The Saving of Children

...Infants born before full term are especially vulnerable to disease until they can be built up to full size...

...But with the steady advances in medical knowledge, the character of the pediatrician's job has drastically changed...

...Promising new drugs may now prolong life for months or even years for some leukemia victims, but the disease is still fatal...

...The more healthful living conditions made possible by higher incomes are giving more and more children a chance to develop within the limits of their heritage...

...Only one out of every 2,500 boys and girls now dies between the ages of five and 14...

...Maternal infections and dietary deficiencies, accidents during pregnancy and mishaps at birth are now regarded as the principal reasons for the deformities which annually bring untold heartbreak to many thousands of families...

...Carelessness in the use of the blood derivative known as gamma globulin is believed to be an important factor in the higher incidence of this ailment, for which no effective treatment exists...

...There are two facets to the problem of prematurity, the biggest hazard associated with human birth...

...But an important function of good pediatric practice is the training of the mother, to help her understand and meet the special needs of her child for care and protection, emotional as well as physical...

...Accidents now account for about one-half of the deaths among boys and for one-fourth of the fatalities among girls in the United States...

...One of the most common and obvious causes of prematurity is toxemia, a complication of the latter half of pregnancy in which excessively retained salt in the body leads to an abnormal accumulation of fluid and an elevation of blood pressure...

...Because of better medical care and the availability of drugs to fight off secondary infections, neither measles nor mumps is now serious in childhood...

...One of the earliest and most important contributions of this branch of medicine was the discovery and clarification of the fact that the child is not just a "little man," that he has many characteristics—in the structure and function of his body, in his metabolism and nutritional requirements, and in his psychological and emotional needs—peculiar to his biologic age...

...The mortality rate for infants under one year has been cut by more than half since 1935 and now stands at less than 30 for every 1,000 live births...

...German measles and some other virus infections during early pregnancy and over-exposure of pregnant women to X-rays are so far the only definitely established causes of congenital malformations...

...Pasteurization of milk and other public health measures have eliminated major sources of infection...

...And there is evidence that, even with our present knowledge, many of the infant lives now lost could have been saved through better obstetric management and medical care during the early weeks of life...

...Early labor can be precipitated if certain female sex hormones fall below a normal level...

...Without the enormous advances of medical science it would have been impossible to achieve the progress made in saving the lives of our children, in sparing them much serious illness, and in giving them a far better start toward growth to healthy maturity than youngsters have ever had before...

...But bright though the picture of child health is, there is room for much further improvement...

...Whooping cough, not so long ago a major menace for infants, can still strike with epidemic force...

...Death or injury can be caused by such things as the faulty choice of anesthesia, improper use of forceps as well as failure to use them at appropriate times, and poor handling of the infant immediately after birth...

...This meant that many thousands of youngsters grew up with weak hearts, poor vision or hearing, and many other impairments of vital organs, which made them particularly susceptible to the degenerative diseases later on...

...But experiments with animals, in whose offspring scientists have produced artificially some of the defects with which human babies are sometimes born, are gradually clarifying the mechanisms of abnormal development...

...The chances of his becoming a casualty later on are immeasurably lessened by love and understanding and by the building of robust emotional health...

...In no medical specialty is the emphasis on the prevention of diseases and on treating the whole person rather than isolated illness as strong as it is in pediatrics...

...At each stage of his development, the child is subject to particular health hazards and has special psychological needs...

...The development of sound minds and bodies in childhood and adolescence is the best guarantee of health in later years...

...These infants come into the world with such conditions as congenital deformities, epilepsy, cerebral palsy, and mental retardation...

...Immunization and potent drugs either prevent altogether or modify the severity of a host of diseases...

...Gradually he learns how to adapt himself to his environment and to resist physical illness and emotional challenges...

...While stature and weight depend to a large degree on heredity, they can be modified considerably by living conditions...

...Pediatric authorities feel strongly that childhood and adolescence, which are highly impressionable ages and marked by an almost abnormal anxiety to conform, offer a unique opportunity for inculcating sound health habits that will last for a lifetime...

...Another statistic graphically illustrating the benefits reaped by the young is this: about 100 years ago an American family had to have 12 children in order to raise six...

...The severity of such other viral conditions as measles, chickenpox, and mumps has declined, even though there are still no vaccines for any of them...

...A major remaining dark spot is to be found in the complications of pregnancy and birth which still present medical research with a tremendous challenge...

...While temporary immunity against measles can be obtained with gamma globulin, many doctors feel that the best and most lasting immunity is provided by having the disease...

...growth and development...

...But other factors also have played a vital role in the picture...

...Among other reasons for prematurity are a variety of physiological disturbances, including an upset in the mother's hormonal balance...

...In the course of a year, about 650,000 pregnancies are terminated by miscarriages or result in live babies who either die at birth or are unable to survive the first month of life...

...While the precise cause of toxemia remains unknown, its effects can usually be modified through dietary control and bed rest if it is caught early enough...

...This condition can seriously affect the fetus...

...In the early part of this century, the major effort of pediatrics was still concentrated on saving young lives...

...Increasingly, his interest is in the amelioration of the factors that produce illness rather than illness itself...

...Others are much milder than they once were and their after-effects are not nearly so serious...

...Behind this dramatic fact lies the greatest success story of American medicine and public health—and one which holds a lesson of the utmost significance for health at all ages...

...This highly contagious condition can usually be prevented, however, by immunization at the age of two or three months, with two follow-up shots during the next two or three years...

...Much more progress has so far been made in saving the lives of premature babies, who are often kept for weeks in incubators under special oxygen therapy, than in prolonging the period of normal gestation in many thousands of pregnancies—a measure which in itself is the best insurance for survival of the offspring...

...Better knowledge of nutrition has made possible artificial feeding of infants with supplementary vitamins which supply the requirements for SELIG GREENBERG, writer on medical problems for the Providence Journal and Evening Bulletin, has twice been honored by the lasker Foundation for distinguished writing on medicine...

...Premature births and congenital malformations continue to take a heavy toll among the newborn...

...Much of the pediatrician's practice is now devoted to immunization procedures and to periodic examinations designed to make sure that the child's development is normal...

...Rheumatic fever, which starts with streptococcal infection and leads to impairment of the heart, can now usually be prevented with regular use of penicillin...

...Fostering in the child a sense of emotional security is the soundest precautionary measure against his caving in under the strains of adult life...

...Polio and rheumatic fever, two of the worst crippling ailments, are on their way out...

...Crucial landmarks in this progress have been better prenatal care of the mother, improved obstetric procedures, more effective care of premature infants, control of infections and of respiratory and gastrointestinal disorders that are particularly menacing in infancy, the successful treatment of Rh factor incom-patability in the infant's blood through complete transfusion replacement, and greater recognition of the role of oxygen at birth and in the first few weeks of life...

...Many gains have been made in the reduction of death and injury during what is known as the prenatal period—from the last 20 weeks of pregnancy through the first month of life...

...Once an infant has survived the hazards of the first month of life, he is safe in the vast majority of cases...

...One of them is the prevention of the premature onset of labor, and the second is improvement in the care of the infant born too early...

...Much of this waste of life could be prevented by more effective education designed to foster greater safety consciousness on the part of both parents and children...

...The relatively few pediatricians in practice at that time and the general practitioners carrying most of the load had their hands full fighting off death on the threshold of life...

...About 350,000 premature deliveries occur every year...

...Public Health's Greatest Success Story The Saving of Children Afirst birthday will be observed in the United States this year by about 300,000 babies who would not have survived infancy if they had...

...The causes of congenital malformations are still largely unknown...

...With the conquest of the major contagious diseases and the expanding knowledge of nutrition, the pediatrician now has more time to look at the whole personality of the child and not just his arms, legs, lungs, and other organs...

...Heading the list are mishaps in the home and the toll of life taken by automobiles and drownings...

...Another important factor in curbing this disease has been the improvement in nutrition and in housing conditions resulting from the general rise in the standard of living...

...In general, the communicable, respiratory, and diarrheal maladies of infancy and early childhood have been conquered...

...Since then, and particularly during the past two decades, the fear that a child might be snatched by death has been lifted from millions of parents, provided the infant is normal at birth and receives good medical care...

...Considerable attention has been attracted within the past year by a drug known as releasin, which compensates for the deficiency of a certain sex hormone involved in the process of delivery and is reported to be effective in many cases either in preventing premature labor altogether or in averting stillbirths if early birth cannot be stopped...

...Often he also functions in an advisory capacity to young parents...

...One measure of the progress of medicine and of the hazards of modern life is the fact that accidents have replaced the contagious diseases as the leading cause of death and crippling injuries in childhood and adolescence...

...Scientific opinion, however, has been increasingly veering away from the concept that hereditary influences are paramount in such failures of normal development...

...Equally important have been improvements in hygiene and nutrition, the readiness of American mothers to apply the scientific gains—through adequate prenatal care, deliveries in the hospital rather than the home, and preventive medical care for infants and older children—and the shift in emphasis in the pediatric branch of medicine from the treatment of acute disease to the prevention of needless illness and the promotion of physical and emotional health...

...Although cancer is ordinarily associated in the public mind with middle and old age, leukemia and other forms of malignancy take the lives of more youngsters between the ages of one and 14 than any other disease...

...Much disability and premature death could be avoided by a similar accent on prevention in the field of adult health...

...Recent studies indicate that American boys and girls are now six to nine per cent taller and eight to 15 per cent heavier than their counterparts half a century ago...

...Here, of course, the mother plays a crucial role...

...The influence of environment on a child's native rate of growth is clearly demonstrated by the fact that children from the lower economic groups are often smaller than those of families that are better off...

...The childhood killers rampant in those days carried off the other six before they had a chance to grow through adolescence...

...With Salk vaccine now readily available, paralytic polio is expected to become as obsolete as smallpox within a few years...

...been born forty years ago...

...But even with the good foundation now generally laid in the early years, health cannot be taken for granted...

...While there have been many improvements in delivery techniques, birth injuries are still fairly common...

...The spectacular progress against the ravages of the infectious diseases is certain to have an increasingly profound effect on health in middle and old age...

...A number of the ailments once prevalent in childhood usually left serious after-effects if they did not kill their victim outright...

...To do so successfully, he needs suitable guidance, at home, at school, and medically...

...He can pay more attention to the preventive aspects of medical care, including the social and psychological conditions which contribute to the child's health and sickness...

...Even greater advances have been made for older children...

...A basic criterion of a child's health and normalcy of development is provided by his body measurements...

...If youngsters are undersized and underweight, the trouble usually stems from poor eating practices and other faulty living habits...

...Birth injury is frequently the fault of the mother rather than of the obstetrician...

...The prevailing belief is that although constitutional weaknesses are sometimes transmitted from parents to child, a variety of disturbances in the mother's health during pregnancy plays a major role in producing defects of body or mind...

...Concentration on the disease problem of the moment has given way to the over-all promotion of positive health by eliminating the detrimental influences which might interfere with the child's optimum growth and development, in the emotional no less than the organic field...

...The accent in pediatrics on the emotional aspects of growth is of special significance, for it is in the younger group that the best hope lies for prevention of mental disease in later life...

...A significant difference in quality of the diet has been found between groups of women who manage to bear their babies to full term and those who fail to do so...

...Other branches of medicine might well take a page out of the book of pediatrics by laying far greater emphasis than they now do on the preventive approach toward health care...

...These experiments and other studies are shedding more and more light on the nutritional requirements of the embryo for normal growth and on the sensitive metabolic exchange between mother and fetus...

...But some of them continue to present an occasional threat...

...But the wastage of the reproductive function still remains enormous...

...An additional 330,000 pregnancies annually produce babies who are malformed in body and mind...

...Parents need no longer fear the attack of such one-time fatal or crippling diseases as typhoid, scarlet fever, diphtheria, meningitis, pneumonia, a variety of diarrheal conditions, rickets and rheumatic fever...

...It may also be brought about by dietary deficiencies during pregnancy...

...Dietary deficiencies and a higher incidence of illness are among the major reasons for this retarded development...

...It can be squandered by poor living habits and by failure to heed the danger signals of incipient disease...

...A child's feelings are a most delicate mechanism—sensitive to the slightest wound of fear, indifference, and thoughtlessness...

...Some of these diseases have been virtually erased with the sulfas, antibiotics, vaccines, and vitamins...

...Periodic medical examinations enable the physician to detect early or incipient sickness when it is most amenable to treatment...

...About 10,000 infant deaths a year are reported to be directly attributable to injuries at birth, and many other babies are crippled for life...

...Among the virus diseases most common in childhood, there has been an increase in recent years in the prevalence of infectious hepatitis, a form of jaundice which may leave its victims with permanent liver damage...

...If a woman fails to get proper prenatal care and to have pelvic measurements, the obstetrician has no way of learning beforehand what special delivery problems he might encounter so that adequate preparations can be made for handling such difficulties...

...He is the winner of the Associated Press Managing Editors Association Award for his series of articles on the problems of the aged...

...The general rise in the standard of living and growing understanding of preventive hygiene have increasingly led to an environment conducive to the health of youngsters at home, at school, and at play...

...The infectious ailments he will acquire will give him relatively little trouble...

...In 1900, death was still claimby SELIG GREENBERG ing one out of every four boys and girls in this country...