Some mornings, as I go out to my porch to get The Inquirer, I trip over a box of gently used books that some anonymous donor has left during the night for children at my hospital. This has been happening for years, and the generosity inspires me and my colleagues to help young children of lower-income families in Philadelphia increase their exposure to the spoken word.
As I drive to work with books in the backseat, my route takes me past Taylor Elementary School and Roberto Clemente Middle School. State reading scores at these schools are 50 percent and 40 percent proficient respectively. The poverty level at both is above 90 percent.
My first patient of the day is a 5-day-old boy. As I approach the exam room, I listen for any sounds that will clue me in to who is with him and what interactions he is having. Silence. I open the door and see a mother alone with her baby, who is wide-eyed and yawning.
I go through the complete history and physical, and gather information about the pregnancy, birth, and social history: This woman, 19, has yet to finish high school. She lives with her mother near our North Philadelphia hospital, which is in the third most impoverished district for children in America. I glance back as the young mother dresses the baby to leave. Her face inches from his, she looks at him lovingly but silently.
Almost 50 years ago, pediatrician Julius B. Richmond studied how infant brain growth relies on organized input from the external world. He noticed that poor children in Syracuse, N.Y., sat up on time, walked on time, and began to speak on time. Yet at 18 months of age, something happened and their development slowed.
Visiting the homes of these children, he saw only the bare essentials. Toys, crayons, and books were missing. The poverty of these families offered little developmental stimulation. In 1965, to address such disparities, and with President Lyndon B. Johnson's support, Richmond implemented Project Head Start, which continues to this day.
More recently, a landmark 10-year study by psychologists Betty Hart and Todd Risley showed that by age 3, children on welfare had heard 30 million fewer words at home than children from professional families. In the same study, the 3-year-olds in professional households spoke on average 1,100 words; those in impoverished households, fewer than half that.
In a modern house of poverty, there are still the bare essentials: shelter, clothing, food (although almost 40 percent of children in North Philadelphia are food-insecure). But unlike in Richmond's era, when free play was more prevalent, the faces of too many of our children reflect off television, computer, and video game screens. These youngsters have entertainment, not education.
In early life, infants and toddlers are making more than 700 new neural connections per second, much of that development relying on a baby's external environment and experiences with caring adults. When one holds a baby, her gaze begs the holder to care for her, teach her, and talk to her, which feeds the branches of her rapidly growing brain connections. Human speech and loving interactions are the water and sunlight for a developing brain's healthy growth.
So what do early-childhood experiences, exposures, and speech have to do with health? Several studies have shown that early exposure to words, especially novel words spoken with kindness, improves academic success. That, in turn, promotes a lifetime of improved health. Better health leads back to academic success, which fuels the next generation. The spoken word resonates.
In a large 2009 study by the Robert Wood Johnson Foundation, the tipping point for adult health and decreased mortality was the quality of education. (See www.commissiononhealth.org/).
Parents with new babies need to hear how health links to the spoken word. Successful programs such as Reach Out and Read (www.reachoutandreadphilly.org) give families guidance on the importance of early literacy and school readiness.
Back to my morning patient. I discuss with his young mother the importance of nutrition and safety, outline ways to reduce some stressors at home, and recommend that she talk to her little boy, sing to him, and nourish him. As she walks toward our checkout area, I hear her chatting with her baby, reviewing our visit, connecting with him.
I drive home, thrilled that I may have helped this mother. I slowly pass Edison High School, one of the largest high schools in Philadelphia, and recollect that only 17 percent of tested students were proficient at reading. Their future health is jeopardized. There is much more talking to do.