#460 - Reading as a neuroprotective intervention

Hello friends 👋

Why does reading in the NICU still feel optional when the evidence says otherwise? Daphna sits down with Paige Pedroli, author of the Nic Zoo book and two-time NICU mom, and Dr. Raquel Garcia, a craniofacial and feeding specialist, to unpack why reading to preterm and critically ill infants belongs alongside kangaroo care as neuropromotive, not just neuroprotective. They cover the evidence behind auditory stimulation and language outcomes, why reading gives overwhelmed parents a real role in their baby's care, and how units can build low-cost reading programs with book libraries and student volunteers. A practical, moving conversation for anyone building developmental care into daily NICU practice.

Link to episode on youtube: https://youtu.be/pMWJk5r16h8

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Short Bio: Raquel Garcia is a trained craniofacial speech-language pathologist who is a core member of the Joe DiMaggio Children's Hospital Craniofacial team. She has worked in the acute care setting in the Neonatal Intensive Care Unit, Cardiac Intensive Care Unit, and transition to home settings for over 15 years. She graduated with her M.S. in communication disorders from Nova Southeastern University and her doctorate of speech-language pathology from Northwestern University. Her clinical interests include upper airway disorders, infant feeding, neonatal care, and dysphagia.

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The transcript of today's episode can be found below 👇

Daphna Yasova Barbeau (00:02.097): Good morning, everybody. Welcome back to the Incubator Studio, the Incubator podcast. I have a really exciting episode today, something that's super near and dear to my heart — a good discussion about the importance of reading in the NICU (Neonatal Intensive Care Unit). I'm so pleased to have with me today Paige Pedroli and Raquel Garcia. Thank you both for joining me.

Paige Pedroli (00:29.151): Thanks for having us.

Raquel Garcia (00:29.378): Thank you for having us.

Daphna Yasova Barbeau (00:31.792): It's my pleasure. Dr. Garcia is a trained craniofacial and feeding specialist, an assistant professor at Nova Southeastern University with a specialty in feeding and swallowing. On a personal note, we've worked together for almost a decade now on a variety of projects, including reading in the NICU and our collaboration on our Tiny Tots program — education, hot meals, crafts, and peer support for parents. Rocky, I always love having you nearby to chat about the things we love. And Paige, you come to us as the author of the Nic Zoo book, and also as a NICU mama — you had two babies in the NICU. So a two-time NICU mama for sure. I already told everybody what the episode's about — reading in the NICU. But I'd love to hear a little about your story, your experience in the NICU, and then why you felt it was important to put together a book like Nic Zoo.

Paige Pedroli (01:57.789): Yeah, so my first daughter, Penelope — she's eight years old now — but when she was born, I had a placental abruption and an emergency C-section, and she ended up in the NICU for 10 days. Being a first-time mom, it was really more of a shock, figuring out how the NICU worked. So having books, having music, communicating with her as much as we could was really important. I thought it would be great to have a children's book about the NICU, and there wasn't really anything out there at the time that I could find. So I came up with the idea — my sister came up with the title, Nic Zoo, and the baby animals concept. But then when Penelope came home, everything got busy and I put the idea aside. Four years later, I was pregnant again with my daughter Sydney, and she surprised us at 34 weeks. After having two babies, I thought, maybe this really is something I should pursue. I put pen to paper and it all came out so easily, just from the experience. I wanted to do a shout-out to parents, what they go through, and to doctors and nurses. It all came together nicely. Our illustrator — who was a NICU baby herself — did all the illustrations. I have the book right here. It's very kid-friendly.

Daphna Yasova Barbeau (03:45.766): Very cute, lots of beautiful colors, easy to read. My first thought about the title was that I loved the idea of baby animals as the NICU team. I

wasn't sure if "Nic Zoo" was playing on the chaos of the NICU or just the animal theme.

Paige Pedroli (04:14.815): Some people have said that — it kind of works both ways. But we mostly thought of it as a play on words: NICU, Nic Zoo.

Daphna Yasova Barbeau (04:25.096): I love that. Did you intend this for siblings, for parents to read to their baby, for parents' own comfort? What were your goals?

Paige Pedroli (04:36.329): With my first daughter, I thought it'd be great to have a book for parents like myself — something to relate to, that gives a message of hope and shows they're not alone. But with my second daughter, I had a four-year-old at home, and my husband and I were traveling back and forth to the NICU, and she was confused about what was going on — we told her, your baby sister is going to come home. So I realized the book would also be great for siblings. It's kind of a dual-purpose book.

Daphna Yasova Barbeau (05:17.926): I love that. I'll disclose — Rocky and I have been writing a book or two ourselves, on and off, so we know how hard it is to work with an illustrator. How long did the process take, from putting pen to paper onward?

Paige Pedroli (05:36.757): I came up with the idea with my first daughter, but once I really sat down and committed, it took probably six months to a year. The illustration was tricky because we wanted it kid-friendly but also with some medical equipment, to keep it realistic — it's a serious topic, but we wanted it relatable to kids too. My illustrator did a fantastic job combining those two things.

Daphna Yasova Barbeau (06:10.384): I love that. I know you've been going to conferences and dropping books off at NICUs to support families and babies. What's the feedback been like?

Paige Pedroli (06:22.761): The feedback's been awesome. I thought this might be a one-time thing, but it's been incredible — so many people say the book helps them through hard times in the NICU, and helps older siblings at home too. I've been doing this almost three years now, and it keeps growing. It's fun, and really fulfilling.

Daphna Yasova Barbeau (06:54.590): I thank you for bringing another NICU book into the world — there are only a handful of books for NICU families, so it's nice to have another resource.

Paige Pedroli (07:06.217): Through this journey, I've met a lot of other NICU moms and dads who've also written children's books — I didn't know of any at the time I was a NICU mom myself.

Daphna Yasova Barbeau (07:22.002): I love that. I think for a long time, reading in the NICU has been seen as something cute and nice we do for babies. Even though parents who are well-resourced are often really invested in reading to their children at home, something about the baby being in the NICU makes people feel like they can't do it, or it's too overwhelming, or they just don't think of it. Rocky, I'll have you start — what evidence is there now that reading out loud is a real developmental intervention, and should be part of comprehensive care — not just neuroprotective, but neuropromotive care?

Raquel Garcia (08:26.562): Thank you. First — Paige, I'm so excited about your book. It's a great way to explain a challenging environment to families using infant animals, and I'm excited to dive into it with my graduate students. When it comes to the evidence, when I'm talking to families about reading in the NICU, I try not to lean too heavily on the science — I try to speak to the humanity of it: this is your baby, and how can you support them growing and maturing the way they would at home. One of the first things I tell parents is that we want to support the developing brain, and there's significant evidence that hearing a parent's or caregiver's voice helps with white matter maturation, through auditory stimulation. There was a 2025 article by Travis et al., a randomized controlled trial, where they took very early preterm babies — 24 to 31 weeks — and exposed some to maternal voice reading and some not. The infants exposed to reading showed more white matter growth, and we know white matter tracts support language processing — speech exposure alone can make a real difference. One thing parents often ask me, as a speech pathologist, is whether their child will have autism because of their NICU stay. Instead of saying "I don't know, because we can't see the future," this is a way to say we can help support that developing brain, especially if a baby is at higher risk for neurodivergence or other brain differences.

The next thing we talk about is supporting developing language — how children understand information and express it to others. People often say, "they can't talk yet, they're a baby," but babies have pre-linguistic, or pre-talking, skills from their very first day — crying, body posturing, how they interact with their environment. There's significant literature showing reading in the NICU helps both receptive language, meaning auditory comprehension, and expressive language. Babies read to in the NICU have about an 80% higher chance of normal receptive language, and about a 90% higher chance of normal expressive language — and there's a spectrum of "normal," of course. That's a consistent protective measure offered consistently, giving the child a better chance at positive language outcomes.

Another factor is the sensory environment. The NICU is a busy place — phones beep, ventilators make noise, parents talk — and while we try to make it protective, things happen. Reading provides a consistent sensory cue that isn't excessive or noxious, giving the baby access to a meaningful human voice through a sensory pathway. I compare it to touch — babies get that sensory pathway built through kangaroo care, and reading is similar. When they hear mommy or daddy's voice, or even a nurse's voice, or Dr. Barbeau reading — I know you do — the baby associates that human voice with something positive, replacing some of the noxious stimuli they're otherwise exposed to.

And this one matters most to me, not just as a clinician but as someone focused on empowering parents and caregivers: when you can read to your baby in the NICU, you have a role in their care. Often parents feel like they don't have a role — like everything is happening to their baby and they're just watching. But when you're reading to your baby, you're supporting their engagement, bonding with them, helping their mental health — which we know is real — helping your own mental health and anxiety too, and that actually influences the baby's neurodevelopment. That parent or caregiver connection is really the secret sauce of reading — forget everything else I said, that's where the magic happens. For parents who say they're not comfortable reading, I tell them: just grab a book and make up your own story, look at the pictures, or tell your favorite story — what matters is being present with your baby, calming them, helping their heart rate and breathing normalize. There's so much evidence on this, and programs like Reach Out and Read build their whole model around that idea.

Daphna Yasova Barbeau (15:04.339): I love that, Rocky, thank you. This feels especially important right now in the neonatal community — our mortality numbers are decreasing, and we're finally moving the needle on some specialized pathologies, but developmental outcomes really aren't changing that much, especially for our sickest, youngest babies. So this seems like an obvious way to support brain growth during NICU care. I have a question I'll save for later, but Paige, I know you'll want to weigh in — not from the scientific side, but as a parent: what's it like to have the opportunity to read to your baby?

Paige Pedroli (15:59.211): Exactly what you're saying — the bonding, and feeling like you're part of your baby's care, is priceless. With Penelope, she had to be in the incubator for the first few days and I wasn't able to hold her. That feeling is just so hopeless. But having a book, being able to talk to her, feeling like I was part of her care meant so much. It seems small, but in that moment, it's such a big thing.

Daphna Yasova Barbeau (16:32.285): I love that. This question is for both of you — if it's obvious this is an important intervention, low-cost, frankly potentially free — we tell parents, if you're in school, read your textbook out loud; if you're reading the newspaper, read it to your baby; read on your phone if you want. Obviously there's something different about showing pictures, that's a different developmental step, but even just telling stories counts. It's evidence-based, potentially neuroprotective and neuropromotive — so why isn't there more urgency across NICUs to put this into practice, the way we have with other developmental care techniques?

Raquel Garcia (17:29.600): From a clinical perspective — I worked in clinical practice for years before academia — clinicians are often focused on other factors during intervention: head shape, feeding success, positioning, sensory integration. We're so focused on the big markers of success for transitioning a baby home that reading may fall outside what rehab managers or billing productivity standards capture. I've heard leaders say, "why don't you do that on your own time, after you punch out?" But there's also just so much going on with the baby in the bigger picture that reading can end up at the bottom of the list. To me, as a developmental specialist and a passionate NICU reader, it's just as important as an NG (nasogastric) tube feed or a diaper change, because it helps with autonomic stability and teaches babies that touch — like mommy touching the isolette — is good, not something to fear. Hopefully, in the next few years — and Dr. Barbeau and Paige, you're part of our tribe now — we can shift the mindset so reading becomes just another essential piece of care.

Paige Pedroli (19:31.625): It is becoming more popular — I'm working with a lot of hospitals that have reading programs now, readathon months, even friendly reading-minutes competitions between NICUs. As a parent, I was so consumed with everything else going on, but our NICU handed out care packages that included a little baby book, and that sparked the idea to read and normalized the situation for me — any parent reads a story to their baby every day. I think it's important for hospitals to have a library if they can, and those care packages that charities and organizations put together are amazing.

Paige Pedroli (20:29.909): So yeah, I think hospitals need to be the ones to introduce the idea of how important reading is.

Raquel Garcia (20:37.262): I have to toot Dr. Barbeau's horn here — one of the things I love walking into her NICU is that right when you enter, there's a library shelf with all different types of books, in different languages, to accommodate the families who come through. Parents can choose a board book or a longer story. They don't have to think, "I forgot the book at home" — it's right there. And it's not just books out in the wild — there are books that look like the families too, inclusive books that help parents feel represented. We also run a parent support group every Friday, where Dr. Barbeau and I offer complimentary board books, brand new, in Spanish, Haitian Creole, and English, covering NICU themes but also things parents might just enjoy — music, space, silly topics. One time I gave out a book about Dolly Parton, and the mom said, "I don't even know what this is, but I'll read it" — and I said, great!

Daphna Yasova Barbeau (22:11.485): I want to underscore that this is an expense. In our unit, we've made a big commitment to it, but Rocky herself has done fundraiser after fundraiser through the university and her private connections — and out of her own pocket — to keep a steady flow of books. But compared to some of the interventions we spend money on in the NICU, this seems like a no-brainer, a great return on investment. Books need to be accessible, families need to be educated that it's something they can and should do, and we need to provide the books, since not every family can afford new ones. I think part of what keeps units from having a library is concern about infection control — books from home, board books, hardback books, parents can wipe those down, and if a reader is coming in, they bring their own wiped-down books, especially if a book is going between babies. In general, our library isn't really a lending library — a parent takes a book home and starts their own library, so books aren't traded between babies, which reduces the infection control concern. Some hospitals do run lending libraries, treating books with UV light and wiping them down between uses.

Daphna Yasova Barbeau (24:35.517): Paige, you reminded me of something — there's good data supporting that when we ask parents to be involved in medical tasks, like hanging a feed, suctioning, weighing the baby, taking a temperature, what parents are really looking for are tasks they feel are "parent tasks," not nursing tasks. It's such a nice reminder that engaging parents in reading doesn't take a lot of staff effort — you just let them run with it. Any tips for communicating that to families?

Paige Pedroli (25:30.687): To families, or to the NICUs?

Daphna Yasova Barbeau (25:30.687): Let's talk about both — that's actually my next question. If a unit wanted to start a reading program, what are some tips? Let's start with the messages we should send to parents.

Paige Pedroli (25:49.845): Just letting parents know they're not alone, that reading can bring some normalcy, help them bond with their baby, and relieve stress. There's a lot of support out there — social media has such a big NICU community now, which I wasn't even aware of at the time I was going through it. But being part of it now is amazing.

Daphna Yasova Barbeau (26:25.533): I love that. So then — how do we engage NICU teams if we're starting a reading program? We've talked about getting books, fundraising, statewide initiatives that can help with access. A few years ago, a library that was closing donated all their children's books to us — we treated them with UV light, wiped them down, let them sit for weeks before putting them out, and it was well received by families. Beyond the book investment, what else do units need for a reading program?

Paige Pedroli (27:10.897): It depends on what they're capable of and how much space they have. When I visited Tufts Medical Center, they had a whole resource room for siblings and parents — set up like a little nursery, with a reading nook and coloring activities. That kind of space is important for siblings, and for making parents feel comfortable, safe, and quiet if possible. Not all hospitals have room for that, but it was really nice.

Raquel Garcia (27:59.534): Another way — I'm always thinking about how to help budding clinicians learn about the NICU environment. I'm passionate about being a neonatal therapist, I'd do it until the day I die, because I love making connections with babies, families, and the medical team. If we can think creatively about starting a reading program without adding an extra step for the medical team — maybe a roster or schedule of clinical volunteers who go through special training in universal precautions and hand hygiene to reduce infection risk — you can build a system of reading buddies who volunteer to read to babies. It's usually only five to 10 minutes per baby, since you don't want it to become noxious or stressful. That's the sweet spot for most NICU babies. If you can partner with a university that has a developmental program — SLP (Speech-Language Pathology), PT (Physical Therapy), OT (Occupational Therapy), even RT (Respiratory Therapy) — students can learn about the medical environment and about the baby's sensory and motor systems, without the added pressure of touching the baby. That's what we've done in your unit, using occupational therapy and speech pathology graduate students, and it's been very successful — we've never had any incidents. And it's never interrupted nursing or medical care, or parents — if parents are there, we offer to read to the baby, and a lot of parents say, "oh, please read to my baby, I didn't even think I should do that." Then next time they see the students, they say, "I read to my baby too," and they have that connection to talk about. It's really beautiful to see.

Daphna Yasova Barbeau (31:05.724): I love that — it's been very successful for us too. Shout out to my nurses, some of the most invested in developmental care in the whole country, but they don't have time to sit and read to babies. So having you come in multiple afternoons a week with students has been really valuable, and the parent education has been incredible — through signage, the book library, and on Fridays giving out books and encouraging reading. Parents bring in their own books too, so there's a little library developing at every bedside, which I love. Even nurses who don't have time to read themselves, I hear them talking to parents about reading — that's been a big shift for our unit. Rocky, one more question — when we first started the program, nurses looked at us like we were nuts. What was the key to getting their buy-in?

Raquel Garcia (32:39.392): NICU nurses always want what's best for their babies, they'll do anything for them — that's so inspiring to see. I think they just didn't know the value of reading, since it wasn't something they were used to, and they wanted to be sure it would actually support the baby before adding it to their routine. Once they saw that babies were calmer when we read to them — more midline flexion, more sustained awake states, respiratory rate coming down — they started to shift. I remember a nurse once told me a baby had been tachypneic all day, and she asked if we could read to him one more time — and he had a great day after that. That helped nurses realize this isn't just for older babies in the NICU, it's also for smaller, more fragile babies who still need that developmental interaction and positive auditory stimulation — any interaction is neuropromotive. It's about shaping the reading task to support both the baby and nursing care together. Now when they see us, they just say, "come read to my baby" — it's not even a question anymore.

Daphna Yasova Barbeau (34:29.885): I love that. That brings me to one of my last questions — we're going over time, as always. A lot of people, not just families but the bedside and physician team, will say a baby is too sick, too small, too immature, or too overstimulated to be read to. What signs can people look for that a baby is ready to be read to? Do they have to be awake? Can they be feeding? Can they be in an isolette? Rocky, you first, then Paige.

Raquel Garcia (35:19.808): We still don't really know who's "too little" or "too sick" — that hasn't been firmly established in the evidence, and a lot of what we go by is personal or anecdotal practice. It's very baby- and family-specific. We've read to intubated babies, micropreemies, critically sick babies who are stable in the moment. Like kangaroo care, it's a therapeutic option — if it's working for the baby, we continue; if we see stress, more anxiety, or anything detrimental, we stop immediately. That's why understanding a baby's pre-linguistic cues matters — state dysregulation or autonomic instability could be medical, or it could be the baby trying to communicate something. This helps everyone, not just the medical team, but the readers too, learn about the baby. There's no hard and fast rule — it's about that specific baby at that specific time, understanding that we're working with the baby, not doing something to them. That's the co-occupation piece that matters so much.

Paige Pedroli (36:50.825): I'd add — read when it feels natural, when there's a little break in the day. That's when I'd read to my daughters, from day one, whether they were in the incubator or I could hold them, awake or asleep. Even asleep, I felt like just the sound of my voice, breaking up all the monitors and beeping with something else, a background voice, was good for them — a chance to take a break.

Daphna Yasova Barbeau (37:24.251): I love that. I'll end with a bit of a controversial question — I know there's no clear right answer yet, but I want to hear from both of you. If reading is good, why not just play videos of people reading, or parent recordings — which we've seen real value in, especially when parents can't be there? How is that different from the act — you used the term "co-occupation," Rocky — the act of reading in response to a baby's cues?

Raquel Garcia (38:04.142): Great question, especially now that technology, and AI, is at our fingertips — you can just turn something on. But reading is multisensory. I talked a lot about the auditory piece, but if you're reading to the baby in person, you might also do a hand hug or touch them at the same time, so they feel your presence alongside your voice. There's nothing quite like the rise and fall in pitch and intonation when you're reacting to something the baby's doing — "you think that's cute? I know, that monkey's cute, let me tell you more about it" — connecting to the baby's pre-talking skills in real time. Your voice shows interest and connection in a way nothing else replicates. That's why we don't put a baby skin-to-skin with a mannequin — they need to feel the person, the warmth, hear the real sounds. It's the same with reading.

Paige Pedroli (39:32.191): Ideally, it's best to read in person, skin-to-skin, as much as you can. But in situations where you can't, having recordings or monitors is nice — and if a parent can't be there, having a nurse or volunteer read instead is valuable too. It's good to have options, since everyone's situation is different. And for parents who have apps to view their baby remotely from their phone, that's a nice comfort as well.

Daphna Yasova Barbeau (40:16.479): Absolutely. Paige, people can find more information about the Nic Zoo book at nic-zoobook.com. If a hospital system wants to place a bulk order, what would that look like?

Paige Pedroli (40:36.927): For hospitals, it's best to reach me by email at nic-zoobook@gmail.com — I have specialty pricing for bulk orders. The book is also available for individuals on Amazon.

Daphna Yasova Barbeau (40:53.577): Thank you both so much for joining me today, and especially for bringing attention to the critical need — the imperative — of reading to babies in the NICU for neuropromotion. So grateful for you both.

Paige Pedroli (41:10.079): Thank you, thanks for having me.

Raquel Garcia (41:11.064): Thank you so much. Bye bye.