<p><strong>OBJECTIVE: </strong>To determine feasibility and explore effects of literacy promotion using e-books vs. board books on the home reading environment, book reading, television use, and child development.</p>

<p><strong>METHODS: </strong>Randomized controlled trial comparing digital literacy promotion (DLP) using e-books to standard literacy promotion (SLP) using board books among Medicaid-eligible infants. DLP participants received e-books on home digital devices, while SLP participants received board books at well visits between 6-12 months of age. Differences in StimQ Read Subscale (StimQ-Read) scores, parent-reported reading and television use, and Bayley Scales of Infant Development-3 Edition (Bayley-3) scores between groups were assessed using intention-to-treat analysis.</p>

<p><strong>RESULTS: </strong>104 Medicaid-eligible infants were enrolled and randomized from 3 pediatric practices. There were no differences in socio-demographic characteristics between groups at baseline. Children in the DLP group initially had lesser StimQ-Read scores but showed similar increases in StimQ-Read scores over time as children in the SLP group. Parents in the DLP group reported greater use of digital devices to read or engage their child (65% vs. 23%, p&lt;0.001) but similar board book reading and television viewing. There were no differences between groups in cognitive or motor scale scores, but DLP participants had marginally lower language scales scores (DLP 85.7 vs. SLP 89.7; p=0.10) at the 6-month follow-up.</p>

<p><strong>CONCLUSIONS/DISCUSSION: </strong>Literacy promotion using e-books was feasible and associated with greater e-book usage but no difference in board book reading, television viewing, or home reading environment scores. A potential adverse impact of e-books on language development should be confirmed in future study.</p>

<p><strong>TRIAL REGISTRATION: </strong>Clinicaltrials.gov Identifier NCT03121365.</p>

<p><strong>OBJECTIVE: </strong>Literacy promotion is a pediatric standard of care in which clinicians provide guidance on shared reading. Latino parents are more likely to hear advice to read with children but are less likely to do so. We sought to understand literacy promotion from the perspective of Latino parents and to identify facilitators and barriers.</p>

<p><strong>METHODS: </strong>We purposively sampled Latino parents who participated in Reach Out and Read (ROR) for a qualitative, semi-structured interview study. We identified themes using immersion/crystallization and achieved thematic saturation after 21 interviews.</p>

<p><strong>RESULTS: </strong>Two-thirds of participants had less than high school education; half of whom had not completed 8th grade. The mean child age was 16.4 months. Primary facilitators of engagement were advice from a pediatrician during a clinical encounter and receipt of the ROR book. Barriers identified included: (1) parents' perceptions that their children were not developmentally ready and that their children's behavior (e.g., activity) indicated they were not interested in shared reading; (2) self-perceived limited literacy and/or English proficiency; (3) parenting demands occurring in the context of poverty; and (4) continued child media use despite advice from pediatricians to choose alternate activities such as shared reading instead.</p>

<p><strong>CONCLUSIONS: </strong>Parent-clinician relationships are central to ROR's impact but clinicians need to pay more attention to factors in a child's broader environment to strengthen literacy promotion. Specifically clinicians should emphasize skill building during the clinical encounter (e.g., sharing knowledge about child development and modeling) and work collaboratively with other stakeholders to address poverty-related stressors.</p>

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Understanding of parent anxiety and its effect on infant postoperative pain is limited. We sought to identify psychological factors associated with preoperative anxiety for parents of infants and toddlers undergoing elective surgery and to determine whether parent anxiety is associated with child postoperative pain.</p>

<p><strong>METHODS: </strong>This was a prospective cohort study of consecutively eligible patients aged ≤18 months undergoing craniofacial surgery and their parents. Preoperative parent assessment included anxiety, coping, parent health locus of control, and self-efficacy. Postoperative inpatient child pain scores and medication use were collected. Analyses included hierarchical multivariable logistic and linear regression models.</p>

<p><strong>RESULTS: </strong>Parents (n = 71, 90% female) of young children (mean age 6.6 months) undergoing cleft lip or palate (n = 59) or cranial vault repair (n = 13) were enrolled. Maladaptive coping (odds ratio 1.3; 95% confidence interval, 1.1-1.6), low parent self-efficacy (odds ratio 2.4; 95% confidence interval, 1.3-4.5), and external locus of control (odds ratio 1.74; 95% confidence interval, 1.1-2.9) were independently associated with high parental anxiety. The adjusted odds of moderate/severe parent anxiety was 3.6 (95% confidence interval, 1.5-9.1) higher with each SD increase in maladaptive coping. High parental anxiety was correlated with significantly higher hospital mean child pain scores (1.87 points on 0-10 scale; 95% confidence interval, 0.42-3.70; P = .045).</p>

<p><strong>CONCLUSIONS: </strong>Coping and self-efficacy are modifiable factors that contribute to parent anxiety before and during hospitalization and may be targets for intervention. Infants and toddlers undergoing elective craniofacial surgery with highly anxious parents may be at greater risk for higher postoperative pain.</p>