Look how far we've come as advocates for children-but consider where we still need to go!

Pediatricians have a long and distinguished record of advocating for the health and welfare of children. The record includes not only the individual contributions of exemplary pediatricians and social servants but also the broader role that advocacy and legislation play in bringing about major improvements in children's lives. It's worthwhile to review here what advocacy for children has accomplished over the past century and what challenges we face today, and to reflect on the role of advocacy in the 21st century.

The bad old days

Flash back a century to the year 1905. Child health care was still in its infancy, and the death toll for children was staggering. Infant mortality was more than 10% for white children and 20% for black children.¹ Child mortality (deaths of children older than 1 year) was greater than 3%.¹ The roster of culprits reads like an infectious disease textbook: tuberculosis, diarrhea and dehydration, diphtheria, measles, scarlet fever, typhoid and paratyphoid, influenza and pneumonia, and pertussis. Mortality statistics for the United States compiled by the National Center for Health Statistics in 1905 attribute tens of thousands of deaths each to tuberculosis, pneumonia, diarrheal disease, typhoid fever, and diphtheria.² Poverty, overcrowding, and sanitation contributed to the spread of these deadly scourges.

Pioneering reforms

Much of the decline in mortality among infants and children in the US in the early part of the 20th century resulted from the work of committed individuals and government reforms. In 1908, S. Josephine Baker, MD, founded the Bureau of Child Hygiene in New York City in response to the high rate of infant mortality there. The first such organization in the country, the bureau promoted maternal education and infant welfare, operated milk stations, and sent trained nurses to visit immigrant mothers in tenement houses.⁴

In 1909, President Theodore Roosevelt convened the First White House Conference on The Care of Dependent Children to improve the care of destitute children and thus "benefit the welfare of the nation."⁵ The conference gave rise to the US Children's Bureau, under the Department of Labor, in 1912. The bureau was run by a Chicago-based reformer named Julia Lathrop, the first woman to head a US government agency. She selected the reduction of infant mortality as the bureau's primary objective.⁴ In 1916, Congress finally addressed the plight of working children by passing the Keating-Owens Act to regulate child labor.

In 1921, Congress passed the Sheppard-Towner Maternity and Infant Act, the first federally funded social welfare measure in the US. It disbursed federal funds to states for maternal and child health and welfare programs. In the seven years after passage of the legislation, Sheppard-Towner agents distributed 22 million pieces of health literature, conducted hundreds of health conferences, visited more than 3 million homes, and established nearly 3,000 prenatal centers.⁴