Pediatricians prescribe many things, but a prescription for books may surprise parents.

Research shows many parents don't read enough to their children, and literacy gaps can emerge in kids as young as 18 months.

In response, doctor's orders are to read bedtime stories, sing and talk to keep infants and toddlers from falling behind.

Dr. Elena Huang was examining 17-month-old Keith Patrick recently at the Children's Hospital of Philadelphia Karabots Pediatric Care Center in West Philadelphia.

Like every child from 6 months to 5 years old, he gets a new book at every checkup.

"So you remember we've given him books before," she tells Keith's dad, Larry. "And now we try to pick one that might be some of the things he's doing, like learning his body parts."

She turns to the toddler and coos, "Like, where's your nose? Where's your mouth?"

keithKeith Patrick, 17 months,  gets a book from Dr. Elena Huang at the Karabots Pediatric Care Center. (Emma Lee/WHYY)

The clinic is part of Reach Out and Read -- a national nonprofit that partners with medical providers to give free books at doctor's visits and promote school readiness, with a special emphasis on children from low-income communities.

Dr. Trude Haecker, a pediatrician at the Children's Hospital of Philadelphia, is the medical director for Reach Out and Read Greater Philadelphia and the hospital's program.

"Those first thousand days are the most important for brain development. And to stimulate language, you want to be talking, singing, reading to your baby," she said.

She founded the Philadelphia program almost 20 years ago. It grew out of her own interest in reading with her children.

"We were at home reading to them every night. We had more books in the house than we knew what to do with," she recalled. "I was seeing patients in the clinic and, in fact, those children didn't have books. And it was very clear to me that there was a difference in the experience that our families were getting and that I was able to give my own children."

After learning about the national program, Haecker helped form a Reach Out and Read program at CHOP and, eventually, the coalition throughout Greater Philadelphia.

Reach Out and Read Greater Philadelphia has 47 sites in Southeastern Pennsylvania and serves more than 40,000 children annually. Nationally, it has more than 5,000 programs and serves 4 million children.

"For many of our families, they don't think to have books at that very young age," Haecker said. "So it's very unusual for some of our families to have books in the home and to have the ability to think about reading early to their baby."

doctorDr. Trude Haecker presents a book to 2-year-old Kareem Brown-Smith during a visit to Karabots Pediatric Care Center with his parents. (Emma Lee/WHYY)

Besides the children who get a new book at every well visit, their siblings or children in for a sick visit receive a gently used book.

The "literacy-rich" sites include waiting rooms filled books and volunteers who read to kids, book bins in every exam room, and books everywhere that children are welcome to take home.

"Because we have books in the waiting room, if I walk in and a mother or grandmother or caregiver and a child are reading together I know that I've done my job."

'Not just a feel-good program'

In 1996, Tamia Howard was pregnant with twin daughters.

"I was high risk. I was also told that one of them wouldn't make it," Howard said. "And [Haecker] told me she would do everything she could and she did."

Now 19, twins Tamairra and Tiairra Cannady were born at 28 weeks. They were 12 weeks early and underweight, and one was transported to CHOP.

"One got better. She came home, and the other one stayed in the hospital for almost a year," their mother said.

Howard took the girls to "day hospital," which was all day Monday through Friday.

When the girls were 8 months old, Haecker started Reach Out and Read.

"She told me there was to be a program where they can get books inside the doctor's office, and I'm like, 'Books? They only little kids,'" Howard recalled. "But she used to tell me all the time, no matter how old they were, just keep reading books. And I would buy little books and just read."

twinsTamairra (left) and Tiairra Cannady, 19-year-old twins, are off to college this year. Their parents credit their academic success in part to the Reach Out and Read program. (Emma Lee/WHYY)

The pediatrician says the program makes sense from a medical perspective.

"It's not just about a 'feel-good' program," Haecker said. "It actually is changing brain growth. Neurons are developing at about 700 neural cells per second in those first three years of life. If they're not stimulated by us talking to our children, reading to them, engaging with them, those are pruned back."

Howard credits the program with helping her daughters surpass expectations, especially since other doctors said her daughters would likely struggle intellectually.

"I had one doctor that told me that, 'No matter what you did, your kid will probably be 50 percent to 80 percent delayed,' and I'm like, 'No, that's not possible.'"

Improving school outcomes

Tiairra Cannady says without their doctor always pushing them to read, she and her sister would probably be one of those premie statistics.

"If we didn't have her, I think we would be like behind a little," she said.

Her sister Tamairra says the program played a big role as they grew.

"I think it did have an impact because it improved our vocabulary and writing out sentences and stuff like that."

Both girls attended magnet high schools and, this fall, they headed off to college on academic scholarships.

Research shows the program improves school outcomes.

Howard said she probably wouldn't have read to the girls that early, but it was something the girls wanted to do.

"It got to a point where all they wanted to do was go to the doctor's office because they could get the books."

She said the program influenced her parenting, but it also helps communities without bookstores and serves some parents who may not have graduated high school.

"This is a change, and it was one of the things that I really liked about the doctor's office. They were bringing change in a community that really needed it."

Each site is responsible for raising its own funds to provide books, and relies on philanthropy. The twins have hosted book drives at their schools and plan to at their college.

'Essential component'

The American Academy of Pediatrics, for the first time, is promoting early literacy as an essential component of primary care visits.

Haecker says one reason doctors are involved in pre-literacy is because they're a consistent voice in children's early years.

"We see kids at many ages so we get to know them very well. They look to us for trusted guidance on diet, nutrition, safety, development issues, and so this is absolutely a natural extension of that."

And the pediatrician is still handing out books.

"Hi guys. Hi, Jania. How are you? And there's Taylor. I have a book for each of you. Do you like books, Taylor? Look, Jania, this is a new one," she said to twins in the exam room.

The Greater Philadelphia sites give out nearly 80,000 new books a year, available in 15 different languages.