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Verbally rich interactions beginning in early infancy are critical to future vocabulary development. We explored the effectiveness of introducing finger puppets in the primary care setting to support caregiver-infant interactions. The intervention cohort was given a puppet at 2 months, with high dosage defined as using the puppet daily in the first 2 weeks. At 6 months, a usual care cohort was enrolled, and outcome measures were collected for all participants. For the intervention, 92% (n = 70) of those eligible participated, and 80% (n = 56) completed the 6-month visit. For usual care, 78% (n = 60) of those eligible participated. In per-protocol analysis, overall cognitive stimulation (StimQ-I) ( P = .04) and Parental Involvement in Developmental Advance subscale ( P = .03) scores were higher for the high-dosage group (28.68, 5.16) than those for the low-dosage (24.81, 4.48) and usual care (24.15, 3.98) groups. Finger puppets may provide a low-cost and scalable way to support early language and child development., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Disadvantaged children often show disparities in early language development. We tested the feasibility, acceptability, and preliminary efficacy of introducing finger puppets in the primary care setting at the 2-month well visit to support caregivers talking with their infants. Caregivers completed a sociodemographic survey and were contacted by phone 2 weeks later to assess initial usage and satisfaction. Ages & Stages Questionnaires (ASQ-3) were independently recorded at well visits. A family cumulative risk score was calculated from the sociodemographic survey. Thirty-four caregiver-child pairs were enrolled. Caregivers reported high satisfaction with the intervention. ASQ-3 Communication and Total scores at 6, 12, and 18 months were significantly higher for high puppet users across all age levels with no significant interactions with age or cumulative risk. Finger puppets provide a low-cost way to promote language-rich interactions. Preliminary evidence suggests that high puppet usage may have long-lasting effects on child development and should be further evaluated.