There has been extensive research on the science of “Early Brain and Child Development” that supports the critical impact of children's early experience upon their learning, health and life course trajectory.1 More specifically, reading with young children stimulates optimal patterns of brain development and strengthens parent-child relationships, which in turn builds life-long skills in different aspects - language, literacy and social-emotional skills. 2 In response to the rapid increase in knowledge of neuroscience in the recent decades, programmes to enhance ‘emergent literacy' were developed with promising positive outcomes in language development, parent-child bonding, as well as later success in reading and academic achievement. 3, 4


The American Academy of Pediatrics Policy statement on literacy promotion2 recommended paediatric providers to promote early literacy development from infancy. By being read to from infancy, children learn to associate books with enjoyment and social closeness,5 while their joint attention with adults is being promoted.6 Moreover, they are starting on the road to ‘emergent literacy' which refers to the child's knowledge of language emerged before reading and writing.7 Emergent literacy consists of the skills, knowledge, and attitudes that are presumed to be developmental precursors to reading and writing and the environments that support these developments. It is a developmental continuum rather than an all-or-none phenomenon. Oral language, reading and writing develop concurrently and interdependently from children's exposure to interactions in the social context. 3 Reading promotes joint attention and language development as well as social emotional development, laying the foundation for school learning. The earlier the reading habit develops, the more solid foundation of learning creates.


There are only a few small scaled local studies on reading with young children (also called shared reading or reading aloud) published. 8, 9 In a recent survey by the Department of Health10, 614 parents with children of 12 months, 18 months and 48 months old were asked about reading with children. Fifty-one per cent said they would always accompany their children in reading. Only 6% said they had never read with their children. The results suggest that parents were aware of the importance of shared reading.

The Progress in International Reading Literacy Study (PIRLS) survey11 commissioned by Education Bureau on reading of Hong Kong grade four students found that the more the students had been engaged in home literacy related activities before entering primary school, the higher their subsequent reading attainment. Parents' interest in reading, provision of books and educational resources for children at home, and their expectation about children's academic success were found to be positively related to children's reading achievement. Nevertheless, reading interest of Hong Kong parents was found to be far lower than the comparing countries. Another interesting finding was that Hong Kong parents' education and socioeconomic background were found to have insignificant impact on their children's reading performance. The PIRLS results suggest that in addition to the reading activities in school, parental involvement is important in promoting children's reading performance. The latter is particularly important in the early years.


There are various overseas campaigns and programmes on reading for raising parents' awareness of the importance of reading for children and equipping them with necessary resources and skills. A few examples are described below:

In UK, National Literacy Trust provides tips, research evidence and best practice examples to help early childcare workers and preschool teachers to involve disadvantaged families with young children in reading in various community settings.

In US, a 10-year National Campaign called Read Aloud 15 MINUTES was launched in 2013 with the vision of having every child being read to for 15 minutes every day to change the face of education. Another US programme named Reach out and Read (ROR) is an evidence-based national programme promoting early literacy in paediatric clinics. 12 The target population is families, particularly those economically and socially at risk, that have children from 6 months to 5 years of age. During health supervision visit, medical providers offer parents anticipatory guidance about shared reading for children. The other two components of the programme include providing literacy-rich waiting rooms in clinic and giving an age-appropriate book to children after health visits. This ROR model incorporated in routine health care of pre-school children has been introduced to India and demonstrated significant benefit in promoting literacy and school readiness. 13 A modified ROR model has also been started in Taiwan14 since 2007.

In Hong Kong, there is no centralized literacy programme for young children. Promotion of early literacy is mainly supported by the Kindergarten and Primary Section, Curriculum Development Institute under Education Bureau which has developed resources for parents of children aged 0-9 years as well as parents seminars since 2010. The Hong Kong Public Libraries organize regular reading programmes,workshops and paired reading talks while a few non-government organizations e.g. Bring Me a Book Hong Kong, Hans Anderson Club run reading promotion activities.

As there is still much to develop for emergent literacy programmes in Hong Kong, we may take reference from the overseas programmes. Other than early childhood educators, social workers and medical professionals can play a proactive role in promoting early literacy, starting from guiding parents with developmentally appropriate tips and develop further on with structured evidenced-based programmes.


Child development is a dynamic process of learning in a planned, organized and independent manner. Children's developmental milestones are convenient guidelines for looking at the rate or the extent of their progress. 5 If parents understand the expected “typical behaviour”, they can have more realistic expectation on children's development and be more confident in using appropriate shared reading skills:

  • Reading literacy starts with listening and speaking. Talk frequently and respond positively to baby's actions
  • Establish a daily routine of shared reading help to form a reading habit early in life
  • Teach children to learn how books work, including holding the book the right way up, turning pages, orienting the books so that listeners can see the pictures, the relationship of pictures and text, and following print with index finger from left to right, are all acquired through repeated modelling and prompting.5
  • Offer language-rich exposure to books and provide developmentally appropriate books at home to facilitate language development
  • From Birth to 6 months old, babies can read gestures and facial expressions of adults. Parents can talk, sing, smile and gesture to their babies. The more stimulation babies receive, the stronger the brain cells connection develop.15
  • The 6 to 12 months olds like to reach out and pat the pictures in the book. Parents can point to and name the picture baby interested in, look at him and copy the sound baby makes. These back-and-forth conversations build up not only brain cells connection but also emotional bonding with parents.
  • The 12 to 24 months old toddlers are able to point to objects of interest. Parents can respond to what their child says while looking at a picture, name and say a few words about the picture to build up his vocabulary.
  • Around 24 months old, adults can adopt the dialogic reading approach which uses active listening, asking questions, adding information and prompting the child to increase the sophistication of his description of the materials in the picture book. 3 For instance, after reading “The little dog runs away”, parents can pause to ask, “Where's the little dog? ”. As young child points at the dog in the picture, parents can point at the words “little dog”. This helps children understand that picture stands for the dog and the words are symbols which do the same thing. The questions and prompting get more sophisticated with the increase of child's understanding and vocabulary.
  • The 3 to 4 years olds can sit for a longer story and recite some phrases from a book. Parents can ask their child “What happens next?” in familiar stories. In addition, they can make up stories about the pictures together.
  • The 4 to 5 years olds recognise familiar words and retell familiar stories. Parents may invite their child to tell you the story and relate the story to his life experiences. Parents can also encourage him to create stories using drawing and simple writing.


  1. Books Build Connection Toolkit, by American Academy of Pediatrics
  2. Reach out and Read Resource Center
  3. National Literacy Trust – resources and tools for early years
  4. Words for Life
  5. Booklets and Pamphlet on Parent-child Reading is Fun – for Parents of Children Aged 0-9, by Curriculum Development Institute, Education Bureau, HKSAR
  6. Health Information from Family Health Service, Department of Health:
    1. Parenting Series 7 Connecting with your baby – for parents with babies under one
    2. Parenting Series 9 - Learning to Talk For 1-2 Years Old
    3. Parenting Series 13 - Communicating with Words For 2-4 years old
  7. Early Literacy for Chinese Children, by the Department of Psychology, The Chinese University of Hong Kong

Dr. Wendy WONG, Asso Con, Dept of Paed & Adol Med, PYNEH
Mrs. Francis AU, Clin. Psy., FHS, DH


  1. American Academy of Pediatrics. Evidence Supporting Early Literacy and Early Learning.
  2. Council on Early Childhood. Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. Pediatrics 2014:134: 2:404-409.
  3. Whitehurst GJ, Lonigan CJ. Child development and emergent literacy. Child Development 1998:69:3:848-872
  4. Duursma E, Augustyn M, Zuckerman B. Reading aloud to children: The evidence. Arch Dis Child 2008 :93(7):554-7.
  5. Sharma A, Cockerill H. Mary Sheridan's From Birth to Five Years - Children's Developmental Process (4th ed). Oxon: Routledge, 2014.
  6. Farrant BM, Zubrick R. Early vocabulary development: The importance of joint attention and parent-child book reading. First Language 2011:32: 3:343-364.
  7. UNESCO. Emergent Literacy in Early Childhood Education. Israel: UNESCO, 1993.
  8. Chow BWY, McBride-Chang C, Cheung H. Parent-Child Reading in English as a Second Language: Effects on Language and literacy development of Chinese Kindergarteners. Journal of Research in Reading 2009:33(3): 284-301.
  9. Chow BWY, McBride-Chang C. Promoting Language and Literacy Development through Parent–Child Reading in Hong Kong Preschoolers. Early Education and Development 2003:14(2): 233-248.
  10. Department of Health. Survey on television viewing and use of electronic screen products among pre-school children. Unpublished paper.
  11. Progress in International Reading Literacy Study (PIRLS) 2016 International Report (Hong Kong Section).
  12. Klass P, Dreyer BP, Mendelsohn AL. Reach Out and Read: Literacy promotion in pediatric primary care. Adv Pediatr 2009: 56: 11–27.
  13. Srivastava G, Bhatnagar S, Khan H, Thakur S, Khan K, Prabhakar B. Impact of a clinic based literacy intervention Reach Out and Read (ROR) modelled program on preschool children in India. International Journal of Contemporary Pediatrics 2015:345-348.
  14. Wu, S.C., Lue, H.C., & Tseng, L.L.(2012). A pediatric clinic-based approach to early literacy promotion-experience in a well-baby clinic in Taiwan. Journal of the Formosan Medical Association, 111(5), 258-264.
  15. Center on the Developing Child, Harvard University. Key Concepts: Serve and Return.