'Readiatrician' incorporates books into her pediatrics practice

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Dr. Jaclyn Sisskind is a pediatrician who loves to read, and she's been known to write prescriptions for particular books to patients when she thinks it might help them.

Her nickname is "the Readiatrician.". And with me to talk about that is Dr. Sisskind herself. She's an assistant professor of pediatrics at Upstate. Welcome back to "The Informed Patient," Dr. Sisskind.

Jaclyn Sisskind, MD: It's a pleasure to be back again.

Host Amber Smith: I know you enjoy reading. Why is it important, particularly for children and adolescents?

Jaclyn Sisskind, MD: It's such a wonderful way for children and adolescents to connect with the people around them, their teachers, their parents, their friends, and even at young ages, reading helps build so many tools that we need for our lives. It builds vocabulary. It builds the opportunity to think about other people and other situations and other worlds outside of their own. And it gives kids the language to be able to express how they might be feeling when they are exposed to it in a book or in a picture that they see in a book.

Host Amber Smith: Does it build imagination?

Jaclyn Sisskind, MD: Absolutely, to experience something they might not have thought of before. And many children's books have an element of the fantastical to it or the imaginative. And it gives kids permission to think about things in a new and different way, which really opens up a world of possibilities for them.

Host Amber Smith: Do you think that making books a part of childhood has a lasting effect on people into adulthood?

Jaclyn Sisskind, MD: For sure. It certainly did for me, and I'm noticing that with my children as well. When you ask someone a book that they enjoyed as a child, you can almost see their face change with the joy of that memory.

And there are certain characters or certain situations that carry through, not to say that every book that you read as a child is going to change the way that you face adulthood. But I think that the experience of reading lots of different things, being exposed to lots of different things, in childhood makes a big difference.

One example that I always give people is that one of my favorite books when I was young, kind of in middle grade, was "Anne of Green Gables" by Lucy Maud Montgomery. And in that book, the main character, Anne, has to go help one of her friend's little sisters, who has diphtheria. And I got a question right on my pediatric boards (exams) about diphtheria because of a scene in that book, it just stuck in my brain.

It was like Anne and Diana were friends of mine. And when I was faced with that question, I remembered that. I think that the things that we read when we were kids really stick in our heads for a long time,

Host Amber Smith: That's funny. I was going to ask if it matters, what type of book? I mean, some kids like fiction and some like nonfiction, poetry, even graphic novels.

Does it make a difference what a kid gravitates to?

Jaclyn Sisskind, MD: So glad you asked this question because often parents ask me, "Well, they like to read 'Dog Man,' " for example. "Dog Man" is a very popular graphic novel, and parents will say to me, "But that's not really reading." And of course it is really reading. Reading magazines, reading graphic novels, nonfiction, fiction, historical fiction, biography, whatever someone is connecting to counts as reading. Reading is the act of interacting with text and with narrative and making it a part of what you're thinking about, and that applies across the board. And I actually think it's very important for kids to be exposed to all different types of books so that they can decide what it is that they really like. You know, it's one thing for a parent to say, "My kid doesn't like reading," and we can offer some things. But the flip of that is for a parent to say, "Oh, my child loves reading. They devour books," but if they're just devouring one kind of book, if they're just really into one series or one type of fiction, and they haven't learned what else is out there, they might actually like lots of different kinds of books, and what a service to be able to show them when they're young. You know what? You like sci-fi, or you are really interested in biography. I think that's a great thing to teach kids when they're young and focusing on just the classics or just what would be considered to be a chapter book is not necessarily the way to go.

Host Amber Smith: Well, I'd like to ask you, because we've seen a lot of this in the news lately about book bans. Some schools and some public libraries are banning certain books -- "Of Mice and Men" by John Steinbeck, "To Kill a Mockingbird" by Harper Lee, "Speak" by Laurie Halse Anderson, even the graphic novel "Maus" by Art Spiegelman. And these are books that are popular and award-winning that have been used for years in educational curriculums. What is motivating groups to ban these books?

Jaclyn Sisskind, MD: So glad you asked me this question. This is it's truly a passion of mine. I am not entirely sure where the motivation is coming to ban books, and I think a lot of it comes down to adults feeling uncomfortable. I see in my office, many times, when parents want to talk about different things in front of their kids, or they ask me how to broach particular topics with their kids, and this could be about a family has got a divorce coming up. It could be that they're not ready to have "the talk," and I know this is an audio medium, but I did the air quotes around "the talk." Right? You know, they want to discuss puberty, body changes or relationships. Parents maybe don't know how to handle talking about gender with their children or history or what might be happening in the news right now.

And they get uncomfortable. I think that parents and adults don't like to enter a conversation in which they feel unsure because adults like to be sure. And when we feel unsure or unsteady, it is easier to say, "We just don't talk about that," as opposed to saying, "Let's explore it together." And so I think that there are so many motivating factors right now around freedom to read and limiting access to books and different materials and what it boils down to is people being afraid of something that they're not familiar with or being unwilling to open up to something that they haven't encountered before.

And certainly, there's all sorts of different political motivating aspects behind it. And I am not a politician. That's not for me to speak on that, but I think a lot of it really just comes down to discomfort and people not liking the feeling of being uncomfortable.

What's remarkable to me is that I think one of the best ways to start an uncomfortable conversation is with a book because you can read a book together with your child or your adolescent, and you can be open and say, "You know, I've never read a book like this before," or "What's happening in this book makes me uncomfortable because of X, Y, or Z. And how does this book make you feel? And let's talk about it together."

And then you can explore this topic that you're not sure about through the lens of a book, through a character that you become invested in. I think it takes a lot of that fear away, and many of the books that are being banned in different school districts in libraries across the country are books that, as I've listened in on these town halls and school board meetings, many of the adults involved admit that they have not read, that they are uncomfortable with what they think the subject matter might be, what they've heard the book is about based on the cover or the title alone, based on the author alone, and that to me is a mistake.

I think if someone is certainly willing to read a book and say, "You know what, this made me uncomfortable, and here's why," that's a different story from just a blanket "I don't want to talk about this."

Host Amber Smith: Do you think that banning the books, backfires, does it make kids want them all the more, if they're told they can't have them?

Jaclyn Sisskind, MD: I'm a parent, so I fall into this trap sometimes, right? Like, I'll talk about how great broccoli is or, oh my gosh, you can't have any broccoli tonight because I ate it all, in the hopes that my kid will be more excited to eat it. But I think when it comes to books, that's not necessarily true.

A great example: You talked about "Maus." So, "Maus" is a graphic novel by Art Spiegelman that is written about the Holocaust and his parents' experience during the Holocaust. In the book, the Jews and other people who are persecuted by the Nazis are depicted as mice, and the Nazis are depicted as cats.

And it talks about all the experience of the Holocaust, but through this cat and mouse instead. That book is taught mostly in high schools, and shortly after it was banned, it sold out everywhere. You couldn't get a copy in any bookstore. You couldn't get it on Amazon. There was this big rush on it.

All of us that had it on our shelves from when we were in high school or college felt very cool that we already had a copy, right? So I think there's an example where people might say, "Look, this got a lot of attention. Any press is good press. And the book flew off the shelves. Isn't that what you want?"

But not really, because most of the people who are buying up copies of "Maus" were adults, who wanted them for themselves. When we talk about book banning, we have to keep in mind that for many kids, the public library or their school library or classroom is the only place that they have access to those books.

Many kids don't have the means to get to a bookstore or a library on their own for transportation reasons. Many kids don't have the money to be able to purchase a book on their own, or again, to get to the public library. And so if a book is banned, yes, it might increase the conversation around that book briefly, and maybe someone could say, "Well, if this book is banned, it's edgy. It's the cool thing to do. Kids will want to read it," but we have to think about the fact that many kids won't have the opportunity to get that book in their hands, unless it is available in the schools or the public library.

And when we say that a book is being banned because it's inappropriate, what we're really telling the kids that see themselves reflected in those books is that they are inappropriate simply for being who they are.

Host Amber Smith: And it erases them, and it makes them feel like their story isn't worthy of being told. To me, that's such an important point, that kids need to be able to see themselves and their experiences in books, even if it makes other kids uncomfortable, because when we ban some books to, quote-unquote, protect some kids, what we're really saying is that there's only one kind of kid that's worthy of protection and that everybody else isn't.Are there any books that you would not want your own children to read?

Jaclyn Sisskind, MD: I think that my kids can read anything that they want to read, and if they don't like it, or the subject matter is too much for them, or they don't understand it, or the print is too small, I think they're going to put it down, or they're going to ask me a question about it. But anything that's in my house, anything that they would find in the school library, anything that we would go to the public library -- I'm trying to think of anywhere else they would access books -- if they went over to a friend's house, in a non COVID world, when they could walk in any house, they could pick up a book and read it. That would be fine with me. And if they found something that they were uncomfortable with, or they didn't understand, we would talk about it.

A great example of this is, a couple nights ago, I was putting my 4-year-old to bed. My husband had a Zoom meeting, so he was like locked away. So I put my 4-year-old to bed. We read a story. And my 9-year-old is waiting for me because we're reading a chapter book right now together. And he was sitting in my bed waiting for me, and he promised he wouldn't read ahead in the chapter book because then I would be lost, and it's a good book, and I didn't want to miss anything.

So he was sitting in my bed waiting for me, and he got bored. So he picked up the book that I'm reading that was on my nightstand. And I walked in and said, oh, you're reading my book. And he said, "Yeah, it's a little hard for me to read. The words are big, and the print is small." He picked up that the font and kids books is a little bigger.

And he said, "What's this book about?" And I told him what the book was about. And he said, "Oh, that sounds interesting. But I don't think I want to read that. Let's get back to my book," and we just moved on, and it was fine. And I thought it was nice that he saw that I read, which he knew anyway, but that he was welcome to pick up anything he wanted in the house and that we could talk about it.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with "Readiatrician" Dr. Jaclyn Sisskind.. She's an assistant professor of pediatrics at Upstate.

How do you work books into your pediatric practice?

Jaclyn Sisskind, MD: I love working books into my pediatric practice. It is probably the thing that gives me the most job satisfaction these days and has been such a lift during the pandemic.

So when kids come to my office, they get a brand-new book to take home with them. If they are between the ages of 6 months to about 7 years old. There's a program called Reach Out and Read that helps provide training on how you can use books in your practice. And they help with securing funding for kids 6 months to 5 years.

And I felt like that wasn't enough for us. I wanted to be able to give to older kids as well. So I've been able to secure a few grants where we now give books out to kids up to age 7, maybe even 8. And I'm working on being able to get books for older kids, too. When I walk into the room with a book, it does so many things.

First of all, it shows parents reading is important, and here's how important I think it is, that I'm going to start off your whole pediatric medical visit by showing your kid a book and talking to them about it. The second thing is it shows the parent, or the caregiver who's there, how to interact with a book and your child at whatever age the child is.

So when I walk in with a book with a 6-month-old, the parent looks at me like, "I don't know how to read to this kid yet." And it's nice to be able to show you can use the book for so much more than just reading. I think that a lot of parents feel that the way to read to your child is to sit down at a prescribed time, they're in your lap, you open the book up, and you read every word, and then they say, "Well, my kid loses interest," or "They want to flip the pages too quickly," or "They want to talk about the pictures."

And that's really where all of the important stuff is. You don't have to read the words to read the book. So I'll walk into a room and show a 6-month-old a book. It's often a board book at that age, and I'll knock on the board book to make a noise and see if they look up at the noise. And if they're interested at me, I will hand them the book and see if they can pass that book from one hand to the other, or if they bring the book right up to their mouth and start chewing on it, which has all the gross milestones that we're looking for as far as motor development at that age. With a 3-year-old, I'll open a book up, and I'll say, you know, there are some fish on this page. What does a fish say? What color is the fish? How many fish do we see? Or, can you show me somebody who looks happy in this page?

There's a book that I'm using right now in my office for 4-year-olds called "Too Many Carrots," and it's about a bunny who likes carrots so much, they just keep gathering them. And the whole house is full of carrots. They're coming out the windows. It's very cute. Andthere's a picture of the house where it looks like it's just about to burst, and I'll say to them, what do you think is going to happen next, based on what you see? And a lot of times the kids will say, "There's going to be carrots everywhere!" and I'm like, exactly, that's predicting. That's visual intelligence. That's understanding what happens next.

Even, with kids, when we're looking to see, can they follow an object, I'll hold the book up, and then I'll drop it.

And if that 1-year-old follows the book down, then they're demonstrating what we call object permanence, which is understanding that objects move and don't disappear when they're out of sight. So these are all developmental screening things that I can do with the book in the room. So much more fun than having a parent fill out a questionnaire.

And it also demonstrates to the parent, these are lots of ways you can play with a book together as opposed to just reading it.

Host Amber Smith: Do you ever encounter patients, maybe older patients, who just straight out say, "I don't like reading"?

Jaclyn Sisskind, MD: Absolutely. Every day. It's one of my favorite things, because when someone says, "I don't like reading," it's fun to just say, oh, I'm so sorry to hear that. You must not have gotten this book yet, and then I launch into a full-scale pitch of a book that I think they might enjoy. Sometimes I will base this off of something that they're wearing, if they've got a particular character on their shirt, or if there's something we've talked about earlier where you know, they're into sports. Something that they've brought up to be able to launch into a conversation about that, and I'm pretty chatty during my exam. And so as I'm looking in their ears and listening to their lungs and tapping on their knees, I'll just chat about the book.

And so many times when we're done, the kid is so excited to give that book a try. And then for me to be able to say, you know, the library is like right up the road over here, I guarantee they have this in your school. My husband, for the holidays last year, made me a prescription pad that I can write books and authors down on it.

And it says "your prescription from the Readiatrician," which my patients find very amusing, but it's great to be able to write down a title and an author and hand it to the kid. And I always make a note in their chart about the book that we discussed, so when I see them the next year, I can say, Hey, did you like that book?

Or if they are reading one already, I'll write down what they read. If they've recommended a book to me, and I read it, then I'd make a note, so I remember to talk about it with them next year.

What is your favorite book to be a baby's first book?

Jaclyn Sisskind, MD: I love "The Very Hungry Caterpillar." I know that sounds like it's such a classic. It is truly my favorite baby book to give. And if someone ends up with five copies, that's fine because they're going to go through five copies of it. "The Very Hungry Caterpillar," in my mind, is one of the most perfect baby books ever written because you get so much out of it.

So for anyone who's listening and doesn't know, you should go right away to read this. "It opens up, there's a leaf with a little egg on it. A tiny caterpillar comes out, and he's very hungry, and it goes through the days of the week. So on the first day of the week, he eats through one apple, and then the next day he eats two pears, and then three plums and four oranges and so on and so on. The book is written with little punch holes that go through the vegetables or fruits that he's eating, so kids can stick their fingers in the holes. Then he gets so full, and he goes into a cocoon, which Eric Carle, the author, later said he should've made a chrysalis. And then it turns into a butterfly.

And in this book you get fine-motor planning because they can stick their fingers in the little holes of the book. You get colors, you get learning the days of the week, you get counting, you get some vocabulary words that kids aren't necessarily used to. So he eats through like salami and sausages and some things that are just not your typical baby foods.

And you get the life cycle of a caterpillar. All in one little book. I mean, I just think it's wonderful. So that's one of my favorite baby books to give, but there are so many new books that are coming out all the time that are wonderful that I like to give as well, but that's always my go-to.

Host Amber Smith: Do you have a favorite book for a kid who's getting ready to start kindergarten?

Jaclyn Sisskind, MD: There's so many "getting ready for kindergarten" books out there. And so my answer would certainly, change all the time, but right now there's a book that I really like called "School's First Day of School." And it's a book that talks about the first day of school from the perspective of the school.

And so the school has the voice through the book. It starts just before the first day of school, and the school is looking around and remarking at how big it is and how clean it is, and it doesn't know what's going to happen. And then all the kids show up and the school is caught by surprise. And it's like, "I didn't expect there to be so many of them, and they're so loud."

And one kid on the playground is sort of saying, "I hate school," and it hurts the school's feelings. Like the building's feelings are hurt when it hears that. And my son's favorite page in this book is, there's the playground, and the kids at recess are going down the slides, and the school says, "Oh, so that's what those are for."

And my son just lost it. He thought that was the funniest thing he'd ever heard. And at the end of the day, all the kids go home. And the custodian comes in and is cleaning up, and he's sort of become friends with the school. And the school says, " You know, when we first met, I thought this was your house."

And the custodian says, "No, I live somewhere else."

And he says, "Oh, well, I hope you come back tomorrow."

"You know, everyone's coming back tomorrow."

And the school is so excited to see the children again. And it's that wonderful, typical trope of first-day-of-kindergarten anxiety, anticipation, what's going to happen, but told from the perspective of the building.

I justthink that's great.

Host Amber Smith: Are there books that you think would work particularly well for parents to read along with their children, particularly parents that maybe aren't used to reading to their child?

Jaclyn Sisskind, MD: There are a lot of great children's books out there that are fun for parents to read as well.

And I think if parents are only thinking of the memories of their own children's books and haven't dipped into children's literature in the last 20 years, they would be just overwhelmed with the number of enjoyable choices. I mean, Dr. Seuss is great, but there's so much more out there now than that.

One of my favorite books to recommend to parents and young kids is the "Elephant & Piggie" series by Mo Willems. "Elephant & Piggie" are early readers. They're very simple to read, and they are done with very simple designs, and it's just the speech bubbles. And the two characters. are just talking back and forth to each other. Every once in a while, there's another character in the book, but it's almost always just Elephant and Piggie, and they are playing pretend, or they are having fun, or they're having an argument, or they're doing something imaginative together.

Jaclyn Sisskind, MD: It is really entertaining to read. It's almost like putting on a little play with your kids. And the way the book is written, because it's speech bubbles, when someone is shouting, the letters are huge. And when someone's whispering, the letters are teeny-tiny, and it's easy for kids, even those who can't read yet, to pick up on how the characters are feeling and how their speech is changing.

So that's a great one to read together. I think any book that has a call and response to it, where there's a refrain, is a good one to read, and so, by that, I mean a book where every page sort of ends on the same predictable note. A good example of this would be like the song "I Know an Old Lady Who Swallowed a Fly," and every verse builds on it, but the end of the song is always, "perhaps she'll die."

Jaclyn Sisskind, MD: And then you start the next one, right? So when there's a line that's always very predictable, and a parent is reading to their child when they get to that predictable line, the child can fill in the blank and feel like they're participating in that reading experience as well. And that makes it more engaging for both of them.

Host Amber Smith: How do you feel about electronic books?

Jaclyn Sisskind, MD: I think electronic books are fine. I think that some people would argue that there's some research out there that paper books are better than electronic. And I haven't seen that research. I don't know. All I know is that reading is reading, and if a child is really engaged in reading and they prefer to read on a electronic book, a tablet, a Kindle, what have you, I'm fine with that. What I don't like is for kids to have access to a book on some sort of tablet, and then they also have access to other things on that tablet, like games and texting and chat, and that's interrupting the flow of their reading. But just from the stance of whether it's better to read on a page or a screen, I don't think there's much difference as long as the child is connecting.

And I'm not, you know, promoting any particular brand, but some of those brands out there, if a child doesn't know the definition of a word, they can click on it, and it will tell you, or it can make the font bigger. And for some kids that makes reading a little more of a game. I'm OK with that.

Host Amber Smith: Do audiobooks give the listener as much value as a reader reading the same book, do you think?

Jaclyn Sisskind, MD: Absolutely. I think we need to understand, there are so many different kinds of learners out there in the world. Some people are very visual learners. Some people are auditory learners. I think as adults, we can all understand that, right?

There are some adults out there who would say, "If someone's explaining something to me, I've got to have a piece of paper. I've got to write it down," or "They have to draw me a diagram," or "It's like, you might as well have not told me at all." And for other people, they can be looking at a page, for example, I don't know, putting together a piece of Ikea furniture, but they can't figure it out by looking at it.

But if someone read the directions to them, then they could do it, no problem. And I think when I was in school, that was not as celebrated, and more and more teachers are realizing that there are all sorts of learners out there. So for some kids, audiobooks is definitely the way to go. And I think another great example of that is how many adults like to listen to podcasts? I don't think anyone would say, "I get the same enjoyment listening to a podcast as I do sitting down and perhaps reading the entire transcript of a podcast," if someone has the ability to hear the podcast. So I think an audiobook is going to have the same benefit.

You're still connecting with language. You're still learning about other worlds.

Host Amber Smith: Before we wrap up, I want to ask you if there are books that you found yourself recommending during the pandemic to help with the heightened stress that so many of us are feeling?

Jaclyn Sisskind, MD: I was reading a lot of children's literature during the pandemic, a lot of it with my children and a lot of it on my own. I think that for adults, reading children's literature is nice because you feel like you're accomplishing something more quickly because most of the books move along at a more rapid pace.

And it brings your mind back to a time of when you were younger. A lot of times people will ask me, how do you know if a book is age appropriate for a certain child? And I don't think that that's really the right question because for me, age appropriateness is not just based on subject matter, which I think is what parents are asking, but more on your individual child, what's their reading level, what can they handle? What brings them joy when they're reading? What opens their mind when they're reading? And so, to that end, during the pandemic, I found myself recommending a lot of picture books to children of all ages, even adolescents and their families, because there's a lot to explore there.

I found myself reading a lot more poetry than I used to because it was small, and my brain was exhausted at the end of the day. And I could just focus on one poem and move on.

But there were two books that really were big in our house over the last couple of years. One is called "Starfish" by Lisa Phipps. This is a middle-grade novel in verse -- a novel in verse is a series of poems that all go together. And it's a book about a young girl named Ellie who is overweight, and she is teased for her weight. And the biggest bully in her life is her mom. And also kids at school. And she learns in this book how to love herself for who she is and to take up as much space as she deserves.

And that's why the book is called "Starfish," because she's spreading her arms and her legs out wide on the cover, and she's taking up space. And that book was a wonderful discussion in my house about bullying, about standing up for what you need and trusting that you are enough as a person. And that book, when I finished it, made me feel so happy and just renewed as a person, and I've been recommending it to everybody.

And the other book that we read that was wonderful over the last year was called "Amari and the Night Brothers" by B.B. Alston. The way I describe it to patients is imagine Harry Potter, except that the main character is an African-American 12-year-old girl. And she learns that she's a magician. And she goes into this magical world, much like Harry, except that the world that she goes into is kind of like the FBI. And they're all solving these mysteries in the magical world. It's a great book that is exciting, and it had us all flipping through the pages. There's a second one coming out this year that my son can't stop asking about when is it coming?

But also in this book is again, themes of bullying, themes of racism, themes of inequality that got a lot of conversations going in our house as well. So those were the two big, hot books that we've read recently.

Host Amber Smith: Well, I really appreciate you making time to share your passion with us today, Dr. Sisskind.

Jaclyn Sisskind, MD: I will come back and talk about books anytime you'll have me.

Host Amber Smith: My guest has been Dr. Jaclyn Sisskind.. She's an assistant professor of pediatrics, who loves reading, at Upstate Medical University. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York. Find our archive of previous episodes at upstate.edu/informed. I'm your host, Amber Smith, thanking you for listening.