Conference Coverage

No benefit to infants from e-books over board books



– Despite the greater portability and seeming convenience of electronic tablets or smartphones, providing low-income families with e-books did not increase parents’ frequency of reading to their children or the children’s language development, compared with giving them physical board books, according to preliminary findings.

Mother reading a book to her child on the bed. Bedtime story. Learning how to read. globalmoments/iStock/Getty Images

James Guevara, MD, MPH, professor of pediatrics at the Children’s Hospital of Philadelphia, presented his findings at the annual meeting of Pediatric Academic Societies in a session focused on the changing nature of children’s digital media use as digital natives.

The session chair, Danielle C. Erkoboni, MD, of the University of Pennsylvania, Philadelphia, opened the session with a review of research to date regarding children’s frequency of digital use and relative benefits of independent and shared reading, both with traditional books and e-books.

Nearly all U.S. children (98%) live in homes with mobile devices, and about a third of U.S. children (35%) use those devices, according to a 2017 Common Sense Media Report. The same survey found that children aged under 2 years get an average 42 minutes a day of overall screen time, but children in low-income households get twice as much screen time as those in middle- and upper-income homes.

Research into e-books exists for preschoolers, showing that animated pictures and sounds directly matching an e-book’s story text can potentially promote language memory, but that too many interactive features or other bells and whistles can overwhelm children and contribute to poor vocabulary development and comprehension.

Researchers also have found that parent reading of e-books has greater benefits for children than children listening to an e-book’s audio narration. However, little to no research has looked into e-reading for infants and toddlers, a gap especially relevant for physicians who participate in the Reach Out and Read program.

Dr Guevara’s study enrolled 100 Medicaid-eligible children aged 5-7 months from three participating practices in a single geographic area. Only English- or Spanish-speaking parents who owned a smartphone or tablet participated.

At the children’s 6-month well visit, the clinicians gave parents information about the importance of early parent-child reading. Then parents received Dr. Seuss’s “Hop on Pop” as either an e-book download (n = 45) or a physical board book (n = 54). The parents similarly received “Barnyard Dance” at the 9-month visit and “Goodnight Moon” at the 12-month visit.

No significant differences between the two groups existed in terms of race/ethnicity, parent age, household income, education level, marital status or the total number of adults or children in the household. Maternal depression rates (based on the Edinburgh Postnatal Depression Scale), Adverse Childhood Experience scale scores, health literacy scores (Short Assessment of Health Literacy) and scores on the StimQ home cognitive environment assessment also were similar at baseline between the two groups.

The children were assessed with the StimQ Infant measure at 7-8 months and 10-11 months, and then with the StimQ Toddler and Bayley Scale of Infant and Toddler Development (BSID-III) at 13-15 months. At the final check-up, 37 parents remained in the e-book group and 43 parents remained in the board book group.

A similar proportion of parents in both groups reported reading to their children, and parents in both groups said they read an average of 5 days a week to their child.

However, parents who received the e-books had read an average 18 books at the final follow-up, compared with an average of 31 books among parents who received the board books (P = .039).

No significant differences in children’s StimQ scores or any of the BSID-III scores (cognitive, language, motor) existed between those who received e-books versus those who received board books.

The study results showed the feasibility of promoting literacy by providing e-books to parents of older infants, but doing so did not appear to confer any advantage over providing families with traditional, physical board books. Further, language development among children in both groups remained below average, albeit not statistically different from one another.

“Pediatric clinicians should exercise caution in recommending e-books to parents of young children.” Dr Guevara said. “Additional strategies beyond clinic-based literacy promotion are needed to enhance language development among poor children.”

The research was funded by the Vanguard Strong Start for Kids Program. Dr. Guevara reported no disclosures.

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