Guiding parents to play and read with their babies increased parental support of their children’s cognitive development by the time they turned 2—setting the stage for children’s improved school readiness by age 4.

This is the finding of a new study led by researchers at NYU Grossman School of Medicine; NYU Steinhardt School of Culture, Education, and Human Development; and the University of Pittsburgh. The work evaluated the effects of a parental education and support program they developed, called Smart Beginnings, for primarily Black and Hispanic children growing up in low-income and under-resourced communities.

Smart Beginnings combines two programs: the Video Interaction Project (VIP) and the Family Check-Up (FCU).

Previous studies have shown that children in minority, under-resourced, low-income families are more likely to have behavioral problems, such as hyperactivity from prolonged toxic stress, an abnormal stress response that often coincides with lack of caregiver support and reassurance. And they often perform more poorly in school, according to the researchers.

For the study, 403 newborns in New York and Pittsburgh were enrolled by their mothers. Slightly more than half, 203, were randomly assigned to receive Smart Beginnings, and the remaining 200 received standard pediatric primary care. Most of the mothers were married or had a live-in partner, and all were eligible for Medicaid. Almost all were Black or Hispanic.

As part of the VIP component of Smart Beginnings, mothers were videotaped with their infants for three to five minutes during routine monthly checkups as they played with a new toy, such as cars or black-and-white patterned blocks. A trained coach encouraged interaction as they played. Mothers took home the videotape and educational pamphlets and were encouraged to repeat the playtime at home. As their children got older, parents were given books to read to them.

In the FCU component, at the six-month mark, the reading and playtime activities were followed up by a visit with a social worker at home or, for families that had additional family management issues or child behavior problems, at the well-child clinic. Lasting as long as two hours, these conversational sessions were designed to screen for signs of family problems, such as symptoms of depression in the mother, evidence of family violence, and lack of food. Counseling and government services were offered as needed. The social worker conducted another in-depth visit a year later.

In contrast, the 200 children receiving standard care still went for monthly visits to the pediatrician but did not receive any videotaped play and coaching, or any sessions with a social worker.

Analysis of the program, published online in the Journal of Pediatrics on December 5, showed that at 2 years of age, scores for the parents of the 203 children who were randomly assigned to receive Smart Beginnings were significantly higher among three broad survey and observational measures of cognitive development and the home environment compared with scores for the parents of the 200 children who had been randomly chosen to receive standard pediatric primary care.

“Our study adds to the evidence that positively stimulating cognitive development from infancy to toddlerhood through coaching of parents and home visits that encourage play and reading can dramatically improve the child–parent relationship, and shape the child’s social, emotional, and academic development later in life,” says study lead investigator Elizabeth B. Miller, PhD, an assistant professor in the Department of Population Health at NYU Langone Health.

“Programs such as Smart Beginnings can possibly help reduce the disparities in early childhood development that disproportionately impact Black and Hispanic children in America,” adds Dr. Miller.

“Smart Beginnings offers an efficient and effective strategy to promote childhood cognitive development from infancy through toddlerhood,” says senior study investigator and co-principal investigator Pamela Morris-Perez, PhD, a professor of applied psychology at NYU Steinhardt School of Culture, Education, and Human Development and an affiliated professor at NYU School of Global Public Health. “Because our program is delivered directly from the pediatrician’s office, it reaches mothers of newborns where they are most likely to go as part of their routine family care, and it tailors resources to family strengths and needs.”

Dr. Miller says the cost of the Smart Beginnings program, which is ready to be implemented and scaled, is about one-tenth the cost of other interventional programs with similar goals.

Funding for the study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, grant R01HD076390.

Besides Dr. Miller and Dr. Morris-Perez (co-principal investigator), other NYU study investigators are Alan L. Mendelsohn, MD (co-principal investigator); Erin Roby, PhD; Lerzan Coskun, PhD; Marc Scott, PhD; and Juliana Gutierrez, BA. Additional study co-investigators are Yudong Zhang, PhD, at Northwestern University in Chicago; and Johana M. Rosas, PhD, and Daniel Shaw, PhD (co-principal investigator), both at the University of Pittsburgh.

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