ecological models of human development.in: Gauvain M. Cole M. Readings on the development of children. 4th ed. Worth Publishers, New York, NY2005: 3-7
- Infant gaze following and pointing predict accelerated vocabulary growth through two years of age: A longitudinal, growth curve modeling study.Journal of Child Language. 2008; 35: 207-220
- Cumulative social risk, parenting, and infant development in rural low-income communities.Parenting: Science and Practice. 2008; 8: 41-69
- Adult talk in the NICU with preterm infants and developmental outcomes.Pediatrics. 2014; 133: e578-e584
- Audible television and decreased adult words, infant vocalizations, and conversational turns: A population-based study.Archives of Pediatric and Adolescent Medicine. 2009; 163: 554-558
- Social interaction in infants' learning of second-language phonetics: An exploration of bran-behavior relations.Dev Neuropsychol. 2015; 40: 216-229
- Relation between language experiences in preschool classrooms and children's kindergarten and fourth-grade language and reading abilities.Child Development. 2011; 82: 870-886
- Getting it right for young children from diverse backgrounds: Applying research to improve practice with a focus on dual language learners.2nd ed. Pearson, New York, NY2014
- SES differences in language processing skill and vocabulary are evident at 18 months.Developmental Science. 2013; 16: 234-248
- Double jeopardy: How third grade reading skills and poverty influence high school graduation.Annie E. Casey Foundation, Baltimore, MD2012
- Annual growth for all students, catch-up growth for those who are behind.The New Foundation Press, Inc, Kennewick, WA2007
- Early warning: Why reading by the end of third grade matters.(KidsCount) Annie E. Casey Foundation, Baltimore, MD2010
- Early child language mediates the relation between home environment and school readiness.Child Development. 2009; 80: 736-749
- The power of talk: Impact of adult talk, conversational turns, and TV during the critical 0–4 years of child development.LENA Foundation Technical Report, ITR-01-2, 2009: 3-30
- Improving joint engagement in parent-child interaction: an intervention study.Journal of Early Intervention. 1994; 18: 155-167
- Muenster Parental Programme empowers parents in communicating with their infant with hearing loss.International Journal of Pediatric Otorhinolaryngology. 2013; 77: 2023-2029
- Parenting behaviors, perceptions, and psychosocial risk: impacts on young children's development.Pediatrics. 2010; 125: 313-319
- Assessing children's home language environments using automatic speech recognition technology.Communication Disorders Quarterly. 2011; 32: 83-92
- Maternal speech to infants in a tonal language: Support for universal prosodic features in motherse.Developmental Psychology. 1988; 24: 14-20
- Hagan J.F. Shaw J.S. Duncan P. Bright Futures: Guidelines for health supervision of infants, children, and adolescents. Pocket guide. 3rd ed. American Academy of Pediatrics, Elk Grove Village, IL2008
- Disparities in early learning and development: Lessons from the Early Childhood Longitudinal Study-Birth Cohort.Child Trends, Executive Summary. Washington, DC2009 (Retrieved from http://www.childtrends.org/wp-content/uploads/2013/05/2009-52DisparitiesELExecSumm.pdf)
- Meaningful differences in the everyday experiences of young American children.Brookes, Baltimore1995
- Bilingualism as a potential strategy to improve executive function in preterm infants: a review.Journal of Pediatric Health Care. 2015; 29: 126-136
- Influence of Language Nutrition on children's language and cognitive development.Early Childhood Research Quarterly. 2016; 36: 318-333
- Literacy promotion: An essential component of primary care pediatric practice.Pediatrics. 2014; 134: 404-409
- The specificity of environmental influence: Socioeconomic status affects early vocabulary development via maternal speech.Child Development. 2003; 74: 1368-1378
- Interpreting the early language trajectories of children from low-SES and language minority homes: Implications for closing achievement gaps.Developmental Psychology. 2013; 49: 4-14
- How children use input to acquire a lexicon.Child Development. 2002; 73: 418-433
- Does input influence uptake? Links between maternal talk, processing speed and vocabulary size in Spanish-learning children.Developmental Science. 2008; 11: F31-F39
- Early vocabulary growth - relation to language input and gender.Developmental Psychology. 1991; 27: 236-248
- Sources of variability in children's language growth.Cognitive Psychology. 2010; 61: 343-365
- My brother's keeper: Task force to the president.The White House, Washington, DC2014
- Starved for words? Program uses talking to nourish kids' brain.Georgia Health News, Atlanta, GA2014 (Retrieved from)
- Fetal sensitivity to properties of maternal speech and language.Infant Behavior and Development. 2009; 32: 59-71
- Implementation of a relationship-based school readiness intervention: A multidimensional approach to fidelity measurement for early childhood.Early Childhood Research Quarterly. 2010; 25: 299-313
- Is speech learning ‘gated’ by the social brain?.Developmental Science. 2007; 10: 110-120
- Foreign-language experience in infancy: Effects of short-term exposure and social interaction on phonetic learning.Proceedings of the National Academy of Sciences, USA. 2003; 100: 9096-9101
- A responsive parenting intervention: the optimal timing across early childhood for impacting maternal behaviors and child outcomes.Developmental Psychology. 2008; 44: 1335-1353
- The effects of a responsive parenting intervention on parent-child interactions during shared book reading.Developmental Psychology. 2012; 48: 969-986
- Parent picture-book reading to infants in the neonatal intensive care unit as an intervention supporting parent-infant interaction and later book reading.Journal of Developmental and Behavioral Pediatrics. 2011; 32: 146-152
- Do verbal interactions with infants during electronic media exposure mitigate adverse impacts on their language development as toddlers?.Infant and Child Development. 2010; 19: 577-593
- Use of videotaped interactions during pediatric well-child care to promote child development: A randomized, controlled trial.Journal of Developmental and Behavioral Pediatrics. 2005; 26: 34-41
- Bookstart: A qualitative evaluation.Educational Review. 2003; 55: 3-13
- The nation's report card: 2015 mathematics and reading assessments (NCES 2015-136).Author, Washington, DC2015
- English language learners in public schools. The condition of education (NCES-2016-144.U.S. Government Printing Office, Washinton, DC2016: 92-95
- Health, United States 2011: With special features on socioeconomic status and health. (2012–1232).U.S. Government Printing Office, Washington, DC2012
- Clinic-based intervention to promote literacy. A pilot study.American Journal of Diseases of Children. 1991; 145: 881-884
- Effectiveness of a primary care intervention to support reading aloud: a multicenter evaluation.Ambulatory Pediatrics. 2005; 5: 209-215
- On the issues. Education.Author, Atlanta, GA2015 (Retrieved from)
- Dual language development and disorders: A handbook on bilingualism and second language learning.Paul H. Brookes Publishing, Baltimore, MD2011
- Neural language networks at birth.Proceedings of the National Academy of Sciences U S A. 2011; 108: 16056-16061
- Education matters of health. Vol. 6. Author, Princeton, NJ2009: 1-15
- The effectiveness of parent-implemented language interventions: a meta-analysis.American Journal of Speech and Language Pathology. 2011; 20: 180-199
- Assessing the effects of a parent-implemented language intervention for children with language impairments using empirical benchmarks: a pilot study.Journal of Speech Language and Hearing Research. 2012; 55: 1655-1670
- The formative role of home literacy experiences across the first three years of life in children from low-income families.Journal of Applied Developmental Psychology. 2009; 30: 677-694
- Child-directed speech: Relation to socioeconomic status, knowledge of child development and child vocabulary skill.Journal of Child Language. 2008; 35: 185-205
- A longitudinal investigation of the role of quantity and quality of child-directed speech in vocabulary development.Child Development. 2012; 83: 1762-1774
- The pace of vocabulary growth helps predict later vocabulary skill.Child Development. 2012; 83: 508-525
- Motherese in interaction: At the cross-road of emotion and cognition? A systematic review.PLoS One. 2013; 8: e78103
- The pediatric forum: Effective elements of literacy intervention: book, talk, or both?.Archives of Pediatric and Adolescent Medicine. 2002; 156: 518-519
- A randomized trial examining the effects of parent engagement on early language and literacy: The Getting Ready intervention.Journal of School Psychology. 2011; 49: 361-383
- Shonkoff J.P. Phillips D.A. From neurons to neighborhoods: The science of early childhood development. National Academy Press, Washington, D.C.2000
- Effects of the acoutstic properties of infant-directed speech on infant word recognition.Journal of the Acoustical Society of America. 2010; 128: 389-400
- The consequences of dropping out of high school: Joblessness and jailing for high school dropouts and the high cost for taxpayers.Northeastern University, Center for Labor Market Studies, Boston, MA2009
- A parent-directed language intervention for children of low socioeconomic status: a randomized controlled pilot study.Journal of Child Language. 2016; 43: 366-406
- Talk With Me Baby.2015 (Retrieved from)
- Language intervention with children who have developmental delays: Effects of an interactive approach.American Journal on Mental Retardation. 1992; 97: 145-160
- Third grade reading success matters.2014 (Retrieved from)
- Constructing a language: A usage-based theory of language acquisition.Harvard University Press, Cambridge, MA2003
- Parent-infant interaction and children's language development.Educational Psychology. 2013; 33: 391-426
- Pequenos y Valiosos.2016 (Retrieved from)
- Start early, finish strong: How to help every child become a reader.Author, Washington, DC1999
- Newborn literacy program effective in increasing maternal engagement in literacy activities: An observational cohort study.BMC Pediatrics. 2012; 12: 100
- Mind in society: The development of higher psychological processes.Harvard University Press, Cambridge, MA1978
- Talking to children matters: Early language experience strengthens processing and builds vocabulary.Psychological Science. 2013; 24: 2143-2152
- Language Nutrition: Filling the word opportunity gap. Speech given at the National Meeting of State Leads for the National Campaign for Grade Level Reading.(Washington, DC)2014
- Literacy promotion for families participating in the Women, Infants and Children program.Pediatrics. 2011; 127: 454-461
- Teaching by listening: The importance of adult-child conversations to language development.Pediatrics. 2009; 124: 342-349
- Promoting early literacy in pediatric practice: Twenty years of reach out and read.Pediatrics. 2009; 124: 1660-1665
- Reach Out and Read: Evidence based approach to promoting early child development.Current Opinions in Pediatrics. 2010; 22: 539-544
Biography
Lauren Head Zauche, Doctoral student, PNP student, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
Ashley E. Darcy Mahoney, Director of Infant Research, George Washington University Autism and Neurodevelopmental Disorders Institute, and Assistant Professor, George Washington University School of Nursing, Washington, DC.
Taylor A. Thul, Doctoral student, FNP student, Emory University, Atlanta, GA.
Michael S. Zauche, Research Assistant, Emory University School of Nursing, Atlanta, GA.
Arianne B. Weldon, Director, Get Georgia Reading Campaign, Atlanta, GA.
Jennifer L. Stapel-Wax, Associate Professor, Division of Autism and Related Disorders, Department of Pediatrics, Emory University School of Medicine; and Director of Infant and Toddler Research Operations, Marcus Autism Center, Atlanta, GA.
Article info
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2017 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The Power of Language Nutrition for Children’s Brain Development, Health, and Future Academic Achievement—Continuing Education PosttestJournal of Pediatric Health CareVol. 31Issue 4
