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HEALTH

Doctor's practice is an open book

Pediatrician prescribes reading as a key to enriching kids' lives

By Neil Osterweil
MedPage Today Senior Associate Editor

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Dr. Barry Zuckerman

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BOSTON, Massachusetts (MedPage Today) -- Here is one doctor whose prescriptions are easy to read, good for what ails you and last a lifetime.

Dr. Barry Zuckerman is a founding director of Reach Out and Read, a program in which doctors and nurses are shown how to nurture the minds as well as bodies of children in poverty, where reading may be an unfamiliar practice and books an unimaginable luxury.

"I have spent my whole career with low-income children," says Zuckerman, a pediatrician, "and I began seeing them be hospitalized for things my kids wouldn't be hospitalized for, seeing them return to be hospitalized for the same things and seeing them not do well in school, and I went around trying to figure out solutions for it."

The Reach Out and Read program is one of his attempts to find solutions. So is the Family Advocacy Program, which works with lawyers to help poor children, and the Healthy Steps Program, a collaboration between doctors and parents for children 1 to 3 years old.

More than 2,500 pediatric and family medical practices throughout the 50 states, Puerto Rico and Guam take part in Reach Out and Read. In hospitals, clinics and doctor's offices, kids from low-income families are given books at each well-child visit between the ages of 6 months and 5 years.

An estimated 2.1 million children benefit from the program, which hands out more than 3.4 million books each year.

"This isn't a book giveaway or 'take a book on your way out' kind of program,' says Zuckerman, who is also a professor of pediatrics at Boston University School of Medicine and chairman of the department of pediatrics at Boston Medical Center.

Advice on reading

Along with the books, the health care professionals dispense to parents age-appropriate advice about reading along with their children.

For babies, that may mean giving them cardboard or soft-vinyl books they can put in their mouths, with simple words and pictures of faces that appeal to the developing infant eye.

Toddlers can be treated to brightly colored books with simple, rhythmic texts and repetition, such as "Goodnight Moon" and "The Very Hungry Caterpillar." Kids approaching their fifth birthdays may thrill to humorous and engaging fare such as "Mr. Brown Can Moo. Can You?", "Curious George" or "Alexander and the Terrible, Horrible, No Good, Very Bad Day."

"It's simple, inexpensive, and the results are quite remarkable," Zuckerman says. "Not only are parents more likely to read to their children, as much as fourfold, but also children's expressive and receptive language scores increase. So we're talking about helping kids get ready to enter school ready to learn, and there's no other intervention that I'm aware of that has that kind of evidence."

National data show that about a third of all parents, regardless of income, don't read every day to their young children. For well-to-do parents, it may be more of an issue of what Zuckerman calls "time poverty," but for low-income families the problem revolves in part around the high costs of good books and the lack of children's bookstores or adequately funded libraries in rural or inner-city areas.

In addition, in many families for cultural or socioeconomic reasons reading "was just not part of what you did with younger children, or the parents didn't do well in school so reading was not one of their favorite activities," he adds.

Re-engineering health care for children

Reach Out and Read is just one means whereby Zuckerman hopes to level the health care playing field for children.

"What I've been trying to do for most of my career is to re-engineer, to change pediatric practice to make it more effective for low-income children," he says.

"Reach Out and Read is to provide the appropriate stimulation, and we have another program, which I'm very fond of, called the Family Advocacy Program, where we have lawyers working side by side with doctors to make sure that children have their basic needs met: food, housing, safety and access to education, health and mental health services."

Zuckerman is also instrumental in the Healthy Steps Program aimed at fostering close ties between parents and physicians to help children in their physical, emotional and intellectual growth during the critical first three years, and in Project Health, which focuses on the health and welfare of children from low-income families through hospital-based advocacy and community-based programs.

"Barry has had people work on housing issues for children and legal issues for children and literacy and hunger -- everything you can imagine that poor children go through -- nothing is out of bounds. He's been very creative and very successful in translating that vision into reality for the children of Boston and elsewhere," says Dr. Robert Sege, chief of general pediatrics at the Floating Hospital for Children at Tufts-New England Medical Center in Boston.

Physician as 'vehicle for social justice'

Zuckerman, who grew up in central New Jersey, says that having a brother with a disability "had an important impact on my wanting to make a difference for children and their families."

He received his medical degree from Georgetown University School of Medicine in 1972 and completed a residency at the Boston Medical Center, then known as Boston City Hospital, in 1974. He then did a fellowship in child development at Children's Hospital Boston.

His concern for low-income children grew out of his work at City Hospital, which served a large population of patients without insurance or the financial resources to pay for expensive hospital care.

Zuckerman says he sees his role as a physician as "a vehicle for social justice."

"I get satisfaction out of curing individual children, but I think there's so much more that can be done and that I want to do in terms of helping parents help their children reach the aspirations that they all want for their children and that we all want for society's children," he says.

In addition to the thousands of children he has cared for, Zuckerman and his wife, Dr. Pamela Meyer Zuckerman, also a pediatrician, raised two children: a son who is a musician and a daughter who is an artist.

His colleague, Sege, says that Zuckerman's focus on the whole child is a model for how health care should work for all children.

"Barry understands so well that the health and well-being of children, particularly poor children, involves a lot of social factors, making the concern of the primary care doctor be the overall health of the child -- not just a narrowly defined protection from a particular biomedical illness, but actually helping us work better to optimize the development of the child," Sege says.

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