INTRODUCTION
The series of papers in this Supplement comprise reports based on completed case studies from the Longitudinal Studies of Child Health and Development-Series II, Department of Maternal and Child Health, Harvard School of Public Health.
DESCRIPTION
OF
PROJECT
875
PEDIATRICS, November, Part II, 1959
Harold C. Stuart, M.D., Robert B. Reed, Ph.D., and Associates
History and Nature of the Project
I
N 1929 the senior author initiated the“Center for Research in Child Health and Development” as a research activity of
the newly organized Division of Child Hy-giene at the Harvard School of Public
Health. Subsequently, this Division became the Department of Maternal and Child
Health. This “Center” was organized to pro-vide staff and facilities for the periodic and broadly oriented follow-up of individual
children from birth throughout childhood
and of their mothers during pregnancy. The
term “Center” was then used because the project was conducted in a building outside the School with the co-operation of the Chil-drens Flospital, the Boston Lying-in
Hospi-tal, the Forsyth Dental Infirmary for
Chil-dren and members of their respective staffs. Early in 1930 the first prosPective mother
was enrolled at the Boston Lying-in Hospital for study of 11cr family and the course and
outcome of pregnancy. The program carried
out at the hospital was designed to provide background for the subsequent enrollment of her infant at birth for continuing periodic
studies during early childhood. The initial
plalls were gradually extended in respect to breadth of studies and the length of periodic
follow-up was extended throughout adoles-cence and included a terminal, more
com-prehensive eighteenth-year examination. In 1939 the last mother was enrolled during
pregnancy and in 1956 the last child still
being followed was discharged because of
having completed tile terminal examination.
One hundred and thirty-four children, 67
boys and 67 girls, were followed to 18 years.
These constitute the Maturity Series upon
which the present group of reports is based.
The nature of the studies originally
carried out under this project and the
prog-ress made between 1930 and 1938 were
described in a Monograph published by the Society for Research in Child Development,
hereinafter referred to as Monograph 1.1
This dealt in considerable detail with the
children enrolled and their families, with the
methods of selection and follow-up, with
the composition and operations of the multi-disciplinary staff and with the
methodolo-gies and techniques then employed in the
collection and recording of data. Each item included in the routines adopted was
se-lected to reveal some aspect of each child’s health, growth, development, dietary habits
or physical or psychological experiences as well as certain aspects of family composition,
home environment or social circumstances. In addition, the staff explored freely, through
questions and observations outside of tile routine, leads which might add further
un-derstanding of the individual child or family.
The reader is referred to Monograph I for information regarding this research in
its early phases and for the details of
tech-niques and procedures used, many of which were followed consistently throughout the later years. Two subsequent Monographs were published by this Society which
de-scribe selected aspects of these continuing studies, and numerous additional papers were published during subsequent years
reporting preliminary findings from
cross-sectional or short-term longitudinal studies
in selected areas of investigation. A full
cer-876
tam technical procedures used, is given
on pages 972 to 974 of this Supplement.
During the years from 1938 to 1956 the
program of data collection was far from static. Procedures were dropped or added
and some were altered in content or method-ology, sometimes to discard unpromising or
unreliable items or to improve techniques,
at other times to explore promising new
leads for investigation or to accommodate to
changing interests of the staff. Changes in procedure were made most often to adapt
procedures to the advancing age of the child.
It is imperative that in such a relatively new
field of investigation the staff should grow and develop with the children being
ob-served and in part as a result of their obser-vations. However, continuity and
consist-ency in the basic objectives and
methodolo-gies and in the routines of follow-up of the
children enrolled were maintained to a very
substantial extent. This project has come to
be known as the “Longitudinal Studies of
Child Health and Development of the
Har-vard School of Public Health” and it will be so referred to in this and subsequent
pub-lications. The term “Center” in the former name was discontinued in the later years of
the Study during which the clinical research
was carried out at the Child Health Division
of the Children’s Medical Center, Boston,
and other staff activities at the Harvard School of Public Health.
Financial Support
This project was started and for several years
conducted largely by staff members of the
De-partment of Maternal and Child Health, Har-vard School of Public Health and other
De-partments of the University or co-operating
institutions, but increasingly with small
short-term, specific, project-directed grants. Most of
the latter have been acknowledged in Mono-graph I and others will be acknowledged in
later publications dealing more specifically
with the studies supported by them.
The first major grant for the support of this
research in terms of amount, breadth of
cover-age and duration was made by the General
Education Board of the Rockefeller Foundation
and was available for the years July 1933
through June 1942. The next was from the
James Foundation of New York which applied
to the period, July 1942 through June 1951.
Since July 1947 the Research Grants Division
of the United States Public Health Service has
made a broadly applicable grant each year and has committed continuing support for the
evaluation of many aspects of the completed
case studies for the years 1959 and 1960. The
Nutrition Foundation, Inc. of New York, the
McCallum Foundation, Inc., under the
super-vision of the Nutrition Foundation, Inc., and
the Hood Foundation of Boston also have sup-ported various aspects of this research program for considerable periods since 1945. Through-out all the years, however, those responsible for directing programs as well as carrying out much of the clinical routine of collecting data
in their particular fields have done so in
con-nection with other duties under University
ap-pointments and salaries, chiefly through the
Department of Maternal and Child Health,
Harvard University School of Public Health,
but also in the Harvard Medical or Dental
Schools or the Forsyth Dental Infirmary for
Children.
The Staff
The names of those who participated in this
research prior to 1939 were listed and their
contributions acknowledged in Monograph I,
to which reference has been made. Since that
time a large number of people have contributed
to these continuing studies for long or short
periods and in major or minor ways. All have
met some important need but the list is too long
to name and the varieties of activities of each
too involved to recite in this general account.
Those who contributed a substantial amount
of data in a very specialized field will be named
in the appropriate reports to follow. The
au-thor and present staff are deeply appreciative
of the careful and extensive studies by this
group which make the present case analyses possible.
The author who initiated this project in 1929
(H.C.S.) and the nutritionist in charge of
die-tary studies since 1932 (B.S.B.) are the only
persons listed in the 1939 Monograph who
are presently continuing with the study and
reporting of the data assembled. Among others
who made this research an important aspect
co-CHILD HEALTH AND DEVELOPMENT 877
operating with it for substantial periods since
1938, the following should be mentioned:
As pediatricians-Edward
J.
Touhv, StantonGarfield, Edna H. Sobel, Jane Borges, Jean
Webb, Stuart Stevenson, and Isabelle
Valadian.
As obstetricizns-Harold Ted and Samuel B. Kirkwood.
As orthopedists-William Green, consultant
and Arthur Trott.
Asdentists or orthodontists-Paul Losch,
Vic-tor Hurme, Reidar Sognnaes and Coen-raad Moorrees.
in the field of anthropology-Stanley Cain
and Edward Hunt.
in the fields of anthropometry and
roent-genology-Vernette Vickers Harding,
Mar-garet Anderson, and S. Idell Pyle.
In the field of nutrition and dietary studies
-Virginia Beal, Kathleen Scobie, Ruth
Johnston, Elinor Maguire, Mary Lou
John-son, and Anna van den Berg, all under the
direction of Bertha S. Burke.
In the field of social studies and family
follow-up-Josephine Touhy, Barbara
L’nch and Margaret Murray as public
health nurses, and Ruth Butler, with tl#{236}e
guidance of Elizabeth Rice, as social worker.
In the field of psychology and
psychiatry-Mary Shirley, Robert Harris, Pepita Kudarauskas Kaufman and Robert Ravven.
In the field of biostatistics-Carl Doering,
Jane Worcester, Olive Lombard, Elizabeth
Grant Flanagan, Joan Cornoni, and in
re-cent years others under the continuing
direction of Robert Reed.
The staff presently devoting their major
at-tention to the evaluation of the data in hand
and the preparation of monodisciplinary and
multidisciplinary reports in case studies are as
follows:
Harold C. Stuart, Director.
Bertha S. Burke, in charge of nutrition
studies and assisted by Anna S. van den
Berg.
Robert B. Reed, in charge of statistical
studies and assisted by Joan Cornoni.
Isabelle Valadian, in charge of pediatric
studies.
S. Idell Pyle, in charge of studies of
roent-genograms.
Those assisting in these and other fields will
appear as joint authors in selected papers to
which they have made specific contributions.
General Plan of Reports
This is the first of a series of papers which
will report studies of total childhoods, made
possible by the completion of the follow-up
of all children enrolled. These papers will
report findings in various fields of
investiga-tion, the first dealing with specific aspects of the research but later ones with studies of
interrelationships. To distinguish these final
reports from the earlier ones listed in the
accompanying Bibliography, they will be
designated as Series II.
The purpose of this first paper in this
series is to provide general information re-garding the project during the years
subse-quent to 1938. With brief references to
Monograph I and fuller descriptions of op-erations during the later years, it should avoid the necessity for repeating in each subsequent report information relevant to all.
Terminology
Certain terms are used by different in-vestigators with such different meanings that
confusion may arise unless authors define
their use of them. The following definitions
are given here because they relate to terms
commonly used in this type of research but with rather special meaning. The definitions
given will apply to all subsequent reports of these longitudinal studies, unless the specific
use is qualified.
Health refers as broadly as possible,
con-sidering the data at hand, to the total
well-being of the individual or group. The term
implies absence of major illness, referring to
observable pathology or disease, but it is used
also in a positive sense to include good status
in consideration of age and individual
ex-pectancies. Because of the breadth of possible
meanings in relation to physical, mental and
psvchologic factors, its use in these reports may require explanation, although context usually should indicate the limitations of its
scope.
in pediatrics. It refers to the natural changes
in size, for the body as a whole or any of its
(limensions, parts or tissues which are part of
progress toward manhood or womanhood,
com-monly referred to as maturity.
Development, in contrast to Growth, refers
to the differentiation and other changes in
structures and functions and the resulting
changes in complexities, capacities and
adapta-tions which also are manifestations of progress
toward adult maturity.
Status refers to the situation at a given age
or examination, as reflected in one or many
measurable or observable attributes. It may
deal with size, form, configuration,
arrange-ment, balance or other observable attributes.
A Cross-sectional Study is one that deals
with Status. It may relate to an individual or
to a group or groups at a comparable period,
usually of the same age. One may therefore
refer to cross-sectional data to distinguish them
from those which are concerned with progress
or change.
A Longitudinal Study is one that deals with
repeated observations of the same individual
or group over a period of time. The purpose
of such study is to observe and record changes
with time, which alone can reveal the progress
of individuals in growth, development,
adapta-tion and other aspects of change.
Pattern may be used in cross-sectional studies
to describe a combination of attributes. In
longitudinal studies it is used, as in these
papers, to describe the course of progress of some measurable or classified changes from
age to age as observed and recorded repeatedly.
A Pattern is most commonly portrayed by the
use of a chart or charts on which repeatedly
observed data are plotted against age as a
series of points. When these are joined
to-gether they produce a curve, the shape of
which reflects the characteristics of the
pat-tern concerned, such as magnitude, level of
advancement and rate of change in these with
time.
PRINCIPAL OBJECTIVES OF THE RESEARCH, 1930-1956
At the time this research was initiated it
was appreciated that there were wide
differ-ences between children of the same age and
sex and many studies had been made on the
variability in selected measurable or
classifi-able attributes of groups of children of like
age. Tile flO5 derived from these were
being used widely for the assessment of
individual children. In a few centers tile
same children were being re-appraised
periodically over varying but selected age
periods. In 1922 Dearborn started at the
Harvard Graduate School of Education to
follow children in a few selected schools,
applying to them periodically a series of
measurements and tests. This came to be
known as the “Harvard Growth Study” but
should not be confused with the project
presently being reported.
Other major studies, started about the time
of this project with many features in common
but differing in major objectives, were as
fol-lows. In 1929 Todd started to organize at
Western Reserve Medical School the Brush
Foundation Study of Child Growth and
De-velopment and between 1931 and 1938 to
enroll groups of infants and children of all
ages to 14 years for periodic follow-up. In
1930 Washburn became Director of the Child
Research Council in Denver and developed it
from a small beginning in 1927 to a most
ex-tensive continumg longitudinal study of
chil-dren. Those enrolled in infancy are being
fol-loved in adult life and presently studies start
with pregnancy’ and include second generation
enrollments. Also, in the fall of 1929 Sontag
established at the Fels Research Institute at
Antioch College a Study of Prenatal and
Post-natal Environment which has continued
ob-servations of families enrolled for a variety of
purposes, including longitudinal studies of
children. Jones has directed an “Adolescent
Growth Study” initiated in 1932 to follow
children ill schools as did Dearborn. These
studies have continued at tile Institute of Child
Welfare, University of California. Several
groups of investigators2 later used tile data
from these projects as the basis for many re-ports of individual variabilities. Other studies
of a longitudinal character with widely
dif-ferent methodologies and basic purposes
pre-ceded them or emerged during the succeeding
years.
Tile philosophy which led to the initiation
in 1929 of the research here to be described,
which governed the original planning for it,
and with increasing definition has motivated
CHILD HEALTH AND DEVELOPMENT 879
tile concept that variabilities in status by
age result in the main from variabilities in
progress and that it is primarily the latter
which are related to health or have health
significance. Earlier experiences had
sug-gested that there are consistencies within
in-dividuals as well as differences between
them in rates, magnitudes, levels and other
characteristics of their progress from age to
age; also that there are changes with time
in these n tile part of individuals. It was a
basic concept, therefore, that children tend
to be like themselves from period to period
but that they also change in characteristics
of their growth and developmental progress
in different ways and to variable extents
with time. These concepts indicated that a
child’s positions within the ranges provided
by group norms, although generally similar
from age to age should be expected to
change in accordance with his individual
patterns of progress. It was conceived that
there are a wide variety of individual
pat-terns for every aspect of growth and
devel-opment, but little evidence was available as
to their characteristics or frequencies.
With these concepts as background, the
prime objective at the start of this research
was to secure, through periodic assessments, data relating to the progress of individual
children from birth throughout the period
of growth and development, covering as
many aspects of the progress of the same
individuals as was found practicable.
It was an objective from the start of this
project to improve the precision and extend
the reliability of methods in current use for
obtaining and recording data. Fields of
rec-ognized importance were not disregarded
because of known limitations in the methods
available, but much time and effort were
expended during the initial phase of this
research to improve on available techniques
or to devise new ones.
Characteristics of Individual Development
As these studies progressed, certain
char-acteristics of individual development,
par-ticularly as to consistencies within
individ-uals and differences between them, became
more and more apparent and a few more
specific principles were derived from them.
The following are stated below to provide
the reader a better understanding of the
objectives and methods adopted both in the
selection of data to be collected and in the
use of these data in the case studies which
are to follow in this and succeeding reports.
CHARACTERISTIC I: All children lacking
gross defects pass through recognizable types
and stages of changes in their progress toward
adult maturity. These relate to most measurable
or observable aspects of growth, development
and adaptation to life experiences. The
char-acteristics and sequential expressions of these
are referred to as “human patterns” for,
al-though they have counterparts in the
matura-tion of many animals, their human expressions
are distinctive.
Principles Derived from 1. (1) The
char-acteristics of progress during any one stage
and the resulting status at any age have
im-portant bearing on the nature of health needs
and the types of health problems requiring
attention. (2) Personal health services for
chil-dren would be far more effective if these
re-lationships were better understood.
CHARACTERISTIC II: Individual children
dif-fer widely between themselves in all attributes
at any given age. The distribution of values for
a given attribute at any given age has a
char-acteristic form, but the means as well as the
extremes of the ranges tend to differ
consider-ably between groups.
Principle Derived from II. The careful
ob-servation, assessment and recording of values
or ratings for various aspects of growth and
development of populations of children of
specified ages adds to knowledge of the extent
of individual differences, which in turn permits
better understanding of the findings on
indi-vidual cases within such populations. They do
not however permit definition of the limits of
normality. Such data have greater value when
the children from whom they were derived
have been studied from other points of view
such as the incidence of illnesses, general health
and nutrition. When those holding a unique or
fringe position within the range for any one
attribute can be studied in respect to these
other factors, more light can be thrown upon
the possible importance of such position to
CHARACTERISTIC UI: Individual differences
between children apply also to the magnitudes
and timing of changes from period to period
in all aspects of developmental changes, and
a wide variety of patterns of progress are
recognizable. Children tend to differ also in
the consistency with which they follow any
given pattern. The importance to the individual
of his characteristics in these respects with few
exceptions are poorly understood.
Principles Derived from Iii. (1) Only by
studying children periodically can individual patterns of progress be recognized. Repeated and carefully recorded data in respect to
vari-ous attributes of groups of children at
speci-fled ages, or over suitable intervals of time,
reveal their common or characteristic patterns
of progress. They also call attention to
irregu-lar or unique patterns deserving further study.
(2) To be most revealing, these longitudinal studies of individuals should be extended to cover as long segments of total childhoods as
possible. Only thus can progress at one age
period be related to that at another or to con-current aspects of health.
CHARACTERISTIC IV: There is an
interre-latedness within individuals between status in
one attribute and that held in one or more
others at given ages. There is also a tendency
toward interrelatedness in progress as to the
ages at which changes in rates occur or at
which specific developmental occurrences take
place. However, some children tend to be far more uniform or balanced in their status and
progress than are others.
Principles Derived from IV. (1)
Recogni-tion of the varieties of interrelationships
oc-curring between the various aspects of growth
and development and the regularity with which
they are encountered can be attained only
when many aspects of these processes have
been studied on the same individuals. (2)
Studies of relationships between patterns
repre-senting progress in different attributes in the
same child should contribute to understanding
the possible significance of selected observable
attributes as indicators of general development.
(3) Measurements or ratings of a wide variety
of attributes, made periodically on a group of
children, would be expected to reveal that some
attributes are closely interrelated while others
are quite independent.
CHARACTERISTIC V: Hereditary factors
de-termine in large measure the characteristics
of a child’s progress. However, progress may
be modified or adversely affected in one or
more ways by disease or defect or by
nutri-tional, psvchologic or other environmental
factors.
Principles Derived from V. (1) Intrinsic
and extrinsic factors, operating conjointly and
often over long periods of time will produce
combined effects which can be distinguished
only when a dominant factor is known to be
operating. (2) The position held by any child
at a given age within “the appropriate range”
for a given attribute may be due primarily
to genetic causes, to one or more environmental
causes or to a combination of intrinsic and
ex-trinsic factors. In some children this position
may represent appropriate status, whereas for
others the same position may indicate a
devi-ation of some health significance. (3)
Geneti-cally determined individual characteristics tend
to persist and to be repeatedly manifest over
age periods, contributing toward consistency
in progress. Characteristics which may readily
be modified by various environmental factors
would be more apt to reflect the influence of
these by irregularity in patterns of progress.
Attributes subject to 1)0th would lead to more
irregularity in some children than in others.
(4) The more that is learned about the extent
to which children max’ differ in growth and
development, in the absence of evidences of
disease, injury, poor diet, care or environment,
the clearer should become our understanding
of the role played by intrinsic factors in
deter-mining individual differences. (5) Studies of
contrasting groups of children in respect to
having undergone or not haing undergone
specific stresses or deficiencies in care should
reveal major or important differences resulting
from these environmental factors.
CHARACTERISTIC VI: There are wide
differ-ences between the effects upon children of
ap-parently similar factors at different ages and
upon different children of the same age. Except
in cases where there is defect in specific organ
or abnormality in particular physiologic process
the causes of apparent retardations are difficult
to identify.
Principles Derived from VI. (1) There are
recurrent, if not constant, interactions between
a child and his environment. The nature of the
resulting changes in the child depends on his
maturity and on his individual capacities for
various kinds of adaptations. Thus, the effects
of single environmental circumstances will
CHILD HEALTH AND DEVELOPMENT 881
constitutional characteristics and the stage of
their development. They will also be influenced
by the child’s nutritional state and by past or
recent environmental forces which may have
affected his present physiologic processes or
adaptive capacities. (2) Many deviations from
expected progress represent for the individual
concerned inappropriate or inadequate progress
and therefore may be considered “abnormal”
for him. It would enhance the value of health
services to children greatly if “failures to pro-gress normally” could be more clearly
differ-entiated from normal variations” and
particu-larlv if tile environmental or controllable factors
frequently causing the former could be
identi-fied with greater certainty. The types of studies
which could contribute most to these ends
would include periodic assessments of both
progress and environment on the same children.
(3) The objective of protecting each child from
unfavorable environmental influences or
mini-mizmg their ill effects can be attained only in
part by measures directed toward improving
the total environment. It involves in some
meas-tire adapting environmental circumstances to
the particular needs of the child. This calls for
periodic study of each child and of the
char-acteristics of his environment.
CHARACTERISTIC VII: All of the
character-istics of children as listed above apply in some
measure to fetuses and the newborn. The types
and stages of changes with advancing fetal age
and tile individual differences between fetuses
of the same age cannot be observed directly
or measured periodically in the living fetus.
Studies of aborted or prematurely born fetuses
have revealed some of the aspects of the
former, and findings on exammation of the
in-fant at birth reflect the latter. The
character-istics of the intrauterine environment and the
extent of influence of each on the fetus are
dlifferent, less well known and less readily
studied than are those of the extrauterine
en-vironment upon the child.
Principles Derived from Vll. (1) There is an
interplay between genetic and environmental
factors in determining the course of fetal growth
and development. (2) Owing to the more
con-stant and physiologically controlled
intra-uterine environment of normal pregnant
women, the course of fetal progress may be less
frequently or importantly modified by
environ-melltal factors than is that of a child’s
prog-icss. However, abnormalities of amniotic fluid,
cord, placenta or uterus may retard or distort
progress without necessarily causing abortion or
fetal death. (3) The health and development of
the fetus may be influenced by the illness
ex-periences, nutrition and other features of health
of the pregnant woman. These influences may
lead to premature birth or they may delay
growth and development so that even if carried
to full term the newborn may show features
which suggest immaturity. (4) Careful studies
of the general health, illness experiences,
phys-ical and emotional health, and nutritional state
and dietary habits of the pregnant woman
periodically, and of the course and outcome
of pregnanc’ may provide clues to the
intra-uterine experiences and nurture of the fetus.
The effects of these may be recognized in
studies of the condition of the infant at birth.
(5) Periodic and comprehensive studies of the
pregnant woman should be part of longitudinal
studies of health and development of infants
and children. They should include also health
and developmental histories of the woman
her-self and of other members of the family and
forbears, to the extent possible under given
circumstances.
THE GROUP
OBSERVED-CHARACTERIS-TICS OF THE FAMILIES ENROLLED
As described more fully in the 1939
Mono-graph I, after which there were no new
en-rollments, the selection of families for study
was made at tile prenatal clinics of the
Bos-ton Lying-in Hospital. Women coming to the
Hospital for prenatal care, and anticipating
ward admission for delivery and postnatal
service, were enrolled tentatively as early as
possible, usually at the beginning of the
second trimester of pregnancy. Enrollments were made by the public health nurse of the
project staff on the basis of one or more clinic interviews and a subsequent home
visit. Although the dominant consideration
was, of necessity, to insure good prospects
for long-time follow-up and good
co-opera-tion in providing reliable histories and
keep-ing appointments, a number of considera-tions operated to restrict and determine the
nature of the sample.
Of the mothers enrolled for prenatal studies
as part of this research project the intent in
DESCRIPTION OF PROJECT
l)irth in the longitudinal studies except when
there was definite pathology of such nature or
degree as to forbid inclusion in a group
in-tended to represent essentially normal children.
The causes for exclusion have been listed in
Monograph I. The question of inclusion or ex-clusion of the prematurely-born infants was somewhat different from that of pathology and
it was initially resolved by setting up a
“pre-mature series.” Thus, the initial “normal series”
consisted only of infants weighing 2.27 kg
(5 Ib) or measuring 47.5 cm or more at birth,
except that twins were enrolled even though
one failed to meet the specifications. Six of
the infants originally enrolled in the
“pre-mature series” were finally transferred to the
“normal series” and are included among the
134 followed to 18 years. The smallest
in-cluded, however, weighed 1.70 kg (3.75 lb) at
birth. Data obtained from the six prematures
and the twins in the “normal series” have been
included in the distributions and assignment
of pattern of t\pes for measurements, skeletal development and dietary intake. In Monograph
I, Section 3, were described a special series of
infants born prematurely. These were followed
ill a comparable manner to the “normal series”
throughout infancy hut not into later childhood.
Tile “premature series” as a whole and the
studies made of the individuals enrolled in it
came to differ in many ways from the “normal
series” so that direct comparisons between the
two groups were not possible. For this and
other reasons the series of prematurely-born
illfants was discontinued.
Economic Status
The very circumstances of enrollment limited
selection to women unable to pay for private
ol)Stetrical services and also private pediatric
care at the start but able to pay hospital charges
for clinic t’pe services. Furthermore, evidence
was sought of what appeared to be secure
con-tinuing and locally established employment of
the husband. These considerations essentially
assured at enrollment exclusion of the indigent
as well as those of high economic status.
How-ever, many of the fathers became unemployed
during the depression and economic strain was
frequent and sometimes prolonged during the
early years of the lives of some children. On
tile other hand, many fathers raised their
eco-nomic status substantially in later years. Some
attained sufficiently high economic status to
send their children to college and to 1)rovide
private medical care and ver’ comfortable
liv-ing for the family. The sample, therefore,
rep-resents middle class self-supporting families,
except for short periods, usually during the
children’s early years and progressing to higher
status, usually attained during the subject’s
adolescent years. The major occupational
cate-gories were skilled manual and white collar
workers.
National Origin
All but 48 of the 592 parents of the children
initially enrolled were born and educated in the
United States, and most of the others were
born in Ireland and brought to the United
States early in life. Some of their parents were
born abroad, although 878 out of the 1,184
were born in the United States or Canada. To
avoid too great complexity in respect to tile
racial and national origins, enrollment was
limited to white families of precloiTiinantly
North European stock. The basis for this latter
selection was that three of the four
grand-parents of each husband and wife were known
to have been born in North America, the British
Isles or North European countries. As a result
one grandparent of either the mother or father
of several of the children ellrolied was born in
other parts of Europe. The location of tile re-search activities was such that the predominant
national origin of the families enrolled was
Irish.
Education
Most of the parents had completed eight
grades of public schooling. Approximately half
had finished high school or equivalent
educa-tion. About one quarter had obtained further
education after high school although few
re-cieved degrees.
Prospects for Co-operation and Good Follow-up
It should be emphasized here that no
attempt was made to secure a representa-tive cross-section of any population but
rather to obtain women who were able and willing to act in a sense as assistants to the
research team. Although this automatically
compe-“Prenatal” l)uring pregnancy and the infant at birth
“Preschool” I)uring pregnancy and through infancy and preschool
years (to the sixth year)
“Maturity” During pregnancy, infancy and through school years
and adolescence (to tile eighteenth year)
Total
CHILD HEALTH AND DEVELOPMENT 883
The periodic examinations were sched-tence, maternal instincts and the like.
Mis-takes in initial selection in these basic
aspects accounted for most of the families
dropped after a short period of observation
to avoid further investment in unpromising ventures. Reliance initially had to be placed
upon a very subjective evaluation by the
nurse, but short experience with the mother
in various situations by all members of the staff sometimes led to a revised evaluation.
Tile appeal which secured in most cases a genuine interest and co-operative intent upon tile part of parents, who initially at
least manifested stable husband-wife
rela-tionships, appears to ilave been a desire for
more personal and enduring professional in-terest in the prospective baby and the
assur-ance of regular and unusually broad, con-tinuing “ilealth services”. The latter
in-cluded help in securing appropriate medical
and specialist care when required in illness, but it did not include direct medical care
from the research staff.
Children Enrolled
The number of children whose records
are suitable for study and future reports
differs somewhat between the various fields
of investigation depending upon the
com-pleteness and reliability of selected types of
data. Tilis in turn depends in some measure
upon the year of enrollment. Based upon
tile duration of enrollment and successful
follow-up, there are three major groups:
Series Period Studied
The large decrease in numbers between
the first and second group is accounted for
by the fact that initial enrollment was on a
tentative basis, with the understanding that
follow-up wouldI continue only if mutually
acceptable to the parents and the staff of the study. Fifteen infants were not enrolled
after birth, because of stillbirth, neonatal
death, premature birth or gross defect.
Thirty-two infants were not enrolled after a
3-month trial period and a few more were dropped during early infancy. Reasons were
usually that the mother proved unreliable when giving information, lost interest or found it more difficult than expected to come to the clinic or meet requirements in other ways. The Maturity Series included
one boy who had a final examination at 16
years, 24 children between 17 and 18, and
109 at 18 years or later.
METHODS OF STUDY AND TYPES
OF DATA OBTAINED
For a full discussion of the methods of
study of the mothers during pregnancy,
labor and delivery and of the infants during the first 10 days of life, reference is made
again to Monograph I.’ These phases of the project, as far as the collection of data is
concerned, had been completed by 1939. The studies of the family and home of the infant and young child for the most part
were carried on throughout these ages for
all children in the manner described at that time.
To facilitate the periodic study and
fol-low-up of these children after discharge from tile hospital, a pediatric type of health conference was organized at the beginning, differing chiefly in the unusual number and
variety of disciplines represented on the
staff. Despite several changes in location
Number of Cases Boys Girls
152 157 309
111 117 228
67 67 134
and various changes in procedure, this
special health conference was carried on
throughout the 2 years during which the
clinical studies of the children were in
progress.
uled routinely at the following ages: at
birth, 14 days, 3, 6, 9 and 12 months, and
every 6 months to 10 years, and every year to 18 years. Most of the infants had
addi-tional examinations at 6 weeks and 15 months. Partial or special examinations have
been added or withdrawn from the routine at various times but the basic
comprehen-sive histories and examinations continued throughout the years. The whole project was interrupted for a period of somewhat
over 1 year in 1942 and 194,3, because of
the absence of staff on war assignments. As
a result, all the children enrolled missed one
or mere examinations, for the most part during ages ranging from 7 to 13 years,
so that many of the missed examinations
occurred while children were undergoing
rapid pubescent changes.
Attahed to the staff of these special
study conferences, usually referred to by the families as “The Clinic” were, besides the pediatrician, those responsible for taking
special histories and conducting special examinations. The personnel involved
dif-fered somewhat depending upon the stage of the research and the ages of those
sched-uled for attendance. The pediatrician, nurse, roentgenologic and photographic
techni-cian, and nutritionist were regularly re-quired, nd orthopedist, psychologist,
an-thropometrist and social worker usually so
during infancy and early childhood. Visits to these study conferences required
a full half day for each subject and provided a major portion of the data obtained at each
age. They were supplemented, however, at certain ages or under special circumstances
through home visits by nurse, social worker or other members of the staff, visits to the
Study’s nursery school and visits of each
child for special study purposes to other
clinics. Among the latter were visits to the
Forsyth Dental Infirmary for Children or the psychiatrist’s office at the time of the
eighteenth-year examination.
The periodic interviews and examinations carried out under the above circumstances
provided continuing histories of health and
illness experiences and the details of dietary intakes.
The health history taken at tile time of
each examination covered the illterval since
the preceding one and included a
de-tailed investigation of major occurrences
brought to light. It dealt first with all ill-nesses reported. The purpose ilere was to
record as explicitly as possible all episodes
of illness in terms of nature, severity,
dura-tion, type of medical attention received and the care provided. A more detailed
descrip-tion of these records of illnesses was given in Monograph I and they are discussed more fully in the fifth paper in this group.
The interval histories include also much material on “health problems” presented by
mother or child which cover physical, die-tary, emotional, educational and behavioral
manifestations, as well as habits, activities, interests, failures and accomplishments and
family and social factors.
Histories of dietary intake providle the
basis for the estimates of the customary
intakes of nutrients as well as of calories for
each age interval. These histories were
taken by a nutritionist and covered the
elapsed interval of time since the last his-tory. The nutritionist who developed this method of securing dietary histories, and
was in charge throughout the duration of
the research, conducted tile interviews
her-self or supervised their being taken by an
assistant experienced in the use of this technique. They dealt with the mother’s
food intakes during each trimester of preg-nancy and the cilild’s during eacil age period from 1 to 18 years. The method
employed in securing these histories has
been fully described.7
Numerous reports Oil tile maternal
die-taries during the prenatal period and their
relation to the outcome of pregnancy and the condition of the infant at birth have been published.8
REFERENCES
(For “References in Bibliography,” see p. 972.)
4.
CHILD HEALTH AND DEVELOPMENT 885
2. Dearborn, W. F., Rothney,
J.
W. M., andShuttleworth, F. R.: Data on the growth
of public school children (from the ma-terials of the Harvard Growth Study). Monograph of Soc. for Res. in Child Devel., 3:serial 14, No. 1, 1939.
3. Simmons, K., and Todd, R. W.: Growth of
well children. Analysis of stature and weight, S months to 13 ‘ears. Growth,
2:93, 1938.
Board of Control of the Child Research Council, Denver, Colorado, October 1955.
5. Sontag, L. W.: The Samuel S. Fels Re-search Institute. Antioch College, Yellow Springs, Ohio, 1938.
6. Jones, H. W.: The adolescent growth study. I. Principles and methods. II. Procedures.
