The 90 minutes that Whitney Zachritz, MSN, RN, CPNP-BC, spends offering books and snacks to parents of the hospital’s littlest patients are typically the most special of her week.
Zachritz, an Intensive Care Nursery (ICN) clinical practice leader at the Hospital of the University of Pennsylvania (HUP), hands out between 30 and 50 children’s books every week to parents, depending on how many babies are in the nursery. Some families want Zachritz to select the book, while others enjoy perusing the cart. Sometimes they chat about how the baby’s doing and the vibe they’re projecting that day—strength, calm, and stick-to-itiveness are popular in this environment—and Zachritz will look for a fitting title. A lifelong reader herself, Zachritz loves making recommendations.
One day last fall, baby Mohamed (“Mo”) was getting his breathing tube taken out after three months in the intensive care nursery. “He needs a ‘You can do it!’,” Zachritz said to his mother, Boura Zerbo. “It’s a lot of work to have the tube removed and breathe more or less on his own.”
Zachritz found two children’s classics that seemed to suit the occasion: Oh, the Places You’ll Go, by Dr. Seuss, and The Little Engine That Could. Mo had amassed quite a library during his time in the ICN, ranging from Ada Twist, Scientist, to The Berenstain Bears Keep the Faith.
With the baby’s dad in West Africa, Zerbo sat by Mo’s incubator all day, every day, and often read to the infant. He was born at 23 weeks of gestation, weighing 1 pound. Love You Forever was his first book, which she remembers reading to him through tears, thinking about how hard he was fighting to stay alive.
“I want him to be a smart, smart, smart boy one day,” Zerbo said. “My child is a warrior … and I will love him forever.”
Most of her time on duty in the 38-bed neonatal intensive care unit, Zachritz is responding in moments of crisis to assist the nurses; explaining things to families while the teams work on their babies; or generally helping parents through the frightening roller coaster of having an extremely low-birth-weight or medically fragile newborn in intensive care for days or months. But when Zachritz is walking through the room with her cart of books, granola bars, and other freebies, the moments are lighter: She’s just there to give out books and treats.
“The cart is meant to break up the day and bring a sense of lightness and joy to families,” Zachritz said. “No matter how their day has gone, the cart is meant to bring joy, not add stress.”
The book-brain link
Zerbo and Zachritz peruse the cart for the perfect selection.
Beyond providing feel-good moments, the mission underlying Books4Brains, as the initiative is named, is meant to drive home the importance of reading, talking, and singing to babies for healthy brain growth and parent-child bonding. The benefits of reading to infants are well-established, said neonatologist Hallam Hurt, MD, education director and attending neonatologist in the Neonatal Follow-up Program at Children's Hospital of Philadelphia (CHOP)'s Buerger Center for Advanced Pediatric Care (where families also get a book at every visit through the national Reach Out and Read Program). Previously an attending physician in the HUP ICN, Hurt sees those babies at the follow-up clinic once they’ve been discharged.
“The literature absolutely supports better thinking and improved language skills for babies who are read to,” plus increased warmth and affection between baby and parent, Hurt said. The physician tells families they can read anything—board books, religious scriptures, poetry, or a favorite novel.
Books4Brains is one of several programs at intensive care nurseries and neonatal intensive care units (NICUs) throughout the health system devoted to early literacy, including the Bonding With Books program at Chester County Hospital’s (CCH’s) NICU, where there is a basket of books at the front of the unit and parents are welcome to take as many books as they would like through their infant’s stay. The NICU’s volunteer “Cuddlers” often also choose a book to read during their session and then leave the book at the bedside for the family to keep, said Lisa R. Drinker, MD, a CHOP neonatologist and the CCH NICU’s medical director.
Conquering that helpless feeling
Besides the benefits for infant brain development, reading in the intensive care nursery gives helpless parents a way to feel a sense of purpose, even when they can’t hold their fragile babies, Hurt and Zachritz said.
“With every single patient in the ICN, the situation is out of your control,” Hurt said. “And so, when you can do something to say, ‘This is going to help my baby’s thinking and language and warmth when they hear my voice,’ it’s a wonderful thing.”
Zachritz reassures parents that they will not disturb their infant, no matter how fragile. “‘Your baby knows your voice,’” she tells them.
Chipping away at inequities
At HUP, the Books4Brains program is the latest iteration of a series of programs to promote books for intensive care babies that in the past have included a standard take-home book for parents and a lending library in the waiting room.
Many, roughly half or more, of the families the HUP ICN serves are low-income, Zachritz said. This means the program can be particularly meaningful because access to books in the home and in the community has a huge impact on child development, yet that access varies drastically with socioeconomic status, according to national research. Children from low-income families have fewer reading materials than children from middle- or high-income families. An often-referenced study found middle-income neighborhoods had 13 books per child, while low-income neighborhoods had only one book per 300 children. “A lot of our families don’t have a home library and live in neighborhoods that are book deserts,” Zachritz said, referring to areas where children and families have limited access to books and other reading materials. “To put books in their hands … it’s a really powerful thing.”
Drawing on personal passions
Reading to infants from birth aids in parent-child bonding as well as brain development, experts say.
Zachritz finds this work especially meaningful because literacy, books, and libraries have meant so much in her own parenting experience. She and her daughters spent years maxing out their library cards each week until a librarian gifted Zachritz a teacher library card, which gave her more privileges.
The support of multiple grants, including two from the Penn Medicine CAREs program, along with book drives throughout the hospital and multiple local partnerships, has enabled Zachritz to build an abundant inventory of books for ICN families. Help comes from all over the health system and beyond. Last year, Oncolink Innovation Director and fellow CAREs Grant recipient Carolyn Vachani, MSN, RN, who collects books for BookSmiles—a local nonprofit with a book bank where teachers can come “shopping”—read about Zachritz’s project and connected her with the founder to get baby/toddler books, as teachers generally don’t want those. Hundreds more books have come through thanks to a certified nursing assistant on the unit (and nursing student at Penn) who has a strong interest in early literacy and has done fundraising and book drives.
With an interracial family, a same-sex partner, and adopted children of her own, Zachritz puts a priority on equity and inclusion in the literature she offers. She likes the notion of books being both mirrors and windows, with some reflecting the circumstances of the reader, and others exposing the reader to different worlds. There are classic, rhyming, and religious titles; books in different languages and literacy levels; and characters and stories representing all sorts of families, races, religions, and abilities.
Between April 2022 and early December 2023, Books4Brains has given out more than 3,100 books, with each ICN infant receiving at least eight books for their home libraries, on average. Through her relationship with her neighborhood library in Philadelphia, Zachritz also procured a stack of library cards and applications that parents who live in the city can fill out when they’re leaving the hospital, along with a map of libraries in the city, to encourage them to use that local resource.
“The public library has had an enormously positive impact on me and my family, and I like to share that with people. They are welcoming and safe places, full of kind and helpful people, which is a wonderful resource, especially to parents. Additionally, they are obviously committed to literacy and are free, so I like to highlight the resource to families.”
Recently, Hurt, the neonatologist, was visiting parents in the ICN. There was a barrier around one incubator, so she couldn’t see the parent, but she heard, in a somewhat halting voice, “Is—your—mama—a—llama?”, a line from Deborah Guarino’s 1997 book of the same name.
A smile came to Hurt’s face.
“Reading is a lifelong journey,” Hurt said, “which for families in the HUP ICN, begins with receiving a book, and the assurance that they are contributing to their baby’s well-being amidst a backdrop of emotional highs and lows.”