By: Arthur Lavin, MD, FAAP

In the year following its founding (1931), the American Academy of Pediatrics established the Committee on Mental Hygiene and appointed as its first chair the eminent Dr Bronson Crothers, who in 1932, served as chair of President Herbert Hoover's White House Conference on Child Health and Protection. Over the following nearly 90 years, the Committee on Mental Hygiene was renamed to recognize key themes such as mental health and development and in 1980 was given its current name as the committee charged with issues relating to the psychological and social health of children and their families. Chairs have included such remarkable leaders as Dr Julius Richmond, Dr Morris Green, and Dr T. Berry Brazelton.

As we celebrate the 90th year of the founding of the AAP, it is compelling to take a look back at the roots of COPACFH, roots that are foundational concepts of improving the lives of children, and how the early work of COPACFH informs and aligns with Academy priorities to this day.

The origins of COPACFH, as well as many of the core founding principles of the AAP, derive from the work of 2 women, Dr Elizabeth Blackwell, the first female physician of the United States, and her protege Dr Sara Josephine Baker. Their work led directly to the beginning of the career of Dr Abraham Jacobi, the “Father of American Pediatrics”. It also led to the inspiration of President Theodore Roosevelt to address the needs of the health of children, which led to the first federal public health law: the Sheppard-Towner Act, a proximate cause of the founding of the AAP.

Dr Blackwell, born in England in 1821, graduated as America's first female physician in 1849. She devoted her career to the concept that women were in a better position to offer caring medical services and that a large proportion of health derived from social and moral health. Conquering the odds of entry into an all-male profession, she took her courage to New York City where she founded an infirmary where women could provide care and address what we would now call social determinants of health, perhaps the first instance in America in which a physician devoted their career to these concerns. That infirmary is now called the New York / Presbyterian Lower Manhattan Hospital. At the same time, Dr Blackwell founded a medical school for women and one of her first students was Dr Sara Josephine Baker. As a true protege of Dr Blackwell, Dr Baker took leadership positions in the Infirmary in New York City and went on to establish the core principles that still define much of pediatric public health in the world.

Dr Baker's work in the poor neighborhoods of New York City starting in 1901, established a 9-point program:

  • Clothing babies to reach safe temperatures
  • Promoting good feeding and nutrition
  • Promoting good sleep
  • Establishing access to clean milk
  • Creating an infant formula to allow mothers to seek work
  • Established silver nitrate prophylaxis of neonatal ophthalmic gonorrhea
  • Trained and implemented a community midwife program for safe delivery
  • Created the concept of free school lunches

Just in the neighborhood she worked, infant and maternal mortality plummeted and annual cases of blindness dropped from 300 to 3. Dr Baker went on to end the scourge of trachoma and found the index case of typhoid in the neighborhood, Typhoid Mary.

One of Dr Baker's early hires and greatest champions was a young refugee from the German Revolution of 1848, Dr Abraham Jacobi. Dr Jacobi pursued 3 avenues in his career: academic pediatrics at Columbia, clinical care in Dr Baker's Infirmary, and professional society work at the American Medical Association (AMA). At the AMA he founded the pediatric section and rose to be overall president of the AMA. Members of the pediatric section of the AMA would in 1930 be the group that formed the AAP.

Dr Baker's work also inspired a rising politician in New York City by the name of Theodore Roosevelt. He took his inspiration from what could be done to actually reduce the harm done to children when he went to the White House. Teddy Roosevelt, inspired by Dr Baker, initiated efforts to establish Federal support for the health and well-being of children. These efforts came to fruition under President Taft when he established The Children's Bureau in 1912. Over time the federal government established the Maternal and Child Health Bureau (MCHB) which serves 40 million children a year in the United States today. The MCHB is a close partner of the AAP. Dr Baker's work also led to the establishment of the US Public Health Service.

In 1921, shortly after women were granted the right to vote, the Promotion of the Welfare and Hygiene of Maternity and Infancy Act, sponsored by Senator Sheppard and Representative Towner, subsequently known as the Sheppard-Towner Act, was passed. This law put into place the program of health for mothers and children created by Dr Baker, including the establishment of over 3,000 maternal and infant clinics around the country and the provision of free and clean milk to low income children around the nation. As soon as the law was passed, reaction to these efforts ignited, leading to Congress agreeing to not renew this Act, thereby terminating these programs by 1926. In the 5 years of the life of the Sheppard-Towner Act, dramatic reductions in infant mortality were achieved using the now well-known strategies of home visits, improved sanitation, improved nutrition, and increased access to medical care. The intense controversy about whether our country should embark on reducing infant mortality through these efforts came to a fever pitch within the AMA when the organization formally sided with the forces opposing such efforts and banned member Sections from commenting on AMA policy. The pediatric section of the AMA, whose roots noted above trace to Drs Blackwell, Baker, and Jacobi, could not support this decision by the AMA. Support for the concept of a nation helping its babies and children played a significant role in the decision of some members of the pediatric section of the AMA to create the American Academy of Pediatrics.

Despite the remarkable progress initiated by Drs Blackwell and Baker, there was one domain not addressed. This major issue has consistently been ignored throughout American history, namely the well-being and care for the African American community. The dramatically increased chance that a baby of color would die before their first birthday relative to a white baby persisted despite the extraordinary introduction of public health measures by this team which did lower infant mortality for all, a disparity still very much alive and little changed today.

All the themes that helped lead to the formation of the AAP continues through the work of the Committee on the Psychosocial Aspects of Child and Family Health as well as many other AAP entities to this day.

The Committee recently concluded a strategic planning process which yielded 4 key priorities for addressing the psychosocial health of children and families. Three of these are identical to those established by doctors Blackwell and Baker: poverty, mental health, and safe and healthy environments. These 3 priorities which accurately defined leading challenges to the psychological and social well-being of America's children in 1930 remain so today. The committee’s 4th priority has always deserved priority but has only recently been recognized formally as such by the nation and its professional societies: racism. The AAP has already begun efforts to impact racism and its effect on children’s health, including the creation of task forces and a major policy paper on the subject.

It is very fitting that on the occasion of celebrating the AAP's 90th anniversary, we are reminded that so much of the spirit of the Academy and of its great work finds its roots in the work of the first female physician of the country, her remarkable protege, and the doctor they hired who went on to become the “Father of American Pediatrics.”

©2020, American Academy of Pediatrics

This article was prepared by Dr Lavin on behalf of the AAP Committee on Psychosocial Aspects of Child and Family Health, of which he is the current chair