Pediatrics - Pediatric Milestones

History of Pediatrics

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Pediatrics

What is pediatrics? That's an easy question for most people, especially those who went to a pediatrician when they were kids. Pediatrics is just the branch of medicine for kids, right?

That is basically true, but doctors who go into pediatrics have long known that kids aren't just small adults. Newborns, toddlers, preschoolers and even teenagers all have different physical and mental needs and problems than adults.

Pediatricians take care of all of those needs for kids from birth up to age 21.

History of Pediatrics

Although traditional medical doctors have been around since Hippocrates in ancient Greece -- and likely before if you consider the medical practices of non-western cultures -- pediatrics is a relatively new branch of medicine.

Today's pediatricians have their roots in the formation of the American Pediatric Society and the American Academy of Pediatrics. As with other medical specialties, the move toward a pediatrics specialty seemed to evolve after the American Medical Association pushed to restructure and reform medical education in the early 20th century.

Early leaders in pediatrics, often called the fathers of pediatrics, include Drs. Abraham Jacobi, Osler, Rotch and Forchheimer.

In fact, in their policy statement on "The Pediatrician's Role in Community Pediatrics," the American Academy of Pediatrics calls Abraham Jacobi (1830-1919) "a founder of the discipline of pediatrics." Born and trained in Germany, Jacobi eventually came to New York City and began practicing and then teaching pediatrics.

In addition to being a strong advocate of breastfeeding, Dr. Jacobi warned that women who did not breastfeed should not give their babies raw cow's milk and introduced the concept of bedside teaching of students.

Early Milestones in Pediatrics

Some of the more significant early developments in pediatrics include:

  • Edward Jenner did tests that led to the first smallpox vaccine in 1796
  • Dr. Eli Ives gave lectures to medical students at Yale about diseases in children and other medical topics between 1813 and 1852
  • Two of the first textbooks in pediatrics are published in 1825, "Treatise on the Physical and Medical Treatment of Children" by Dr. William Potts Dewees and "Practical Observations on Diseases of Children" by Dr. George Logan
  • Dr. Elizabeth Blackwell becomes the first woman to graduate from a U.S. medical school in 1849 and then goes on to study at children's hospitals in London, Scotland, and Paris, returning to help start the New York Infirmary for Women and Children
  • Children's Hospital of Philadelphia is established in 1854 and becomes America's first children's hospital
  • New York Medical College starts a regular professorship for the diseases of children in 1860
  • Louis Pasteur invents pasteurization in 1862, which is later applied to keeping milk safe by Franz von Soxhlet in 1886
  • Dr. Abraham Jacobi helps start the "American Journal of Obstetrics and Diseases of Women and Children" in 1868
  • In 1872, Dr. Mary Putnam Jacobi becomes the first woman to become a member of the Academy of Medicine. She also opened a children's ward at the New York Infirmary in 1886.
  • Dr. Frederick Forchheimer is the chief physician when the Home for Sick Children in Cincinnati, Ohio, opens in 1883 - the first children's hospital in the Midwest
  • The first issue of the Archives of Pediatrics is published in 1884
  • The American Pediatric Society is established in 1888, by Dr. Job Lewis Smith, with Dr. Abraham Jacobi as its first president, who later becomes president of the AMA
  • Dr. Thomas Morgan Rotch is appointed America's first full professor of pediatrics at Harvard Medical School in 1893
  • Dr. Dorothy Reed Mendenhall was the first to recognize that Hodgkin's disease was a blood cell disorder and not a form of tuberculosis in 1901. She later did an internship in pediatrics and did research on children's health issues for the Children's Bureau in Washington D.C., including the development of growth norms and standards of child development.
  • The "American Journal of Diseases in Children," published by the AMA and now called the "Archives of Pediatrics and Adolescent Medicine," begins publishing in January 1911
  • Seasonal epidemics of polio begin to occur in the United States in 1916
  • Sir Edward Mellanby, a doctor in London, discovers that cod liver oil can treat rickets
  • Dr. Emily Partridge Bacon became the first pediatric specialist in Philadelphia (1918). Among the innovations she introduced was the "well-baby" clinic.
  • Dr. Jessie Boyd Scriver was one of the first women to study and graduate from McGill University in Montreal, Canada. She became president of the Canadian Pediatric Society in 1952 and was a major influence on neonatologists in Canada.
  • The diphtheria vaccine was introduced in 1923, soon followed by a pertussis (whooping cough) vaccine in 1926
  • Dr. J. P. Crozier first publishes his pediatrics textbook "The Disease of Infants and Children," which eventually becomes the Nelson's Pediatrics textbook that is still used today
  • Alexander Fleming discovers penicillin in 1928, although it isn't until the 1940s and 50s that penicillin began to be widely used as an antibiotic
  • The American Academy of Pediatrics is formed on June 23, 1930, by a group of 35 pediatricians in Detroit, Michigan
  • The American Board of Pediatrics, a certifying board of the American Board of Medical Specialties, is founded in 1933
  • Cases of rickets start to decline as milk begins to be fortified with vitamin D in 1933
  • A study is published describing the use of benzedrine (a form of amphetamine) in children with behavior problems in 1937 by Dr. Charles Bradley
  • Dr. Dorothy Hansine Andersen was a pathologist and in 1938, became the first person to recognize that cystic fibrosis was a disease. She also helped created the first tests to help diagnose CF.
  • Hattie Elizabeth Alexander, MD was a pediatrician and microbiologist at Babies' Hospital (now NewYork-Presbyterian Morgan Stanley Children's Hospital) who developed a treatment for Hib meningitis in the 1940s that was more effective than previous treatments. She also identified antibiotic resistance in Haemophilus influenzae bacteria, another milestone at the time.
  • Drs William E. Ladd and Robert E. Gross (who performed the first PDA ligation three years earlier) publish the first modern pediatric surgery textbook in 1941, "Abdominal Surgery of Infancy and Childhood"
  • Dr. Norman M. Gregg reports on congenital rubella syndrome in 1941
  • Dr. Helen Taussig and Dr. Alfred Blalock work to develop a palliative surgical treatment for babies with Tetralogy of Fallot in 1943
  • Dr. R. L. Jackson and Mrs. H. G. Kelly publish the first widely used pediatric growth charts in 1944
  • The first edition of "Baby and Child Care" is published by Dr. Benjamin Spock in 1946
  • The first military pediatrics residency program opens at Boston's Chelsea Naval Base in November 1946, although pediatricians were already serving in the Army and Navy Medical Corps, including more than 900 pediatricians in World War II
  • C. Everett Koop, MD becomes surgeon in chief at Children's Hospital of Philadelphia around 1947
  • Martha May Eliot, MD becomes the first woman to be elected president of the American Public Health Association and was known as "one of the most influential pediatricians to hold positions of public authority in the United States during a long and distinguished career."
  • The first issue of Pediatrics, the journal of the American Academy of Pediatrics is published in 1948
  • A study in 1948 showed that only 58% of newborns were discharged from the hospital before they were 8 days old and 35% were strictly bottle fed, 27% fed from both the breast and bottle and only 38% were exclusively breastfed
  • Margaret Morgan Lawrence, MD was a child psychiatrist and was the was the first African American women to be certified by the American Board of Pediatrics and also the first African American  to complete a residency at the New York Psychiatric Institute (1948).
  • Dr. Roland B. Scott, who was the chairman of pediatrics at Howard University from 1949 to 1973 and became the first African-American member of the American Pediatric Society in 1952, is likely the first black pediatrician in the U.S.
  • In 1949, Dr. Edith M. Lincoln, who was head of the children's chest clinic at Bellevue Hospital Center in New York City since 1922, successfully treated a dozen children with tuberculous meningitis and miliary tuberculosis, which were typically fatal at the time.
  • The Harriet Lane Handbook is first published in 1950, and long becomes the go-to reference for pediatric residents
  • In 1951, Dr. Natalia Tanner became the first African American fellow of the American Academy of Pediatrics and "played a very personal role in improving underserved patients' access to healthcare and minority physicians' access to the institutions of professional medicine."

Modern Milestones in Pediatrics

In addition to the early milestones in pediatrics, other important developments include:

  • Dr. Virginia Apgar, an anesthesiologist, develops the Apgar Score in 1952, which is used to test a baby's response to resuscitation right after they are born
  • Katherine Dodd, MD became the first woman to chair a Department of Pediatrics in a US medical school in 1952 - University of Arkansas Medical Center.
  • Dr. Edward Press and Louis Gdalman, a pharmacist in Chicago, start the first poison control center in 1953, largely prompted by the work of George M. Wheatley, MD and his work on child safety and risk of child poisonings
  • Jonas Salk develops his polio vaccine in 1952, and it was used to help eradicate polio in the U.S. until a live, oral polio vaccine was licensed by Albert Sabin in 1962
  • 56 children develop polio in 1956 from contaminated polio vaccines in what becomes known as the Cutter Incident
  • A study in 1956 of newborns at hospital discharge (usually at 4 or 5 days of life) now showed that 63% were strictly bottle fed, 16% fed from both the breast and bottle and only 21% were exclusively breastfed
  • The La Leche League is founded in 1956 to promote breastfeeding and reverse trends towards increases in bottle feeding
  • Dr. Ethel Collins Dunham published the Standards and Recommendations for the Hospital Care of Newborn Infants, Full Term, and Premature in 1936 and in 1957 received the John Howland Medal from the American Pediatric Society, their highest honor.
  • Frances Kelsy, Ph.D. blocked the sale of thalidomide in the US while working at the FDA in 1960, the drug that was soon linked to birth defects in the more than 40 countries that had approved the sleeping pill that was given to pregnant women.
  • Commercial baby formula begins to be marketed in the early 1960s and includes Lactum, Similac, Enfamil, and SMA, which compete with homemade baby formula (evaporated milk plus water and an added sugar, like Dextri-Maltose) and breastfeeding
  • Dr. C. Henry Kempe publishes the first paper about child abuse, "The Battered Child Syndrome," in 1962, which helps create programs to help prevent and treat child abuse
  • Recommendations are made for fluoridation of city drinking water at a concentration between 0.7 to 1.2 ppm in 1962
  • Dr. Robert Guthrie develops the Guthrie test to screen newborns for phenylketonuria (PKU) in 1963
  • Dr. Dilip Mahalanabis creates his own packets of oral rehydration solution (ORT) to treat patients with diarrhea and dehydration in Calcutta, India in 1966
  • Dr. Forrest Bird invents the Baby Bird in 1970, the first mass-produced, low-cost, pediatric ventilator, after having invented some of the first portable mechanical ventilators in the 1950s and 60s.
  • The Nestle boycott is started in 1977 to protest the companies promotion of baby formula in developing countries, which led to decreasing rates of breastfeeding and increased infant mortality, especially because of a lack of clean drinking water in these countries
  • The Consumer Product Safety Commission bans lead paint in housing in 1978
  • Autism is recognized as a separate disorder in the DSM-III in 1980, although autism symptoms and behaviors were described as early as 1911
  • There were 8,000 to 10,000 cases of Hib meningitis in the US each year in the early 1980s, leading to 240 to 770 deaths in children, and an additional 6,000 cases of other serious diseases caused by the Hib bacteria, including epiglottitis, pneumonia, cellulitis, and bacteremia
  • The recommended childhood immunization schedule in 1983 included 4 vaccines (DTP, OPV, MMR, Td)
  • The Hib vaccine is recommended for all kids aged 18 to 59 months in 1988 and is later expanded to all infants beginning at 2 months in 1990
  • The back to sleep campaign helps to greatly reduce the risk of SIDS.
  • Although it began to be gradually phased out beginning in 1973, it wasn't until 1996 that the sale of leaded gasoline is totally banned in the U.S.
  • In 1986, Dr. Mayilyn Hughes Gaston publishes a nationwide study proved the effectiveness of penicillin to prevent infections in children with sickle cell disease, which showed that all newborns should be screened for sickle cell disease.
  • By 1997, the number of reported invasive Hib cases had declined 99%
  • Many states begin expanded newborn screening programs to screen for 25 to 40 or more conditions around 2004, responding to public pressure to use tandem mass spectrometry technology that had been around since 1996
  • The CDC releases a study in 2007 that reports autism rates in the range of 1 in 150 children
  • The World Health Organization declares the start of the 2009 H1N1 influenza pandemic on June 11, 2009
  • Cerarix, a vaccine against HPV, is approved in 2009, and joins Gardasil (another HPV vaccine) on the vaccine schedule to protect kids from an ever growing list of vaccine-preventable diseases, including chickenpox (Varivax), pneumococcal disease (Prevnar 13), rotavirus (Rotateq and Rotarix), meningococcal disease (Menactra), and hepatitis A, for which vaccines have been approved since the hepatitis B vaccine was added to the immunization schedule in 1994.
  • Quadrivalent flu vaccines become available for the 2013-14 flu season. These new flu vaccine options provide protection against four strains of flu.
  • HPV 9 was approved in 2014.
  • Two Men B vaccines were approved in 2014.

Becoming a Pediatrician

After college, students interested in becoming a pediatrician take the MCAT and then attend one of the 125 allopathic medical schools or 20 osteopathic medical schools to become a doctor first.

After four years of medical school, three years of pediatrics residency will prepare you for a career in general pediatrics.

Pediatric Specialists

In addition to general pediatrics, pediatricians can choose to specialize in a number of fields, including:

  • Adolescent Medicine
  • Pediatric Gastroenterology
  • Pediatric Cardiology
  • Pediatric Hematology-Oncology
  • Child Abuse
  • Pediatric Infectious Diseases
  • Pediatric Critical Care Medicine
  • Neonatal-Perinatal Medicine
  • Developmental-Behavioral Pediatrics
  • Pediatric Nephrology
  • Pediatric Emergency Medicine
  • Pediatric Pulmonology
  • Pediatric Endocrinology
  • Pediatric Rheumatology

Other pediatric specialists, such as a pediatric surgeon, pediatric radiologist, or pediatric neurologist, etc., aren't necessarily pediatricians, though, and instead, undergo training in their own fields, and then additional specialty pediatric training.

Sources:

American Academy of Pediatrics Policy Statement. The Pediatrician's Role in Community Pediatrics. Pediatrics Vol. 115 No. 4 April 2005, pp. 1092-1094.

American Academy of Pediatrics. American Pediatrics: Milestones at the Millennium. Historical Archives Advisory Committee. Pediatrics 2001;107;1482-1491

CDC. Current Trends Prevention of Secondary Cases of Haemophilus influenzae Type b Disease. MMWR. December 24, 1982 / 31(50);672-674,679-680.

Charles W. Callahan. History of Military Pediatrics: Fifty Years of Training and Deploying Uniformed Pediatricians. Pediatrics Vol. 103 No. 6 June 1999, pp. 1298-1303.

Edmund C. Burke. Abraham Jacobi, MD: The Man and His Legacy. Pediatrics, Feb 1998; 101: 309 - 312.

Herman F. Meyer. BREAST FEEDING IN THE UNITED STATES: EXTENT AND POSSIBLE TREND: A Survey of 1,904 Hospitals with Two and a Quarter Million Births in 1956. Pediatrics, Jul 1958; 22: 116 - 121.

Katherine Bain. The Incidence of Breast Feeding in Hospitals in The United States. Pediatrics, Sep 1948; 2: 313 - 320.

Robert C. Brownlee, MD. Pediatric History. The American Board of Pediatrics: Its Origin and Early History. Pediatrics, Nov 1994; 94: 732 - 735.

Women in Health Care and Pediatrics: Historical Perspectives. Pediatrics, Apr 1983; 71: 681 - 687

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