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The Child-Health Conference
Suggestions fo r Organization
a n d Procedure

Publication No, 2 6 1
Federal Reserve Bank of St. Louis

Federal Reserve Bank of St. Louis

F rances P erkins, Secretary



K atharine F. L enroot, Chief


The Child-Health Conference
Suggestions fo r O rganisation
and Procedure

Bureau Publication No. 261

United States
Government Printing Office
Washington : 1941

For sale by the Superintendent of Documents, Washington, D. C. -
Federal Reserve Bank of St. Louis


Price 10 cents
Federal Reserve Bank of St. Louis

Introduction ......................................................................................
Functions o f conference.........................................................................
Community responsibility for child h ealth...................................................................
Relation o f child-health conference to local and State health departments................
Local situations affecting the organization o f a conference............................................
O r gan izing thb conference ...................................................................
In an area having a full-time health department...............................................................
In an area having a part-time health department.............................................................
In an area having no organized health department................................ ..........................
T he conference center ....................................................................................
Division o f space in conference center................................................................
Preparation o f conference center........................
Reception and w aiting room ............................................................................
W eighing and measuring room ............................................................................
Physician’s consultation room ................................
R egularity a n d frequency of conferences...........................................................
A ppointments for exam inatio n .......................................................................
T he conference staff ....................................................................................
The public-health nurse..............................................
The volunteer helpers........................................................................................
The conference physician..................................................................................
The nutritionist..................................................................................................
The dentist...................................................................................................
The social w orker.........................................................................................
P rocedure for mother and child visiting the conference ..............................................
In the reception and w aiting room .........................................................................
In the w eighing and measuring room ...........................................................
In the consultation room ................................................................................................
E xaminations , immunizations , and tests needed ..................................................................
Medical examinations........................................................................................................
Screening tests for vision and hearing..................................................................................
Urinalysis........................................................................... ; ..................................
Dental examination........................................_........................................................
R ecord forms an d record k eepin g ........................................................................................
A ppendix A .— Suggestions for organization and functions of local conference committee ..
A ppendix B.— Sources o f posters...... ....................................................................








Federal Reserve Bank of St. Louis

Federal Reserve Bank of St. Louis



Functions o f Conference
The purposes of the child-health conference are to educate
parents in better methods of child care and to provide or
stimulate the provision of continuous health supervision for
all children of the community from birth through school age.
Being part of a broad public-health education program, the
service of the child-health conference, particularly in rural
areas, should be available to all parents whose children are
not under the supervision of a private physician. Its function
is to keep the well child well and to -promote his best possible state
of health.
The plan for the accomplishment of these purposes includes:
(1) Review of the child’s physical and mental health record
and examination of the individual child by a physician at
regular intervals; (2) the physician’s conference with the
mother, at which he discusses with her all aspects of the
child’s health and development, advising her regarding the
child’s special needs, including the correction of any abnormal
conditions, the solution of behavior problems, and the per­
formance of accepted immunization procedures; (3) service at
the conference by the public-health nurse, and when feasible,
although not necessarily at every conference, by nutritionist
and dentist; and (4) follow-up service by the public-health
nurse and, as needed, by other specialists such as the nutri­
tionist, social worker, and child psychiatrist, when these
workers are available.
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Community Responsibility fo r Child Health
While it is well recognized that the health of the individual
child is the responsibility of his parents, parents must have
an understanding of the fundamentals of child health in
order to discharge that responsibility. In addition to the
necessary knowledge they must have access to facilities for
the protection and promotion of child health. Many parents
have no way to acquire the needed knowledge of child care,
nor have they access to the necessary health facilities except
by means of provisions made through organized community
The organization policy for the child-health conference
should be to bring together in a cooperative community under­
taking the public and private health, education, and welfare
agencies that are interested in child health so as to eliminate
duplication of expense and to develop unity of service.
Relation o f Child-Health Conference to Local and
State Health Departments
A child-health conference in a district, county, city, or town
having a public-health department is developed as part of the
local public-health program under the supervision of the local
health officer. The State health department can assist also with
organization and supervision through the professional staff
of its maternal and child-health division and by provision of
literature and exhibit material. The local health department
or, if there is none, the local organizing group w ill obtain
full information on the assistance that is available from the
State department of health and take advantage of all it has
to offer.
Local Situations Affecting the Organization o f a Conference
In both rural and urban areas the various community situ­
ations that need to be considered when establishing a childhealth conference are :
A. A district, county, city, or town having a well-developed health
department w ith a full-time health officer, which assumes
full administrative responsibility for the conference.
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B. A district, county, city, or town having a health department
w ith a part-time health officer and a public-health nurse,
where a local voluntary agency or group o f individuals takes the
initiative in organizing and conducting the conference.
C. A district, county, city, or town having no organized health
department but having a public-health nurse, where a local
voluntary agency or group assumes responsibility for the

A county or a community without a -public-health nurse should not
attempt to organise a child-health conference. Conferences without
public-health-nursing follow-up service are of doubtful value.

Federal Reserve Bank of St. Louis


With conditions differing as they do in communities
throughout the country, it would be impossible to offer sug­
gestions for the organization of child-health conferences that
would meet the requirements of all situations. It is the
purpose of this outline to present the fundamental principles
of the organization of a conference with suggestions for
working them out in certain situations. The details of organi­
zation procedures in each locality w ill need to be developed
according to the local requirements.
A. In a district, county, city, or town having a well-developed
health department w ith a full-time health officer, which
assumes full administrative responsibility for the conference.

A child-health conference in such a community is organized
by the health department and conducted under its supervision.
As it is a combined public-health, medical, and community
undertaking, the cooperation of local physicians and the *
support of intelligent, interested, and representative com­
munity groups and individuals is necessary. To gain such
support for their programs many health departments have
developed community health councils which serve the needs
of child-health conferences as a part of the whole health
program. (See appendix A, p. 38.)
Where child-health conferences are being established for the
first time, the health officer w ill probably wish first to discuss
the proposition fully with the local physicians and gain their
support for the undertaking. Where there is a community
health council the matter would then be taken up with that
group for the purpose of discussing the need for the proposed
conference, its functions, and the local resources and facilities
available for its maintenance and operation. In some cases
it may be wise to have a subcommittee of the health coun­
cil appointed to study the matter and assist the health
officer with the details of organization and conduct of the
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In communities where there are pediatricians or physicians
giving special attention to pediatrics, their advice w ill be
particularly helpful in the planning and their services should
be obtained, if possible, to conduct the medical conferences.
B. In a district, county, city, or town having a health department
w ith a part-time health officer and a public-health nurse, where
a local voluntary agency or group of individuals takes the
initiative in organizing and conducting the conference.

The realization of the need for the conference in such com­
munities usually originates within the community. Whatever
the origin of the initial action, the official county or local
health department should be consulted early in the planning,
and in turn the health department should give all possible
assistance. Where the promotion is done by local groups, the
public-health nurse usually provides leadership in organizing
the conference, with the local health officer and local physi­
cians represented on the organizing committee. The State
department of health should be consulted regarding the
assistance it can give.
When the health officer and local physicians are thoroughly
familiar with the proposal and have agreed to give their sup­
port, a meeting of local groups representing the community
to be served by the conference may be called for the purpose
of discussing the need for the proposed conference, its func­
tions, and the local resources and facilities available for its
maintenance and operation. The nonofficial or voluntary
agencies, including the local medical and dental associations,
nursing groups, voluntary health and welfare groups, parentteacher associations, men and women’s civic and service
clubs, churches, and other organized groups of citizens are
invited to participate in the organization meeting. The local
board of education should be represented. Local boards that
are responsible for the expenditure of public funds for health
and welfare are urged to attend, and the economy of providing
services for health education and prevention of disease should
be called to their attention. A careful inventory is taken of
the assistance that can be given by each group represented.
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If the group agrees on the desirability of proceeding with
the establishment of a conference, an organizing committee
is appointed.
C. In a district, county, city, or town having no organized health
department but having a public-health nurse, where a local vol­
untary agency or group assumes responsibility for the conference.

The procedure here would be similar to that described under
B, except that there would be no health officer to assist. It
is emphasized that where conferences are being organized by
voluntary agencies, there is need for medical counsel all along
the way.
Before the service is undertaken a local conference Com­
mittee should be appointed by the sponsoring agency and
the cooperation of local physicians should be assured.
For a discussion of the organization and functions of the
local conference committee see appendix A, p. 38.
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In planning for a child-health, conference, early consideration
should be given to the conference center. In a county or
community having an established health center or having
available the office of the public-health department, the
conference would naturally be held there if it is conveniently
located for the majority of mothers who w ill bring their
children. In larger communities a location convenient to
families of low income is important. Communities of more
than 10,000 population w ill need more than one conference
center to give adequate service.
Certain minimum requirements for the conference are
mandatory in even the smallest rural community; in the
following pages these requirements w ill he italicized. Beyond
this there can be such expansion as funds w ill allow for meet­
ing further needs and providing additional conveniences.
In small communities a centrally located -place is best for the
conference center. Where possible, rooms on the ground floor
are obtained, with facilities for light, ventilation, heat, running
water or convenient water supply, and with windows and doors
well screened in warm weather. Safe drinking water and paper
cups, and a toilet which is in sanitary condition are essential.
There should be no hazard to the safety of small children in
or about the building. In a town where mothers w ill walk
to the center, a protected space for baby carriages is needed.
Division o f Space in Conference Center
Many types of quarters are used for conference centers, such
as hospitals, schools, libraries, and clubrooms. Space and
facilities for the conference w ill vary with the community
to be served. When the attendance is too large to allow
adequate service in small quarters, this difficulty can be met
by holding conferences on two successive days or in two suc­
cessive weeks, adhering in either event to a definite regular
day and hour.
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It is desirable to have three rooms: one for a reception and
waiting room; one for undressing, weighing, and measuring;
and one for the physician’s consultations. Where only two
rooms are available, one of these may be divided by screens
or a curtain. Similarly when a single large room must be
used, some -privacy for history taking, for weighing, and for
the examination can be provided by means of screens or
curtains. A quiet corner of the waiting room is selected for
history taking, arranged so that the mother sits at one side
of the nurse’s table with her back to the waiting group; a
screen w ill provide further privacy. This same comer can be
used for the nurse’s conference with the mother.
The rooms used for undressing and examination should be
provided with heat and, if possible, with running water, and
the room in which immunizations are done must have means
for sterilizing equipment.
Preparation of Conference Center
Well before the time for the conference to open, the rooms
are made ready for use. In cold weather the waiting room is
kept at a temperature of 70° to 72° F. and the weighing and
measuring room and the consultation room at about 74° to
76° F. It is important to arrange ventilation throughout so
as to avoid drafts. The nurse w ill make a final inspection of
each room and of all equipment to be sure that everything is
in its place and ready for use.
The conference rooms are made as inviting and attractive
as possible. Clean light-colored walls, bright-patterned cur­
tains, and suitable posters (see appendix B, p. 42) help to
accomplish this. Needless to say the rooms are kept clean
and in good order at all times.
Reception and Waiting Room
Room is needed to seat comfortably as many adults and small
children as are expected to be present at one time, with space
also for a desk and two tables.
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Equipment (Essentials are in italic)
A desk or writing table for use in taking histories; blotter, pen, ink,
pencils, paper clips, and scratch pad.

Record file for conference cases. This may be only a box or other
small compartment for keeping records.

Infant and -preschool record forms.
A table for exhibit material.

Chairs or benches.
Several small chairs, a low table, and large washable toys for
Hooks on the w all for wraps.
Clock, w all thermometer, and wastebasket.
A blackboard for teaching purposes.

Educational Material.
Excellent use can be made of good exhibit material, and this phase of
the conference service is w orth considerable thought. The material could
be made up by local groups under the direction o f the public-health nurse.
It might include demonstration material pertaining to both mothers and
For the baby.—K layette, utensils used in preparing milk formulas,
approved infant garments, bath equipment, a miniature baby bed,
display of foods for children of various ages.
For the child o f preschool age. —Proper clothing, toys, especially home­
made toys, and appropriate picture books.
For the m other—Approved garments for the expectant mother, obstet­
ric supplies, a miniature obstetric bed, and display o f foods for
the expectant mother.
To be most effective, an exhibit is limited to a single subject, a new
exhibit being shown, if possible, at each conference session. For example,
one exhibit might include the utensils used in preparation o f milk formulas;
another exhibit might be clothing appropriate to the season, such as
winter clothing for the baby and the child o f preschool age, out-of-door
play suits, and clothing for the baby’s out-of-door nap in cold weather;
or foods needed for an adequate diet during pregnancy or during the pre­
school age.
A ll exhibit materials should be clearly labeled and kept fresh and clean.
It is important to make all exhibits practical for the group to be served.
Some State health departments have exhibits for loan.
P osters—T he best obtainable posters on maternal and child-health
subjects should be procured. (For suggestions see appendix B, p. 42.)
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A supply o f a ll the literature pertaining to maternal and child health distrib­
uted by the State department of health should be available. The Children’s
Bureau, U. S. Department of Labor, Washington, D. C., w ill supply lists of
its publications, some of which can be obtained without charge. These
publications are not to be placed where they can be taken indiscriminately;
they are given out by the nurse to provide information on specific questions.
It is important to have literature printed in the language spoken by groups
attending the conference.

Play Space for Children.
When a very large room is available, a good play space for little children
can be made in the center or in one comer o f the room by placing chairs or
benches together facing outward. These seats can be used by the mothers
if desired. The play space may contain a low table, small chairs, and toys.
Noisy toys are best avoided. Where a trained play supervisor is available
she could be helpful in demonstrating the proper handling of children.

W eighing and M easuring Room
It is convenient to have the weighing and measuring room
between the waiting room and the physician’s room. A
space of about 8 feet by 10 feet is needed, well lighted and
ventilated, heated in cold weather, and free from drafts.
Equipment (Essentials are in italic).
Closet or w all cabinet for supplies.
A table about 60 inches by 30 inches, or 2 smaller tables for scales
and measuring board.
Two tables for the convenience of the mothers in undressing and
dressing the babies, or
A shelf about 30 inches deep by 48 inches long, w ith ends about 12
inches high, and divided into two equal compartments by a parti­
tion of the same height. This makes a convenient arrangement
for undressing and dressing the baby. Two such shelves would be
adequate for both undressing and dressing. Similar cubicles w ith
a back the height of the partition can be made by a carpenter to
fit over the top of a kitchen table. These have the advantage of
being portable.
Baby scales. —Balance platform type.
Measuring board or stationary tape measure on the table.
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Standard platform scales and measuring rod for older children. In
case there is no measuring rod on the scales a metal tape line
secured straight and flat against the w all w ill serve. It should be
attached at a point where there is no molding at the contact
angle of w all and floor.
A desk or small table for use in recording; pen, ink, pencils, and
scratch pad.

Clinical thermometer.
Four chairs.
W all thermometer.
Wastebasket or pillowcase on chair back or large paper bag for paper
that has been used on the scales.

Supplies (Essentials are in italic).
Pads about 16 inches by 30 inches for measuring and dressing tables
w ith rubber sheeting or oilcloth slip cover for each.1
Several baby blankets for mothers who may come unprepared.
Scale paper,2 soft paper towels, or sheets o f tissue paper for baby scales ,

measuring board, and dressing and undressing tables.
Safety pins.
Baskets, shopping bags, or large paper bags for carrying clothing
while child is undressed. Mothers ordinarily should supply their

Physician’s Consultation Room
Minimum size of room needed is about 6 feet by 8 feet.
Good light (natural light if possible) and heat in winter are
Equipment (Essentials are in italic).
Examining table. A shelf underneath is a convenience.
Steel tape measure, otoscope, stethoscope, flashlight, and percussion ham­
mer if not provided by physician. An extra battery for the flash­
light should be on hand.
Table for trays , and for pen, ink, pencils , laboratory blanks, scratch
pad, sample diet lists, leaflets , and literature , and printed or typed
instructions for mothers.
Posture charts.
Samples o f proper shoes for infant and preschool child.
1 Made like pillowcasing and left open at both ends. This has the advantage of completely
covering the pad and it w ill not slip out o f place on the table.
2 Paper that has been sized so as to be semiresistant to moisture, such as the paper used by
retail meat dealers.
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Blanks for report to family physician or specialist or to clinic if
family has no regular physician, on abnormal conditions found on
Bowl w ith hot and cold running water. If this is not available, a
basin and -pitcher, hot plate for heating water, and pail for waste
water. Soap.
Closet or w all cabinet w ith lock for supplies.
W all thermometer.
Wastebasket or large paper bag for waste.

Supplies (Essentials are in italic)
Pad, or blanket, about 16 inches by 30 inches, for examining table,
w ith rubber sheeting or oilcloth slip cover.
Scale paper, soft paper towels , or sheets of tissue paper for examining

Specimen bottles.
Tray containing—
Small-size tongue depressors.
Throat swabs.
Glass slides.
Gauze sponges in jar.
Cotton sponges in jar.
Roll 3-inch adhesive tape.
Roll sterile 2-inch gauze bandage.
Blunt-pointed scissors.

Tube o f petroleum jelly.
Silver-nitrate pencil.
Immunization and venapuncture equipment and supplies:
Sterilizer or basin for boiling syringes and needles.
Tray containing—

Tuberculin-test m aterial?
Smallpox vaccine .3 •
Diphtheria toxoid .8
Wassermann tubes.
Syringes , two 2-cc., marked for %-cc. doses.
Syringes , two 2-cc., marked for 0.1-cc. doses, one of which
is kept for tuberculin tests only.
Syringe, 10-cc.
Needles, 1 dozen %-inch 26 or 27 gauge.
Needles suitable for venapuncture.
Forceps, straight, 8-inch, 2 pairs.
Iodine, 3-percent solution.
Alcohol or acetone.
8 These must be kept in a refrigerator between conferences.
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Green soap.
Spirits of ammonia.

Sterile towels.
(The articles provided for the immunization tray need not be duplicated
on the regular tray for the examining table.)
Equipment for urinalysis:
Test tubes.
Test-tube rack.
Test-tube holder.
Test-tube cleaner.

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10-percent acetic-acid solution.
Blue litmus paper.
Red litmus paper.
Alcohol lamp.
Benedict’s solution, qualitative.


The primary aim of the conference is to provide continuous
health supervision for the child. In order to do this it is consid­
ered that a regular schedule is essential—weekly, biweekly, or
monthly, depending on the size of the community and the
attendance at the conferences. It is important to set a definite
day and hour for the conference—for example, the first and
third Wednesdays of each month at 2 p. m.—and adhere to the
schedule. When conferences cannot be arranged for through­
out the year they are planned for as much of the year as is
In some areas annual itinerant conferences are held. Con­
ferences held as infrequently as this, or even those held twice
a year, do not meet the requirements of general health super­
vision. They do, however, serve to demonstrate the need for
and value of such service, and to call the attention of parents
to abnormal conditions and give them some information on
child care in general. For these reasons they are considered
worth while, even though far from adequate.
Federal Reserve Bank of St. Louis


The advantage of appointments for examination is unques­
tioned and in most places they have been found feasible even
in rural areas.
When making appointments the hour as well as the day is
specified. As a rule it has been found best to schedule new
cases and the more urgent cases first. An appointment for a
new patient is given for about an hour before the time when
the child w ill be seen by the physician. For example, when
the conference is scheduled to begin at 2 o’clock, the first
appointment would be made for 1 o’clock. This allows time
for the child’s history to be recorded and the height, weight,
and temperature to be taken, so that no time w ill be lost by
the physician between his consultations with mothers. Since
taking the history of a new patient, or of several children of
one mother, requires considerable time, it is a good plan to
schedule ahead of new patients, one or two children who are
making revisits. Having all in readiness beforehand gives
the public-health nurse more opportunity to be present at the
physician’s conference with the mother; her presence is
desirable although not always possible.
There is a tendency in some communities to make the childhealth conference a social occasion, the mothers congregating
early and staying until the last examination has been finished.
This custom provides good opportunities for group instruction.
It has disadvantages, however, particularly in winter, when
colds are prevalent and rooms may be poorly ventilated; but
even this situation could be utilized for health education, such
as teaching the mothers the needed precautions against trans­
mission of colds.
Federal Reserve Bank of St. Louis


The minimum conference staff includes the physician, the
public-health nurse, and from one to three volunteer helpers
to work in the reception room, the weighing and measuring
room, and, if desired, the physician’s room.
When available and where facilities permit the services of a
nutritionist, a dentist, and a social worker, especially in the
capacity of advisers and consultants to the medical and nursing
staff, add to the completeness of the conference service. These
special consultants need not all be present at each conference.
When any are present additional room is necessary so as to
avoid confusion.
The conference staff should keep in mind always that the purpose
of the conference is to serve the individual mother and child. To do
this best, it must make a ll service as considerate and prompt as possi­
ble; each mother is made to feel that her individual problems are being
given careful consideration and she is given such satisfactory service
that she w ill wish to return and w ill influence other mothers to come
for similar service.
Such things as a friendly reception, assistance in disposing
of wraps and in finding a place to sit while waiting, a simple
explanation by the nurse of conference procedure and especially
of the need for the information asked in taking the history,
aid greatly in the psychological preparation of the mothers.
Likewise a quiet understanding manner on the part of all
conference workers in handling the children not only w ill do
much to help overcome apprehension on the part of the
children but is an excellent demonstration for the mothers.
The Public-Health Nurse
The effectiveness of a child-health conference depends in
large measure upon the services of the public-health nurse.
The quality of her services, in turn, depends upon her qualifi­
cations for public-health nursing in the field of child health.
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In most communities the public-health nurse, because of her
acquaintance with many families through her general health
services, w ill know of the children in need of conference
service and w ill refer the parents to the conference.
Because of her knowledge of the health, economic, and social
conditions of the family, the public-health nurse can at the
time of the conference supplement the information of the
doctor. At the same time she can interpret to the parents, in
terms of their particular home situation, the medical, dental,
and nutritional advice given at the conference and w ill show
them how they can put it into practice.
Although the efficient management and smooth operation
of the conference are a responsibility of the public-health nurse,
they are only a part of her larger responsibility of making sure
that the educational potentialities of each conference are fully
realized for each mother. Efficient management is important
because it facilitates the creation and utilization of opportuni­
ties for teaching by public-health nurses, as well as by other
members of the professional staff.
The number and types of services performed by the publichealth nurse at the child-health conference are influenced by
the physical arrangements of the conference, the number of
public-health nurses present, and the number of other types
of workers assisting. As the most important services for her
to perform are those that contribute most to the educational
value of the conference, the duties of the public-health nurse
may be summarized as follows:
General management of the conference.
Taking part o f the histories of newly admitted children. (This
may be done in the home before the conference takes place.)
Conferring w ith the mother before she sees the physician.
Observing signs o f illness o f children as they come to the conference
and isolating or excluding them as indicated.
Instructing and supervising volunteer aids in the performance of
their nonprofessional duties.
Carrying on individual or group instruction or demonstrations of
exhibit materials for waiting parents.
Introducing to the physician the mothers and children w ho come to
the conference for the first time.
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Discussing with, the physician any facts related to the progress being
made or to home conditions.
Being present, whenever possible, during the physician’s conference
w ith the mother.
Conferring w ith the mother before she leaves the conference concern­
ing the recommendations of the physician, to give her an appoint­
ment for her next visit to the conference, to determine whether
or not her questions have been satisfactorily answered, and, if
indicated, to make an appointment for a home visit.
If indicated, referring parents to other community agencies, such as
hospital, clinic, welfare agency, school, or private physician.
Participating in joint conferences o f professional staff following the
conference to review recommendations and plan jointly for carry­
ing them out.
Seeing that individual service records and activity reports for each
conference are complete.

Probably the most important function of the public-health
nurse is further to interpret medical advice and to give practical
help to the parents in carrying it out by means of visits to the
home. This type of individualized health service is a neces­
sary supplement to the service of the child-health conference
and an effective method of health teaching.
The number of the public-health nurse’s visits to the home
and the intervals between them are governed by circumstances
such as the intelligence and cooperativeness of the parents,
the condition of the child, the economic and social conditions
in the home, regularity of attendance at the conference, and
the progress being made in carrying out the medical recom­
The medical examination at the child-health conference can
be regarded as the incentive for continuous health supervision
of the child, to which the public-health nurse contributes in
other environments and in other ways.
The Volunteer Helpers
Volunteer helpers not only give valuable service in the con­
ference by releasing the nurse from the more routine work so
that she may confer with individual mothers but widen the
interest in and understanding of the work in the community.
These helpers are selected for their intelligence, dependa­
bility, and interest in child-health work. They must he
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impressed with the need for guarding honorably a ll information of a
personal nature that is acquired in connection with the conference.
It is important that they refrain from giving advice to mothers
from their own experience. It would be helpful if volunteers
could be found who had had some special training pertinent
to the functions of the child-health conference, such as nurses,
nutritionists, nursery-school workers, laboratory technicians,
social workers, or teachers. It is important to have a sub­
stitute for each volunteer.
The volunteer sta ff is under the direction and supervision of the
public-health nurse. Each helper must be individually instructed
in the duties she is to perform. Group instruction also may
be given and conferences held with the volunteer staff for the
purpose of improving individual efficiency and developing
When possible without hardship, volunteers might wear
simple smocks to identify them as members of the conference
staff. Superfluous jewelry should not be worn.
All volunteers w ill be at the center ready for duty at least
half an hour before the conference is scheduled to start.
When one cannot be present she w ill arrange to have her substitute
attend and w ill notify the nurse in charge.
One volunteer may be made responsible for opening the
center and seeing that it is properly heated and ventilated
before the scheduled time for the conference to start. This
duty might be rotated among the volunteers.
At the close of a conference each volunteer sees that the
equipment in her department is properly cared for; that the
paper towels and other waste are disposed of; and that every­
thing is left in good order.
The Conference Physician
Choosing the physician is a matter of particular importance.
The success of the conference w ill depend to a large extent upon
the qualifications of the physician in charge. A pediatrician
is chosen when at all possible. When a pediatrician is not
available an endeavor is made to procure a physician having
special training in child-health work. If no such physician
is available in the community, the State health department
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may be requested to assist an interested local physician to
acquire the necessary experience in conference work. It may
be possible to enlist the aid of a pediatrician to act as con­
sultant to the regular conference physician and to conduct
demonstration conferences from time to time for local physi­
cians to observe. It is advantageous to have a pediatrician
or a physician who has shown an interest in the public-health
phases of pediatrics or in general public health, and who has
the confidence of the community. In some areas it w ill be
necessary for the health officer to do the work. It is important
to have the same physician serve regularly at the conference.
A substitute physician also is chosen having the same quali­
fications, if possible, as the regular conference physician. An
agreement is made with the regular -physician that he w ill arrange
for the substitute physician to attend the conference when he cannot
be present and that he w ill notify the nurse whenever this is necessary.
Rotation of conference physicians is not conducive to satis­
factory service and is done only where there are several quali­
fied physicians in the community who wish to serve. In this
case arrangements are made for each physician to serve for at
least 6 months and preferably longer. There should be con­
tinuity of service of the conference physician and he should be
paid a stipulated fee for his services. The fee may be determined
by the administrative agency and the local medical society.
The Duties of the Conference Physician.4
The physician is the medical director of the conference, and
his attitude toward parents and children and the type of service
he renders make for the success or failure of the conference.
It is important that he be present at the hour appointed for the
beginning of the conference; otherwise the consultations and
examinations must be hurried and the entire plan of work dis­
He w ill wear a washable gown or coat while making exami­
nations and wash his hands bef ore the examination of each child.
The physician reads the child’s record before the child is
brought to the consultation room. When mother and child
4 Objectives and Techniques for Conducting Child-Health Conferences, by Amos Christie,
M. D., Department o f Pediatrics, University of California, San Francisco. Reprints are avail­
able without charge from the Children’s Bureau, U. S. Department o f Labor, Washington, D. C.
Federal Reserve Bank of St. Louis



enter, a kindly greeting helps to put both at ease. It is im­
portant for the physician to make the mother feel that he is
interested in assisting her with her child-care problems.
The Medical History.
A good medical history is essential, and the physician w ill
need to obtain this, although he may assign to the nurse the
responsibility of assisting. The value of the advice given by
the physician to the mother at the child-health conference
probably depends as much upon his obtaining a satisfactory
medical history as upon his examination of the child. Aside
from obtaining specific data regarding the child’s background,
which physician and nurse must know, they w ill find out what the
mother considers to he her problems regarding the child and the points
on which she wants help.
It frequently happens that the physician in charge of the
conference is so occupied with the examination of the child
and with entering notes on the record that he overlooks
giving the mother an opportunity to talk. After the physician
has obtained from the mother the desired information on the
child s history, it may be a good plan for him to ask the
mother: “Now what do you want to tell me?’’, giving her a
chance to relieve her mind and at the same time furnish clues
for further questions pertinent to the individual case. The
physician w ill be careful in his questioning not to suggest the
proper answers. The taking of the history offers an excellent
opportunity for teaching by both physician and nurse.
Getting Acquainted With the Child.
With the little child who is attending the conference for the
first time and to whom the procedure is new and strange, the
physician needs to make friends. If the child is apprehensive,
timid, or shy, it may be well not to pay too much attention to
him at the start but to talk with the mother regarding the
more general phases of the child’s history, perhaps handing a
toy to the child and giving him opportunity to orient himself
and become more at ease. He should be approached quietly
and gently. It strengthens the older child’s confidence in the
physician if the physician explains honestly to him any
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unfamiliar or disagreeable procedure that is necessary. Never
tell a child a procedure w ill not hurt if it will.
The Physical Examination—Appraisal of the Child.5 6
At least 15 minutes is required for a satisfactory examination
of the child and conference with the mother. New cases, of
course, w ill require longer.
In making the examination it is important to keep in mind
the picture of a normal healthy child—not merely the “aver­
age” but the child who is in an optimal state of health.
With a standard of excellence in mind and a knowledge of the
fundamentals of nutrition and of mental hygiene, the physician
is able to give advice to the parent that w ill help toward the
attainment of optimal mental and physical health for each
Both the infant and the older child are completely undressed
for the examination and for subsequent inspections. There is
probably nothing that w ill so impress the parent as to see the
physician make a thorough examination. Time must be
taken for details, and the physician should not be nor appear
to be hurried. It is well to bear in mind the educational as
well as the inherent value of strict adherence to cleanliness
throughout the examination and of aseptic technique where
this is indicated.
The order of procedure in examining a child varies w ith the child’s
age and disposition. One cannot proceed in a stereotyped course,
as is possible w ith the adult. One must pick and feel one’s w ay,
starting generally w ith the things that are not unpleasant and
gradually, as the child’s confidence is established, passing on to
things that are more unpleasant or more dreaded. The throat is
nearly always best left until the last unless there is something still
more unpleasant, except in the case o f the older child w ho knows
that the ordeal is inevitable and wants it over w ith. (See footnote
6, below.)
The Appraisal of the Newborn Infant, by Ethel C. Dunham, M. D., Director, Division of
Research in Child Development, Children’s Bureau. Single copies available without charge
from the Children’s Bureau, Washington, D. C.
6 Examination of the Child in the Practice of Pediatrics, by Joseph Brenneman, M. D., vol. 1,
ch. 19.
7 Signs of Health in Childhood. National Education Association, 1201 Sixteenth Street NW.,
Washington, D. C. 20 cents per copy.
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The general appearance should be noted, alertness, state of
nutrition, color of mucous membranes and skin, posture, gait,
responsiveness, and activity.
A child in good mental health is alert, with a happy expres­
sion, and is interested in his surroundings. There is a very
close relationship between bodily and mental health which
cannot be too strongly emphasized. In order to be able to
appraise a child’s mental status, the physician must be familiar
with the psychological aspects of child development.8
Optimum nutrition is evidenced by smooth, clear, and elastic
skin; good color of the mucous membranes; sound teeth; firm
but not superfluous subcutaneous fat; muscles that are well
developed and firm. To determine the amount and turgor of
the fat and muscles the physician should feel the tissues of the
upper arm, the abdomen, and the calves or thighs. The mus­
cles should be felt relaxed as well as under tension.
Weight should be suitable to body build. A number of
years ago there developed a practice of judging a child’s state
of nutrition by comparing his height and weight with tables
giving average heights and weights of children of his age.
It has been generally accepted that this is not a reliable method
of judging nutrition because in the compilation of the heightweight-age tables, no consideration was given to the varia­
tions in type of body build. For example, a child having a
large bony frame might compare favorably in height and
weight with the average given in the tables for children of his
age, but, having small amounts of muscle and subcutaneous
fat, he might be much undernourished. Another child having
a small bony frame might weigh considerably less than the
average for children of his height and age and yet, having
well-developed muscles and subcutaneous fat, he might be in
an excellent state of nutrition. For these reasons the heightweight-age relationship should not be the basis of judgment
of nutritional state. The picture of the whole child is taken
Child Management, Are You Training Your Child To Be Happy?, Habit Clinics for Child
Guidance, The Child From One to Six—His Care and Training, pp. 1-5 (Pubs. 143, 202, 135,
and 30, Children’s Bureau, U. S. Department of Labor, Washington, D. C .).
Federal Reserve Bank of St. Louis



into consideration. Satisfactory gain in weight is an important
evidence of good nutrition.
G ood Posture.— Signs of good posture are—
Level shoulders.
Flat scapulae.
Spine free from abnormal curves.
Head held erect w ith chin level.
Symmetrical chest, w ith equal expansion on both sides during
Abdomen, protruding slightly in children up to about 5 years of age
but in line w ith the chest in older children.
Legs neither bowed outward nor w ith knees inclined inward.
Inner and outer sides o f ankles equally prominent; the inner not
projecting as when the arches o f the feet are weak.
Feet strong and flexible; inner borders straight from heel to tip of
great toe. The feet are normally flat in the infant and very
young child, but the arches should develop after the child begins
to w alk. The arches o f some children are normally higher than
those of others.
Head.— Scalp clean and free from scaling or signs of irritation. The
anterior fontanel is usually closed before the child is 15 months old.
Eyes are bright and clear, lid slits equal, movements coordinated, and pupils
equal. Obvious defects in vision and muscle balance may be detected in
the conference. Such cases and those in which any abnormalities are
suspected should be referred to an ophthalmologist. (For a discussion of
screening tests see p. 34.)
Mouth w ith smooth and pink mucous membranes; teeth that are w ell formed,
w ell enameled, clean and even, free from cavities or w ith cavities properly
filled, w ith good occlusion (the grinding surfaces of the bicuspids and
molars meeting directly, the upper incisors and canines slightly overlap­
ping the lower). This inspection w ill of course not take the place of an
examination by a dentist.
Tonsils.—Large tonsils are not necessarily abnormal unless they cause
obstruction to breathing and swallowing or give evidence of acute or
chronic infection.
Ears.—Canals clear; drums showing well-defined light reflexes and other
landmarks. Obvious hearing defects may be detected in the conference,
and such cases and those in which any abnormalities are suspected should
be referred to an otologist. (For a discussion of hearing testing see p. 34.)
N ose unobstructed, free from discharge, septum in the midline; mucous
membrane pink and moist.
T hyroid gland.—Not enlarged.
Cervical lymph nodes.—Not enlarged or tender on palpation.
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Heart.—Satisfactory examination of the heart can be made only when the
child is quiet. The heart rate is normally more rapid in a child than in
the adult, and there is greater variability o f rate w ith activity. A mur­
mur is not necessarily evidence o f a pathological condition, but it is an
indication for careful examination and medical supervision.
Lungs resonant to percussion and clear to auscultation.
Abdomen flat and soft when the child is reclining, w ith no enlargement of
the viscera. When the head is lifted the abdominal muscles normally
become tense w ithout midline separation or bulging. Likewise, there
is normally no bulging in the inguinal region when the child stands or
Umbilicus should be healed and dry when the infant is 3 weeks o f age.
There is normally no herniation.
Female—clean and free from discharge and signs of irritation.
M ale —clean, foreskin easily retractible, testicles descended.

In addition to the attributes of positive health outlined
above, the physician obviously should search for the recog­
nized evidences of physical abnormality. Many abnormal
conditions such as glandular dyscrasias, nutritional disorders,
allergic diseases, and mental retardation make their appearance
during infancy and early childhood. Their early recognition
and advice as to the steps necessary for early correction are
important functions of health supervision.
See also Examinations, immunizations, and tests needed
(p. 34).
The Conference With the Mother.
The physician’s responsibility does not end with the making
of the examination. While it is essential to have the best
possible physical examination, this alone does the child no
good. If it is to be of value, the mother must be informed of
the findings and of better ways of caring for the child so as
to -promote his optimal mental and physical health.
Mothers of infants and young children need some general
principles to guide them in everything they do with or for
their children. These include not only matters pertaining to
physical health but also principles of mental health. These
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principles need to become part and parcel of health-guidance
work. It is not logical that parents receive only medical
guidance from the physician, and receive their guidance in
forming attitudes and habits of everyday living from a psychol­
ogist or, as is more usual, from grandmothers and the neigh­
bors. Emotions and physiological functioning are too closely
interrelated to permit this division of responsibility. An
important causal factor in producing the “below-par” child
is frequently found to be the parents’ inability to cope with
either their own emotional disturbances or those of their chil­
dren. Under these circumstances good health habits cannot
be developed.
For these reasons, in the best health supervision time and
thought w ill be devoted to the psychological aspects of child
development as well as to the physical aspects.
The physician in making recommendations, particularly
with reference to diet, w ill keep in mind the economic status
of the family and avoid recommendations which the family
w ill be unable to follow. To make effective his advice, the
physician needs to have the confidence of mother and child.
A kindly attitude and genuine interest in their problems w ill
rapidly build confidence. Care needs to be taken not to over­
burden a mother with too much advice at one time. It is
often better to stress one thing at a time and to take up other
matters at later visits. Most mothers who come to the childhealth conference are eager to learn better ways of caring for
their children and are perfectly capable of making good use
of the advice given by the physician. The child may, if
desired, be excused from the consultation room during this
conference. Care should be taken not to discuss the child’s
behavior in his presence. When possible, it is very desirable
that the public-health nurse who is responsible for the con­
ference follow-up service be present, although when the physi­
cian and nurse have learned to work together the physician’s
notes on the child’s record w ill usually give the nurse sufficient
information for her conference with the mother.
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The physician’s conference with the mother w ill include
information on—
a. The child’s general condition.
b. Any deviations from normal, w ith recommendations for correc­




tion and referral to a private physician, or to the proper public
agency for the family in the low-income group. Every effort
should be made to find means for correction.
The relationship of daily habits to the health o f the child and the
importance o f establishing from the beginning proper habits
(1 ) Taking food.
(5) Exercise and play.
(2) Sleep and rest.
(6) Emotional control.
(3) Elimination.
(7) Social habits.
(4) Cleanliness.
The prevention or overcoming of undesirable habits—thumb
sucking, bed wetting, and temper tantrums, masturbation, and
so forth, as the need for such information occurs.9 10
The management of breast feeding.
The need for proper preparation of food and the addition o f certain
foods to the diet at certain ages. It is important for the physi­
cian to keep in mind the economic status of the family and avoid
making recommendations the family w ill be unable to follow.
The importance of satisfactory gain in weight.
The need for immunization against diphtheria and smallpox for
all children and against other diseases in special cases.

The physician w ill indicate clearly when the child is to be
brought again to the conference. The date w ill be entered
on the appointment record and also on a slip which is given
to the mother.
Printed Material as an Aid to the Physician’s Conference With
the Mother.
It is very helpful both to the conference staff and to the
mothers attending to have approved information and direc­
tions on certain subjects in printed or mimeographed form.
Paper of different colors may be used for different subjects if
desired. The purpose of this is to supplement, but not to take
the place of, the physician’s or the nurse’s explanation, and to
give the mother the material to refer to when necessary.
8 See footnote 8, p. 23.
10 The Psychological Aspects of Pediatric Practice, Benj. Spook, M . D ., and Mabel Huschka,
M . D. New York State Committee on M ental Hygiene of the State Charities Aid Association
105 East Twenty-second Street, New York, N. Y . 25 cents.
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Such instructions are written in very simple terms. Many
subjects might be treated in this way, such as—
Breast feeding.
Food for the nursing mother.
Routines for the care of the child at various ages.
Preparation of the milk formula.
Bathing the baby.
Directions for laundering diapers.
Sleep, exercise, and play.
The need for cod-liver oil and directions for giving it.
The need for sunshine and directions for giving sun baths.
The care of the baby in summer.
Prevention of digestive disturbances.
Prevention of colds.
The baby’s teeth.
Weaning the baby.
Bowel and bladder control.
The importance of immunization against smallpox and diphtheria.
Forming good eating habits.
Low-cost nourishing foods.
Playthings for the little child.
Common communicable diseases.
Thumb sucking.

Source material on these and other subjects can be obtained
from State departments of health, and from the United States
Children’s Bureau and the United States Department of
Agriculture, Washington, D. C.
The Nutritionist
A nutritionist can add to the effectiveness of a conference in
a number of ways. She may supply simple posters, food
models, and other devices for teaching the waiting mothers.
She may be able to furnish or to suggest sources of printed
material on low-cost foods for families with young children.
A nutrition consultant on the State health-department staff
can often interest local nutrition workers (county home
demonstration agents, home-economics teachers, and others)
to give volunteer service at child-health conferences. She
can also give them supplementary training for this new
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If a nutrition worker in the community can attend confer­
ences regularly, she can instruct both individuals and groups.
If someone is present to entertain the children the mothers are
free to listen to a short talk on low-cost foods, preferably
accompanied by a demonstration of the preparation of some
simple, nourishing dish. If there is no time that can be set
aside for teaching the entire group, the nutritionist can carry
on a continuous demonstration for small groups of mothers
waiting for their turn with the physician.
The physician and the dentist w ill find that some mothers
need detailed instruction in how to carry out the dietary
recommendations noted on the record. Much of this instruc­
tion w ill be given by the nurse as she explains also other
recommendations of the physician and the dentist. A nutri­
tionist can observe the nurse’s instruction of the mother, so
that she may know the points that should be stressed in her
staff-education work with nurses. She can also confer with
mothers in the presence of the nurse as a demonstration of how
to teach them to make the most of the money they have to
spend for food. Following the conference, the nutritionist
can go over with the nurse special food and budget problems
that can be worked on during the nurse’s visits to the homes
of families represented at the conference.
The Dentist
A dentist who has had special training or experience in
children’s dentistry and is interested in teaching dental health
would contribute to the value of the conference service. In
some localities dental hygienists serve in conferences. Con­
sultation between physician and dentist regarding dental
conditions affecting the child’s health is obviously desirable.
A separate room or partitioned space is needed for the
dentist s work. As equipment he w ill need dental explorers
and mirror, which he w ill usually supply, a small sterilizer,
paper towels, a small table, and chairs.
Plenty of time should be allowed for the dentist to become
acquainted with the child. He w ill explain to the mother
the need for regular dental supervision, corrective procedures,
and prophylactic measures.
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A summary of the dental findings and recommendations is
entered on the child’s conference record.
The Social Worker
The public-health nurse and the physician w ill often find
social problems that make it difficult for a mother to care
properly for her child. It is important that the services of
the local social worker be utilized to the fullest extent in deal­
ing with these problems. In some instances it would be
helpful to ask the local social worker to come to the confer­
ence from time to time to receive and to give reports and dis­
cuss these problems with the physician and the nurse. In
rural areas, particularly where the functions of the social
worker are not fully understood, there would be advantages in
introducing her at the conference to families needing help.
Plans for assisting the family w ill be made jointly by the
public-health nurse and the social worker, and they w ill
confer with each other as frequently as seems necessary between
the conferences in regard to the families receiving social care.
Significant social reports should be summarized on the child’s
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When a mother attending the conference for the first time
is not acquainted with the conference staff, the person in
charge of each department w ill be careful to introduce to her
the person in charge of the next department when she is re­
ceived there.
In the Reception and Waiting Room
a. The hostess, usually a volunteer worker, who has been
previously instructed, should be on the alert for signs of
obvious illness in infants as they are received. As she greets
a mother and perhaps assists her to remove her wraps, she has
an opportunity to observe the child for possible signs of illness.
If any are noticed, the mother is questioned regarding the
child’s condition and is requested to occupy a place apart
from others who may be present. The doctor and nurse are
notified, and the doctor w ill see the sick child immediately.
If the case appears to be of an infectious nature, the child is
usually dismissed immediately from the conference. But if
conditions are such that the mother is unable to take the child
away at the moment every effort is made to isolate the child
as completely as possible while arrangements are made for
suitable care. The method of providing for isolation w ill be
determined by the physician and nurse, depending upon the
facilities of the individual center.
When a child appears to the hostess to be well, the mother
is taken to the admission desk.
b. Identification data such as date, names of child and
parents, and address are obtained and identification numbers
are assigned. In most conferences the person acting as hostess
obtains this information. The mother is then referred to the
nurse, who takes the part of the history delegated to her
unless this has been done at a previous home or office visit.
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In the W eighing and M easuring Room
There may be a volunteer helper in this room to weigh and
measure the children and to enter the weight and height on
the record cards. When there is available a volunteer helper
who has had nursing training, she might well be assigned to
weigh and measure the children. It is a good plan to utilize
this opportunity to teach the mother how to weigh and
measure her child.
The weighing and measuring should be done promptly so
that the physician does not have to lose time between examina­
tions. However, after children are undressed, long waiting,
which causes restlessness and apprehension, is to be avoided.
To be of value the weight and height must be measured and
recorded accurately. Incorrect measurements may be harmful by
causing anxiety on account of a supposed failure of the child
to grow in height or gain in weight, or by creating a false
sense of security in the belief that the child has grown or
gained when he has not. Great care should be taken to see
that each measurement is correctly taken and correctly re­
corded. To facilitate this the scales and measuring board
should be placed where the light is good. The scales should
be checked for balance between weighings.
A fresh sheet of scale paper or paper towel is used for each
child on the scale pan, on the measuring board, on the plat­
form scale, and on the undressing and dressing tables.
While the child is still on the measuring table it is a good
plan to take his temperature. Although single isolated tem­
perature recordings are of doubtful value in themselves, the
taking of the temperature at the conference affords a valuable
opportunity to teach the mother this procedure. It certainly
should be done if the child appears ill.
After being weighed and measured the child is not dressed
before the examination but should be adequately covered with
the small blanket which the mother brings. The child who
walks may put on his shoes after being weighed. The diaper
should be replaced on the infant.
For children who object to complete undressing, light­
weight underwear, shorts, bloomers, or sunsuits may be left
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on. Their weight is negligible. Infants, however, should
be entirely undressed for weighing.
In the Consultation Room
Each child coming to the conference for the first time
should be given a complete examination. In places where
the appointment system is in use every effort w ill be made to
keep to schedule. This w ill call for careful planning and for
limiting the number of appointments. If a mother comes in
without an appointment, an effort should be made to accom­
modate her. If she cannot wait, an appointment may be
made for a later date and an opportunity given for an interview
with the nurse, who w ill consider the advisability of a home
visit and perhaps give the mother some appropriate literature.
A thorough physical examination of a child, allowing
opportunity for the mother’s questions and for discussion and
instruction, requires time (15 to 20 minutes) to be effective
and should not be hurried. Obviously less time is required
for children coming to be weighed, measured, and inspected
after having had a recent complete examination.
Immunizations or any other procedures which are particu­
larly unpleasant or painful are best deferred until after the
completion of the examination and the conference with the
mother. There is real advantage in allowing a crying child
time to recover before he is sent back to the weighing room
or the reception room.
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M edical 'Examinations
Each child w ill be given a complete examination on his
first visit to the conference. The frequency of subsequent
examinations w ill depend largely on the needs of the indi­
vidual child and w ill be determined by the physician.
The following schedule represents good practice for com­
plete examinations:11
During the first year—examination at least once a month.
During the second year—examination at least every 3 months.
From the second to the sixth year—examination at least every 6
Inspections w ith the child undressed and conferences w ith
the mother w ill be scheduled between the examinations at intervals
depending upon the needs in the individual case.
Parents should be informed that an examination is advisable after
any illness.
The weight and height are taken and recorded at each visit to the

Screening Tests fo r Vision a n d Hearing
Because they require a special room, special equipment,
considerable time, and ordinarily two persons to give them,
vision and hearing tests for preschool children at regular
conference sessions are not usually considered advisable.
However, it is highly desirable that children’s visual and
auditory acuity be determined before they enter school; and
if proper facilities can be arranged for at the conference center
and the tests done by special appointment, they would add
to the completeness of the health supervision.1213
11 The Health Supervision Program Your Child Should Have. Leaflet prepared by the
American Academy of Pediatrics, 636 Church Street, Evanston, 111.
12 Publications of the National Society for the Prevention of Blindness, 1790 Broadway,
New York, N. Y. (these include directions for testing the vision of children of preschool
age). Testing the Sight of the Young Child, by Parke Lewis, M . D. (American Medical
Association, 535 West Dearborn Street, Chicago, 111.; 10 cents.)
18 Publications of the American Society for the Hard of Hearing, 1537 Thirty-fifth Street
NW ., Washington, D. C. (these include suggested hearing tests for children of preschool age).
Testing Kindergarten Children W ith the 4-A Audiometer, by Warren H. Gardner, Ph. D.
(Reprint No. 468 available from the Volta Bureau, 1537 Thirty-fifth Street N W ., Washington,
D. C .).
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In case the examining physician discovers at any time any
evidence of impaired vision or hearing he w ill promptly refer
the child to a specialist, if possible, for further examination
and recommendation as to treatment.
It is advisable to make routine examinations of the urine
of children who can urinate into a receptacle, in order to
detect the presence of albumin or sugar. Laboratory facili­
ties are necessary in examinaing for urinary-tract infection.
D ental Examination
Dental examination and advice on the care of teeth by a
dentist should be begun after the second year.
Inasmuch as there is considerable difference of opinion as
to the immunizing agents to be used, dosage, interval between
administrations, and age when immunization should be
started, it is suggested that the State department of health
be consulted regarding its recommendations.
The committee on immunization and therapeutic procedures
for acute infectious diseases of the American Academy of
Pediatrics has issued a report14 giving information on im­
munity including technique of tests and dosage of immunising
Vaccination against smallpox before the age of 12 months is
generally accepted as the best practice.
It is recommended that the baby be immunized against
diphtheria through the injection of three doses of toxoid at
about the age of 9 months. A Schick test about 6 months
after the last dose and another about a year after the last dose
are advised in order to determine whether protection against
the disease is complete or whether another injection is needed.
The Schick test should be repeated when the child enters
school and again when he enters high school, or at about the
ages of 6 and 12.
» Copies of the report are available at 10 cents each from C. G. Grulee, M . D., Secretary of
the American Academy of Pediatrics, 636 Church Street, Evanston, 111.
Federal Reserve Bank of St. Louis



Some physicians now immunize against diphtheria and tet­
anus in the same injection.
Typhoid immunization is seldom necessary in infancy because
of the precautions taken in preparing infants’ food and in
sterilizing their drinking water. However, in later child­
hood, if children are at all likely to come in contact with con­
taminated water or milk supplies, typhoid vaccine may be
indicated. The immunity produced is of limited duration.
While the effectiveness of vaccine for protection against
whooping cough is not established, the protection that it may
afford during early childhood, when the mortality from whoop­
ing cough is highest, would seem to justify consideration of its
It is advisable that each child be given a tuberculin test.15
Children having positive tuberculin tests are referred to a
physician for further examination and recommendation as to
care. A positive test in a young child usually indicates con­
tact with someone who has active tuberculosis. Every effort
should be made to determine the source of infection, which,
when discovered, should be reported immediately to the local
health department.
Routine blood tests for syphilis are being advocated, par­
ticularly in areas where syphilis is prevalent. State depart­
ments of health make provision for the treatment of children
whose parents cannot pay for this service.
« For technique of tuberculin test see report referred to in footnote 14 and Diagnostic
Standards, issued by the National Tuberculosis Association, 1790 Broadway, New York, N. Y.
Federal Reserve Bank of St. Louis


Orderly recording of significant information regarding the
child’s health and development and services rendered at the
conference is essential for insuring continuity in the child’s
care and for the evaluation of accomplishment in the confer­
ence program.
The record system should be flexible enough to permit
adaptation to the needs of the area concerned, but as a basic
principle the use of the same form is recommended for recording
service at the conference and in the home. This procedure
promotes the integration of services and lessens clerical work.
It is advantageous also to have entered on a single record the
findings and recommendations of all professional personnel
serving the child in the conference.
To be of maximum value, a copy of the preschool health
record should be furnished to the school health authorities
upon the child’s entrance to school.
In addition to the record form relating to the care of the
individual child, certain records are essential in connection
with administrative reports and arrangements for the confer­
ence, and in the preparation of summaries of conference
In order to have available at all times information on the
children attending the clinic and the dates of their attendance,
an attendance-record book is helpful. It can also be used for
keeping a record of the appointment dates for visits to the
Statistics for monthly or annual reports of conference
attendance may be compiled from the information in the
attendance-record book. Another plan for assembling this
information is to count from the individual case records, at
the end of each conference session, the number of infants and
preschool children in attendance, the number of new admis­
sions, and the number of réadmissions. The count is entered
on the daily report of the nurse or on a summary sheet relating
to service in one or more conference centers. At the end of the
month or year the counts relating to each conference session
are added for the statistical report.
Federal Reserve Bank of St. Louis

The local conference committee is an advisory committee serving the
district, county, city, or town health department or the local sponsoring
agency or agencies. This committee is selected w ith much care since it
w ill be a permanent one. Members are appointed so that their terms of
office w ill expire in different years. In appointing the members the health
officer or appointing body should give careful consideration to the com­
munity needs and the background of community life, as w ell as to the
qualifications and interests of the individuals selected. Members are chosen
who can be expected to attend meetings w ith reasonable regularity. The
size of the committee should be governed somewhat by the size of the
community to be served, 10 to 12 members probably being adequate for
most communities. The district, county, city, or town health officer and
public-health nurse are members ex officio.
It is important to have on this committee, which is composed of both
men and women, representatives of the local medical and dental professions,
the public-health-nursing groups and other public-health and public-welfare
organizations, the public schools, the local government, hospital adminis­
tration, church organizations, organizations and clubs interested in com­
munity improvement or civic service, and parent-teacher associations. It
is advantageous to include also a capable businessman on the committee.
The officers of the committee include chairman, vice-chairman, and
secretary. These persons should be community leaders, preferably w ith
some knowledge of and particular interest in public-health work.
Counties, districts, cities, or towns having full-time public-health
departments may already have public-health committees or councils which
have agreed upon policies and standards for child-health conferences appli­
cable to the whole area. In such places the local conference committee
may be a subcommittee of such a public-health committee or it may be an
independent committee. It should be informed of the policies adopted by
the public-health committee in order that such policies may be discussed
and that the plans of the local conference committee may not conflict w ith
those policies.
The local conference committee meets at regular intervals. It is helpful
to the physicians and nurses directly responsible for conducting the confer­
ence to discuss w ith the committee the progress o f the w ork and questions
of policy, equipment, publicity, and so forth. The manner in which the
w ork of the conference committee is conducted w ill have much to do w ith
the success of the conference. Reports of subcommittees should contain
material of interest in addition to the necessary statistical material, and
Federal Reserve Bank of St. Louis



there should be opportunity for free discussion by all members o f the
committee. Each local cooperating agency or group is kept informed by
its representative regarding the w ork of the conference.
It is advisable for the committee to hold an annual meeting to which
the public is invited. The purpose of this is to acquaint the public w ith
the accomplishments o f the child-health program during the year and the
committee’s plans for the future, and to stimulate further community interest
in the service. Arrangements might be made for a special address on some
phase of child health at such a meeting.
Appointment and Duties of Subcommittees

As need occurs subcommittees may be selected by the chairman of the
conference committee in consultation w ith the health officer, or, if the
local conference committee is under a voluntary agency, by the chairman of
the local committee in consultation w ith the sponsoring agency. Only
such subcommittees are appointed as are immediately necessary and w ill
be active, and they may be dismissed on the completion of their specific
The subcommittees may include any or all o f the following committees:

Medical advisory.
Conference center.
Volunteer personnel.

The w ork o f each of these subcommittees also is important and great
care should be exercised in the selection of its members. Individuals should
be appointed who may be expected to have a sustained interest in the
service, who are capable of performing the necessary duties, and who have
time to give to the work. It is considered advisable that the public-health
nurse in charge of the nursing service of the conference be a member ex officio
of each committee. The physician in charge of medical service at the
conference w ill be a member of the medical advisory committee. The chair­
man of the local conference committee w ill be a member ex officio o f the
Medical Advisory Committee.
The membership o f the medical advisory committee includes the local
health officer as an ex officio member and members o f the local medical pro­
fession, particularly those physicians who are experienced or especially
interested in child-health or general public-health work.
Where there is a full-time local health officer, he may appoint the medical
advisory committee after consultation w ith the local medical profession.
In rural areas where there are few physicians all of them may be members
o f the committee.
Federal Reserve Bank of St. Louis



The functions of this committee include advice on the plan and scope of
the conference, the medical procedures to be followed, and selection o f
physicians to conduct the conferences; advice on medical problems; assist­
ance in preparation of medical information to be included in publicity;
assistance in preparation of subject matter relating to medical problems for
all publications prepared locally; interpretation of the w ork of the confer­
ence to the medical profession and assistance in arranging for public speakers
on subjects pertaining to child health.

Finance Committee.
In communities where the State or local health department does not
assume the financial responsibility for the conference, this committee w ill
be responsible for estimating the financial needs of the center (the prepara­
tion of the budget) for the year; for obtaining money to meet the budget
requirements; for purchasing the equipment for the conference center; and
for paying bills, including rent, incidental to the operation of the center.
It is probable that most of the equipment, supplies, and furnishings for
the center can be obtained through interested groups and individuals so
that little w ill have to be purchased.
The finance committee works closely w ith the conference-center com­
mittee, purchasing as promptly as possible any needed supplies or equipment
that the latter committee is unable to provide.

Conference-Center Committee.
This committee w ill probably be required in the beginning to give a
considerable amount of time to its duties. These w ill include cleaning and
renovating the rooms in the beginning; considering facilities for heating and
water supply; obtaining and installing the furnishings, making the center
as attractive as possible but keeping the furnishings simple and of a type
that can be cleaned or replaced easily; obtaining the necessary equipment
and supplies and arranging them in their places.
This committee w ill be responsible for the general housekeeping o f the
conference center; it w ill keep informed on the condition o f supplies and
see that they are replenished as needed.

Committee on Volunteer Personnel.
The committee on volunteer personnel, together w ith the public-health
nurse, w ill analyze the conference jobs, taking into consideration the
number o f public-health nurses available regularly for duty at the confer­
ence, and w ill determine which places are to be filled by volunteers. The
requirements o f each place should be carefully studied and a person should
be selected for each place w ho is qualified to fill it. A substitute is chosen
for each volunteer. It is important to select volunteers w ho can attend
Volunteers and their substitutes are instructed and trained for their work
by the public-health nurse.
Federal Reserve Bank of St. Louis



Publicity Committee.
A t least one member of this committee should be familiar w ith publicity
technique. It would be w ell to have a member of the medical advisory
committee also on this committee. The services of a representative o f a
newspaper, a broadcasting station, or an advertising agency would be
helpful if available.
The functions of the publicity committee are to inform the general public
of the service offered by the conference, its purposes, principles, and progress,
and to stimulate public interest in the conference. This may be done
through newspapers, radio, and public addresses. The publicity com­
mittee w ill make arrangements w ith the local newspapers to carry ample
notice of conferences. Similar announcements might be made in schools or at
local meetings.
It is desirable to plan a year-round publicity program, including news­
paper articles, radio talks, and local addresses by qualified persons on sub­
jects pertaining to child health and community responsibility for child
health. Members of the local medical profession and organizations such
as parent-teacher associations, service clubs, farm bureaus, and homeeconomics extension bureaus are often available for this purpose.
Transportation Committee.
The duty of the committee on transportation w ill be to endeavor to find
transportation facilities for parents so situated that they cannot avail
themselves of conference service unless some means of transportation is
provided. It is w ell to determine as far as possible in advance o f each con­
ference who w ill need this assistance.
Volunteers performing this service carry their own automobile liability
insurance and need to be fully informed on State laws regarding such
Federal Reserve Bank of St. Louis

C hildren’s Bureau, U. S. Department of Labor, Washington, D. C.

on diet for the expectant mother and on posture.
Bureau of Home Economics, U. S. Department o f Agriculture, Washing­
ton, D. C. Charts on nutrition and child feeding.
Extension Service, U. S. Department of Agriculture, Washington, D. C.
Charts on nutrition.
M aternity Center A ssociation, 654 Madison Avenue, New York, N. Y.
Posters on prenatal, postpartum, and infant care.
A merican M edical A ssociation, Bureau o f Health and Public Instruction,
535 North Dearborn Street, Chicago, 111. Posters on infant and child
A merican D ental A ssociation, Bureau o f Public Relations, 212 East Superior
Street, Chicago, 111.
N ational Society for the Prevention of Blindness, 1790 Broadway,
New York, N. Y.
N ational C hild W elfare Federation, Educational Building, 70 Fifth
Avenue, New York, N. Y. Posters on health and mental hygiene, and
educational posters for children of preschool age.
N ational Safety C ouncil, Educational Division, 1 Park Avenue, New
York, N. Y.
N ational D airy C ouncil, 11 1 Canal Street, Chicago, 111. Posters on the
contribution of dairy products to good nutrition.
N ational L ive Stock and M eat Board, 407 South Dearborn Street,
Chicago, 111. Posters and charts on nutrition.

Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis