Nursing Book Club

A Good Time to Be Born by Perri Klass

Revisiting the birth of pediatric medicine

I once heard Oprah Winfrey say that American women are “the luckiest girls on the planet.” Perri Klass, M.D., pediatrician and author of A Good Time to Be Born: How Science and Public Health Gave Children a Future, would argue that timing is a major part of that equation.

In A Good Time to Be Born, Klass details the history of pediatrics as a specialty separate from general medicine, and illustrates why it’s been so important that children no longer be treated as just miniature adults.

The book is divided into several parts. In the first, “The Desolation of the Empty Cradle,” we learn that while we might think of large families as emblematic of the past, mothers of that era often dealt with the loss of their babies. Ten percent of all infants born in the early 1900s never reached their first birthdays, and the mortality rates were even higher among minority and rural populations.

Today, all early infant deaths are considered preventable. Good prenatal care, vaccines and regular preventive pediatric care have dramatically reduced infant mortality figures, although, as Klass explains, that change wasn’t easy, nor was it swift.

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Incremental Progress

The second part of the book investigates the rise of pediatric care and its impact on public health.

For example, diseases causing dehydration, which are more dangerous to children than to adults, were rampant in the past, especially in crowded living conditions. Pediatric health campaigns eventually eliminated many of those diseases, including cholera infantum, a deadly diarrheal infection that was very common 200 years ago.

The book also reminds us that improvements in standards of care don’t always proceed in a straight line. In earlier eras, for instance, mothers were encouraged to breastfeed, which temporarily transfers some immunity to common infections and also strengthens maternal-infant bonding.

Unfortunately, it wouldn’t be until decades later that breastfeeding (whose benefits we better understand now than people did back then) would again be widely promoted.

Child Safety Advances

Part 3 — “What Marvelous Days” — discusses modern medical science, including improved pediatric care both in-hospital (such as infant warmers) and at home. Public health safety campaigns and legislation such as requirements for the use of seat belts and car seats have further reduced childhood mortality.

Nursing Education

Klass also discusses the advances in the prevention of SIDS (sudden infant death syndrome, now known as sudden unexpected infant death, or SUID).

A Good Time to Be Born is full of old photographs that I’d never seen before, along with charts vividly explaining many of the author’s points. Klass provides good, readable explanations for many of the issues she discusses. (For example, I’d never really understood why strep causes so many different sequelae, some dangerous and some curable with a simple dose of antibiotics.)

Klass has unearthed some fascinating stories that illuminate the health issues of the past and how the evolution of healthcare specialties many of us take for granted has helped to shape our own experience. It’s a great addition to the background knowledge of anyone involved in pediatrics or public health.

A Good Time to Be Born: How Science and Public Health Gave Children a Future by Perri Klass (W.W. Norton & Company, 2020)

CHRISTINE CONTILLO, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.

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