Kids' Health Matters Podcast Ep. 3: How Reading Impacts Early Brain Development
Reading and interactive learning can have a profound impact on a child's brain development. Dr. Mariana Glusman, an attending physician in Advanced General Pediatrics and Primary Care at Lurie Children’s, shares how parents can nurture their children’s cognitive, emotional and social development through meaningful, engaging interactions at home. As a passionate advocate for Reach Out and Reach, a program in pediatrician’s offices that promotes literacy, Dr. Glusman shares the powerful benefits of regular reading with children, how parents can aid in the early relational health of their children, and how they can support their child’s development in a multilingual home.
“People think that babies are like sponges, but actually, babies are not sponges. Babies need to be active participants in their own learning. So it's not just about putting a child in front of a TV or in a room that has Mozart… to try and have the child absorb everything. That's not going to happen. The way that babies learn is by looking at what's happening, and then they respond, and then their caregiver responds to what they do.”
-Dr. Mariana Glusman
- [00:03:33] Dr. Glusman began investigating the value of reading to a child every day when she began noticing her own child’s exceptional language development after daily reading.
- [00:05:30] In 1995, she discovered a program called Reach Out and Read, that takes place in pediatricians’ offices. Promoting literacy and school readiness, the program exposes both children and parents to the many valuable ways children can interact with books. Over the past 30 years, it's become one of the most studied interventions in primary care pediatrics.
- [00:10:35] Synaptic connections in the brain are reinforced through interaction. While people often say that babies are “sponges,” babies primarily learn by interacting with others rather than by absorption. Reading can play a central role in this.
- [00:12:36] Prolonged toxic stress impacts brain development and long-term health. However, positive childhood experiences and nurturing relationships, termed "early relational health," can counteract these effects, promoting long-term well-being.
- [00:16:44] Emphasizing the powerful role that interaction plays, researcher Urie Bronfenbrenner says that all babies need to have at least one person who is crazy about them. Loving interaction with a rich language environment through reading, talking, singing, and playing can not only impact brain development but social and emotional development as well.
- [00:18:42] In bi- or multilingual homes, speaking to children in the preferred (or fluent) language of the parent is better for a child’s development.
[00:00:00] Nina Alfieri, MD: Welcome to Kids Health Matters. I'm Dr. Nina Alfieri.
[00:00:06] Rob Sanchez, MD: And I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world-renowned Ann and Robert H. Lurie Children's Hospital of Chicago.
[00:00:14] Nina Alfieri, MD: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because kids' health matters. So if you're one of our patients, you might notice that we run into the room with a big smile on our face in a book at many of the checkups. This isn't just because we love watching the smile on kids' faces when we give them a present, but it's also because there is real research and data behind the importance of promoting literacy within households.
[00:00:44] Rob Sanchez, MD: I totally agree. A shared experience, it’s tactile. It's supportive. It's close. It's a nice kind of precious moment. It's such a key part of development.
[00:00:52] Nina Alfieri, MD: Rob, my daughter is obsessed with this book called Grumpy Monkey and we don't even read the whole thing. She flips through the first three pages and she gets to the point where Norman, the big gorilla, shows up and all she wants to do is see her dad do the gorilla beating his chest. And that's 40 minutes for us there. We just spend all day doing the grumpy monkey gorilla.
[00:01:12] Rob Sanchez, MD: Nothing but grumpy monkey. I gotta get this book.
[00:01:14] Nina Alfieri, MD: And it's so fun. Well, today we are so thrilled to have Dr. Mariana Glusman join us.
[00:01:20] Rob Sanchez, MD: Dr. Glusman is the past president of the Illinois chapter of the American Academy of Pediatrics, very passionate about Reach Out and Read, which is a program that our clinic participates in and many pediatric clinics do. She's truly phenomenal. And every single time I go to grab one of our reach-outs and read books in the clinic, I think about Dr. Glusman. I think of how passionate she is about it, how just a tremendous advocate she is for it, that love of reading, that love of literacy. It's such a key part of development, the earlier that you start reading, the more that kids are engaged with this, the more words that they hear. It ties directly to all of that development that comes thereafter. She's at the heart of it. She's one of the biggest proponents of it that I've ever met, and she's right here, at our own institution.
[00:02:04] Nina Alfieri, MD: One of the best things I learned from Mariana was really how to interact with a book. It's not necessarily that you need to go from front to back, and we'll cover this during the episode, but you could spend 40 minutes on one page just pointing out colors. And that was something that was new to me when I learned the reach out and read training. And that's something we're excited to bring to all of you.
[00:02:22] Rob Sanchez, MD: And I just gotta say, I just love this whole notion of books as gifts. I love walking through neighborhoods and seeing their little, like a little free library, rotating in and out. Just brings such a smile to my face because I know that that's just so much added value, to that family, to that child, and to their future. It means so much to me and I'm so excited to be able to talk with someone who's literally made this their life's work in some ways.
[00:02:45] Nina Alfieri, MD: Without further ado, let's talk to our guest. Hello, my friend Dr. Glusman. I have been so excited for this episode.
[00:02:58] Mariana Glusman: Hello. I am so happy to be here to talk about my absolute favorite topic with one of my favorite people.
[00:03:04] Nina Alfieri, MD: Awesome. Today we are so excited to have listeners walk away with a better understanding of the important role that reading and communication with your child has on their brain development. We're gonna talk about simple things that parents can do to literally transform their baby's brain for the better. We're excited to hear more about all of this. Tell me a little bit about, from the very beginning, when did you develop your passion for reading in early childhood literacy? Give me the lowdown.
[00:03:33] Mariana Glusman: So, my oldest daughter, who is now 30 years old, if you can actually believe it, she was born when I was in medical school and then she was six months old when I started my residency. So I was basically learning to be a mom and a pediatrician at the same time. And one of the things I used to love doing with her after I'd come home after these very long nights of being on call and working, you know, eighty-hour work weeks, was reading with her and partly, it's kind of selfish to say, but it was like one of my favorite things to do because I could do it lying down, and it didn't take a lot of energy, but she loved it and I loved it too. And fast forward, as she kept growing, I was noticing that her language was developing so beautifully. I was so mesmerized by all the ways that she could speak and the sentences that she could put together. And at the same time, I'm going to work and I'm seeing that my patients are not developing in the same way. And so I started saying to myself, well, what could be the cause? Why are my patients not developing as fast as my own kid? I know that their parents love them. I know that the parents are really good parents. What is the difference? And so I thought, well, could it be all this reading that I'm doing with Abby every single night? And I started asking people and sure enough, they were not reading with their families. And so I thought, maybe this is something that I could start talking about. And then I came across a program that was just coming out right then and there. It was in 1995, called Reach Out and Read, which was being developed in Boston. And somebody else had the same kind of thought that maybe books would be something that we could do for families. If we gave out books, maybe that would help parents read more with their children. And so I became hooked. That was it. I joined the Reach Out and Read bandwagon and I've been really going at it ever since.
[00:05:12] Nina Alfieri, MD: I love it. It's a bandwagon that I'm excited to be a part of too, and I had to smile, Mariana, when you were talking about horizontal parenting and how reading a book is a great way to spend that time. As a toddler mom, that really resonates. Okay, so I loved hearing about the origins of this. Can you tell us a little bit about the Reach Out and Read program?
[00:05:30] Mariana Glusman: Absolutely. So Reach Out and Read is a program that takes place in pediatricians' offices. And the idea of it is that because pediatricians start seeing parents and babies from very, very early on, and we're a trusted messenger, we can give that message about the importance of reading, and interacting and talking with your child from the very beginning. What happens in a return and revisit is we walk into the room and the first thing we do is give the book to the child and talk about why reading is so important and how to make it fun. A lot of times people don't think about reading with a little baby. Oftentimes when people think about reading aloud with a child, they're thinking about perhaps a school-aged kid or a library group where you're reading and the child is sitting still, but little babies don't sit still for a story. And 15-month-olds, toddlers, are running around the room. They barely sit still for anything. Right. But when you come to your pediatrician and they give you a book and they show you how to use the book depending on your child's age, that can change things. And so, it started out as this program where it just seemed like a good idea. But over the past 30 years, it's become one of the most studied interventions in primary care pediatrics. We know that when pediatricians give out books in the office, parents are more likely to read with their children. Not only that, we know that their children's language development is three to six months more advanced than in clinics where Reach Out and Read is not being implemented. We also know that kids are more ready for school when they go to their pediatrician and their pediatrician has a Read Out and Read program. So there's lots and lots of studies that have shown that it's an effective program. it not only feels good, it is good.
[00:07:11] Nina Alfieri, MD: I love it. It is my absolute favorite thing to walk into an exam room and hand a kid a book and see their face light up and see the babies nibble it, and the toddlers throw it and the parents read with the kid. It's so fun, such a great way to develop a different relationship with your families over time.
[00:07:29] Mariana Glusman: Oh gosh. Yeah. There's so much joy with it. You can hide behind the book when the child is a little bit nervous. You can play with it, make animal noises, and it changes the tenor of the whole visit when you have a book.
[00:07:41] Nina Alfieri, MD: You touched a little bit about the research behind Reach Out and Read, but just from a broader perspective, how has our understanding of literacy and brain development changed over the course of your career?
[00:07:51] Mariana Glusman: Yeah, I mean, Reach Out and Read started out as a program that promotes literacy and school readiness, but over the years we've come to understand that there's so much more that happens when a parent shares a book with their baby. And it has to do with all that cuddling time. And that time that you spend together doing something that is interactive, and just the warmth of it all, actually helps children's social-emotional development as well. So it is something that we are talking about now in terms of promoting early relational health and the strength of the relationships between caregivers and their babies.
[00:08:27] Nina Alfieri, MD: That's amazing. As someone who has to juggle a lot of different things, it's nice to know that you can spend, a small amount of really dedicated time and not feel so bad about having to be away at work for part of the day or doing the dishes and letting them play alone, because you know you have that time with them. It's great that there's actual research behind this and it's something that is fun and, and not that hard to do honestly.
[00:08:51] Mariana Glusman: You don't even have to read the words on the page. You can just look at the pictures, ask questions, and make up your own story.
[00:08:57] Nina Alfieri, MD: I love it. We do it all the time. We have lots of different animal noises, and my daughter's favorite right now is the really ridiculous seal sound with the clapping my husband does lately. So all kinds of strange noises during bedtime from our family. Okay, I can't wait any longer. Mariana, we have to talk about my favorite topic: baby brain development. So when we're talking about how important the early months and years are, tell me a little bit about brain development and how connections happen in the brain.
[00:09:18] Mariana Glusman: So, the way that the brain grows, unlike other parts of our body, which is actually where the cells divide and make new cells, the way that our brain develops is by making connections. And those connections are called synapses. And it's amazing. Early on, our brain is making thousands of new connections per second. And all those connections are what's bringing the information from one part of the brain to another part of the brain. And here's the thing, the connections that are not used are lost. Our brain prunes the synapses that are not being used just to make things more efficient, kind of the way that a bush gets pruned to make it look the way you want it to look. And so, those synapses that are reinforced are the ones that are maintained. And guess what? You and I have 50% fewer connections than we did when we were two years old. Can you believe that?
[00:10:20] Nina Alfieri, MD: Oh man. I always knew babies had a leg up on us, even if it was smaller.
[00:10:24] Mariana Glusman: It's probably why we are able to pay more attention than babies.
[00:10:27] Nina Alfieri, MD: Mm. Makes sense knowing about that, like what are some common misconceptions that people have about the way our babies learn or develop?
[00:10:35] Mariana Glusman: The way that the connections are reinforced are through interaction. So the more you interact, the more those brain cells are used and reinforced. A lot of times people think that babies are like sponges, but actually babies are not sponges. Babies need to be active participants in their own learning. So it's not just about putting a child in front of a TV or in a room that has Mozart or you know, whatever it is to try and have the child absorb everything, that's not gonna happen. The way that babies learn is by looking at what's happening and then they respond and then their caregiver responds to what they do, and then they go back and forth. And that's something that we call serve and return interactions. Kind of like a tennis game, that's exactly what happens with a caregiver and a child as they both serve and return their interactions. Guess who serves more? Parents or babies.
[00:11:29] Nina Alfieri, MD: Ooh. It's a hard one. You have to tell me.
[00:11:31] Mariana Glusman: Babies, babies, babies serve so much more than parents do. And it's really up to us to look at what they're doing and respond to it in the appropriate way. And that's how babies learn.
[00:11:41] Nina Alfieri, MD: I constantly see babies kinda looking to adults to sort of validate or interpret the world. And I think being a little more mindful of what they're throwing at us will allow us to hit the ball back in their court.
[00:11:52] Mariana Glusman: Exactly. You know, and that's how they feel like we're paying attention and they feel like we love them.
[00:11:58] Nina Alfieri, MD: So Marianne, I heard you touch a little bit about this idea of relational health, and quite honestly, before you said that, I thought to myself, I'm using book time to steal snuggles out of my daughter. Which I do, I love the snuggles with book time, but it seems like there's a deeper story here with the relational aspect and why that actually really matters. And, juxtaposed with that, there's this idea in the pediatric world about toxic stress can you tell us a little bit about the two of those? How do they manifest and what can families do to build up relational health to try to protect babies from this idea of toxic stress?
[00:12:36] Mariana Glusman: So there are different types of stress. Stress is not always bad. There's actually something called positive stress, and that's what happens when, you know, you're about to take a test or you're about to give a presentation and your heart rate's a little bit high, you know, and your hands are, your palms are a little bit sweaty and your adrenaline goes up. And that actually helps you focus and give a really great presentation. But then there are other types of stress, more prolonged stress, where your adrenaline goes up and it takes a longer time to come down. That would be, for example, with the loss of a loved one. And then there's this concept of toxic stress, which happens when the stressor, whether it is domestic violence or unmet social needs that are relentless, or racism, things that are happening in the child's home or in their greater environment. Not just for the child, but for the family, when they're there all the time. what happens inside our bodies is that our adrenaline and our cortisol, which our stress hormones go up and they stay up. And what we end up being is in a constant state of fight or flight or freeze. Like when you see a mountain lion, you're in fight, flight, or freeze mode. Well, that's how people who are in toxic stress are all of the time in terms of their body. And we've come to realize that those hormones actually affect the way our baby's brains develop. And certain parts of the brain actually get bigger and certain parts of the brain don't grow as much when they are bathed in stress hormones. We also know that stress can affect the way the DNA folds on itself. That's a new science called epigenetics and those stress hormones actually cause the DNA to fold differently. And so different genes are expressed or not expressed, and that seems to be the mechanism by which a lot of the things that we talk about with adverse childhood experiences, people talk about ACEs, have long-term effects on adult health, stroke, heart disease, immune issues, longevity. So we know that what happens in early childhood doesn't stay in early childhood, actually can have long-lasting effects into adulthood and into the next generation. Now the good news is, and you asked about early relational health, is that it's not all determined. There are things that we can do and there's this new science that is being developed now over the past five years or so. That is looking at positive childhood experiences and how those can actually protect our children from developing or succumbing to the effects of toxic stress. So we know that the positive interactions with caregivers actually are protective. This new concept of early relational health is now really being thought of as the other side of the coin to toxic stress and early relational health is really the ability to create safe, stable, nurturing relationships. And those have been shown to be really important for long-term health and wellbeing.
[00:15:38] Nina Alfieri, MD: That's amazing and I'm so glad that the science is moving forward in this area because there are a lot of things that are hard to change. And unfortunately, stress is everywhere, but it's so good to know that what we do at our dinner tables, on the couch reading with our kids, can actually combat some of the things that families are up against. And I just think that's such a wonderful message and it really puts the power back in our hands as parents in sometimes what seems like impossible situations.
[00:16:09] Mariana Glusman: Yeah, that is so important. Parents are so important and they need to know how important they are. And that's actually one of my favorite things to let people know when they come to see me in the pediatric office.
[00:16:20] Nina Alfieri, MD: Absolutely. Parents are by far the most important first teacher a baby will ever have. And I think we all worry about doing our best, but, really everybody is enough for their kid and it's such a beautiful sentiment to share that this is actually grounded in science. So, thanks for sharing that. In that vein, if you're trying to build up your family's relational health, what are some examples of things we can do?
[00:16:44] Mariana Glusman: What babies need is the love of at least one adult. Urie Bronfenbrenner, who is the father of Headstart, really talks about all babies needing to have somebody that is crazy about them. And I love that quote. And the way that we show our love or the way babies see our love is the way we respond, by the way we respond to them. And so when we respond in consistent, affectionate ways as parents and we're paying attention to their needs, again, doing that serve and return interaction, giving them a really language rich environment, reading with them, talking, singing, playing. Really that is what they need not only for their growth of their brain and for their ability to speak and to do well in school, but also for their own ability to form relationships in the future. It really doesn't take a lot of time or effort, but just consistency and love.
[00:17:36] Nina Alfieri, MD: You know what? I just love a great simple solution in the world of Instagram and Facebook. As a parent, I'm so inundated with ads for items that you need. And to hear that from an expert in this area, that time is everything. And that literally, I could pick up a book or pick up some measuring spoons and we could have an enriching time. It's. Just so reassuring to me. So thank you for sharing that.
[00:18:04] Mariana Glusman: Parenting is hard. We don't need to make it harder than it is.
[00:18:08] Nina Alfieri, MD: I wanna frame that quote. Okay. I would love to talk a little bit about bilingualism. So you and I have the advantage of working in this beautiful clinic and serving many families who are very culturally diverse and speak many languages. There used to be some thought about this working against language development, but it seems like science has really pushed forward on this. And as someone who's considered to be a world expert and a thought leader on this, can you catch us all up to speed on bilingualism, multilingualism, and what it means for a baby's brain development?
[00:18:42] Mariana Glusman: Learning two languages is like learning one language, except that there is more input. And it's amazing. Baby's brains can actually learn to distinguish between multiple languages that they're hearing from their environment. So there is nothing that is harmful about being exposed to more than one language. In fact, there are multiple people all over the world that speak 2, 3, 4, 5 languages. It's just more unusual here in the United States, but in many countries it's a very common thing. And the important thing though to remember is that serve and return interaction that we talked about. And how important it is to be able to expose your child to a really rich vocabularies. Syntax, the way that you use sentences. And that's actually why books are so important. Because books can be complicated and tell all sorts of words that we don't even use in regular day-to-day interactions. But what happens when you are trying to speak in a language that you don't speak that well? Well, your language is simple. So for example, if you are not a native English speaker and your English is not that great and you really want to do the best by your child so that they learn English and you speak to your child in English, but you're not able to give the rich language input that you would in your own language, then you're doing them a disservice. It turns out that parents should speak with their babies and children in the language that is most comfortable for them, or languages. If you speak more than one language fluently, by all means, speak all your languages, but really make sure that you are speaking in a rich language with rich vocabulary, and that you're able to really express all the things that you need to express. Your emotions, your worries, your dreams. This is important for babies and for teenagers and for children and parents all their lives to be able to communicate with each other.
[00:20:29] Nina Alfieri, MD: So, it sounds like by all means, use your family language. It's actually great for your child's brain development.
[00:20:35] Mariana Glusman: Yes. The richer your own home language is, the easier it's gonna be for your child to learn English.
[00:20:43] Nina Alfieri, MD: These babies' brains are so incredible. Learning multiple languages. This has been such an amazing topic to discuss with you. Can you leave us with some final thoughts on resources and places parents can go to learn more about enriching their baby's brain?
[00:20:58] Mariana Glusman: My goodness. There are so many things. An easy one is the public library. There are so many books there. You don't have to buy them all. We do love giving up books as part of Reach Out and Read so that people can actually take home the book and read it with their child, and they don't have to go anywhere else to do that. But you know, there's so many more books in the library, so that's a great resource. Another thing is being outdoors and looking at nature, looking at just everything around you, the city that gives you so many things that you can talk about with your child and help them learn so many different things. And again, the most important thing is just cuddling and loving your child. And sure, I think that sitting together with a great book is a wonderful way to do it.
[00:21:43] Nina Alfieri, MD: Well, Dr. Glusman, thank you so much for succinctly summarizing years of research and telling us all about Reach Out and Read, literacy, bilingualism. This has been such an amazing area of impact in my career, quite personally as a parent. And I think of you every time we open a book and, and don't follow the words on it, and we make weird noises and we go out of order. And just to have that permission to be silly with a book and have fun and know that that time is worth it and it's helping my baby's brain, it's worth a million dollars. So Thank you for everything you've contributed to our field and thanks for talking today, so our parents can have a little sliver of all the knowledge that you bring.
[00:22:28] Mariana Glusman: Thank you so much, Nina. It's been such a pleasure to share all of these things with you and with your audience.
[00:22:33] Rob Sanchez, MD: Thanks for listening to Kids Health Matters.
[00:22:38] Nina Alfieri, MD: For more information on this episode and all things kids health please visit LurieChildrens.org.
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