Interventions aimed at infants improve school readiness and achievement

Parent education programs delivered through pediatric primary care offices increased parent-child play and reading activities critical for child development and school readiness during infancy in at-risk families, according to two concurrent reports in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

"Research has shown that children growing up in poverty fall behind their middle-class peers in development - even before their first birthday," says Alan L. Mendelsohn, MD, a developmental-behavioral pediatrician and associate professor of Pediatrics at NYU School of Medicine and Bellevue Hospital Center. "Our study found that programs working with parents during pediatric check-ups increase verbal interactions between parents and children and help children in low income families keep up with their peers."

For this study, Dr. Mendelsohn and colleagues enrolled 675 mother-infant pairs receiving pediatric care at Bellevue in a randomized controlled trial of two primary care interventions - the Video Interaction Project (VIP) and Building Blocks (BB).

Of the participating pairs, 225 were randomly assigned to the VIP program, in which mothers and infants had fifteen 30-45 minute sessions with a child development specialist, usually occurring on the same days as check-ups. VIP focuses on supporting verbal interactions in play, book-reading and daily routines. In the most innovative component, mothers and children are videotaped playing and reading books together; the tape is then reviewed to identify and reinforce interactions likely to enhance child development. Toys and books are provided for the family to take home. VIP builds on existing work by some of the same investigators showing that Reach Out and Read, a program that promotes reading aloud in primary care, results in enhanced school readiness.

Another 225 pairs were randomly assigned to participate in the Building Blocks (BB) intervention, in which similar topics are covered through written pamphlets and learning materials such as toys and books mailed to the family's home on a monthly basis.

The final 225 were assigned to a control group, which received standard pediatric care, including routine developmental surveillance and guidance.

In the first report, researchers found that families participating in both the Video Interaction Project and Building Blocks had increased play and reading activities compared to the control group. In addition, VIP families had increased teaching activities and verbal interactions during daily routines.

In the second report, the investigators found that VIP resulted in reduced infant television exposure, which is important because of the adverse impacts that have been shown for television in very young children.

"These interventions begin early in infancy when brain development is most rapid, using innovative strategies to support enhanced interactions, including videotaping with self-reflection in the Video Interaction Project and parent recording of written observations and goals for the child for both programs," says Dr. Mendelsohn. "Infants and young children attend a large number of check-ups so they can stay healthy; these check-ups provide a tremendous opportunity for working with high risk families. VIP and BB can play an important role in addressing the critical public health issue of school readiness and reduce the gap in educational achievement for children growing up in poverty."