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Preschool Storytime at Monroe Street Library

Abby Ryan, assistant youth services librarian, reads "Bunny Cakes" to children during Preschool Storytime at Madison Public Library's Monroe Street Library.  

In the world of pediatrics, we monitor and comment on many developmental milestones that appear miraculous; the complicated interplay of balance, muscle strength, and coordination necessary for a child to achieve walking is but one example. Yet almost all children achieve this at a remarkably young age, and the progression to becoming ambulatory is extensively chronicled and remembered by parents.

One particular developmental achievement outshines most others in terms of how critical it is in our modern world. However, it’s not so easily assessed, and only astute parents and practitioners may glimpse and recognize it early on. Arguably, it is a direct precursor to a capability which confers the single greatest elevation in skills and future potential in contemporary society.

I am talking about the development of print awareness, which is a key component of early literacy. We adults have long since forgotten that there ever was a time that we did not know that printed text was meant to convey information to us. Even when looking at unfamiliar languages or writing systems, we are aware that there is information locked beneath that cryptic surface. Illiterate adults, too, are fully aware that print represents information — they simply can’t decode it fluently.

However, for the average 2-year-old — even one who is read to on a regular basis — the words on a picture book page represent nothing more than decoration. They believe that the reader tells the story simply by looking at the pictures; amazingly, they use the exact same words every time!

In a 3-year-old who is exposed to books and shared book reading, though, print awareness awakens. While letter recognition is still a ways off, they begin to see a connection between those strange black marks on a page and what a reader is saying out loud. With this, the child takes their next big step into recognizing that our world is replete with text. I vividly remember the moment my son pushed my thumb away from the text it covered on a page — at that moment I knew he was achieving early print awareness.

Learning to decode print becomes a welcome challenge for many — but without print-rich environments and responsive adults available and able to read together, this leap may be delayed to the point of interfering with broader, deeper learning for years to come. An old saying in education contains a lot of truth: “Until fourth grade, you’re learning to read; after fourth grade, you’re reading to learn.”

Without developing adequate reading fluency, the promise of education’s benefits becomes progressively more remote as time passes, even with significant efforts at remediation. The outcome is an adult with limited skills in the workforce, and a high likelihood of dependency as a result. Even in relatively wealthy, educated Dane County, one in seven adults struggles with low literacy — enough to fill the Kohl Center more than three times over.

As a pediatrician, this concept of literacy as a core element of what is necessary to be able to succeed in life has become central in my approach to care. On the prevention side, I have been a longstanding participant in and advocate for Reach Out and Read, a program that makes the discussion and advice about sharing books together a routine part of regular checkups. ( nationally, in Wisconsin.)

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While my patients are all children or adolescents, I am equally concerned when I learn about literacy challenges in parents. Why? Not only does it directly affect their ability to perform the good parenting behaviors they want to do (like shared reading), it also affects the economic stability of the home, which affects children. Locally, I refer them to the Literacy Network (, which teaches reading, writing, and speaking skills with the goal of achieving financial independence, better health, and richer involvement in the community. Many communities have similar organizations as well.

(Full disclosure: I am heavily involved with Reach Out and Read locally, regionally, and nationally, and am on the board of Literacy Network — an indication of how much I believe in their missions!)

In this holiday season, you might do well to give many gifts: the gift of books to children in your lives; the gift of advice to parents and caregivers to share books with their young (and not-so-young) children; the gift of your own time and responsiveness in reading aloud to children; and the gift of resources to organizations that work toward these goals.

Dr. Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health and also holds master’s degrees in public health and children’s librarianship. Engaged in primary care pediatrics, early literacy, medical education, and advocacy, he covers a variety of topics related to the health and well-being of children and families.

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