Re: From health surveillance to health promotion: the changing focus in preventive children's service

Blair and Hall's article¹ provides an important justification from a shift in child health surveillance to child health promotion including the important role of other disciplines and agencies. This information is relevant to the US as it is to the UK. However, I would like to bring to their attention for inclusion into their recommendations an important evidence‐based activity that promotes children's development and pre‐emergent literacy. Reach Out and Read (ROR) is a programme practised almost entirely in the US, in which primary care paediatricians give advice to parents about developmentally appropriate strategies to read to their child and give low‐income children a book to take home at each health supervision visit from age 6 months to 6 years.² This effort is now practised in more than 3000 clinics and practices throughout the US and reaches more than three million children. The published evidence from multiple studies shows that parents are more likely to read to their children, literacy oriented activities are increased and, most importantly, children's language development is increased by 4–8 points compared with children not exposed to ROR. Next to immunisations, ROR is the only evidence‐based health promotion strategy in primary care for children. Not only is this strategy effective, but given its cost of £2.80 (€4.20; $5.50) per child/per year it is exceptionally cost effective; children start school with at least 10 books in their home for less than £15 (€2; $30).

I realise that paediatricians infrequently provide primary care in the UK but suggest that an effort like ROR should be part of health promotion activities, whether practised by paediatricians or general practioners to benefit high‐risk, low‐income children in the UK.