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A trip to the doctor for many children means coming home with an inoculation, a prescription, and perhaps a lollipop. Now, though, pediatricians in some cities are presenting their young patients with books, as the profession takes steps to include literacy in its definition of a healthy child.

"It fits well with other changes that have gone on in pediatrics," said Dr. Perri Klass, a pediatrician at Boston City Hospital and a co-director of the hospital's pediatric primary-care clinic and its Reach Out and Read program. "Pediatrics has been moving further and further away from just treating diseases of children."

Under this expanded definition, she said, a well child is developmentally, cognitively, and socially healthy, not just physically healthy.

Founded at Boston City Hospital about six years ago, the program will be reproduced in health-care centers and neighborhood clinics in nine areas across the country. Detroit, New Orleans, New York City, and a Navajo reservation in Arizona are among the sites that are up and running, and others are in the works, Dr. Klass said. The Baltimore-based Annie E. Casey Foundation has given $450,000 to run the program in Boston and its expansion.

The program, which is aimed chiefly at children in poor communities, has three parts. First, volunteers read aloud to children in the waiting room. Not only do the youngsters enjoy it, Dr. Klass said, but it also serves as a model for parents who can see that children don't have to sit still or be quiet. "It also makes waiting a lot easier, " she said.

Second, in the examination room, doctors advise parents about reading aloud to their children and explain what kinds of books and behavior are appropriate for their ages. Babies, for instance, like to put cardboard books in their mouths, while toddlers like to be read the same story--with lots of rhymes--over and over again.

Finally, at every visit--from the time the child is 6 months to 5 years old--the doctor gives the youngster a book to take home.

Because Boston City is also a teaching hospital, Dr. Klass and her associates have made promoting literacy a part of their interns' education.

And they are trying to spread the word among those physicians whose practices are already established. At the annual meeting of the Pediatric Academic Societies in Washington this month, they held a Reach Out and Read session for doctors.

"My goal is that this should be part of pediatrics, part of pediatric training, and part of pediatric practice," Dr. Klass said.

--Karen Diegmueller
kdieg@epe.org

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