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Tumultuous decade of the 1960s ushers in Head Start, medical achievements :

May 1, 2020

Editor’s note:This is another in a series highlighting the AAP’s 90th anniversary. For previous articles, visit http://bit.ly/AAP90thAnniversary. Next month: the 1970s.

The 1960s was the tumultuous decade of the Vietnam War, Civil Rights, demonstrations and the counterculture, along with a growing middle class. The assassinations of President John F. Kennedy, Dr. Martin Luther King Jr. and Sen. Robert F. Kennedy rattled the nation. News reports chronicled the first manned space flight and a moon landing.

The AAP turned 30 in 1960 and had 10,857 members by the end of the decade — a growth rate of 60%.

Medicine and health care saw many advancements, including new vaccines to fight measles, rubella and mumps. Louis Gluck, M.D., FAAP, a pioneering neonatologist (oral history, https://bit.ly/3dQtSKl), designed the first American neonatal intensive care unit. There was an explosion of medical subspecialists but concerns over health care costs and a shortage of pediatricians given the Baby Boom following WWII.

AAP Executive Director E.H. Christopherson, M.D., FAAP, called for a “substantial and immediate increase” in pediatricians to care for the health needs of the growing child population.

Medicine remained a mostly white male profession. In 1961, about 12,000 physicians in the U.S. practiced as pediatricians; approximately half were board certified. At this time, 15% of the pediatricians were women, and only about 2% of all pediatricians were reported as “nonwhite.” 

Social programs

Children take part in a Head Start class in 1965. The anti-poverty program addresses needs of the whole child in the community.

Despite technological and economic progress, poverty — and its attendant problems — existed within an affluent society. The government launched programs to help the poor, including Medicaid and Medicare.

Project Head Start began in 1965. This comprehensive early education program for disadvantaged children was an outgrowth of President Lyndon B. Johnson’s War on Poverty. He spoke of building a Great Society: “… where no child will go unfed and no youngster will go unschooled.”

Since its debut, countless pediatricians have been involved with Head Start, which has served more than 30 million children over the past 55 years.

Head Start was created without the AAP, however. This annoyed AAP leaders, and they formed a committee to investigate how to get involved.

Julius B. Richmond, M.D., FAAP (oral history, https://bit.ly/3c0DQHx), an authority on the development of children in poverty, was appointed the first Head Start director (1965-’68). A letter from Dr. Richmond requesting the AAP’s assistance paved the way for collaboration. The original contract with Head Start ended in the ’70s, followed by a decades-long gap. Today, the AAP operates Head Start’s National Center on Early Childhood Health and Wellness (https://bit.ly/2UOVsA2), providing training and technical assistance.

Dr. Richmond went on to serve as U.S. surgeon general (1977-’81) and highlighted the dangers of tobacco, a legacy that endures with the AAP Julius B. Richmond Center of Excellence (https://bit.ly/AAPrichmondcenter).

In a 1967 speech delivered at an AAP meeting in his absence due to illness, Dr. Richmond called on pediatricians to “pay attention to the early environment of the child …” The biggest problems at that time, Dr. Richmond noted, were challenges from poverty, chronic and handicapping conditions, emotional disturbance and accidents.

Robert E. Cooke, M.D., FAAP, a pediatrician at Johns Hopkins University, also was an influential architect of Head Start (oral history, https://bit.ly/2yq0zho), who led a steering committee and recruited experts to develop the pilot program.

AAP further defines its role

The AAP responded to various practice concerns with a Council on Pediatric Practice, made up of representatives of various committees. In 1967, the council came out with Standards of Child Health Care — a precursor of Bright Futures and the Periodicity Schedule — and which first referenced the need for a medical home. That year, the council also issued Health Insurance Guidelines for Infants and Children.

New committees at this time included the Committee on Indian Health (later, Committee on Native American Health) and a Committee on International Child Health. The AAP also held its first meeting with the National Medical Association.

Another highlight was a landmark publication (1962) by C. Henry Kempe, M.D., FAAP, who is credited with coining the term “battered child.” The following year, the AAP released a statement on the maltreatment of children. The Children’s Bureau suggested language for state laws to require physicians and hospitals to report child abuse; all states passed these laws by the end of 1967.

At the end of the ’60s, the AAP took over publishing Pediatrics and purchased the building next door to the central office.

Accident prevention work continues

The Committee on Accident Prevention set up a clearinghouse for reports of unusual accidents and monitored problems.

Policy statements in the ’60s warned about the hazards of tobacco; the importance of milk sterilization; the need for safety in school buses; the importance of seatbelts and driver education; and diagnosis of lead poisoning. An accidents column in the AAP News Letter (forerunner to AAP News) revealed cases of suffocation of infants wedged between mattresses and bumper guards, strangulation due to dangling cords from blinds and telephones, and injuries from toy boxes.

In 1960, the Federal Hazardous Substances Labeling Act was passed. In addition, the prescription warning label: “Keep all medication out of the reach of children” was a recommendation of the poison subcommittee of the Committee on Accident Prevention. AAP members were reminded to ensure that this label appeared on all medications they prescribed.

It was another example of pediatricians making progress on the founding goals of the AAP to address, in the words of former President Paul W. Beaven, M.D., FAAP: “…all aspects of the work for the welfare of children.”

Visit the AAP Gartner Pediatric History Center at https://bit.ly/pediatrichistorycenter.

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