Robert E. Hannemann, MD, FAAP
As with many things, an idea sometimes has vague and uncertain beginnings. Although there may be other opinions, I think the idea of the American Academy of Pediatrics (AAP) publishing an authoritative book on child care had its earliest inception in 1982. At that time the Task Force on the Promotion of Pediatrics was formed. It consisted of chairman Murray Pendleton and members Don Cook, Bob Grayson, Doris Howell, Dick O’Neill, and me. As time went on, Art Maron, Alan Coleman, Bob Williams, and Don Schiff were added.
This group was assigned to find ways and to promote the pediatrician as the physician for all children from birth to young adulthood and to increase the utilization of their services. Various ideas and techniques were explored and implemented to accomplish this task. These ranged from radio and TV public service announcements to magazine articles and inserts.
Eventually it was recognized that further expertise was needed, and a public relations (PR) firm was hired to coordinate the program. This firm developed the “New Age” slogan, capitalizing on a double meaning of “New Age”, indicating a dawning of an expanded era for pediatrics and pediatricians embracing the adolescent and young adult age group. Although controversial, this slogan survived, and the task force soon became know as the “New Age” group.
In 1983, Doctor Pendleton elected to step down as chairman, and I was assigned that responsibility. I had the privilege of working with the recently-hired director of the Communications Department, Ms Susan Casey. Under her guidance, the projects of the PR firm were rapidly brought in-house. Among these were newspaper and magazine inserts, media placements, and newsletters; all aimed at increasing public awareness of the pediatrician and the value of his or her services to the entire pediatric age range (birth through age 21).
By 1984 it became apparent to the AAP Board of Directors that public communication was going to require a continued commitment of resources so the Task Force became the Provisional Committee on Communications (PCOC). At about that same time, many new ideas on giving pediatricians a competitive edge began to surface. Among these was authoring a comprehensive, authoritative book on child care. This concept was gaining more and more interest but did not crystallize until early in 1985 when the Academy began discussions with Dr Art Ulene and his Feeling Fine Programs.
At one of these early meetings, I showed a current copy of the recent editions of the best-selling child care book written by Dr Benjamin Spock. I had read it completely and annotated areas where it was outdated and where in some cases gave vague and/or confusing advice. These findings immediately piqued Dr Ulene’s interest. As a simplistic example, I also brought along and showed him a copy f my own publication of “The Little White Instruction Book,” which I gave to the new and frequently first-time mothers of my patients. This also impressed Dr Ulene and the “New Age Committee” and the “gestational” period for the complexion of the work began.
These deliberations first centered around a newsletter and television production, but the idea of a book soon became the primary focus. Within 8 months, an editorial board was selected, and I had the privilege of being one of those chosen. This group had its first meeting at the LaGuardia Marriott in November of 1985. In addition to myself, those physicians present were executive editor, Art Ulene; managing editor, Steve Shelov; Catherine DeAngelis; Bob Haggerty; Andrew Mezey; Jack Shonkoff; and Jim Strain. This was an extremely productive meeting. All of the existing major books were reviewed, and their good and bad points discussed. It was decided to divide the Academy effort into 3 publications according to age. Optimistically, it was predicted that the first book (1 to 5-year-olds) would be released in 1988 with a second (6 to 12-year-olds) to be released in 1989, and the final (the teen years) to hit the market in 1990.
Parent focus groups were engaged early to gain public input and a wide a group of AAP “experts” participated in writing the material. In addition to these major decisions, many minor ones were discussed, including gender pronouns to be used and indexing to be employed. As we later found out, this was only the beginning of many difficulties that would have to be faced before this enormous task could be accomplished.
We eagerly went to work on the content of the book, entering every topic we could think of on age-specific worksheets. These were then alphabetized and prioritized as to whether they “absolutely” had to be included or would not need to be addressed.
In early 1986 the focus groups began meeting and their views were funneled to Feeling Fine Programs. Writing was begun and finished material was being circulated through the various Academy section and committees and the Board itself. It was there that invaluable service was performed by Dr Leonard Rome, who was the designated Board reviewer. It was also about the same time that Dr Morris Green, a well-recognized pediatric developmental specialist at the Indiana University Riley Hospital for Children, was added to the Editorial Board, and his writing and editing expertise was utilized.
As the writing progressed, major problems sometimes seemed to be solved more easily than the minor ones. Efforts to be accurate led to many frustrating and amusing episodes. One of the most memorable had to do with correct spelling of Denis Browne of the ‘bar and splint’ fame. I finally photocopied a page of my old medical dictionary to convince the editor of the correct spelling.
In early 1987 Dr Steve Shelov’s title was changed to editor-in-chief, and the editing work took on a new dimension. It became obvious that final rewriting and review mechanisms were necessary. I was asked to assume more responsibility for these efforts. This involved many long (sometimes more than 2 hours) telephone consultations and the development of an editing sheet. All of this eventually led to my being named associate medical editor in 1988 and the development of a final 3-way editing team that involved myself, Steve Shelov, Bob Mendelson (chairman of PCOC) and his wife, Lottie. This resulted in completion of most of the manuscript by the end of the year, and work was begun on illustrations and final format.
By mid-1989 it was thought that things were winding down when a major change in format was made. Originally, the developmental chapters were preceded by “A Day in the Life” scenarios. These were intended to be light, entertaining vignettes, illustrative of the age being discussed. After review, however, it was felt that these were unrealistic and probably could never be written to accurately depict what was happening in the real world. Therefore, they were deleted from the book. This necessitated changes in the remaining copy and further delays in the progress toward the final galley proofs. This goal was not completed until October 1990 after which final work on review of the Illustration was carried out. This required a meticulous check for not only the appropriateness of the illustration but also for accuracy of the labeling. Unexpected “errors” were found, ranging from mistaken location of the “ethmoid sinuses” to commercially biased feeding bottles. After these problems were solved, however, the illustrative results were extremely attractive.
Just when everything seemed to be set for printing and distribution at the spring meeting in mid-March, disturbing changes began to surface. AAP committees were making major alterations and recommendations for immunizations and feeding practices. These had to be accommodated up to the last minute. The most amusing of these involved a special note that had to be added on the page preceding the table of contents to cover the Committee on Nutrition decision to delay introduction of whole milk until 1 year of age. The final review of this was made standing in the snow outside Academy headquarters as I was leaving to catch a plane after a meeting. Lisa Reisberg (Director, Division of Public Education of the AAP Department of Communications) was there to pencil in the final wording as the snowflakes were falling on the page.
And so, in mid-March 1991, 6 years after the start of the project, the book was finished. I espied the first copy of the completed tome at the Academy’s booth at the San Diego Convention Center in San Diego. When I held it in my hands was truly like handling one’s own newborn. Its arrival was analogous to the birth of a child born after an extended and considerable labor. Over 70 Academy contributors and scores of Academy members and scores of Academy staff displayed infinite energy. Included in the book, too, are many of the valuable offerings from my wife, Eleanor, as well as notable support from families of many pediatricians.
Now, I am holding a copy of the seventh edition of Caring for Your Baby and Young Child, Birth to Age 5, and recalling the development of the AAP best seller in this category, as well as the start of its national and international library of pediatric publications.
We are all proud of this book as well as the additional, significant publications and contributions of the AAP.