Medical Leadership News Archive
The commentary below has been provided by Dr. Nikki Gambhir.
The recent [Child Development] study, “An Early Parenting Intervention Focused on Enriched Parent–Child Interactions Improves Effortful Control in the Early Years of School,” highlights the importance of nurturing parent-child interactions in developing self-regulation and cognitive skills, which in turn, are, linked to long-term social-emotional competency and academic achievement.1 Effortful control, the ability to use executive attention to focus, shift attention, and inhibit behavior, has been shown to be influenced by individual temperament, parenting, and broader sociocultural factors.
The smalltalk parenting intervention, delivered as a structured playgroup program, equips parents with practical tools to engage in simple, structured conversations that enhance language and communication skills. Smalltalk plus adds tailored feedback and home teaching to further strengthen and refine these interactions. This study found that the smalltalk plus intervention in the toddler years significantly improved children’s self-regulation in early school years by improving parents’ ability to maintain and extend their child’s focus during joint activities.
This research aligns with Reach Out and Read by promoting early relational health and development through shared reading and positive parenting practices. As a pediatrician, I’ve seen how reading together fosters language development and strengthens emotional bonds, enhancing attention and self-regulation.
Similarly, initiatives like “Talk With Me Baby”2 (which encourages conversational engagement and language-rich environments), and “Healthy Families Thriving Children”3 (which supports child and parent needs through providing access to community resources, mental health services, developmental screening, and parenting support), demonstrate how early enriched parent-child interactions can transform children’s trajectories, fostering lifelong self-regulation and resilience.
Read the complete study here.
1 An early parenting intervention focused on enriched parent–child interactions improves effortful control in the early years of school – Bennett – Child Development – Wiley Online Library
2 https://saportareport.com/talk-with-me-baby-is-defining-the-future-for-every-atlanta-baby/thought-leadership/securing-atlantas-future/atlanta-speech-school/
3 https://www.pressherald.com/2024/10/01/healthy-families-thriving-children-countering-adversity-with-a-two-generation-approach/
Despite nearly 2 billion Muslims worldwide, only 1% of U.S. children’s books feature Muslim representation. Advocates like Ariana Hussain and Mahasin Abuwi Aleem emphasize the importance of inclusive literature to combat stereotypes and foster understanding of the diverse Muslim experience.
Read the complete EdTrust article here.
The American Academy of Pediatrics updated its Literacy Promotion policy, reaffirming that encouraging reading from infancy is a vital part of pediatric primary care. The updated policy highlights Reach Out and Read as a key strategy for fostering early relationships through shared reading and recommends public funding for books and literacy programs in primary care.
Read the complete article here.
A new critical study on positive childhood experiences (PCEs) was published this month in JAMA Pediatrics. Author Christina Bethell, who showed in 2019 that PCEs mitigated the effects of Adverse Childhood Experiences, demonstrated that adults who self-report more PCEs have a lower likelihood of clinical depression or poor adult mental health and a higher probability of healthy adulthood interpersonal relationships.
A good review, and a link to the paper is here.
This Childhood Development study examined the impact of maternal phone use on speech to infants by analyzing 16,673 minutes of real-world data from 16 mother-infant pairs. Findings showed that maternal phone use was associated with a 16% decrease in speech to infants, with even shorter phone use intervals leading to a 26% decrease, emphasizing the importance of minimizing phone distractions to support infant language development.
Read the complete research here.
MMWR Prevalence of Positive Childhood Experiences Among Adults – Behavioral Risk Factor Surveillance System, Four States, 2015-2021. Sege R, Swedo EA, Burstein D, Aslam MV, Jones J, Bethell C, Niolon PH.MMWR Morb Mortal Wkly Rep. 2024 May 2;73(17):399-404. doi: 10.15585/mmwr.mm7317a3
The commentary below has been provided by Dr. Trude Haecker.
It has been four years since Christina Bethell, PhD, published her groundbreaking paper in JAMA Pediatrics examining the effects of positive childhood experiences (PCE) in >6000 adults. Among the questions analyzed were: Before the age of 18, I was …
— Able to talk with my family about my feelings?
— Felt that my family stood by me during difficult times?
— Enjoyed participating in community traditions?
— Felt a sense of belonging in high school?
— Felt supported by friends?
— Had at least two non-parent adults who took a genuine interest in me?
— Felt safe and protected by an adult in my home?
The risk of depression/mental health issues dropped by 72% among adults who reported six or seven PCEs and by 50% for those reporting three to five. Adversity alone does not equal poor outcomes. Children’s experience of safe, stable, nurturing relationships and environments promotes healthy child development and later adult mental and relational health, buffering the effects of ACEs. Reach Out and Read is an integral component of that buffering effect.
Dr. Bethell and collaborators have continued their work and just published in MMWR, the largest population-based assessment of PCEs among U.S. adults, aggregating data from 24,893 respondents in four states (KS, MT, SC, WI). This study analyzed BRFSS (Behavioral Risk Factor Surveillance System) data that included the same PCE questions listed above. Approximately 53% of adults reported six to seven PCEs; 12.2% reported two or fewer. Fewer African American (49.2%), Alaska Native or American Indian (37.7%), and Latino (38.9%) respondents reported six to seven PCEs than White respondents (55.2%). Gay or lesbian (38%) and bisexual (27%) respondents were less likely to report six to seven PCEs than straight adults (54.7%). A PCE score of six to seven was more frequent among persons with higher income and higher education, showing a dose-response relationship between how many positive experiences adults reported and their mental and relational health as well as their economic and educational outcomes.
Reach Out and Read can play a significant role in bridging — and hopefully reducing health inequities — by impacting the number of PCEs through fostering a closer relationship between parents and children. We need to advocate for those policies that support all families as Reach Out and Read is an integral part of the solution.
Read the complete study here.
The Developmental Science study investigated how caregivers communicate with their toddlers, combining various methods, like speech, gestures, and touch, during playtime. The sample consisted of 44 toddler-caregiver dyads from predominantly middle-class, English-speaking families in the U.S. Results showed that caregivers often used multiple communication methods together, adjusting their complexity based on the toddler’s responses and language skills. These findings suggest that these dyadic interactions are richer and more responsive than previously understood.
Read the complete study here.
This Childhood Development study examined the impact of maternal phone use on speech to infants by analyzing 16,673 minutes of real-world data from 16 mother-infant pairs. Findings showed that maternal phone use was associated with a 16% decrease in speech to infants, with even shorter phone use intervals leading to a 26% decrease, emphasizing the importance of minimizing phone distractions to support infant language development.
Read the complete research here.
The Journal of Developmental & Behavioral Pediatrics video abstract is now available for the Reach Out and Read-supported study featured in your July 25 brief (Nikki Shearman is credited as an author). The video features three of the study’s authors — rica Levin and Usha Ramachandran from Rutgers Robert Wood Johnson Medical School and Deepa Srinivasavaradan from SPAN Parent Advocacy Network — explaining the study’s approach, findings, and implications. Overall, the video provides a bite-size, digestible summary of the study and specifically mentions ROR.
Watch the abstract here.
This JAMA Pediatrics study investigated the association between screen time and parent-child communication (adult words, child vocalizations, and conversational turns) in children aged 12 to 36 months, using data from 220 families. The findings revealed a negative correlation between screen time and parent-child talk, with increased screen time leading to significant reductions in adult words, child vocalizations, and conversational turns, especially notable at 36 months.
Read the complete article here.
This Journal of Pediatrics study investigated the relationship between newborn neurobehavioral stress signs, maternal parenting stress, and toddler language development in 202 mother-infant dyads. The results showed that newborns with higher stress signs had fewer social-communicative gestures at 18 months, and those whose mothers experienced low parenting stress had a negative association with receptive vocabulary, highlighting the need for additional support for neonates with increased stress signs to mitigate language difficulties.
Read the complete article here.
Reach Out and Read is an important component of 3-2-1 IMPACT described in the Pediatrics case study, “A Two-Generation, Early Childhood Advanced Primary Care Model.” The model has been piloted in three different clinics in the public hospital system, New York Health and Hospitals (including the clinic at Bellevue where I work). The lead author, Dr. Mary McCord, is the Director of Pediatrics at Gotham Health and Sydenham Health Centers. “We all know that the impact of Reach Out and Read is good and real, because research has proven it and it’s a time that has a long-time impact,” she told me. “We need to integrate ROR into a multipronged approach for early childhood support and additive effect.”
The approach combines ROR and the Video Intervention Project with women’s health, Healthy Steps, child life, and community health workers. My colleague, Dr. Suzy Tomopoulos — Medical Director of Pediatric Ambulatory Care at Bellevue Hospital, and an Associate Professor of Pediatrics at NYU, who is one of the authors — described the model as focusing on the first five years of life, with 0 to 3 the priority. ROR and VIP are provided to all families, and other services are tiered, based on maternal risk. There is screening for maternal depression, and screening for developmental milestones as well as for social emotional and behavioral milestones.
During the pilot, Dr. Tomopoulos said, “We cared for a lot of high-risk patients.” The pilot showed, she said, “we are able to implement an advanced primary care model to enhance long-term outcomes for children and parents.” She pointed in particular to the stigma attached to mental health issues, which can interfere with mothers getting help when they need it, and the importance of offering that care in the setting of the primary care clinic.
The next step is scaling up — and finding ways to approach payers and show that this can help hit benchmarks, “to enhance outcomes and get more dollars for preventive services in the first three years of life,” Dr. Tomopoulos said. “I think we need to be ambitious and think like that, how can we make pediatric primary care have a real impact, and how can we get the world of value-based care and population health and advanced primary care to recognize the importance,” Dr. McCord said. “We need to make the focus of primary care in the early years improving the social emotional outcomes of children.”
Read the complete article here.