PEDIATRICS Vol. 102 No. 1 Supplement July 1998, pp. 243-245
COMMENTARY:
Child Development: A Basic Science For Pediatrics, by
Julius B. Richmond, MD, Pediatrics, 1967;39:649-658
Received Mar 19, 1998; accepted Mar 19, 1998.
From the * Heller Graduate School, Brandeis University, Waltham,
Massachusetts and the Department of Pediatrics, James Whitcomb Riley
Hospital for Children, Indianapolis, Indiana.
ABSTRACT. The era of child development in pediatrics began in the late 1920s with the establishment of a number of child research institutes under medical auspices, the organization of the Society for Research in Child Development, and a growing awareness that an emphasis on all aspects of the life of the child, and not exclusively on his or her biologic development, was essential. This realization was reinforced by the World War II Selective Service experience, which revealed a relatively high incidence of psychologic and social ineffectiveness among our youth. The expectation developed that child care professionals might be in a position to minimize such outcomes in the future, and parents increasingly began to look to professional services for help with child-rearing. Although there was considerable effort during this period to foster pediatric concern with the psychologic and social development of children and their adaptations to a rapidly changing society, conceptual confusion and resistance within the pediatric academic community mitigated against its success.
Clinical investigation prospers most when it draws on theory and methodology from a basic science. In its early dependence on child psychiatry for addressing psychosocial problems in children, pediatrics was relying on another clinical discipline for its research orientation, while lagging in its recognition of developments in the social and biologic sciences, in part because of their separation from pediatric settings.
Resistance to the incorporation of the psychosocial aspects of child
development into pediatric training has come primarily from academic
pediatricians. In part attributable to the rigid institutionalization
that traditionally has inhibited academic change and innovation, the
opposition also may be ascribed to the belief of some academicians that
psychosocial considerations are not a proper concern of pediatricians.
Others hold the view that social science data are "soft," whereas
those derived from biologic research are "hard." Such positions, of
course, have nothing to do with good science, because the scientific
method demands excellence in experimental design, data collection, and data analysis regardless of the discipline. The question is, therefore, one of excellence
not of hardness or softness of data.
Because critical analysis alone is insufficient to meet present needs, a constructive action plan is necessary. Accordingly, the Executive Board of the Academy established the Section on Child Development to stimulate interest and research in the field of human growth and development, to provide a forum to facilitate communication among professional workers in the field, and to foster educational activities for pediatricians and others to increase their understanding and competence in child development. In order to incorporate such teaching and research into the mainstream of pediatrics, a core of pediatric faculty members is required, with a disciplined background of research and teaching analogous to our academic colleagues in pediatric subspecialties such as endocrinology and infectious disease. Such a desired outcome necessitates the establishment of fellowships which encompass a range of clinical and research interests extending from physical, social, psychologic, and physiologic development, through developmental biochemistry, physiology, pharmacology, and psychophysiology, as well as the social and behavioral sciences such as sociology, cultural anthropology, and psychology, among others. It is intended that such training programs will institutionalize child development as a basic science for pediatrics.
Finally, it would be inappropriate to discuss this emerging era of prevention without commenting on the social responsibilities of pediatricians. Our very considerable success in reducing morbidity and mortality from many diseases permits us to address new problems. Precisely because of our past successes, society looks to us for new answers. Many of our current challenges are in large measure social problems. For example, there is good reason to believe that further reduction in infant mortality will depend upon improvements in the living conditions of people in poverty rather than on better medical care alone. We have been slow to catch up with the rapid changes in our society. While continuing to conduct research to provide better data for planning, pediatricians can serve as advocates for wider application of the considerable knowledge we already have.
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