A growing number of pediatric and primary care clinics in Minnesota are using children’s books to improve health care and enhance child development.

The physicians believe they can have a positive and lasting impact on brain development during the critical first three years of a child’s life. That’s before many children go to day care or preschool — and a period when pediatricians have particular access.

Roughly 90 percent of children will see a medical provider at least once within their first year, while only 40 percent of children under the age of 2 are in a licensed day-care center, said Dr. Nathan Chomilo, a pediatrician at Park Nicollet Clinic in Brooklyn Center.

“We need to be more focused on how we can improve the home environment and give parents the skills and confidence to help their children reach their potential from the very start,” he said.

Chomilo is also medical director for the Minnesota chapter of Reach Out and Read, an organization that began 30 years ago in Boston to champion a cost-effective and engaging way to start the conversation about family reading.

It starts with a free book.

One morning last week, Chomilo started a well-child checkup with 15-month old Tedra Gbelia by giving her a small “ABC” book with drawings of foods. A is for apple. B is for banana. C is for carrot.

Under the Reach Out and Read program, every one of the 10 recommended well-child visits between the ages of 6 months and 5 years starts with the gift of an age-appropriate book.

Tedra instantly reached for the book and started flipping through its thick, brightly colored pages with help of her mother, Lorpu Cyrus. She said her youngest daughter has already taken interest in books thanks to Chomilo as well as the books used by her two older daughters, ages 7 and 9.

“It is really good for their development,” said Cyrus. “It gives them a head start.”

The book serves many purposes. It relaxes a child who might be anxious about getting shots and the other fears associated with going to the doctor.

It also helps the doctor or nurse ask parents about reading and encourage them to do more of it.

Researchers have found that reading to and with children increases their chances of succeeding when they get to school and later in life. It also improves family bonds and boosts the confidence of parents.

The book can also be a diagnostic tool. A child’s reaction to the book during an office visit tells a doctor a lot about their progress, both physically and mentally.

“You can see more in that interaction about how that kid is really developing,” said Dr. Rachael Rapacz, a family medicine doctor at Hennepin Healthcare Clinic in Brooklyn Park. “I have been able to catch cases of autism or speech delay much earlier than I could with the older developmental exams, and that has been a tremendous advantage,” she said.

Reach Out and Read in Minnesota has signed up 255 clinics that serve 153,000 children. That is about 1 out of every 3 children in the target age group.

Soon, every Minneapolis clinic that serves this age group will have signed on, which would make it the largest city in the country to have full participation.

“Once a clinic starts, they don’t want to stop doing it,” said Kris Hoplin, executive director of the state group. “The providers don’t want to let it go.”

In order to qualify, doctors and other health care professionals must go through training. Clinics must offer books in the waiting room, post information about local libraries and enlist everyone from the receptionist to nurses in the effort.

Clinics are also expected to buy a wide range of books for different age levels, languages and cultures that match their clientele.

The state organization helps provide books to clinics that serve primarily low-income or uninsured populations, but it has discount arrangements with book distributors that all clinics can use, driving the average book cost down to about $2.50.

Z is for zucchini

Research shows that families served by the program are 2.5 times more likely to read to their children compared to those that were not part of Reach Out and Read. Parents are also more likely to read to their children more than three times a week.

The program also advances children’s language development by three to six months, based on measurements that evaluate communication abilities and understanding language they hear. And more “doses” of reading advice in the doctor’s office result in more parent involvement and more progress for the child.

“I have met some families who don’t have books in their homes. One of them had four children,” said Dr. Lisa Cinar, a pediatrician with the Fairview Clinic in Princeton. In addition to the well-child visit free books, she helped provide the family with additional books that had been donated.

“All four children started reading together more at home,” said Cinar. “They looked forward to bedtime stories and it gives them some bonding time with mom.”

In an era of televisions, tablets and smartphones, Chomilo said he reminds parents that content on screens cannot replicate the brain development that comes from parents and children sharing a book.

“We need interaction to build brain connections,” he said.

For 15-month-old Tedra, development is progressing well. For her, like others at that age, enjoying a book includes gnawing on it and throwing it on the floor.

As the exam was finishing up and Chomilo reached over to examine Tedra, mom flipped to the back of the book to distract her daughter. “Z is for zucchini,” Cyrus said.

The girl let out a short and loud laugh. A connection was made.