Early Literacy Research Library (ELRL) - Article

Encouraging Parental Reading for High-Risk Neonatal Intensive Care Unit Infants

Jain, V.G., Kessler, C., Lacina, L., Szumlas, G.A., Crosh, C., Hutton, J.S., Needlman, R., Dewitt, T.G. (2021) Encouraging Parental Reading for High-Risk Neonatal Intensive Care Unit Infants. The Journal of Pediatrics, 232, 95-102.,

Access: Institutional Access

Publication year


study description

Quasi-experimental intervention study.

core topic(s)

Shared Reading

Population Characteristics

Infant/Newborn , Medical Conditions and Disabilities , Neonatal/NICU

Exposures, Outcomes, Other

Clinic-Based Programs and Interventions , Home Language/Literacy/Learning Environment , NICU Bookworms , Parent Behaviors and Skills , Parent-Child Relationships/Interactions , Reading Frequency


To assess whether a citywide structured book-sharing program (NICU Bookworms) designed to promote reading to infants while admitted in the neonatal intensive care unit (NICU) would increase parental reading behaviors (≥3-4 days/week) in the NICU and after discharge home, including high-risk parents who do not themselves enjoy reading.


NICU Bookworms (book sharing intervention).

outcomes evaluated

Home reading environment and shared reading behaviors.


Infants discharged from the NICUs in the Greater Cincinnati region from May 2018 to May 2019 and attending the Cincinnati Children’s Medical Center (CCHMC) NICU High-risk Clinic were consecutively enrolled.


The NICU Bookworms program comprised staff training, parent education, and building a literacy-rich environment. In this quasi-experimental intervention study, parents of medically high-risk NICU graduates <6 months of age were administered a questionnaire at their first NICU follow-up clinic visit. The survey incorporated questions from the StimQ-I READ subscale to assess home reading environment and shared reading practices.

sample size

n=317 (infants total); n=187 (control); n=130 (treatment)


Measure of Home Reading Environment and Shared Reading: Reading subscale of the StimQ-I, as well as questions on access to books, reading frequency, reading routines, reading aloud advised by a healthcare worker, parents’ educational level, and infant’s ethnicity per parent report. Where possible, these questions were derived from the published literature.


Measure of Demographic Data: abstracted from medical records.


A total of 317 infants were enrolled, 187 in an unexposed comparison group and 130 in the intervention group. Parents exposed to Bookworms were significantly more likely to read ≥3-4 days per week while in the NICU (34.5% vs 51.5%; P = .002; aOR, 2.2; 95% CI, 1.2-4.0), but reading at home did not differ (67.9% vs 73.1%; P = .28; aOR, 0.99; 95% CI, 0.5-1.8). However, among parents who did not themselves enjoy reading, frequency was significantly higher both in the NICU (18.4% vs 46.1%; P = .009; aOR, 5.0; 95% CI, 1.2-21.5) and at home (36.9% vs 70%; P = .003; aOR, 3.7; 95% CI, 1.1–12.9). A qualitative thematic analysis found that Bookworms decreased parental stress, enhanced bonding, and supported positive parent-infant interactions.


A book-sharing intervention in the NICU increased parent-reported reading aloud during hospitalization and among parents disinclined to read for pleasure, both in the NICU and following discharge. This change may have been mediated by enhancement of parent-infant interactions.


Only families attending the high-risk clinic after discharge were included, possibly fueling participation bias. Even though we aimed for consecutive recruitment, some patients were missed owing to staff unavailability. There was also variability in the administration of the program at various participating NICUs, which could have diluted the results relative to administration with maximum fidelity... Follow-up and evaluation of home reading practices were only done at the first clinic visit (mean 45 days) and the long-term effects of the Bookworms intervention are unclear, warranting future study. Outcomes were assessed via parental self-report with no direct observations, diaries, vocabulary scores, or neurodevelopmental assessments, rendering findings susceptible to social desirability and/or recall bias. Baseline levels of parental anxiety or depression were not measured, which can impact shared reading behaviors. We also did not measure how frequently parents were advised by neonatal staff to read to their infant or the quality of such advice, making dose-response estimates uncertain.