Doctors Now Testing Reading Skills During Checkups to Combat Low Literacy

A children's hospital in Ohio has started conducting reading assessments during routine pediatric visits for kids as young as 3 years old. The innovative approach aims to identify early literacy struggles before children enter kindergarten, as national reading proficiency rates continue to decline.

In Columbus, Ohio, some young children are getting their reading abilities evaluated before they even step foot in a classroom — it’s happening right in their pediatrician’s office.

As childhood literacy struggles continue nationwide, Nationwide Children’s Hospital has launched a program to evaluate reading skills during routine medical visits for children beginning at age 3. The goal is to identify potential reading difficulties before they become bigger problems and provide parents with tools to support their children at home.

“They are all doing developmental screenings, they’re all talking to parents repeatedly,” explained Sara Bode, who serves as the hospital’s medical director of school-based health. “So this is an opportunity.”

The hospital strategically selected clinic locations based on their closeness to schools where students scored poorly on kindergarten readiness evaluations. Data from the state’s kindergarten readiness assessment shows that over 63% of kindergarten students in Columbus City Schools were not meeting language and literacy benchmarks during the current 2024-2025 academic year.

The literacy crisis extends well beyond Columbus borders. According to the 2024 National Assessment of Educational Progress — commonly referred to as the nation’s report card — only slightly more than 30% of fourth-grade students demonstrate reading proficiency nationwide. This represents a decline of 4 percentage points since 2019, as educational systems continue working to recover from pandemic-related learning setbacks.

While medical facilities don’t traditionally conduct reading evaluations, several major pediatric hospitals, including Boston Children’s Hospital, have begun offering early literacy resources to families, recognizing how crucial reading skills are for child development.

Children who start kindergarten with weaker reading abilities typically find it difficult to improve in subsequent years. Research from The Children’s Reading Foundation shows that nearly three-quarters of kindergarteners who score in the lowest 20% on readiness tests remain in that bottom tier through fifth grade.

Medical professionals have historically concentrated their developmental evaluations on physical milestones like walking and speaking at appropriate ages. However, Bode noted that children might pass standard pediatric screenings while still lacking other essential skills needed for kindergarten success.

To tackle this challenge, the pediatric facility rolled out literacy evaluations at approximately half of its 13 clinic locations, with each site having a dedicated literacy coordinator. Since the program’s 2022 launch, staff have completed over 2,400 assessments. The hospital primarily serves families without insurance or those covered by Medicaid, representing high-needs communities.

The screenings don’t aim to diagnose specific learning disorders such as dyslexia, but instead pinpoint areas where children might benefit from extra help.

Devin Kearns, an early literacy expert at North Carolina State University, believes having resources beyond the school system to catch reading problems early is beneficial, though selecting appropriate screening methods remains crucial.

Nationwide’s coordinators utilize an assessment tool that evaluates children as they work through a book during their medical appointments — available in both English and Spanish. Staff needed time to perfect the timing, learning to avoid periods right after vaccinations when children might be distressed, but the reading evaluations typically require just 10 minutes.

Following each assessment, coordinators develop individualized literacy plans that identify specific areas requiring additional practice.

These appointments also allow staff to demonstrate activities parents can implement at home, such as reading stories aloud, according to Carneshia Edwards, who oversees the hospital’s kindergarten readiness initiative.

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

Before 3-year-old Juri Sleet underwent her literacy evaluation, her grandmother Quintina Davis was concerned that Juri lacked sufficient early learning experiences. However, working with the literacy coordinator at their clinic helped Davis discover numerous activities she could pursue at home with Juri.

“She didn’t know as much, but our coordinator was very patient with her,” Davis shared.

After completing screenings, coordinators assemble literacy packages containing various tools and activities for home practice. These materials are also shaped by input from Columbus City Schools educators regarding what skills students need when entering kindergarten.

The package contents depend largely on program donations. Common items include dry-erase boards for letter writing and books for reading practice. However, the kits might also contain safety scissors or pencils with rubber grips to enhance fine motor abilities.

“Parents are the first teachers, so we really try to encourage them to sit down with their child and just kind of work with them before going into kindergarten,” Edwards emphasized.

Coordinators maintain contact with families they’ve worked with, sometimes connecting children to early education initiatives like the federally-supported Head Start preschool program or SPARK, which provides educational home visits.

When children return for clinic visits a year later, coordinators meet with them again. For Juri, now 4 years old, the follow-up appointment demonstrated how much progress she had achieved over twelve months, her grandmother reported.

During that year, Juri had improved significantly in identifying letters, sounds, and sight words. With her literacy coordinator’s assistance, Juri also began attending preschool at a nearby YMCA, Davis explained. She’s been performing “awesome” there, Davis said, and she’s excited to watch her continue developing.

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