US childhood literacy rates are lagging. Pediatricians could be part of the solution

For some young children in Columbus, Ohio, reading assessments don’t begin in the kindergarten classroom, but rather in the doctor’s office.

Amid growing concerns about lagging childhood literacy rates across the country, Nationwide Children’s Hospital began assessing the literacy skills of children as young as 3 years old during pediatrician visits. The idea is to detect reading difficulties very early and to guide parents on how to help their children.

“They all do developmental screenings, they all talk to parents multiple times,” said Sara Bode, medical director of school health at the hospital. “So this is an opportunity.”

The pediatric hospital chose the clinics to conduct the literacy tests largely based on their proximity to schools with lower performance scores on kindergarten readiness assessments. In Columbus city schools, more than 63% of kindergarten students fell behind in language and literacy skills during the 2024-2025 school year, according to data from the National Kindergarten Readiness Assessment, or KRA.

Concerns about children’s literacy extend far beyond Columbus. Nationally, the percentage of fourth graders considered proficient in reading sits just above 30 percent, according to the 2024 National Assessment of Educational Progress, known as the nation’s report card. Reading skills have fallen 4 percentage points since 2019 as schools struggle to make up for pandemic-related learning losses.

Literacy tests are not typically conducted in medical settings, but several leading pediatric care centers, including Boston Children’s Hospital, promote early literacy resources to families in recognition of the importance of reading to a child’s development.

Children who enter kindergarten with lower reading skills often struggle to catch up in later years. According to the Children’s Reading Foundation, a nonprofit organization, nearly three-quarters of kindergarten students who take exam preparation tests among the poorest 20 percent of students remain in the bottom 20 percent of their class by fifth grade.

Doctors’ assessments of child development have often focused more on other milestones, like walking or talking on time. But a child can pass a standard pediatric exam while falling behind in other areas needed to be ready to enter kindergarten, Bode said.

To address this dilemma, the pediatric hospital implemented literacy testing in about half of its 13 clinics, assigning a literacy coordinator to each. The program launched in 2022 and has since completed more than 2,400 screenings. Many children come from high-need populations because Nationwide serves families who are uninsured or on Medicaid.

Screening tools are not intended to diagnose learning disabilities like dyslexia, but rather to identify areas where children might need additional support.

Having support outside the education system for reporting early reading difficulties is a step in the right direction, but choosing the right screening tool is essential, said Devin Kearns, a professor of early literacy at North Carolina State University.

Nationwide coordinators use a tool that assesses children as they read a book during primary care visits, either in English or Spanish. It took some practice to fine-tune the timing — avoiding moments after vaccination when kids were upset, for example — but the reading assessments only take about 10 minutes.

Once a child completes a selection, the coordinator can create a personalized literacy plan that highlights areas that need more practice.

The visit is also an opportunity to model activities parents can do at home with their children, such as reading a book aloud, said Carneshia Edwards, who leads the hospital’s kindergarten readiness team.

“When we do the screenings, families are kind of concerned that their kids don’t know certain things and it’s not necessarily about that,” Edwards said. “It’s just about exposing them more than anything else.”

Before Juri Sleet completed her literacy tests at age 3, her grandmother, Quintina Davis, was concerned that Juri would not have enough early learning opportunities. But meeting her clinic’s literacy coordinator opened Davis’ eyes to all the activities she could do at home with Juri.

“She didn’t know much about it, but our coordinator was very patient with her,” Davis said.

After each screening, coordinators prepare literacy kits, a mix of tools and activities for home practice. These materials are also influenced by feedback from Columbus City Schools teachers about the needs of students as they enter kindergarten.

The contents of the kits depend largely on the donations received by the program. There are often items such as dry erase boards for writing letters and books for reading practice. But the kits can also contain safety scissors or pencils with rubber grippers to improve motor skills.

“Parents are the first teachers, so we really try to encourage them to sit down with their child and work with them before they enter kindergarten,” Edwards said.

Coordinators stay in touch with families they meet at the clinic, sometimes referring children to early education programs such as the federally funded Head Start preschool program or the SPARK program, which makes educational home visits.

Then, when a child returns to the clinic a year later, the coordinator meets with them again. For Juri, now 4, the follow-up visit put into perspective the progress she had made in a year, her grandmother said.

Over the course of a year, Juri made progress in recognizing letters, sounds and sight words. Juri also enrolled in preschool at a local YMCA with the help of her literacy coordinator, Davis said. She’s doing “great” there, Davis said, and she can’t wait to see her grow even more.

“The goal is to make sure that by the time she starts kindergarten, she will be absolutely ready without having a lot of challenges,” Davis said. “So right now, I think she’s headed that way.”

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Patrick Aftoora-Orsagos in Columbus, Ohio, contributed to this report.

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