Children living in disenfranchised communities are at risk for growing up without developing the literacy skills they need to succeed and thrive later in life. The ability to read proficiently is a prerequisite for engagement in a myriad of meaningful occupations, financial success, and optimal health management. This set of practice guidelines provides understanding for school-based occupational therapists to begin to support pediatric literacy for elementary school children reading below grade level. The authors examine the theoretical bases underlying evaluation and intervention, which are organized according to four primary performance areas: (1) attention to teacher-led literacy lessons, (2) engagement in independent reading in the classroom, (3) academic self-concept and attitude toward reading, and (4) habits and routines supporting home literacy participation. Occupation-based intervention embeds literacy experiences in play, sensory and kinesthetic experiences, and meaningful functional and social activities. A case example is provided to illustrate these principles in practice. Pediatric literacy support is an emerging practice area in the occupational therapy profession that can have profound impact on the trajectories of children's lives.